The Unresolved grief from a Deceased Child.
The Adopted Replacement Child
Parental BereavementThe death of a child is among the most profound losses that an individual can suffer, and the resulting grief can be especially intense and prolonged. This is in part due to the uniqueness of the parent-child relationship. From the moment of conception, the parents fantasize about the child-to-be, investing in him or her their hopes and dreams for the future. Parents see themselves in their children, and when the child dies, it is as if a part of the parent dies, too. Parents also feel acutely the loss of the parenting role when their children die. The social role of parent, which can begin at conception, is an important organizer of time, activity, and identity. The loss of the parental role often challenges the parent's sense of meaning or purpose in life. The death of a child also changes the nature and composition of the family constellation and alters the family story.
Parents cope with the death of a child in multiple ways. Often, particularly when the death occurs during or shortly after birth, parents express the desire to have another child. They feel a strong need to fulfill the expectations created by the previous pregnancy and assume the parenting role. When the child that dies is older, parents may feel the need to fulfill the expectations, hopes, and dreams engendered by the dead child.
The Replacement Child As a Clinical PhenomenonThere has been much concern in mental health literature about families inadvertently creating replacement children. This phenomenon was first described in a 1964 paper by Albert and Barbara Cain, who reported on six families receiving psychiatric treatment following the death of a child or adolescent and the birth of a subsequent child who later developed psychiatric problems. This clinically important paper led to the prominence of the term replacement child in the mental health field. The parents in the Cain and Cain study were characterized by intense idealization and investment in the dead child, maternal personality dysfunction that predated the child's birth, and a history of losses in the mother's own childhood. The parents were restrictive and overprotective, and the children were fearful, anxious, morbidly preoccupied with death, and lacking in self-esteem. The authors of this study warned that parents should not have another child until they have had the opportunity to completely mourn the death of their child.
Although Cain and Cain note that the replacement of a child who dies at birth or in infancy is less likely to be complicated by confused identifications and comparisons with siblings, other clinicians suggest there may be some risk when a child dies at or near birth as well. In this case, the parents' experience with their baby is very limited. They have few memories to mourn and instead must mourn the wishes and expectations that they held for the child. The baby remains an abstraction even after the death.
The replacement-child concept has influenced contemporary obstetric and neonatal caregiving practice. When a child dies during the perinatal period (at or near birth), parents are encouraged to have contact with the dead baby, including holding and naming him or her, taking pictures, and making memories. It is suggested that parents who have these experiences are better able to grieve the loss, can separate the real baby from the fantasy image they hold, and thus may be better able to parent a subsequent child. Medical personnel have often counseled parents who have experienced perinatal loss to wait before attempting subsequent pregnancies in order to grieve fully for the dead child.
Research into Parents' OpinionsThere is a considerable body of psychiatric case studies on the pathology of the replacement child. Studies that solicit parents' opinions suggest that giving birth after the death of a child may be helpful to the parents and help families grow through loss. One researcher found that recently bereaved parents experienced their loss as a void or hole in the family. For some parents, the decision to have another child provides a reason to begin living again. Although parents indicate that they could not replace the dead child, many want another child of the same sex as soon as possible and often give the subsequent child a name that resembles that of the dead child.
It is important to directly assess the psychological functioning of children born subsequent to parental bereavement. Parental attitudes toward the decision to have other children, parental beliefs about practices, and parents' interpretation of the family structure directly and indirectly affect child mental health. Parental interpretations of the family constellation and stories about family life determine family practices and, through these practices, child development. Family stories give meaning to the past and direction to the future, shaping subsequent development.