The replacement child--a developmental tragedy: some preliminary comments

Invasion of Ukraine: Observations on Leader-Followers Relationships

This paper illustrates how and when the personality characteristics of a political leader can initiate and/or become intertwined with societal and political processes. We are not suggesting that “real world” issues and secondary process calculations are not important or should be discarded in favor of psychological considerations. Instead, we suggest that psychoanalysts and psychodynamically informed mental health professionals can contribute to a more complete analysis of political or societal processes and the personalities of leaders who play major roles in them. Only through such interdisciplinary work can we fully understand the complex and intertwined nature of the crucial events that shape political leaders’ internal and external worlds.

Divorce and parity progression following the death of a child: A register-based study from Finland

Most studies that have examined whether a child's death influences parental relationship stability have used small-scale data sets and their results are inconclusive. A likely reason is that child loss affects not only the risk of parental separation, but also the risk of having another child. Hence parity progression and separation must be treated as two competing events in relation to child loss. The analysis in this paper used Finnish register data from 1971 to 2003, covering over 100,000 married couples whose durations of both first marriage and parenthood could be observed. We ran parity-specific Cox regressions in which process time started from the birth of each additional child. All marriages included women of childbearing age, none of whom had experienced any child death on entering the analysis. We find that child loss only modestly influences the divorce risk, whereas its effect on the risk of parity progression is considerable.

Transgenerational Transmissions and Chosen Traumas: An Aspect of Large-Group Identity

Large-group (ethnic, national, religious) identity is defined as the subjective experience of thousands or millions of people who are linked by a persistent sense of sameness while also sharing numerous characteristics with others in foreign groups. The main task that members of a large group share is to maintain, protect, and repair their group identity. A `chosen trauma' is one component of this identity. The term `chosen trauma' refers to the shared mental representation of a massive trauma that the group's ancestors suffered at the hand of an enemy. When a large group regresses, its chosen trauma is reactivated in order to support the group's threatened identity. This reactivation may have dramatic and destructive consequences.

A Legacy of Loss: Stories of Replacement Dynamics and the Subsequent Child

This article, a qualitative exploration of the experiences of subsequent children, endeavors to clarify common issues and experiences of this population. Subsequent children, also known as subsequent siblings, are children born after the death of a brother or sister. For this study, 25 adult subsequent siblings participated in semi-structured interviews. Few researchers have written about this population, and much of what has been documented was researched from single case studies, or from very small samples. This study aims to explore the commonalities of the unique experience of being a subsequent child. Themes which emerged include various replacement child dynamics, impaired bonding with parents or altered parenting as a result of the loss, family grief and its repercussions, meaning making and spiritual questioning, fantasies about the lost sibling, disenfranchised and unresolved grief, taking on a caregiver role, and survivor guilt. The implications for clinical practice are presented.

Giving birth to life--again!: bereaved parents' experiences with children born following the death of an adult son

This article is based on a qualitative study examining the experiences of parents that lost a son during military service in Israel and consequently choose to give birth to another child. Seven couples and 3 mothers were interviewed for the study, and their interviews were analyzed using a phenomenological-hermeneutic approach. Three main themes were extracted from parents' descriptions of their experiences: (a) "From the place where pain and sadness was sown, a new smile was grown," relating to transforming the experience of loss into a new meaning for life; (b) "No to a child memorial," focusing on parents' awareness of the burden placed on the child who was born; and (c) "Different parenting," dealing with participant's parenting following their loss. The study's findings are discussed in the context of literature dealing with reconstructing meaning through coping and bereavement.

Psychological vulnerability in children next-born after stillbirth: a case-control follow-up study

BACKGROUND

Case studies and anecdotal accounts suggest that perinatal loss may impact upon other children in the family, including those born subsequent to loss. However, there is a dearth of systematically collected quantitative data on this potentially vulnerable group.

METHODS

Case-controlled follow-up of 52 mothers with history of stillbirth with their next-born children aged 6-8 years, and 51 control mother-child dyads. Previously reported baseline data included maternal antenatal and postnatal psychological assessment, and infant security of attachment at 12 months. Follow-up assessments included maternal psychiatric and socio-demographic data, mother and teacher-rated scales of the child's strengths and difficulties, child IQ, observer-rated mother-child interaction and maternal reports of child health.

