“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 She has stopped being able to concentrate and is either silent and withdrawn or screams.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.