Mental health and clements burgess
HOMICIDE IS THE purposeful ending of one life by another. It is sudden, unexpected, and almost always violent (Clements & Burgess, 2002; Clements, Faulkner & Manno, 2003). The victim may be tortured prior to death, the body may be mutilated, the victim may suffer for hours before the actual homicide, or may die instantly from mortally inflicted trauma. Regardless of the mode, manner, mechanism, or timing of the homicide, the victim’s pain and suffering ends with death. However, for surviving family members, many of whom are children, the pain and suffering begin with the victim’s death ( Clements, 2001; Clements, Vigil et al., 2003; Redmund, 1996). The purpose of this article is to explore how the patterns of knowing identified by Carper (1978) and extended by others can be used to enhance comprehensive assessment and intervention for children exposed to the homicide of a family member.
Homicide is defined as the killing of one person by another and is a complex and dynamic event (Clements & Burgess, 2002). Among crimes against a person, interpersonal violence and homicide cause the most severe emotional responses and traumatic reactions ( Clements & Burgess, 2002; Clements, Faulkner, & Manno, 2003). Homicide occurs in a variety of situations, with a variety of motives, assorted manners of execution, including brutal killings during domestic quarrels or skillfully calculated crimes as a method of personal or gang-related revenge, for financial or personal gain, or in retaliation for a previous injustice (Douglas, Burgess, Burgess, & Ressler, 1992).
The Centers for Disease Control and Prevention (1997) and the U.S. Surgeon General (Satcher, 2001) have declared homicide to be a national public health problem. Additionally, Healthy People 2010 (U.S. Department of Health and Human Services [USDHHS], 2000) has set forth goals challenging health care providers to address the many factors that are not only associated with injuries, violence, and abusive behavior, and for the subsequent adaptive mental health of surviving family members.
The terms survivor and victim are frequently used interchangeably to refer to the surviving family members of the victims (Spungen, 1997; Henry-Jenkins, 1993). When the survivors are children, there can be significant responses to those events that threaten their safety or the structure of their family and environment. This can create a chaotic and ongoing threat to their emotional safety, resulting in hypervigilence or being constantly “on guard” for more crime and violence ( Burgess, Hartman & Clements, 1995; Clements & Burgess, 2002; Demaree, 1995). Previous studies have shown that traumatic events that create a sense of overt horror, helplessness, or threat of injury or death can have a detrimental effect on the intrapsychic development of a child and can potentially result in posttraumatic stress disorder (PTSD; American Psychiatric Association, 2000; Burgess, 1975; Burgess et al., 1995; Clements & Benasutti, 2003; Clements, Benasutti, & Henry, 2001; Garbarino, Dubrow, Kostelny, & Pardo, 1992; Kilpatrick & Williams, 1997; Krysinska, K.E., 2003. Loss by suicide: A risk factor for suicidal behavior. The Journal of Psychosocial Nursing 41 7, pp. 34–41. View Record in Scopus | Cited By in Scopus (4)Krysinska, 2003).
As children grow and develop, the issues of a developing moral reasoning, understanding the consequences of one’s actions, and the need for family permanence can be significantly confounded as the result of family member homicide. Pynoos and Nader (1993) emphasized that exposure to a traumatic event, such as homicide, may be particularly challenging for children as they integrate the experience into a new inner model of the world. It can be a painful burden because it can violate the basic beliefs of social appropriateness, fairness, and the sanctity of life itself.
Developmental factors that influence children’s reactions to such deaths include their appraisal of the threat, any intrapsychic meaning they attribute to the event, their emotional and cognitive means of coping, their capacity to tolerate strong affects, and their ability to adjust to other changes in their lives, including loss and grieving (Burgess et al., 1995; Clements & Burgess, 2002; Demaree, 1995). Murder can undermine a child’s evolving faith in the world as an ordered and secure place, and untimely, unnatural deaths can shake the confidence he or she has in this sense of security.
Child exposure to homicide
In 2000, a pilot study was conducted with 13 children who were offered crisis intervention counseling as part of the services of the Medical Examiner’s office in an urban area of the northeastern U.S. (Clements & Burgess, 2002; Clements, Faulkner & Manno, 2003). The central aim of the study was to examine the traumatic presentations and behaviors in a specific group of children, aged 9 to 11 years, who were exposed to homicide through the death of a family member. Interviews were conducted within the initial 1- to 3-month period of bereavement, and drawing and storytelling became a part of the interviews to gather robust information regarding the thoughts, perceptions, and experiences of the participating children. Case study analysis, including interpretation of the drawings and narrative interviews, provided insight into the perceptions and attempts at adaptation for this group of children exposed to family-member homicide. Based on data from the initial study, a subsequent two-site study was conducted in 2001–2002 in a rural southwestern state and a large midwestern city. Thirty-five children were interviewed during the initial 18 months of homicide bereavement.
Data gleaned from study participants are reflective of how the patterns of knowing can be used not only as a conceptual base, but also as a foundational method for nurses to “know” their patients, their practice, and themselves as individuals (Carper, 1978; White, 1995; Heath, 1998). This is significant for the continually developing subspecialty of forensic nursing because treatment and promotion of adaptive coping for survivors of interpersonal violence and crime are often based as much on what is “not seen” as on the highly emphasized empirical, medicolegal facts, and forensic evidence (Clements & Burgess, 2002). Given recent trends in forensic nursing, the patterns of knowing can be of great benefit in assessment, analysis, and intervention with victims and perpetrators of interpersonal violence and crime.
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