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兄弟姐妹死亡与童年创伤性悲痛:儿童悲伤导论

陈明 翻译 2017-4-28

Sibling Death and Childhood Traumatic Grief:Introduction to Childhood Grief
兄弟姐妹死亡与童年创伤性悲痛:儿童悲伤导论
来源:美国国家儿童创伤压力网
陈明 译

Sleep and his Half-brother Death (John William Waterhouse 1874)

Information for Families
为家庭提供的信息

Like adults, children and teens may feel intense sadness and loss, or grief, when a person close to them dies. And like adults, children and teens express their grief in how they behave, what they think and say, and how they feel emotionally and physically. Each child grieves differently, and there is no right or wrong way or length of time to grieve.
当一个与他们有关的人死亡时,儿童和青少年可能也会像成年人一样感到强烈的悲伤,失落或悲痛。儿童和青少年也会像成年人一样通过他们的行为,他们的想法,他们说的话,以及他们的情绪感觉和身体来表达他们的悲伤。每个孩子的悲痛都是不同的,而且悲痛的方式与长短是没有正确与否的。

Some grief reactions cut across all age groups and developmental levels, and children may show their grief in many different ways. For example, grieving children or teens of any age may sleep or cry more than usual. They may regress and return to earlier behaviors, or they may develop new fears or problems in school. They may complain about aches and pains. They may be angry and irritable, or they may become withdrawn and isolate themselves from family and friends.
有些悲痛反应跨越了所有年龄组和发展水平,儿童可能以很多不同的方式表达他们的悲痛。例如,任何年龄段的悲痛的孩子或青少年可能比平时睡的更多或更容易哭泣。他们可能会退行,回到早期的行为,或者,他们可能会在学校出现新的恐惧与问题。他们可能会抱怨头痛和身体疼痛。他们可能会变得愤怒或易怒,或者会变得社会退缩和孤僻,将自己与家人和朋友相隔绝。

Bereaved children may also act in ways that those around them may not recognize as grief reactions. For example, a quiet toddler may have more tantrums, an active child may lose interest in things he or she used to do, or a studious teen may engage in risky behavior. Whatever a child’s age, he or she may feel unrealistic guilt about having caused the death. Sometimes bereaved children take on adult responsibilities and worry about surviving family members and who would care for them if something happened to their caregivers.
失去亲人的孩子所采取方式可能不会被他们周围的人识别为悲痛反应。例如,一个非常安静的幼童可能会更多的突然发怒,一个活跃的孩子可能会对以前他感兴趣或一直做的事情失去兴趣,或者,一个勤奋好学的孩子可能会从事危险的行为。无论孩子多大,他或她都可能会对已经导致的死亡感到不切实际的罪疚。有时,丧亲的孩子承担了成人的责任,并且担心幸存的家庭成员,担心如果他们的照顾者发生了什么事,谁会照顾他们。

Childhood Traumatic Grief
童年的创伤性悲痛

After someone important dies, some children and teens may experience greater than usual sadness and upset and have a more intense reaction known as childhood traumatic grief. In childhood traumatic grief, children develop symptoms associated with posttraumatic stress disorder (PTSD). Children may be more likely to experience traumatic grief if the death was sudden or traumatic, if it occurred under terrifying circumstances, or if the child witnessed or learned of horrific details surrounding the death. Also, although posttraumatic stress reactions may occur after someone has been killed suddenly, they may also occur when the death was expected (such as following a long illness or disabling injury).
一些重要的人死后,一些儿童和青少年可能会体验到比平常更大的悲痛和沮丧,并且有更强烈的反应,这些被称为童年创伤性悲痛。在儿童创伤性悲痛中,儿童出现了与创伤后应激障碍(PTSD)相关的症状。如果死亡是突然的或创伤性的,如果发生在可怕的情况下,或者孩子目睹或了解了死亡的可怕细节,孩子们可能更容易经历创伤性悲痛。此外,虽然创伤后应激反应可能在有人突然死亡后发生,他们也可能发生在可预期死亡(如久病或致残)之后。

