Observations Concerning Fear of Death in Fatally Ill Children and Their Mothers

Observations concerning the behavior of 33 children fatally ill with leukemia or related disorders are presented. The following conclusions are reached: (a) In addition to distress directly due to illness, these children manifested behavioral changes in response to three environmental factors, namely, separation from the mother, traumatic procedures, and deaths of other children. (b) The reactions to these environmental stresses are considered to represent separation fear, mutilation fear, and death fear. (c) There is a strong age-dependence of the fully developed forms of these fears, separation fear occurring first and death fear last. (d) The evolution of these fears seems to be related to the maturation of consciousness. 2. Observations on the 33 mothers of these fatally ill children are also presented. The following conclusions are reached: (a) It is assumed that the fatal illnesses in the children constituted death threats to the mothers. (b) The mothers reacted to the illnesses with a triphasic response when disease lasted 4 months or more. (c) Denial was most characteristic of the initial phase. (d) Calm acceptance of death of the child with improved integration characterized the terminal phase. (e) Increased sublimation was suggested in some mothers during the terminal phase. (f) In contrast to the mothers, the reactions of the staff were least well integrated during the terminal phase. 3. The findings reinforce, but do not prove, the hypothesis that the existential problem of death constitutes an important variable in individual and group development.