Month: October 2015

We are born immortal, as far as we know at the time, and slowly we learn that we are going to die. For most children, death is not fully understood until after the first decade of life – a remarkable amount of time to comprehend the most basic truth of our existence.

There are poetic ways of making sense of this difficulty: perhaps an understanding of our limited time on Earth is too difficult for the fragile infant mind to handle, maybe it’s evolution’s way of instilling us with hope; but these seductive theories tend to forget that death is more complex than we often assume.

To completely understand the significance of death, researchers – mortality psychologists if you will – have identified four primary concepts we need to grasp: universality (all living things die), irreversibility (once dead, dead forever), nonfunctionality (all functions of the body stop) and causality (what causes death).

In a recent review of studies on children’s understanding of death, medics Alan Bates and Julia Kearney describe how:

Partial understanding of universality, irreversibility, and nonfunctionality usually develops between the ages of 5 and 7 years, but a more complete understanding of death concepts, including causality, is not generally seen until around age 10. Prior to understanding nonfunctionality, children may have concrete questions such as how a dead person is going to breathe underground. Less frequently studied is the concept of personal mortality, which most children have some under standing of by age 6 with more complete understanding around age 8–11.

But this is a general guide, rather than a life plan. We know that children vary a great deal in their understanding of death and they tend to acquire these concepts at different times.

Although interesting from a developmental perspective these studies also have clear, practical implications.

Most children will know someone who dies and helping children deal with these situations often involves explaining death and dying in a way they can understand while addressing any frightening misconceptions they might have. No, your grandparent hasn’t abandoned you. Don’t worry, they won’t get lonely.

But there is a starker situation which brings the emerging ability to understand mortality into very sharp relief. Children who are themselves dying.

The understanding of death by terminally ill children has been studied by a small but dedicated research community, largely motivated by the needs of child cancer services.

One of the most remarkable studies, and perhaps, one of the most remarkable studies in the whole of palliative care, was completed by the anthropologist Myra Bluebond-Langner and was published as the book The Private Worlds of Dying Children.

Bluebond-Langner spent the mid 1970’s in an American child cancer ward and began to look at what the children knew about their own terminal prognosis, how this knowledge affected social interactions, and how social interactions were conducted to manage public awareness of this knowledge.

Her findings were nothing short of stunning: although adults, parents, and medical professionals, regularly talked in a way to deliberately obscure knowledge of the child’s forthcoming death, children often knew they were dying. But despite knowing they were dying, children often talked in a way to avoid revealing their awareness of this fact to the adults around them.

Bluebond-Langner describes how this mutual pretence allowed everyone to support each other through their typical roles and interactions despite knowing that they were redundant. Adults could ask children what they wanted for Christmas, knowing that they would never see it. Children could discuss what they wanted to be when they grew up, knowing that they would never get the chance. Those same conversations, through which compassion flows in everyday life, could continue.

This form of emotional support was built on fragile foundations, however, as it depended on actively ignoring the inevitable. When cracks sometimes appeared during social situations they had to be quickly and painfully papered over.

When children’s hospices first began to appear, one of their innovations was to provide a space where emotional support did not depend on mutual pretence.

Instead, dying can be discussed with children, alongside their families, in a way that makes sense to them. Studying what children understand about death is a way of helping this take place. It is knowledge in the service of compassion.

Mother Jones has a fascinating article on how America is attempting to stop school shootings by using community detection and behavioural intervention programmes for people identified as potential killers – before a crime has ever been committed.

It is a gripping read in itself but it is also interesting because it describes an approach that is now been rolled out to millions as part of community counter-terrorism strategies across the world, which puts a psychological model of mass-violence perpetration at its core.

The Mother Jones article describes a threat assessment model for school shootings that sits at an evolutionary mid-point: first developed to protect the US President, then to preventing school shootings, and now as mass deployment domestic counter-terrorism programmes.

You can see exactly this in the UK Government’s Prevent programme (part of the wider CONTEST counter-terrorism strategy). Many people will recognise this in the UK because if you work for a public body, like a school or the health service, you will have been trained in it.

The idea behind Prevent is that workers are trained to be alert to signs of radicalisation and extremism and can pass on potential cases to a multi-disciplinary panel, made up of social workers, mental health specialists, staff members and the police, who analyse the case in more detail and get more information as it’s needed.

If they decide the person is vulnerable to becoming dangerously radicalised or violent, they refer the case on the Channel programme, which aims to manage the risk by a combination of support from social services and heightened monitoring by security services.

A central concept is that the person may be made vulnerable to extremism due to unmet needs (poor mental health, housing, lack of opportunity, poor social support, spiritual emptiness, social conflict) which may convert into real world violence when mixed with certain ideologies or beliefs about the world that they are recruited into, or persuaded by, and so violence prevention includes both a needs-based and a threat-based approach.

This approach came from work by the US Secret Service in the 1990s, who were mainly concerned with protecting key government officials, and it was a radical departure from the idea that threat management was about physical security.

They began to try and understand why people might want to attempt to kill important officials and worked on figuring out how to identify risks and intervene before violence was ever used.

The Mother Jones article also mentions the LAPD Threat Management Unit (LAPDTMU) which was formed to deal with cases of violent stalking of celebrities, and the FBI had been developing a data-driven approach since the National Center for the Analysis of Violent Crime (NCAVC) launched in 1985.

By the time the Secret Service founded the National Threat Assessment Center in 1998, the approach was well established. When the Columbine massacre occurred the following year, the same thinking was applied to school shootings.

After Columbine, reports were produced by both the FBI (pdf) and the Secret Service (pdf) which outline some of the evolution of this approach and how it applies to preventing school shootings. The Mother Jones article illustrates what this looks like, more than 15 years later, as shootings are now more common and often directly inspired by Columbine or other more recent attacks.

It’s harder to find anything written on the formal design of the UK Goverment’s Prevent and Channel programmes but the approach is clearly taken from the work in the United States.

The difference is that it has been deployed on a mass scale. Literally, millions of public workers have been trained in Prevent, and Channel programmes exist all over the country to receive and evaluate referrals.

It may be one of the largest psychological interventions ever deployed.
 

Link to Mother Jones article on preventing the next mass shooting.