Not all children who experience the death of someone special under traumatic circumstances develop traumatic grief. However, in some cases, children may develop symptoms that interfere with their ability to grieve and to have comforting memories of the person who died. Traumatic grief may also interfere with everyday activities such as being with friends and doing schoolwork. PTSD symptoms in children with traumatic grief can include:
并不是所有在创伤性情况下经历特殊死亡的儿童都会产生创伤性悲痛。然而,在某些情况下,儿童可能会出现一些症状,这些症状干扰了他们的哀伤能力,干扰了他们对死去之人有安抚作用的记忆。创伤性悲痛也可能干扰日常活动,例如和朋友一起做功课。创伤后悲痛儿童的PTSD症状包括:

In general, if it becomes apparent that your child or teen is having very upsetting memories, avoiding activities or feelings, or experiencing physical, emotional, or learning problems, he or she may be having a traumatic grief reaction. (See Table 1 for examples of common and traumatic grief reactions in children at various ages.)
一般来说,如果你的孩子或青少年看上去有非常不安的记忆,回避运动或情绪感觉,或体验身体、情绪或学习问题,他或她可能已经有了创伤性的悲痛反应。(见表1,不同年龄的儿童常见的和创伤性的悲伤反应的例子。)

You may wish to seek help or counseling for your child or teen if grief reactions seem to continue without any relief, if they appear for the first time after an initial period of relative calm, if they get worse, or if they interfere with your child’s being with friends, going to school, or enjoying activities.
你可以为你的孩子或青少年寻求帮助或咨询:如果悲痛的反应似乎持续而没有得到减轻,如果他们在初始期的第一阶段后出现相对平静的,如果他们变得更糟,或者如果他们干扰你的孩子和朋友朋友相处、去学校、或享受的活动。


Table 1. Children’s Understanding of Death and Reactions to Grief
表1 儿童对死亡的理解和悲痛反应

Preschool and young children学龄前儿童和幼儿

Understanding of death对死亡的理解

Common grief reactions通常的悲痛反应

Traumatic grief reactions 创伤性悲痛反应

School-age children学龄儿童

Understanding of death对死亡的理解

Common grief reactions通常的悲痛反应

Traumatic grief reactions 创伤性悲痛反应

Teens青少年

Understanding of death对死亡的理解

Common grief reactions通常的悲痛反应

Traumatic grief reactions 创伤性悲痛反应

       

Grief and Sibling Death
悲痛与手足之死

The death of someone special can be very difficult and sad for a child or teen, but when it is a sibling who dies, the family faces a unique set of challenges. Siblings often have very complicated relationships. Sisters and brothers experience a range of sometimes conflicting feelings for each other—they may love and look up to one another, older siblings may feel responsible for, enjoy and/or resent caring for younger ones, or they may be jealous and fight—and their relationships can change over time.
一个特殊的人的死亡对于一个孩子或十几岁的孩子来说是非常困难和悲伤的,但是当一个兄弟姐妹死后,这个家庭面临着一系列独特的挑战。兄弟姐妹往往有非常复杂的关系。姐妹和兄弟彼此之间体验了一系列相互冲突的感情——他们彼此相爱,彼此照顾,年长的兄弟姐妹可能会觉得要为他们的弟弟妹妹们负责,乐于和/或怨恨照顾他们,或者他们之间可能嫉妒/斗争——他们的关系会随着时间而改变。

When a sibling dies, these past relationships and feelings can affect the surviving child’s grief and the family’s bereavement process. Grieving siblings may show some or all of the following common reactions, and there are many ways in which parents and caregivers can help them cope.
当一个兄弟姐妹去世,这些过去的关系和感情会影响幸存孩子的悲痛和家庭的丧亲过程。悲痛中的兄弟姐妹可能会表现出以下一些或所有共同的反应,在此之中父母和照顾者可以有许多方法帮助他们应付。

