PARENTAL BEREAVEMENT: Spiritual Connections With Deceased Children

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PARENTAL BEREAVEMENT: Spiritual Connections With Deceased Children

Mary Sormanti, Ph.D., and Judith August, M.S.W.

Of a sample of 43 bereaved parents of pediatric cancer patients, 38 reported experiencing feelings of continued connection with their deceased child. Analysis of the data revealed several consistent themes in the experiences and in their impact on the parental bereavement process. Implications for research and clinical practice are discussed.

hile many studies have examined W basic human grief responses, few- er have focused on parental grief after the death of a child. Research conducted in the 1960s and 1970s, though it provided some important information about parental grief, concentrated primarily on familial adjustment during a child’s illness. It was in the 1980s that research and clinical observa- tion became more focused on parental grief after the death of a child (Klass & Marwitt, 1988-89; Rando, 1983, 1985, 1986; Videka- Sherman, 1982) and helped develop a more realistic understanding of this adaptation process among those working with bereaved parents. For example, earlier theo- retical frameworks, such as those of Kub- ler-Ross (1969), often depicted grief as a linear process with distinct stages and a predictable timetable; work by Rando (1983) and Videka-Sherman (1987) challenged such frameworks by demonstrating that grief over a child’s death is often long- lasting and can actually intensify during the

first several years after bereavement. Re- searchers also began to explore the impact on the bereavement process of a wider ar- ray of variables, including gender of the deceased child (Littlefield & Rushton, 1986) and bereaved parent (Cook, 1983; Littlefield & Rushton, 1986; Millen & Roll, 1985; Rando, 1983), length of the child’s illness (Spinetta, Swarner, & Sheposh, 198/), and the use of different coping strategies (Vi- deka-Sherman, 1982).

Today, there is considerable consensus in the professional literature that the death of a child is followed by a grief process, unique to parents, that may be lifelong. The use of more general bereavement models to understand and assess parental grief had led to the pathologizing of a process that is now beginning to be recognized as normal. Perhaps the most representative framework of grief resolution in Western culture is the one positing that bereaved individuals must “get on” with their lives after the death of a loved one by “letting go” of the emotional

A revised version of a paper submitted to the Journal in March 1995. The authors are at: School of Social Work, Columbia Universiw, New York (Sormanti); and the Dana-Farber Cancer Insritute, Boston (August)

460 0 1997 American Orthopsychiatric Association, Inc.

SORMANTI AND AUGUST 46 1

connection to that person. In the present authors’ experience, however, bereaved individuals use a continuum of behavioral and thought processes to manage their grief and integrate both the experience of the death and the deceased person into their lives. If this is so, exploration of the ele- ments of that continuum seems desirable.

One of these is the phenomenon of con- tinuing connection between parents and their deceased children, which has received little attention in the literature. In intensive work with a large number of bereaved parents, the authors have heard numerous reports of what might be termed “spiritual” encounters with their deceased children. The encounters have included visions, physical sensations, dreams, and a variety of other experiences that made the parents feel connected to the children and seemed to help them in dealing with their grief.

In the context of mental health work, the need for carefully constructed definitions of spirituality not linked to any particular psychological, religious, or cultural belief system is evident. For instance, rather than accepting a narrow definition equating the concept with any or all of these domains, Hiatt (1986), Kuhn (1988), and Stoddard and Burns-Haney (1990) have suggested that its most basic element is the human search for purpose and meaning transcend- ing individual differences. It is this element that the authors recognized in their work with bereaved parents, and it is from this perspective that the present study, which sought to follow up the bereaved parents’ anecdotal reports in a systematic manner, was initiated

PRIOR RESEARCH Several prominent theorists in the field

of grief and bereavement have recognized the phenomenon of after-death connection. Rando (1986) stated that “a significant proportion of mourners actually experiences some type of visual or auditory hallucina- tion of the child, or feels an intuitive, over- whelming sense of his presence” (p. 17).

Worden (1982) also found that visual and auditory hallucinations were frequently experienced by the bereaved; he proposed that these types of hallucinations fall within a normal range of grief reactions and generally occur within the first several weeks following the loss. Neither research- er, however, undertook detailed exploration of the phenomenon. It should, perhaps, be pointed out here that to describe these grief experiences as “hallucinations” can limit and stigmatize of what may prove to be a common bereavement experience.

