Culture

Explaining Adult Illness to Kids

Fifteen years ago, a close friend, a mother to children similar in age to my own, was diagnosed with breast cancer. She was seeking advice on how to be proactive and ensure that her children would continue to thrive despite her illness. She shared her concerns about how to differentiate between behaviors that reflect normal development and those that would signal reasons for worry.

As a psychiatrist practicing in Boston, I thought it would be easy to connect her with the appropriate expert. I was surprised to discover that none of my colleagues specialized in the challenges of parenting while seriously ill. However, since my career as a child psychiatrist had focused on working with seriously ill children and their families, I felt confident that together with my friend, a devoted and attuned parent, we could address her key questions and concerns. And we did.

Around the same time, many of the chronically ill children I had been working with at the Massachusetts General Hospital for Children were becoming young adults. I would often find myself the rare child psychiatrist on the adult medical wards.

Colleagues would frequently ask me how they could help an ill parent prepare for a visit from young children. What, for example, should a parent tell a child about a diagnosis or an unfolding medical situation?

Supported by the MGH Cancer Center, what began as a few hours of my time is now a six-person parent-guidance program—the Marjorie E. Korff Parenting at a Challenging Time Program (PACT). As I explain in our book, "Raising an Emotionally Healthy Child When a Parent Is Sick" (McGraw-Hill), a child's experience of a parent's illness is influenced by the parent's own experience of that illness, and her own degree of calm. When we help parents feel more confident in their ability to parent and more comfortable with their treatment, it will help their children.

Just as complex surgeries are best performed by experienced surgeons, complex parenting dilemmas are best addressed by experienced clinicians. Every parent deserves expert guidance from someone who understands the interplay of child development, mental health and the challenges of parenting when ill. (One place to start is at our Web site, www.mghpact.org.)

Our work is varied depending on the situation. I remember a teenage daughter regretting that she upset her ill mother by not keeping her room tidy. This gave the mother the chance to explicitly forgive her daughter, to tell her how deeply loved she was and to share her hopes for her daughter's future. The sense of healing and connection in the room that day was palpable. And then there was the mother of a 2-year-old, who appreciated knowing that her son would likely keep looking for his late father for weeks, or even months after he died. "Thank you for telling me to expect that," she said. "He keeps lifting up the blankets on our bed asking where his daddy is. It isn't easy, but at least I know it's normal. I would have thought it was my fault for not explaining things properly."

Being a good parent is often at the core of a person's identity, and this becomes clear in the face of a life-threatening illness. When so much has been stripped away—physical health, job status, appearance—what's left are the relationships with those we love. For many, no loved one is more important than a child.

Our work at PACT isn't only sad—there is often laughter and heartfelt pride expressed in our meetings. Ask parents about their children and more often than not they will light up, and stories will follow. Children are fun and funny, and if we're doing our collaborative jobs well—the parents and our clinicians—the children continue to be themselves. And that is a wonderful, life-affirming thing.

We all live in the same uncertain world, and the parenting strategies we focus on in PACT turn out to be good advice for any parent, sick or well. Parents benefit from informed guidance, and children benefit from stable, loving homes and parents who talk to them about what matters in life. Being a parent is the most challenging and rewarding job I can imagine, and I feel fortunate for every day I get to be one.