Caregiver and Family Grief
照顾者与家庭悲痛

If you have lost a child, the way in which you handle your grief can affect the bereavement process for your surviving children. In some parents and caregivers, grief over a lost child causes them to pull away or become emotionally absent from their surviving children. When this occurs, the surviving siblings may feel guilty for being happy or for needing their parents’ support. They may fear that their parents will never recover from the loss and feel a need to take care of their parents or be perfect to avoid upsetting them further. Children may believe their parents blame them for the sibling’s death and even act out because they feel they need to be punished, or to try to do everything right in an effort to “make up” for what they did.
如果你失去了一个孩子,你处理悲痛的方式会影响你的孩子的丧亲过程。在一些父母和照顾者中,对失去孩子的悲痛会导致他们拉远与孩子的距离,或者在情绪上缺席于幸存的孩子。当这种情况发生时,幸存的兄弟姐妹可能为他们自己的开心或需要父母的支持而感到内疚。他们可能担心父母永远不会从丧失中恢复过来,觉得有必要照顾他们的父母或尽善尽美的避免进一步让他们心烦意乱。孩子们可能会认为父母向责怪他们的兄弟姐妹的死亡,甚至采取行动是因为他们觉得他们需要受到惩罚,或试图做的一切努力,以“弥补”他们所做的事情。

If you are dealing with the loss of a child, it is important to have an active support network as well as safe places to express your grief. When you manage your own grief effectively, it eases the burden felt by the surviving children, offers them a positive role model for coping, and creates a more supportive environment for them to express their own grief. Here are a few other tips for helping your child—and yourself—to manage grief.
如果你正在处理一个孩子的损失,重要的是有一个积极的支持网络,以及安全的地方来表达你的悲伤。当你有效地管理自己的悲伤时,它为幸存的孩子减轻了负担,为他们提供了一个积极的应对模式,为他们表达自己的悲痛创造了一个更为有利的环境。以下是另外一些帮助你的孩子——和你自己——管理悲伤的技巧。

Traumatic Grief Among Surviving Siblings
幸存兄弟姐妹的创伤性悲痛


In come cases, the death of a sibling can lead to traumatic grief in surviving children, particularly if the sibling’s death was itself traumatic (for example, a traffic accident, community violence, abuse, war, or a natural disaster) or stigmatizing (suicide, HIV/AIDS, drug use).
在随后的案例中,兄弟姐妹的死亡可以导致幸存儿童的创伤性悲痛,尤其是如果兄弟姐妹的死是自己的创伤(如交通事故、社会暴力、虐待、战争、或自然灾害)或污名(自杀、艾滋病、吸毒)。

Since children may not express their feelings directly, it is important to be aware of any changes in surviving children’s play and behavior that may indicate their distress. In addition to the traumatic grief reactions discussed earlier, children who are experiencing a traumatic grief reaction to sibling loss may exhibit or express it in the following ways:
由于儿童不能直接表达他们的情感,重要的是要意识到幸存的孩子的游戏与行为的任何变化,可能暗示了他们的不幸。除了先前讨论过的创伤性悲痛反应外,那些经历了对同胞丧失的创伤性悲痛反应的儿童,可以通过以下方式表现或表达:

Sibling Identity
兄弟姐妹的认同

Accepting New Siblings
接受新的兄弟姐妹

The birth or introduction of a new child into the family following the death of another child can lead to mixed reactions. Surviving children may welcome the new child, but they may also feel that they were “not good enough” on their own to satisfy their parents’ needs. In addition, the surviving children may believe that children who die are easily replaced.
在一个孩子死后,另一个孩子的出生或引入新的家庭成员会导致复杂的反应。幸存的孩子可能会欢迎新来的孩子,但他们也可能觉得自己“不够好”以满足父母的需要。此外,幸存的孩子可能认为死去的孩子很容易被取代。

