The challenge of talking with children about life and death | Danai Papadatou | TEDxThessaloniki

Danai Papadatou has dedicated her life to helping children come to terms with death, whether that is a bereavement in their family or even the possibility of their own death following a life-limiting illness. Her TEDx talk provides a bittersweet guide to adults on how to navigate through these difficult conversations and life-changing realities.

Clinical Psychologist Danai Papadatou specialises in bereavement counseling and helps families and communities come to terms with death and traumatic events. Having worked in the oncological ward of a children's hospital, she learned from her young patients of the importance of living a life with quality and substance. In 1995, she co-founded "Merimna", a non-profit organisation that offers emotional support to families faced with bereavement and palliative care to children with life-limiting illness.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx

I would like to begin
by telling you a fairy tale.

Once upon a time,
a little girl called Eleana

was astonished to find, upon waking up,

a dragon by her bedside,
small as a kitten.

She approached and petted it,

and the dragon wagged his tail.

Eleana ran straight
to her mother, shouting,

"Mum, mum, there is a dragon in my room!"

"What are you talking about, Eleana?

There is no such thing
as dragons," she replied.

When Eleana went back
to her room to get dressed,

the dragon approached her
happily shaking its tail,

but this time, Eleana did not pet it.

Her mum said there were no dragons,

so it would be silly of her
to pet a dragon that didn't exist.

As she sat at the table to have breakfast,

the dragon sat there as well!

And how could she possibly tell
a non-existent dragon,

"Get off the table
and stop eating my breakfast"?

The more Eleana ignored the dragon,

the bigger it grew and grew,

and it grew until it took over
the entire house.

Eventually it lifted the house
on its shoulders and started running.

Coming back from work that day,

Eleana's dad was surprised to find
that his house was missing.

Thankfully, a neighbor showed him
which way it had gone,

so when he reunited with his wife
and daughter, he asked them,

"How did this happen?"

"Well, there is a dragon ...,"
Eleana began,

but her mother interrupted her:

"Eleana, there are no dragons."

"No, no," Eleana insisted,

"There is a dragon, a very big one,"

and she petted its head.

And the more she petted the dragon,
the smaller it became

until it went back
to the size of a kitten.

Eleana's mum lifted the dragon up
in her arms and wondered,

"Why did it have to grow so big?"

To which Eleana replied,

"I don't know. I think it just
wanted our attention."

The dragon of this fairy tale,

which was written by Jack Kent
and adapted by me,

could be the fears
that every child and family have.

And one of these fears is death,

which exists in children's
thoughts and questions,

as it did in little Eleana's.

I was once like Eleana.

Looking for answers,

I approached my own dragon
through my professional commitment

to children who come face to face,
early on in their lives,

with their own death
or the death of a loved one.

Children and death:

these are two words
that seem incompatible.

Yet death exists all around
in our children's lives,

in their fairy tales, their games,
the movies or the news they watch,

the losses they experience
in their family.

It's perfectly natural for them to wonder,

to want to understand
what happens to people who die,

and whether they will come back.

These questions are perfectly normal,

there is nothing pathological
or morbid about them.

They indicate that the child
is growing emotionally and cognitively

and tries to understand
the mysteries of life,

such as birth and death.

We adults are usually the problem

because we are stunned

and don't know what to say.

Instead of hurrying to give answers,

it's preferable to give children
some space to express themselves

so that we may understand
what exactly triggered their questions.

Is it something
that caught their attention?

A dead bird in the schoolyard?

Are they upset because someone died?

Maybe a classmate's parent?

Are they worried about
the potential death of their own parents

because they smoke a lot and ask us
if everyone who smokes eventually dies?

The conversation that will unfold

will depend on what the child
wants to know at that particular time

and must be adapted
to the child's evolutionary stage.

With small children,
we use simple, clear words.

We explain, for example,
that when someone dies

their body stops functioning,

their heart stops beating,

they don't breath or feel or think,

and then we take their body
and place it in a box called a coffin,

and bury it in the ground
in a place called a cemetery.

Whereas with small children

it is best to avoid references
to the soul and life after death,

as these are too abstract for them,

with teenagers we can have
very productive conversations

about supernatural or religious
considerations regarding death,

as they have developed
the necessary mental capacity

to think in an abstract
and hypothetical manner.

In any case,

we acknowledge that
no one knows what death is

and what exactly happens
to people who die.

We can share our personal religious
or philosophical beliefs about death,

but these are not the absolute truth,

and it is very important for children
growing up in a multi-cultural world

to understand that there are
different beliefs about death.

These conversations become
even more difficult

when a child's life is
directly affected by death.

How do we talk to a child
about the death of a loved one?

And how do we manage
conversations with sick children

who want to talk about their own death?

These challenges led
eight colleagues and myself

to found Merimna,
a non-profit organisation.

For the past 22 years,

Merimna has offered
specialized, scientific services

in two areas:

services to support children,
families, and school communities

that are affected
by the death of a loved one,

and palliative care to children

who are terminally ill,
and to their families.

