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JOURNAL
OF
THE
ROYAL
SOCIETY
OF
MEDICINE
Volume
92
August
1
999
LJ4
H-
H
Preference
is
given
to
letters
commenting
on
contributions
published
recently
in
the
JRSM.
They
should
not
exceed
300
words
and
should
be
typed
double
spaced
Bereavement
in
children
Reviewing
the
impact
of
bereavement
in
children
Richard
Harrington
and
Lucy
Harrison
point
out
that
many
current
assumptions
are
unproven
(May
1999JRSM,
pp.
230-233).
The
assumption
that
a
child
would
be
equally
disturbed
by
the
death
of
a
parent
irrespective
of
which
parent
had
died
is
not
only
unproven
but
often
not
even
questioned.
As
a
child
I
was
aware
that
not
all
adults
had
the
same
importance
for
me.
For
instance,
only
one
of
my
parents
was
able
to
help
me
when
I
was
ill
or
really
distressed.
That
parent
was
invaluable
to
me.
The
other
parent
could
read
a
good
story,
and
knew
a
lot
of
interesting
things,
but
didn't
understand
how
to
comfort
me.
This
kind
of
distinction
seems
to
be
true
for
many
many
people.
Indeed,
some
describe
their
most
significant
adult
as
being
not
one
of
their
parents
at
all.
A
grandparent,
an
uncle
or
aunt,
a
sibling,
a
teacher,
a
neighbour,
a
childminder
or
nanny
have
all
been
given
this
role
by
the
child.
Losing
the
truly
significant
person
can be
devastating;
losing
the
not
so
significant
person
can
be
distressing.
There
is
no
immediate
way
of
getting
comfort
when
the
comforter
is
gone;
distress
can
be
modified
if
the
significant
adult
is
there
and
able
to
give
this
comfort.
It
seems
to
me
that
many
studies
of
bereavement
in
children
are
essentially
flawed
because
this
has
not
been
taken
into
account.
Only
the
study
of
the
loss
of
the
significant
adult
can
provide
information
about
the
impact
of
bereavement.
Could
it
be
that
some
of
the
reported
ill-
effects
of
bereavement
counselling
are
the
results
of
some
counsellors'
not
realizing
that
the
child
had
no
sense
of
serious
loss,
since
the
dead
parent
had
not
been
felt
by
the
child
as
playing
a
significant
part
in
the
child's
emotional
life?
Expecting
the
child
to
mourn
in
this
case
would
be
more
likely
to
cause
confusion
than
to
help-for
instance,
by
making
the
child
feel
guilty
for
not
feeling
stronger
grief.
Mary
Cheetham
91
Ferry
Road,
Oxford
OX3
OEX,
UK
A
personal
experience
may
be
of
interest.
As
my
father
was
a
colliery
worker
during
the
Second
World
War
he
was
exempt
from
military
service.
To
help
the
war
effort
and
to
provide
us
with
our
own
milk
supply
he
bought,
in
the
spring
of
1940,
a
nanny
goat
and
kid.
At
6pm
on
my
10th
birthday
he
milked
the
goat;
later
that
evening
he
was
called
to
the
pit
and
in
an
accident
he
was
burnt
to
death.
The
next
morning
I
realized
that,
although
I
had
only
ever
watched
the
process,
the
goat
had
to
be
milked
at
8
am.
I
learnt
then
the
valuable
lesson
that
life
goes
on.
By
milking
the
goat
that
morning
I
was
enabled
to
cope
much
more
easily
with
many
instances
of
bereavement.
Bryan
Askew
27
Golf
Links
Avenue,
Tadcaster,
North
Yorkshire
LS24
9HF,
UK
In
the
article
by
Richard
Harrington
and
Lucy
Harrison
the
general
note
of
caution
about
the
wholesale
application
of
well-meaning,
unreasoned
interventions,
which
may
do
more
harm
than
good
is
well
taken.
However,
their
specific
assertion
that
bereavement
counselling
can
harm
children
involves
a
leap
of
logic
which
is
rather
hard
to
follow,
since
it
is
based
on
a
30-year
follow-up
study
published
over
20
years
ago
which
showed
that
counselling
with
delinquents
increased
the
rate
of
delinquency.
They
did
not
mention
the
most
recent
and
comprehensive
research
to
date,
the
Harvard
Child
Bereavement
Study,
reported
in
Children
in
Grief
by
W
Worden,
published
by
Guilford,
New
York,
in
1996.
The
study,
which
followed
125
children
for
two
years
after
the
death
of
a
parent
and
used
a
matched
control
group
of
non-bereaved
children,
found
that
bereaved
children
were
at
greater
risk
of
emotional
and
behavioural
difficulties
and
that
this
effect
was
greater
at
two
years
after
the
death
(21%
compared
with
6%).
Harrington
and
Harrison
also
failed
to
differentiate
between
the
advice
of
a
professional
and
over-enthusiastic
counselling
by
those
with
little
training.
This
confusion
was
maintained
in
the
extensive
news
coverage
which
followed
publication.
The
publicity
could
easily
have
conveyed,
and
perhaps
might
especially
have
done
so to
the
anxious
and
upset
carers
of
bereaved
children,
that
it
is
a
bad
idea
to
seek
any
professional
help
for
a
child
who
has
lost
a
parent.
Julia
Fabricius
Anna
Freud
Centre,
21
Maresfield
Gardens,
London
NW3
5SD,
UK
Richard
Harrington
and
Lucy
Harrison
are
right
to
urge
caution
before
we
offer
interventions
that
may
be
harmful.
However,
lack
of
evidence
for
effectiveness
is
not
the
same
as
evidence
for
ineffectiveness.
Parents
may
not
be
aware
of
the
extent
to
which
bereavement
affects
their
child.
Silverman
and
Worden1
found
that
42%
of
the
children
in
their
study
felt
they
had
to
act
in
a
certain
way
for
the
sake
of
the
surviving
parent,
and
Black2
likewise
reported
that
children
who
lose
one
parent
may
shield
the
surviving
parent
from
their
distress.
Much
of
the
research
conducted
so
far
has
relied
on
parent
and
teacher
reports,
and
to
establish
the
truth
we
need
evidence
from
children
themselves.
There
are
two
particular
dangers
in
this
area
to
lose
objectivity
by
becoming
over-sentimental;
and
to
deny
the
437