Stroebe, Gergen, Gergen, and Stroebe (1992) provided an in-depth analysis of what they termed the “breaking bonds perspective” dominating the modem Western view of grief. This perspective maintains that bonds with the deceased need to be broken for the healthy adjustment of the bereaved, and that efforts to retain ties are abnormal and can lead to maladjustment. Stroebe and colleagues argued that this outlook pathologizes certain types of reactions to the loss of a loved one, that in some historical and cultural settings such reactions are viewed as normal, and that exami- nation of the sociocultural context is therefore necessary for a more comprehensive understanding of the bereavement process.

Shapiro (1994) discussed the diverse ways in which members of different cultural traditions experience bereavement, identifying three bereavement issues defined by a culture’s belief system: the relationship between the dead and the living, the nature of life after death, and the social reconstruction of the disrupted relation- ships within family and community. Thus, while death is universal, the negotiation of these issues, for both the bereaved and nonbereaved, is dependent on the sociocultural milieu. Cultures differ in their pre- scriptions for the behavior of bereaved people and for ways of dealing with them. For example, in our North American culture, death is viewed as a more or less final separation; in Bhuddist-based cultures, on the other hand, death is regarded as a part

462 PARENTAL BEREAVEMENT

of the spiritual life cycle (Shapiro, 1994). Perhaps because of the dominance of the

breaking bonds perspective in Western grief theories, there is little documented research in the area of continued connections with the deceased. The Tubingen Longitu- dinal Study of Bereavement (Rubin, 1993) included questions about the perceived presence of the dead, and nearly one-third of the sample reported sensing the presence of their deceased spouses. Simon-Buller, Christopherson, and Jones (1989) also ex- plored what they termed the “sensing phenomena”-the experience of feeling the presence of a deceased person. They ana- lyzed data (originally collected in a 1980 bereavement study of 500 widows) to de- termine which variables had predictive val- ue for its occurrence. At least half the sample reported experiencing such sensing. The analysis also found that behavior con- sidered as a manifestation of normal grief (e.g., fatigue, anxiety, loneliness, confusion, sleep disturbances, and restlessness), was more characteristic of widows who experienced the sensing phenomena than of those who did not. The former also reported per- ceiving the bereavement process as a more serious problem than did the latter.

The present article describes the qualitative results of an exploratory study with a sample of bereaved parents whose children had been patients at a large city cancer hospital. The aims of the study were to exam- ine the extent of the sensing, or feeling of spiritual connection, by the parents, to explore its impact on the bereavement process, and to trace the clinical implications of this aspect of parental grief.

METHOD Sample and Procedure

Potential participants were the parents of deceased pediatric cancer patients who had been treated at a regional cancer center. From a medical records department list of all patients who had died within the past five years (N=3 lo), a possible 584 participants were identified. Only those parents

who fulfilled the following criteria were deemed eligible for participation: 1 ) they had been followed by a current staff social worker, 2 ) they were assessed as having no major psychiatric disorder, 3) their grief was unlikely to be so exacerbated by participation as to cause major disturbances in daily functioning, 4) they were willing for further communication with the institution, and 5) they could read and write English.

A sizable number (N= 192, from 96 families) of potential participants had not been followed by a current staff social worker; one individual had a major psychiatric disorder; 13 individuals from seven families were felt to be vulnerable to major func- tional disturbance; eight from four families were unwilling for further communication; and 28 from 14 families were non-English- speaking. Although inclusion of non-Eng- lish speaking individuals would strengthen understanding of the bereavement process from a multicultural perspective, staffing and other resources did not permit transla- tion or validation of the instrument into other languages.

A letter describing the study, requesting their participation, and enclosing two stamped postcards addressed to the re- searchers was mailed to a total of 363 eligible individuals from 188 families. It asked each parent in a household to return the postcard within two weeks if she or he pre- ferred not to participate. Twelve individuals from seven families did so, and the postal service returned 2 1 letters marked “address unknown.” Two questionnaires were then mailed to each of the remaining families (N=l60, involving 309 individuals) asking each parent in the household to respond individually. Completed questionnaires were received from 43 parents-including four couples-from 39 families. While the response rate was low for mailed surveys, the sample size was more than ad- equate for a qualitative study and, lacking previous surveys of this type, no real basis for comparing the response rate exists; it is possible that the intensity of the subject

SORMANTI AND AUGUST

matter may have kept more parents from participating.

The eventual sample of 43 parents were primarily North-American Caucasian women with one or two surviving children. More complete demographic characteris- tics are delineated in TABLE 1.