I am here because one of our objectives
at Merimna is to increase public awareness

and assist everyone
who comes in contact with children

in order to efficiently support them,

to help them face
life’s challenges appropriately.

So, how do we talk to children
about the death of a loved one?

We never hide the truth.

We speak directly, honestly,

and give the child
all the information it needs.

We adjust what we say
to what they already know,

what they hope to find out,

and we avoid facts

that they are not ready to hear
at that particular time.

We use simple words like "died"

and avoid expressions
such as "went to sleep,"

"went on a journey," "is gone,"

because they cause confusion,

and a pre-school child

may develop a fear
of going to sleep, in case they die,

or wonder why their loved one left,

when they are coming back,
and why they didn't say goodbye.

We also avoid explanations like,

"The person who died was good
and God summoned them,"

because the child might
develop a fear of God

and start acting naughty
to avoid being summoned as well.

Even when we call things by their name,

we should always remember
that pre-school children

cannot grasp the finality of death.

So, they may ask questions like,

"OK, they died, but how long
will they be dead?

When are they coming back?"

They may also find it
difficult to understand

that vital organs can stop functioning

in someone who died,

and if they attend the funeral,

they may even ask whether those who died

are hungry, cold or upset,
wherever they are.

Only when they become teenagers

do they have the cognitive background

to understand that death

is a final, irrevocable, universal fact

that happens to everyone,
including themselves.

Any such conversation

must leave the child room and time

to talk about the person who died,

to express feelings and mourn.

Expressions like,

"Now, now, don't be sad.
You must be strong,"

or "Don't cry, because
that makes your mum sad,"

or "You are now the woman of the house,"

do not help and postpone mourning,

creating adjustment problems.

Let me tell you about Lydia.

Her mother came to Merimna

for advice on how to help
her nine-year-old daughter

understand that her father
was terminally ill.

After giving her the facts,

Lydia's mother explained
that her father would eventually die

and encouraged her to assist in his care

and say goodbye in her own way.

The day Lydia's father died,

she drew her heart broken in two.

With the support of one
of Merimna's psychologists,

Lydia slowly managed
to talk about her father,

mourn her loss,

and, a few months later,

draw again her heart, glued back together,

while noting that it would
always remain cracked.

Imagine loss, the death of a loved one,

as a red ball

that takes over a child's soul,
which is depicted here as a bottle.

We wrongly believe that, with time,
loss will be forgotten

and the ball will grow smaller
until it disappears.

But this is not the case.

With appropriate support,
any child like Lydia

can develop resilience

in order to accommodate
the loss of a loved one

which will always remain important
and a central focal point in their life.

But what about children whose life
is threatened by an illness?

Do they talk about death?

They unquestionably realize
their health condition,

even when no one explains it to them.

I had the honor
of accompanying many children

towards the end of their lives,

and I have found that
they choose with whom to share

their feelings, needs and wishes,

when death becomes inevitable.

They choose someone who can handle
the pain of saying goodbye,

someone who gives them
the space to express their feelings

and understands what they are trying
to share indirectly and figuratively,

someone we will defend
their wishes and needs,

and someone who, when the times comes,
will allow them to go

without feeling guilty for those
that they leave behind.

When we find it hard
to accept a child's death,

we deprive the child of the opportunity
to say goodbye to us,

and we also deprive ourselves
of the opportunity

to ensure them that they will always
have a special place in our heart.

Danai Papadatou: "What have you drawn?"
I ask five-year-old Ellie.

Ellie: "Stairs that lead up to the sky."

DP: "And who is climbing up the stairs?"
E: "People ... me."

DP: "And what is up there in the sky?"
E: "The sun, the moon and the stars."

DP: "And what will you do up there?"
E: "I will be looking at you."

DP: "Will I be able to see you?"

E: "No, but you will see me
only in your heart."

Next to children like Ellie, I learned
to kneel down to their height,

to look them in the eyes,

and to hear what they wanted
to share with me,

the important things in life,

how fragile and valuable life is.

Closing, I would like to invite you
to a reflection game.

Imagine that through some sort of magic,

you find out that you will die
one year from now,

in whichever way you choose.

So, you have one year to live.

I want you to think of three things
that would change in your lives:

relationships, profession, aspects
of your character, life circumstances?

Something that makes life
difficult for no reason.

Then I want you to think of three things
that you would leave the same,

that you wouldn't change at all.

These are usually associated
with our values and priorities,

anything that makes our life worthwhile.

And finally, I want you
to determine a realistic goal

that you want to achieve within this year,

something that will mark

the story of your life and your existence.

And when you do all these,

I want you to think of the first thing
that you will do, starting today,

to change the things
that stop you from enjoying life

and to celebrate everything
that make life worth living.

In the words of Kazantzakis:

"Death is like salt,
and it adds flavour to life."

Thank you.

(Applause)