Child - Death of a Parent

8/12/2019 Child - Death of a Parent

http://slidepdf.com/reader/full/child-death-of-a-parent 1/6

hildren Who Witness Parental Murder Posttraumatic spects

CARL P. MALMQUIST, M.D.

In this paper the traumatic situation of children witnessing a parent being murdered isexamined. The purposes are to 1) evaluate the psychiatric consequences of such a trauma,in terms of meeting diagnostic criteria, and (2) assess the impact on the affective andcognitive functioning of the child. Methodological complications are present in such rareevents. When a parent is seriously wounded in an attempted murder but survives, thesituation is dissimilar from a parental death; when a child isdirectly involved, such as beingshot at, a key variable has changed; the response to the child may change the outcome;differences in family structure, and the clinical status of the perpetrator (e.g., was theperson psychotic and for how long?) are all relevant. This study investigated 16 childrenbetween the ages of [j and 10 who had witnessed a parental murder. The children wereassessed clinically as wellas by utilizing the Impact ofEvent Scale. Complexlegalsituationsoften arise when children are exposed to a parental homicide.The situations may involveparticipation in a criminal trial as well as civil issues involving mental distress. Both maydemand the child s participation as a witness, beyond the initial traumatic event ofwitnessing a parent murdered.

Journal of the merican cademyof Child Psychiatry 25, : ~ : 3 2 0 : ~ 2 5 986

Increasing attention is be ing paid to the effect of

trauma on people. This is especially so in the areas of

clinical treatment and research with adults, and it has

been extended into a concern for children exposed to

such situations. Diagnostically, under the generic

heading of Anxiety Disorders, there is now a specific

entity of posttraumatic stress disorder in the DSM

III The disorder can be either acute, chronic or de

layed. Although this diagnostic category was not officially recognized earlier, clinicians had been aware of

the impact of traumatic events on personality func

tioning and had made such diagnoses in a nonsys

tematic manner. The events recognized as stressors

have oft en been the expected concomitants of major

trauma, such as that associated with rape; physical

assault; military combat; natural disasters (floods,

earthquakes, tornadoes); terrorism; accidents (cars,

airplanes); or fires. Sometimes t he tr auma is a by

product of political programs (torture, death camps,

forced marches under deprivation, bombing). The dis

order is more severe and longer-lasting when th e stres

sor is of human design rather than seen as a misfor

tune in nature.

The area examined in this paper deals with a spe

cific type of traumatic situation-that of children

witnessing the murder of their parent, conceptualized

Receu ed Sep t. I. 191 2; revised Ike t 191 2; accepted Jan . 5.191 :1

Dr. Malmquist is Professor of Social Psychiatry. Department of

Sociology Unioersitv of Minnesota Minneapolis MN 55455, uherc

reprints may I , requested.

0002-71 :IH/H6/2GO:l-0:120 02.00/0 19H()by the American Academy of Child Psvchiatry.

as an extreme situation giving rise to a posttraumatic

stress disorder. Investigation of th e impact of trauma

on children requires clarification in comparison to

adul ts. However, few would argue that a child wit

nessing a parental murder would not suffer some type

of psychological trauma. A separate article has dealt

with the legal issues when the child, as a third party,

observes the event and claims to have suffered com

pensable emotional injury (Malmquist, 1985).Effor ts have been made to detail clinical psychopa

thology and intervention steps with survivors of dif

ferent kinds of t rauma. Mos t of these have not in

volved children, and those that have often dealt with

the effects of hospitalization. Investigation o f the ef

fects of other traumatic events on children has been

slow to evolve. One s tudy dea lt wi th children whose

school had been destroyed by a coal mining disaster

(Lacey, 1972). Another discussed the responses of

children to terrorism in Ireland in terms of their

proximity to th e areas of actual attack (Fraser, 1973).