How to help: Be ready for mixed reactions. Talk with the surviving children about their feelings and reassure them about what makes them special. Emphasize that you can love more than one child and talk about what the new child represents to everyone in the family. Whenever possible, set aside special one-on-one time with the surviving siblings.
如何帮助:做好复杂的反应准备。与幸存的孩子谈论他们的感受,并让他们相信是他们与众不同的地方。强调你可以爱一个以上的孩子,并且谈论新的孩子代表了家庭中的每一个人。只要有可能,留出与幸存的兄弟姐妹的特殊的一对一的时间。

The death of a child often leads to changes in the structure of the family and in the roles of the surviving siblings. Depending on the number of children and their birth order, for example, a surviving child may now be the oldest or youngest child, the only girl or boy, or perhaps an only child. Parents and caregivers may rely on or change their expectations of the remaining children.
一个孩子的死亡往往会导致家庭结构以及幸存的兄弟姐妹角色的变化。例如,根据孩子的数量和他们的出生顺序,一个幸存的孩子现在可能是最老的或最小的孩子,唯一的女孩或男孩,或者也许是独生子女。父母和照顾者可能依赖或改变他们对剩下的孩子的期望。

These changes may give surviving siblings a sense of pride in their new found responsibilities, but they may also result in feelings of pressure or even resentment if children are expected to replace or live up to the behavior and goals of the deceased sibling. Surviving siblings may respond by acting out or by rejecting their new place in the family. Caregivers should consider that negative changes in family functioning may be due to such shifting of roles. A family meeting or one-on-one talks with children about different feelings, with a goal of discussing different household jobs, can be a good way for everyone to share feelings and take responsibility for creating new family routines.
这些变化可能会在他们新发现的责任的时候,给幸存的兄弟姐妹一种自豪感。但是,如果儿童被寄希望于取代或不符合死去的兄弟姐妹的行为和目标时,他们也可能导致压力的感觉,甚至怨恨。幸存的兄弟姐妹可能会采取行动,或拒绝在家庭中的新位置。照顾者应该考虑家庭功能的负面变化可能是源自于角色的转移。一个家庭会议或和孩子一对一的讨论哪些不同的感情,有一个目标的讨论不同的家庭工作,分享每个人的感情并负责创建新的家庭惯例可以是一个很好的方式。

The death of a sibling also impacts surviving children in many small and large ways throughout their lives. For example, responding to a casual or typical question such as “Do you have any brothers or sisters?” can be difficult. To help children move on in a life without their sibling, prepare surviving siblings for difficult questions by helping them to develop and practice responses. Explore together what kinds of responses feel most comfortable and also what they mean to the surviving brother or sister. Reassure your child that he or she can choose how and when to talk about the deceased child. For example, in group situations or when dealing with new people, it may be simplest to talk about surviving siblings. In more private conversations, a more direct answer such as “my brother died two years ago” may feel more natural. Be aware that this topic may need to be revisited as children mature and face new situations.
一个兄弟姐妹的死亡也影响了幸存的孩子在许多小和大的方式上的他们的生活。例如,回答一个偶然或典型的问题,如“你有兄弟姐妹吗?”可能是困难的。为了帮助孩子们在没有兄弟姐妹的生活中继续前进,为幸存的兄弟姐妹准备好困难的问题,帮助他们形成并练习相应的反应模式。一起探索什么样的反应感觉最舒服的,以及这对于幸存的兄弟姐妹意味着什么。安抚你的孩子,他或她可以选择以什么样的方式以及何时谈论已故的孩子。例如,在群体情况下,或与新的人打交道时,谈论幸存的兄弟姐妹可能是最简单的。在更私人的对话中,更直接的回答诸如“我的哥哥两年前去世了”可能会更自然。请注意,这个主题可能在儿童成熟和面临新的情况的时候需要重新审视。


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