Measure The primary means of data collection

was a questionnaire developed by the authors. It consists of nine open-ended questions designed to elicit information about parents’ “spiritual” connections with their deceased children and their beliefs about life after death, e g , “Please describe the ways in which you continue to feel connected to your child after shehe has died. Are there certain times andor places which prompt you to feel connected?” and “What do you think would be helpful for medical and mental health professionals to know about parents’ spiritual connections with their deceased children?’ “Spiritual” connections are defined in the questionnaire as “occurrences such as visions, physical sensations, dreams, or other experiences which make you feel connected to your child.” This broad definition was chosen to ensure that participants would have a shared foun- dation but could also draw from their own particular belief systems. Basic demographic information, including child’s diagnosis, date of diagnosis, and date of death,

were also included in the questionnaire. Although no statistical validity has been

proved for the instrument, it appears to have good face validity. It has also been re- viewed for readability and sensitivity by the authors’ colleagues and by several bereaved parents. Both groups found the questions relevant to the bereavement process and worded in an understandable and sensitive manner.

RESULTS An analysis of the content of the data de-

rived from the questionnaire revealed several consistent themes.

Continued Connections As anticipated, all the respondents noted

at least one way (usually more) in which they still felt connected to their deceased children. Many parents described actively maintaining a connection by visiting their children’s gravesides, praying, or talking with them. Many also described experiences in the daily course of life, for instance, when listening to music, noticing and enjoying nature, and seeing visual re- minders of their children, that kept them connected and resulted in a feeling of their child’s presence. Others also mentioned less common, perhaps singular, experiences they felt were “signs” or “messages” from their children. The following excerpts il- lustrate these various means of connection:

Table 1 DEMOGRAPHICS OF STUDY PARTICIPANTS (N=43)

CHARACTERISTIC Gender

Women Men

27-35 years 36-45 years 46-63 years

Marital Status Married Divorced Separated

Caucasian African American

Age

Race

N

34 9

9 23 11

37 5 1

42 1

%

79 21

21 54 25

86 12 2

90 2

CHARACTERISTIC Religion

Catholic Protestant None Other

None One Two >Two

Bereavement 4 2 months 12524 months 24 c 48 months 48572 months

Surviving Children

N

26 11 5 1

2 21 12 8

8 11 12 12

%

60 26 12 2

5 48 20 19

18 26 28 28


Mother, aged 58, one surviving child: I talk to him all the time. I “keep him up on” what’s going on at home and with all of us. I feel the strongest connection at the cemetery. I imagine his spirit is in the trees behind his grave. When I begin to talk to him the wind almost always rustles the leaves, which tells me he’s there.

Father, aged 54, two surviving children: Tina is the love of my life. This in no way means my wife is not my love. It is just different with a child, first-born and only girl out of three beautiful children. Tina lives in my heart and soul. I see her picture and say “Hi sweetheart” always. I think I have dreamed of her but am not sure-I dream a lot. It seems that any photo taken of the remainder of my family since her death has a light reflection which tells me she is with us.

Mother, aged 31. one surviving child: So far, it’s not even one year, I feel spiritually connected with An- gela through sunsets, sunrises. It’s always so beautiful now. She hasn’t yet come to me in a dream, although l would love it. She was always a teaser and l feel she is still teasing me by not appearing to me in a dream.

Mother, aged 32, three surviving children: I feel connected to Michael through our other children and also through little things around my home (little signs he is with us). The signs around my house may seem odd to you but to me they mean something, for example a single rose that lives longer than the rest of the dozen. Or the three African Violet plants that were given to us when Michael died-there are three plants but they bloom in four different colors; those four blos- soms represent my four children. These small things always make me smile.

Several parents mentioned feeling connected to their child through what might be called “helpful interventions”-ways in which parents feel that their dead children are somehow assisting them either in their grief or in their daily life. Mother. aged 52, one surviving child: I feel that I know he’s with me when I get where I’m going or find parking places easily, pick things up effortlessly. One night I felt his hand in mine and felt two kisses on the cheek.