Yet another dealt with the consequences on child

survivors of a dam breaking (Newman, 1976). The

effects on 23 children kidnapped together on a bus

has been discussed (Terr, 1979). The impact of a dog

bite on personality development of 3 children under

36 months has been examined (Gislason and Call,

1982). Children already enrolled in a Head Start pro

gram were surveyed for their reaction to a severe

winter s torm (Burke et aI., 1982). Most articles deal

with adult survivors of well-publicized disasters. The

Monticello tornado, the Managua earthquake, the

Wilkes-Barre flood, the Beverly Hills Supper Club fire

:120



CHILDREN WHO WITNESS PARENTAL MURDER 321

in Kentucky, and the Buffalo Creek Dam Cohen ,

1976; Gieser et aI., 1981; Hartsough et aI., 1976; Hef

fron , 1977; Lindy et aI., 1981) are examples.

Several consequences follow from explicit psychi

atric recognition of posttraumatic disorders. can bepredicted that there will be an increase in publ ished

reports. This will provide added data to rework some

of our ambiguous concepts. Second, there will be an

impact outside the strict area of clinical impressions.

The impact will influence sociological thinking and

research which also has a keen interest in the impact

of trauma and disasters. These kinds of situations can

also be anticipated to give rise to an array of lawsuits

and utilization of clinical material in courts. Finally,

the entire field requires a clarification in our thinking

regarding the impact of severe trauma on children.

The same symptomatic picture is not necessarily elab

orated in children exposed to the same trauma. There

is the added element of an underdeveloped psychological state in which the traumatic events may elicit

different responses than in adults. Different develop

mental levels are a significant variable. There is also

the surprising lack of early aftereffects in some chil

dren Lebovici, 1974). Closeness to the event may also

playa critical role in determining response. The anal

ogy has been used of the response of a pond full of

frogs in which a stone is thrown into the middle; the

frogs in the middle experience fear and those at the

rim experience the ripple as anxiety Black, 1982).

Witnessing a parental death can occur in different

ways. The child my be present and actually view the

event, or be in the immediate vicinity and within a

short period of time be a primary reactor to it. is

significant how few of these children receive psychi

atric attention subsequent to such a trauma. Attention

is often first directed to the children at the time legalissues arise, and there may then be a realization that

an exper t witness is needed. Whether this represents

another example of the need to deny some of the

aftereffects of traumatic events on children by the

participants, until forced to do so by those not directly

involved with the children, is not clear. What can be

stated affirmatively is that most of the cases seem tohave had minimal or no psychiatric intervention prior

to the raising of legal issues. Perhaps this requires abackhanded extens ion of appreciation to the legal

profession who force our attention to these cases eventhough their interests are not clinical.

Research Issues

Witnessing a parental murder is categorized as arare event. Hence, generalizations supported by sta

t is tical measures to draw conclusions about signifi

cance are difficult to attain. In any type of rare event,

subtle differences exist between seemingly similar and

traumatic events. Consider some of the following fac

tors which complicate any research conclusions:

1. the parent who has been assaulted in an attempted murder survives, does this make a significant

difference in terms of the psychological impact on the

child? We would be ignoring a crucial variable if we

did not maintain that a live parent alters the group of

survivor children from those where a parent has beenkilled . Perhaps such differences in themselves would

be minimal, and if we could accumulate sufficient

cases with a rigorous methodology over an extended

period of time, we might be able to draw conclusions

about differences between the two outcomes following

a murderous assault.

2. The problem of family violence has been exposed

to increasing discussion. Diverse methodological dif

ficulties exist in these studies. Some studies of violence

within family units have defined violence as including

incidents of slapping while others have extended the

definition to maiming. The whole array of episodes

varying from slappings to homicide may then be

lumped together and conclusions offered about family

violence. We must be wary of extending conclusions

from these sources to the traumatic impact on a child

being privy to a parental death by violence. The cau

tion is not because these diverse situations may not

give rise to an assortment of psychopathological re

actions; some indicate up to one third of children who

witness interparental violence have behavioral or emo

tional problems Hilberman and Munson , 1978; Lev

ine , 1975). However the types of reaction and problemsensuing in such situations may be quite different from

when a parent is murdered.

