“Our seven-year
old, Tania, had to go to hospital for a tonsillectomy. We were both able to be
there before and after the operation. However, Tania went into the operating
theatre one child and came out another although there were no medical problems.
She spent weeks screaming and having nightmares. We hoped it was her way of
recovering but now her school say they cannot manage her anymore. She has
stopped being able to concentrate and is either silent and withdrawn or
screams. Tania is now 8 and nothing is different. Her school cannot keep her
after the summer and no-one seems to know the best place for her.”
Mr and Mrs V.W
Mr and Mrs, V.W.
did all they could to help their daughter in hospital by managing to be there
with her. Thanks to the work of John Bowlby and the Robertsons there is now
greater awareness that, for a little child, lengthy separation from parents in
a hospital ward can produce personality changes of a damaging kind. However,
even with the presence of her parents, Tania still experienced something
traumatic and the drastic change in her has affected the family, and indeed the
wider network of her school too. Whatever the improvement that follows, there
has been a loss for Tania and her family.
Parents with
previously fit children who suddenly acquire a disability (either physical or
mental) from road accidents, accidents in the home, trauma or illness face a
very particular kind of bereavement. They have in their memories and in family
photographs the healthy child before disturbing change occurred. Parents with a
child who is learning disabled at birth also mourn but their grief is for the
healthy child they did not have. A year has gone since the operation and Mr and
Mrs, V.W. are still grieving both for the ordinary child they lost and for the
disturbed child they are struggling to help.
Since nothing
went medically wrong and as both parents were with Tania, why did she react in
such a powerful way? Having an operation is never a casual event even when it
is a minor one. Children and adults can have fantasies about the meaning of the
operation and the experience that bear no relation to the actual reality.
For example,
Jonathon, aged 10, had a grandmother who lived with him and his parents. She
suffered from headaches all the time and told him that his noisiness would be
the death of her. His tonsillectomy coincided with her hospitalisation and he
experienced his operation as a severe punishment of his speech organs. A period
of muteness followed that was only ended when his parents took him to a child
psychotherapist at his local Child Guidance Clinic. Can Mr and Mrs V.W. think
of any such emotional link Tania might have made?
13-year-old has cerebral palsy and had managed that
disability well. However, he suddenly had his first epileptic fit and when he
came to he attacked his parents in a completely alien way. It emerged that he
had experienced the fit as an attack on himself from another person. To the
relief of his parents he got over that state. However, it clarified for them
the way that a physical experience carries many kinds of emotional meanings.
In some schools
and hospitals children are helped to explore their fantasies about forthcoming
operations with the use of puppets or dolls. 10-year-old Mary needed a heart
operation. In her drawings and play she expressed the fear that she would lose
her insides. Being shown educational diagrams of the heart did not help. She
angrily tore the stuffing out of her teddy bear so that it lost its shape. Then
she burst into tears. The hospital teacher helped Mary put the stuffing back in
and sew the teddy up, showing how the stitches stopped the teddy’s insides from
falling out. After that Mary was able to face the operation more calmly.
Some children,
of course, are far more sensitive to these external interventions than others.
Consultant psychiatrist Dr. Marcus Johns points out, “It is not surprising that
we occasionally come up against a child who seems to be developing normally but
who has an excessive reaction to a stress or a trauma. Often the event has
reacted with or highlighted some unconscious phantasy of a terrifying kind”.
Where the
distress is so great that neither the child’s ordinary school nor a special
school can manage it, then a Day Unit, which combines education, socialisation
and psychotherapy, is often the optimum placement. The Day Unit of the
Tavistock Clinic, for example, takes, in small class groups of 6, children who
cannot manage in mainstream schools or in special schools because their
functioning has collapsed under severe stress. It also offers support for
parents and siblings who suffer too when someone in the family is so disturbed.