Mother. aged 33, one surviving child: I feel connected through music I hear, people I meet who have something that reminds me of her, things I find out of the blue at very strange times. I ask for “signs” when I’m feeling really troubled and I always get them im- mediately, in a special song, or whatever. The timing is always uncanny and gives you the chills but you get to expect to “hear from her” just when you need it most. Things happen to me just when I’ve reached my limit and am about to give up; for example oppor-

tunities, people, there’s always a good twist just in the nick of time. I’ll go to a movie completely unsus- pecting or not knowing anything about it and it will have a certain message or something about it will smack of Lucy and I just shake my head because she always gets the message across when I need it most. It has not failed me in three and a halfyears. The trick is to keep your ears and eyes and mind open.

Mother. aged 51, four surviving children: There were times I would cry so hard when I was alone I thought I’d never be able to stop, and the phone would ring every time and I’d have to answer i t and 1 knew it was Eric making someone call me so I would stop crying.

Inexplicable Occurrences Two respondents reported having no

spiritual experiences per se, while five left the question blank. The majority of respondents apparently had their experiences after the child’s death, and seemed to do so with decreasing frequency over time.

Mother, aged 47, one surviving child: The one experience that repeats itself is a kiss Dan gave me about a month before he returned to the hospital for the last time. I was carrying him up the stairs to our apartment and he kissed me on the neck and told me he loved me. I feel that kiss still and it will just happen, usually when I am tired and always on the steps coming up to my apartment.

Mother, aged 51, Jive surviving children: From the first night he died, I have always looked up at the sky and the first star I see I’ve always called Jim and I’ve always talked to it like 1 did to Jim. As we were driv- ing to his brother’s for Christmas dinner I looked out the car window and told him I needed to see his star more than ever. It was so overcast and snowy that night I knew it would be impossible to see a star, but I also knew that Jim never gave up no matter what the odds. There was no star on the way over nor on the way back. When I entered the house, the Christmas tree was lit and 1 saw the star on top of the tree that Jim had picked out and I thought maybe that was the star I was supposed to see that night. I went to bed around 2 a.m. 1 couldn’t sleep and went into the bath- room. I didn’t have to turn the light on because the room was illuminated. As I turned toward the window, the biggest most beautiful star was shining in. I went out on our deck and discovered it was the only star in the entire sky.

Mother, aged 42, eight surviving children: The night of my child’s death, my husband and I were standing outside on our front porch seeing some guests off. We live in the country, so you can see the stars at night. I was crying and said to my husband as I looked up at the star-filled sky through the branches

SORMANTI AND AUGUST 465

of the willow tree, ‘‘She’s up there somewhere. I keep seeing her dead face.” My husband put his arm around my shoulders and said, “But you know she’s happy now.” I said, “But I miss her so much!” And exactly where I was looking through the willow tree appeared an object I can only describe as a piece of the moon. It glowed like the moon, was roundish, and I could see embers falling from it. It slowly started to descend. I said, “It’s Iris.” Then I smiled and laughed and said, ‘‘She’s alive!” It lasted about three to five seconds and disappeared. My husband didn’t see it.

Mother, aged 38, one surviving child: Three minutes before Chris’s heart stopped, the air in my den changed. There was someone coming for my son. The time was 1:14 am., the room was filled with comfort. I sat up next to Chris. I said “Good-bye, go with God, I will see you again. I will always love you.” At that time Chris turned his head, grabbed my arm, took three long, calm breaths. I heard his heart stop. Then a heat went through my body. It felt like a strong arm. Then the feeling left the room. There were people in the den that felt the same thing. The friends in the kitchen never felt it. It is my belief that Jesus carried him and went through me.

Faiher. aged 45, iwo surviving children: The other night, walking home as the sun was setting and a cold wind was blowing, I came to the top of a hill and I could feel Jake with me. I had a sense of a conversa- tion but not one that we would normally recognize. Soon, however, cars came by and it all ended. I felt very exhilarated and excited.

Mother, aged 44, one surviving child: With only three of us remaining in our home, and all of us adults, it is easy to keep track of things, so therefore I know when things get moved. I have had a crystal angel, which is very special to me. Martha always wanted to play with it. Sometimes I would let her hold my angel when she was vomiting, or extremely sick from chemotherapy. A week after she died I found the angel on the mantel with its head fallen off. No one had touched it. The break was perfect so I could glue it back on. Martha?

Moiher, aged 42, two surviving children: At about 9 pm. , two weeks after Stacy’s death, I was in bed and I started smelling Noxzema; this went on for about two hours. I also kept hearing in my head Stacy’s voice saying “Good night mom.” This happened for the entire week. Finally, thinking I was losing my mind, I asked my husband at 9 p.m. one evening if he smelled Noxzema. He said yes, that he thought I had started putting it on like Stacy used to every night before she went to bed. Then suddenly the next night it was over, no more voices of “good night mom” and the smell was gone.