3. There is an overlap with problems of abused

children. Yet, the reaction of a child who has been

physical ly abused by a parental figure not even in

cluding the controversial question of emotional ne

glect), is not analogous to the child who witnesses the

murderous assault on a parent .

etho

In this study, six young children between the ages

of 5 to 10 separately witnessed a parental murder.There were four boys and two girls. In addition a

series of 10 children were present during an act offamilicide in which a family member attempted to kill

all the members of the family Malmquist, 1980). The

details of the situations were often horrifying to the

adults exposed to them. The situations will be briefly

summarized.

s e 1. A boy of 10 years, an only child, heardunusual noises in the kitchen of his home. On going

into the ki tchen to check things, he found his father

beating his mother on the head with a frying pan. The

mother was on the floor screaming. After a few sec-



322 C. P. MALMQUIST

onds, th e boy ran from th e house, returning in 20 to

25 minutes. He then saw a crowd gathered outside an d

a police car. Th e actual incident involved th e mother s

head being smashed in, an d she died short ly after

arrival in th e emergency room from a subdural he

matoma. Th e solution provided by relatives was to

send th e boy immediately a thousand miles away to

live with relatives. Th e father was diagnosed as having

a major depressive episode with psychotic delusions

about his s infulness an d guilt over some minor

transgressions from years earlier.

ses 2 n 3. Tw o brothers, 6 an d 9 years, returned

from a weekend custody visitation with their divorced

father. On entering their mother s home through an

open front door, they stumbled onto th e scene of their

dead mother, lying in a pool of blood with multiple

stab wounds holes all over he r body ). Smelling gas,

t he y r an to th e garage an d found th e motor of her ca r

st il l running, with t he m ot he r s boyfriend slumped

over th e steeringwheel. He was later pronounced dead.

se 4.A lO-year-old girl, arriving home from school

in midafternoon, found h er m ot he r an d father both

shot. A note revealed th e f ather had acceded to killing

his wife who had been diagnosed as having a malig

nancy, a nd t he n tu rn ed t he gun on himself.

se 5. An 8-year-old girl heard her mother engaged

in an argument with her separated father. Th e father

ha d been released from a psychiatric hospital a short

t ime earlier. Upon hearing shots, she ra n to th e scene

from he r bedroom an d saw h er f at he r with a gun inhis hand a nd the mother lying on th e floor bleeding.

Th e father at that point turned toward th e girl, shot

at he r bu t missed, an d ran from th e house.

se 6. A boy of 5 years was sitting on his mother s

lap in a chair when he r former boyfriend barged into

th e home. The boyfriend fired several shots at th e

mother which killed her. One shot grazed th e boy.

Although emergency room repor ts noted his wound

was no t serious, it stated he bled quite vigorously.

ses 7-16. A series of cases of familicide ha d 10

children exposed to th e homicidal scene. Some of these

children were shot at, an d others survived by hidingor running.

A number of points can be no ted from these cases

of children being exposed to t he t rauma of witnessing

a parental murder. They i llustrate how diverse th e

situations ca n be: 1) Some families are i nt ac t a nd

some not. 2) Some of th e perpetrators were acutely

psychotic in a psychiatric diagnostic sense at th e time

of th e act. If so, a different se t of antecedents had

been present which presumably operated before th e

homicide in comparison to th e situation of a child

with a nonpsychotic parent. 3) A suicide by th e

perpetrator following a killing changes th e variable of

a survivingparent. 4) Th e presence of ongoing mental

illness, in one or both par ents such as paranoid de

lusions, needs consideration. 5) Different handling of

th e children following th e event may change th e clin

ical picture in th e child subsequent to th e event. 6)

Th e l ength of time elapsed between th e event an d

some type of professional intervention may alter th e

natural history. 7) W heth er t he child was wounded

or shot at in an y way during th e episode may be a

significant variable. These variables ca n all effect th e

reaction to such an event. They are signposts to make

th e evaluations of conclusions all tentative even if a

larger group was available.

In terms of meeting DSM-III diagnostic criteria for

a posttraumatic stress disorder, all of these children

easily did so. They had r ecur rent thoughts about th e

episode which came back, sometimes at unpredictable

an d unwanted moments. Hence, some of their intru-

sive thoughts occurred when they were sitting in a

classroom or even in th e middle of recitation in class.

No t only did all of th e children dream about th e event,

bu t 14 of 16 ha d nightmares. Th e nightmares were

part of a larger picture of having fears which were

present before going to sleep, or of going into rooms

alone, particularly after dark. Two of th e boys were

frightened about going into a bathroom alone unless

someone first went in an d checked it out. Although

none of these children repor ted feeling as if another

murder was about to occur, they did report associa

tions about th e murder. In this connection, one of th echildren reported going by a certain neighborhood an d

feeling sad. Another connected a persistent depressive

mood with respect to a television program which ha d

a theme of homicide occurring within a family. Fo r

some of th e children th e inescapable presence of pic

tures of th e deceased induced sa d moods. Although

adults might have removed pictures or belongings of

th e deceased from th e children, they could no t effec

tively remove every picture or article.

In terms of a numbing response to their environ

ment, these children were at th e opposite en d of th e

continuum compared to adul ts . Their anxiety, restlessness, hyperalertness, vigilance, an d difficulty con

centrating were prominent. Varying degrees of school

difficulties appeared a nd t he ir trouble concentrating

an d memory impairment were noted in school records.

Th e possibility of diverse outcomes was seen in school

performance. In th e year following th e event all bu t

one ha d a significant decline in their school perform

ance. However, one of th e children went in th e oppo

site direction an d took on a new-found studiousness

following th e parental death . While this might no t

surprise us clinically in terms of th e possibilities of

diametrically opposed outcomes being possible, it is



CHILDREN WHO WITNESS PARENTAL MURDER 323

the type of possibility that often gets obscured in group

data.

Impact of vent Scale

The Impact of Event Scale was developed by Ho

rowitz et al. 1980 to assess a person s recognition ofstates of stress in the 7 days since an event occurred.

Although the instrument was developed for adults, the

i tems seem appl icable to chi ldren who have been ex

posed to a stressful event as well see Table 1 . Pangs

of emotion about the event, preoccupation with it, and

intrusive ideas related to it were the most commonly

reported signs and symptoms with these children. For

children, the questions were asked to them and about

them. A clinical judgment was then made about their

interactions on a 4-point scale from 0 to 5, with 15

items as Horowitz did with adults.

eneral SymptomPicture

Apart from the descriptive criteria meeting DSM

standards for a diagnosis of stress disorders, pres

en t in all of the children, there was a need to under

stand the diverse factors that were operating. The

descriptive symptoms will be elaborated upon from

that perspective. Anxiety and/or nightmares were

present in all of the children. They were described as

exhibiting marked anxiety compared to their pretrau

matic selves. Descriptions from school personnel and

the surviving parent when available were consistent

in this respect. The picture was of generalized res t-

lessness and jumpiness. For one boy, going back to the

house where the incident occurred 2 months earlier to

get belongings, led to periods of restless sleep, periodic

awakening, and nightmares for 10 straight nights.

Nightmares were replays of the scene of discovery bu t

with seemingly minor changes which gave a differentoutcome. Some of the dreams were more diffuse and

less structured. Shapes and hulks chased them, faces

were without features, or other scary features were

prominent in content. A 9-year-old boy, who had

shown no interest in comic books before the death of

his mother, became obsessed with them and began

spending hours a day reading them. Collecting comic

books had become his hobby. An 8-year-old girl who

had expressed minimal interest in drawing before the

episode thereafter became immersed in drawing; the

content varied from extremes of blandness and hap

piness, such as a sun with a shining face, to scenes of

darkness and roads leading nowhere without people.