Mother, aged 41, two surviving children: The most outstanding spiritual experience I had was on the day

my daughter died. She woke up very early that morn- ing. She was upset and scared. She said that there was a lady who kept asking her what her religion was. I told her to tell the lady that she was Greek Orthodox. We talked a little about her beliefs. I reassured her that everything was okay and that Daddy and I were with her. She closed her eyes, relaxed, and said “I’m happy now mommy.” When she awoke later she was calmer. She wanted us to complete some things right now-for example, read her mail (unopened for several days), send Dad to a one-hour photo place to develop her last roll of film, cash in all her scratch tick- ets, shave her legs, do her nails. She wanted to call her brothers. Looking back, I think she had to know her time was near. She had us preparing her for something special, you would think. Later that evening, she described to us what she was feeling. She said she could walk, although she had lost all feelings from the waist down two weeks before. Then she said she felt like she was floating toward the windows in her hospital room. She didn’t feel any pain. Something or someone was calling her to go. She became very anx- ious but at the same time very happy and full of life. We talked to her about going to see her aunt and un- cle, both of whom had also died very young of cancer. She once again said that she was very happy. We calmed her down and she fell back to sleep with a smile on her face. That was the last time she spoke with us.

Nonparental Experiences Experiences by other people of spiritual

connections to their child were reported by 32 of the parents in the study. In order of frequency, those who had such experiences included grandparents, friends, relatives, and siblings. Many of these occurrences were dreams in which the child appeared to give the message that she or he was all right. Father, aged 42, one surviving child: The closest to an experience of this nature was when we learned (a couple of weeks later) that a church about 50 miles away was having its Sunday service at the time Steven died. A lady whom we don’t know, and who does not know us, stood up and said that a young boy was being cured of his cancer at that very moment. It makes me feel better to think that Steven left his cancer in this world and that his suffering is over.

Mother, aged 42, one surviving child: A close friend went to view my son’s body before his funeral. It was a private viewing and she was alone. She told me that she talked to my son and asked him to send some sort of a sign that he was all right. Two days later, her son (my son’s best friend) received a postcard from my son that had been mailed 18 months earlier from Dis-


ney World and had been lost. When 1 got the card and heard the story, I felt confused but momentarily happy. At the time I felt relieved but I need more, more, and more.

Impact on Bereavement Process The majority of parents described these

experiences as positive. Some felt happy and peaceful afterwards, that they were closer to their child and to God. Some felt comforted because the experiences confirmed that their child was in a safe place, with other deceased family members or with God; for them, this was confirmation of an after-life. Two parents were moti- vated to help others in order to fill up the emptiness they felt without their child.

However, at times these experiences were also difficult and painful. Several parents spoke of their frustration in wanting to believe that these were true connections rather than fabrications of their subcon- scious. For example, one father questioned whether his mind was playing tricks on him. Frustration was also expressed about not being able to console the child any longer, wanting to be with the child and to know that she or he was happy. One mother reported that her connections left her feeling guilty for not having been more forceful with medical staff. Others were convinced that the connections showed they had done the right thing by letting their child go. Mother, aged 56, four surviving children: These and other experiences were a tremendous consolation to me; they let me feel that he had known joy as well as suffering, and that I would embrace him again someday, It was also wonderful to know he was in a place of peace, happiness, and total healing.

Mother. aged 57, no surviving children: Sometimes, not often, he comes to me in my dreams. Afterwards, when I awaken, I feel a sense of peace, just as though I had spent some time with him . . . like a visit. Of course there are times when they are disturbing, too, but mostly they’re good.

Mother, aged 42, eight surviving children: Every time I think about that meteor or that star in the sky, I smile. It makes me remember she’s alive. It shows her love for me, the wonder of her. I know she’s help- ing me bear the loss of her, otherwise 1 don’t know

how else I’d keep my sanity. It hasn’t taken away my grief or pain, and sometimes its been pretty bad, but if I didn’t know she was alive and okay, how could I get better?

Mother, aged 36, three surviving children: Since the experience was very brief, I felt cheated. I wanted to know that Amanda was happy. On the other hand, I believe not seeing her means that she is at peace at last.