Signs and symptoms of major affective d isorder

were present, with the children exhibiting persistent

disturbances in mood. Denial of painful affect worked

only up to a point. One boy, who had dreamed he

thought he saw his deceased mother, stated a year

after the event that he had accidentally come across a

picture of her which was inside a book. He told no one

of this bu t when alone, he began to get the book to

t ake out the picture, look at it, and cry. He described

this in the course of his treatment with deep sobbingTABLE 1

S.D.roup Meancale

Impact of Event Scale Response and Clinical Assessment in Subjects Who Witnessed a Parental Homicide N 16_ • - _ __ • _ _ •

Percent Positive

Endorsed

Intrusion Items

I had waves of strong feelings about it 100 4.60 0.87

Things I saw or heard suddenly reminded me of it 100 4.00 1.17

I thought about it when I didn t mean to 88 3.86 U8

Images related to it popped into my mind 88 4.71 0.71

Any reminder brought back emotions related to it [ 6 2.89 1.61

I have difficulty falling asleep because of images or 88 4.87 1.69

thoughts related to the event

I had bad dreams related to the event 81 ::l OO 1.7[

Avoidance Items

I knew that a lot of unresolved feelings were still 6:1 3.20 1.08

there, but I kept them under wraps

I avoided let ing myself ge l emot iorial when I f,O 4.00 1.00

thought about it or was reminded of it

I wished to banish it from my store of memories [ O 4.60 0.80

I made an effort to avo id talking about it. 98 3.86 1.38

I felt unrealistic about it, as if it hadn t happened 6:1 3.20 1.66

or as if it wasn t real

I stayed away from things or situations that might 69 4.46 0.89

remind me of it

My emotions related to it were kind of numb [ O 1.1:1 2.35

I didn t let myself have thoughts related to it 7[ 4.[ 0 0.87 a Scale: ;; is severe; is moderate; I is mild; 0 not at all.





C HI LD RE N W HO W IT NE SS PARENTAL M UR DE R 325

therapeutic context as well. Bergin 1958 described

such details in a 4-year-old girl who ha d witnessed he r

father murder he r mother.

iscussion

Throughout th e evaluation of these 16 cases, th equestion of systematic themes in th e children ha s been

in th e background. It is exceedingly complex to eval

uate th e impact of a specific traumatic event on a

child even when it is so striking as witnessing a parent

murdered. The reactions do no t easily lend themselves

to generalizations that ca n withstand critical evalua

tion. E ve n w it h severe trauma difficulties arise from

unsystematized impressions which lead to hypotheses

that are difficult to t es t a nd refute.

An effort has been made in this ar ticle to assess

empirically th e consequences of one discrete example

of extreme stress. t would be most difficult to conceptualize an event that raises th e possibili ty of having

more potential adverse consequences than being privy

to a parent being murdered. Th e need to be cognizant

of diverse factors which may be operating anteced

ently, causing th e individual child to be left vulnerable,

is important in addition to th e presence of th e provoc

ative event itself.

With these caveats, what might be offered about

children exposed to such a situation? Based on this

sample, there appears to be a great diversity in their

responses. Although they all fit th e minimal empirical

criteria as found in a posttraumatic stress disorder, agood deal of resilience is wi tnessed in t h ei r adapt a

tions. Despite th e presence of diverse symptom pic

tures, indicating distressing signs of anxiety, they did

no t collapse into psychotic states. Perhaps th e key lies

in th e strength of t heir ant eced en t object relations

an d self-esteem which allows them to h an dl e s uc h a

traumatic event an d loss without a massive abandon

ment of ego funct ionings an d defenses beyond th e

clinical picture with which they presented.

All of th e variables connected with a chi ld dealing

with an y type of major object loss ar e present in this

group of children. The situation is also complicatedby th e presence of t he t raumat ic aspects connected

with th e loss to begin with, as well as p er ha ps t he

need to participate as a witness subsequently in crim

inal an d civil proceedings. My impression is that th e

capacity to continue to function, an d eventually over

come th e stress disorder, resides in t he s treng th an d

comforting role of internalized objects. Either these

have been present an d available prior to th e incident,

or in their absence th e chi ld is left qui te vulnerable.

Only if th e child has comforting internal agents, an d

ha s been exposed earlier to minor traumas with which

he ha s been able to cope , ca n he deal with th e possi

bility of a major trauma. The linchpin appears to be

th e suffering of earlier object losses in graduated doses,

an d th e self-esteem system that evolved therefrom.

The children who appear able to cope with such ahorror an d disappointment in their lives ar e those who

ca n still affirm their own value an d worth. Alterna

tively, th e child who is exposed to such a situation in

th e absence of such bulwarks, is likely to remain prone

to episodes of anxiety an d depression long a fte r t he

traumatic episode. Confirmation of this hypothesis

will need testing in th e diverse types of traumatic

situations to which children may be exposed.

eferences

BERGEN M. K 1958 , Th e effect of severe trauma on a four-vearold child. The Psychoanalytic Study of the Child 1:1:407 429.

BL CK D. 1982 , Children an d disaster. Brit. Med. J. 285:9R9990.

BURKE, .J. D., .JR., BORUS .J. F., BURNS,B. .J., MILLSTEIN, K H. BE SLEY M. C. 1982 , Changes in children s behavior after anatural disaster. Amer. J. Psychiat. 139:1010 1014.

COllEN, R. 1976 , Post-disaster mobilization ofa crisis intervention

team: th e Managua experience. In: Emergency Mental Health

Services and Disaster Management ed. H. Parad H. Resnik L.Parad. New York: Prentice-Hall.

FR SER M. l97:l , Children in Conflict. London: Harmondsworth.

GISL SON I L C LL .J. D. 1982 , Dog bite in infancy. This

Journal 21:203 207.

GLESER, G. C., GREEN, B. L., WINGET, C. 1981 , Prolonged

Psychosocial Effects of Disaster: A Study of Buffalo Creek. NewYork: Academic Press.

H RTSOUGH D., Z RLE T. OTTINGER D. 1976 , Rapid responseto disaster: th e Monticello tornado. In: Emergency Mental Health

Services and Disaster Management ed. H. Parad H. Resnik, L Parad. New York: Prentice-Hall.

HEFFRON,E. 1977 , Project outreach: crisis intervention followingnatural disaster. J. Community Psychol. 5:103-11

HILBERM N E., MUNSON K 1978 , Sixty battered women.Victimology 2:560 570.

HOROWITZ M. J., WILNER, N., K LTREIDER N. LV REZ W. 1980 , Signs an d symptoms of posttraumatic stress disorder.Arch. Gen. Psychiat. 37:85 92.

L CEY G. 1972 , Observations on Aberfan. J. Psychosom. Res.16:257-260.

LEBOVICI S. 1974 , Observations on chi ldren who have witnessedth e violent death of one of their parents; a contribution to th e

study of traumatization. Int. Rev. Psychoanal. 1:117-12:1.

LEVINE M. 1975 , Interparental violence an d its eff ect s on th e

children: a study of 50 families in general practice. Med. Sci. Law

15:172-176.LINDY J. D., GR CE M. C GREEN, B. L 1981 , Survivors:

outreach to a reluctant population. Amer. J. Orthopsychiat.51:468-478.

LISTER, E. G. 1982 , Forced silence: a neglected dimension oftrauma. Amer. J. Psychiat. 139:872 876.

M LMQUIST C. P. 1980 , Psychiatric aspects of familicide. Bull.Amer. Acad. Psychiat. Law 8:298 304. 1985 , Children who witness violence: tortious aspects. Amer.

Acad. Psychiat. Law 13:221 231.

NEWM N C. 1976 , Children of disaster: clinical observations at

Buffalo Creek. A mer. J. Psychiat. 133:306 312.TERR, L. 1979 , Children of Chowchilla: a study of psychic trauma.

The Psychoanalytic Study of the Child 34:552 62:3. 1981 , Forbidden games. This Journal 20:741 760.

Documents

Child - Death of a Parent