Mother, aged 50, Jve surviving children: Each time I hear about other people’s spiritual experiences with Jim, I feel marvelous. I know Jim had an influence on them in life and even death is not stopping this connection.

Finally, another mother poignantly described how difficult these experiences can be. Mother, aged 42, one surviving child: I feel a deep sense of loss when I dream of Laura. What I wouldn’t do for a hug from her skinny little arms! But I also sense she does not want me to grieve for her. She tells me she is okay.

Overall, despite some mixed emotional reactions, only two of the parents felt that their experiences of connection were not helpful in the healing process.

Sharing Connection Experiences Only two respondents reported not hav-

ing shared their experiences with others. In order of frequency, those with whom sharing was most frequent were close friends, family members, other bereaved parents, and spouses. A few others reported sharing these experiences with either a priest or surviving children. It is interesting to note that only one person reported sharing with a doctor and only one with a therapist.

Parents seemed quite clear about whom they could confide in. Several responded that they would share with “whoever is in- terested” and with those who share their beliefs, but they were acutely aware that some people would not want to hear about their experiences; as one mother wrote, “I don’t tell people who don’t get it.” Those who have shared with others reported positive feedback-acceptance, interest, com- passion, and love.


Changes in Religious/Cultural Belie& The majority of parents reported that

their beliefs about life after death had changed since their child’s death. Many reported a strengthening of existing beliefs, several reported a belief that emerged only after the death. About one-third of the respondents referred to a belief in heaven and God, many stating that they believed their children were now in heaven, with God, or in a place of peace and happiness where they were healthy. approximately one-third also believed that they would be reunited with their children in an afterlife, and that those who had already died were able to greet their children when they arrived in that afterlife. More than half of the respondents stated that their religious and cultural background or community had influenced their beliefs, while only nine believed they were no so influenced.

Grieving parents, however, often doubted their belief in an afterlife. The following quotes were among the most poignant because they depict the very difficult struggle faced by many parents when they try to make sense of their child’s death. Mother. aged 45, two surviving children: TO tell you the truth, I never thought about life after death until Jake died. Then I found great comfort in wanting to believe that he was existing in some other life totally without pain and suffering. I won’t let myself believe that there is nothing after this life.

Father. aged 31, one surviving child: My thoughts and beliefs about life after death have changed. I cannot believe that he is spiritually dead. Possibly it is in defense of the pain that I would feel if I were to admit that he is actually spiritually dead. Maybe it is that I have never really thought about it before this. I really cannot say for sure what the reasons are. I can only say that I refuse to let go of the memories, the legacy, and the spirit of Tony. I have released in my heart and mind the physical responsibility that I once had and felt for him. I have “digested,” if you will, the fact that his little body no longer exists. But his spirit, at least the parts of him that are so much a part of me, will now live forever inside me. Is this life after death, or is this so great a love between father and son that even death can never break the bond?

Mother, aged 40, one surviving child: I want desper- ately to believe in life after death. Prior to my son’s death I was ambivalent. I held no strong beliefs one

way or another. Now, I’m willing to be convinced and use anecdotes to help. Other people’s experiences are encouraging and make me hopeful.

Mother, aged 58, two surviving children: Since I’ve lost so many loved ones in my family, I feel I have to believe that there is something else after death and that maybe death is the end of our world and a new one starts. I have to believe I will see my son again or I couldn’t get through each day now.

Parents ’ Suggestions for Health Care Professionals

Parents overwhelmingly stated that they want staff to be open, respecthl, and nonjudgmental of their bereavement experiences and to allow and encourage them to talk openly about their experiences and beliefs. Parents want staff to know that these connections do exist, are reassuring to them, and help them in their grieving process. Some parents felt staff should raise these issues directly with parents as a way of preparing them for what they might experience at the time of, or after, a child’s death. In summary, parents want staff to listen, respect, accept, and to be informed about the bereavement process. Some of their advice to medical and mental health professionals, which could also be valuable to clergy, pastoral counselors, and funeral directors, is as follows. Mother, aged 50, five surviving children: These connections are reassuring to the parents; they make it easier for parents to go on with their lives; although their child is no longer with them physically, he or she is still there spiritually; it keeps alive the hope that death is not final, and that someday we’ll see each other again. Whether these spiritual connections are real or only part of our imaginations, they help get us over the rough spots and maintain our sanity.

Mother, aged 39, two surviving children: How can any of us judge the authenticity of such experiences unless we, too, have been the parent of a deceased child? Professionals should also realize that these experiences can serve as a helpful tool for parents in working through their bereavement. My philosophy is whatever it takes to get through it, do it as long as it leads one out of the darkness and into the light of living once again.

Mother. aged 33, one surviving child: If you listen long enough and are open and nonjudgmental you will hear at least one story from each person about

PARENTAL BEREAVEMENT

something “weird’ and unexplainable that connects them with the one who died. It’s there. They may not choose to disclose it for fear of ridicule.

More than half of the responding parents included additional thoughts and comments. Almost one-third thanked the research team for carrying out this study, for keeping in touch, for taking this issue seri- ously, and for making them feel normal. Many others thanked the staff in general for their caring and support during the child’s illness. These comments confirmed the need for continued inquiry about this aspect of parental bereavement. Several respondents shared knowledge and advice about grieving. Finally, several reflected on their relationship with their child and told more of their story; one mother, for example, recounted her son’s actual death, while another told of her treatment choices and the process of understanding and accepting that her daughter was going to die.

DISCUSSION Although spiritual factors play a role in

health and illness they are often overlooked or disregarded by the scientific community because of their intangible quality. As Kuhn (1988) noted, “the spirit does not lend itself easily to objective scrutiny and measurement”. Nevertheless, the spiritual dimension merits continued exploration in order to understand fully such universal as- pects of the human experience as illness and grief.

It is evident from the present study that with very few exceptions, the parents who experienced continued connection to their dead child derived psychological benefits from the connection. The experiences described seemed to perpetuate parents’ per- ceptions of their children’s unique quali- ties; to maintain their identity as parents of that child; to provide reassurance, hope, and a sense of peace amidst the confusion and despair of their grief; to help them manage better on a day-to-day basis; and to tolerate the uncertainty and ambiguity of life and death.

Limitations of the Study While the sample was probably a reason-

able representation of the pediatric patients and families treated at the cancer institute from which it was drawn, its racial, ethnic, and religious variety was limited. For example, 86% of the participants were Chris- tian, which, since a belief in an after-life is one of the main tenets of Christianity, is likely to have influenced the study’s results. Furthermore, a smaller but substan- tial proportion (25%) of participants was Irish, a fact that might be accounted for by a cultural characteristic that McGoldrick (1991) described as a “long history in beliefs in all sorts of spirits” @. 181). An in- depth exploration of the influence of ethnic, religious, and other sociocultural factors such as socioeconomic status was beyond the scope of the present study but would be an important contribution of future research to our understanding of the grief process for diverse populations.

It should also be recognized that individual circumstances surrounding a death can lead to different bereavement processes. For example, the death of a child from a life-threatening illness such as cancer, is a significantly different experience than that from a sudden traumatic event or even from an illness with a more predictable course. The period of bereavement is also pertinent-in this study, the majority of participants (N=26) had been bereaved for at least two years, although a significant minority (N= 17) had been bereaved for less time than that. The length of illness, too, may be an important variable in the experience of spiritual connection. Almost half of the participants’ children (46%) in this study had died within a year of diagnosis, almost one-quarter (23%) between one and two years after, and a small minority (10%) more than five years after. The qualitative analysis undertaken for this study did not reveal any distinctions based on such variables. Nevertheless, future research might address this possibility by investigating potential differences between subsamples of


parents whose children died in different circumstances.

Future research into this phenomenon would also be strengthened by the use of standardized instruments to measure the impact of connective experiences on such psychosocial outcomes as coping, quality of life, and marital stress. Finally, studies carried out in different settings with different subsamples of bereaved persons would also enhance the data on this topic. For example, adaptations of the present study to samples of bereaved siblings or of children whose parents have died could provide in- sight into children’s grief experiences and the phenomenon of spiritual connection with the deceased. Also, health care providers who work closely with termi- nally i l l patients and their families might be queried about their experiences of these kinds of connections to their patients.

Although the generalizability of the data is limited as a result of the homogeneity and purposive nature of the sample, it seems probable that bereaved parents in other samples-purposive or random- would experience some of the same phenomena collectively described in the present sample. The data disclosed by the study will, it is hoped, stimulate further research about parental grief and so that professionals will be guided towards a more sensitive and informed practice with bereaved parents.

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For reprints: Mary Sonmanti. Ph.D.. School of Social Work. Columbia University, 622 West 113th Street, New York, NY 10025

PARENTAL BEREAVEMENT: Spiritual Connections With Deceased Children

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