RESULTS

There were no significant between-group differences in child cognitive or health assessments, or in teacher-rated child difficulties. However, mothers with history of stillbirth (the index group) reported increased child difficulties, in particular peer problems, and more adverse interaction was observed in respect of higher levels of maternal criticism of the child's actions, more overall controlling behaviour by the mother, a less harmonious emotional atmosphere and a lower level of maternal engagement with the child. Some of these effects appeared to be mediated by maternal perinatal psychological symptoms and family breakdown.

CONCLUSIONS

This study provides no evidence to suggest that siblings born after stillbirth are clinically at risk but does lend empirical support to clinical reports that such children are seen by their mothers as having problems and that they are exposed to less optimal interaction with their mothers. Possible interpretations of these findings are discussed in the context of theoretical accounts of 'replacement child' and 'vulnerable child' syndromes.

The myth of the replacement child: parents' stories and practices after perinatal death

Parents bereaved by perinatal death adapt to their losses in different ways. When bereaved parents give birth to a child or children subsequent to a perinatal death, their constructions of the family necessarily change. The subsequent child is thought to be at risk of psychopathology (the replacement child syndrome) if parents have not sufficiently grieved their losses. This qualitative interview study examines the family stories told by bereaved parents, with particular attention to how parents represent the dead child and subsequent children in the current family structure. We categorized parents' stories as those which suggested that parents replaced the loss by an emphasis on parenting subsequent children, or maintained a connection to the dead child through storytelling and ritual behavior. The two ways in which parents maintained the connection were to preserve the space in the family that the dead child would have inhabited, or to create an on-going relationship with the dead child for themselves and their subsequent children. There seem to be multiple paths to parenting through bereavement. The place of rituals and memorial behavior is also examined.

Toward A Model of Parental Grief

Literature relating to naturalistic and laboratory studies of primates, human bonding, family systems theory, psychoanalytic notions of multiple inner representations, and pathological parenting in child abuse and neglect is reviewed in an attempt to understand the uniqueness of parent/child attachments and the unique grief experienced at the death of a child. A model accounting for phenomenon within parental grief is proposed.

Death of the Future?: An Outcome Study of Bereaved Parents in Israel

Child loss has been described as the most devastating of bereavements. To explore this multidimensional phenomena, thirteen Israeli parents bereaved of young children were compared with forty-two parents who had lost sons to war. Although all parents demonstrated pronounced mourning, those bereaved of adult sons were particularly affected by the loss. This was true for the initial year as well as the current status of the bereavement response, an average of ten years post loss. These findings are discussed and implications for the family are considered.

Sexual Intimacy and Replacement Children after the Death of a Child

The stress on couples who have a child die is tremendous. Fourteen couples who had a short or long preparation time for their child's death were interviewed. All parents expressed guilt. It was also discovered that because of this grief and the accompanying guilt, sexual intercourse was performed only by three couples within the first three days after the death, with sexual guilt occurring with one couple. Hugging and being held, however, became a comforting behavior found in all but one couple. This behavior was a new experience for the men. Although sex was perceived as undesirable, it was again initiated for a specific reason: to produce a replacement child. Although the literature indicates that replacement children could be potentially pathological, the question arises whether a replacement child could be a “normal” need for parents of childbearing years.

Perinatal loss. A critique of current hospital practices

Dramatic improvements in the hospital management of perinatal loss have taken place in the past 20 years. However, there has been no critical examination of current approaches. Four possible hazards of current hospital practice are described: 1) Institutionalization of bereavement: Instead of offering parents an empathic awareness of the unique dimensions of their perinatal loss, caregivers often interact according to detailed behavioral protocols. 2) Idealization of contact with the dead baby: This approach may equate actual physical contact with the dead child with the more complicated and variable process of mourning. 3) Homogenization of grief: Counselors tend to denigrate different grief responses by focusing on a preconceived grief reaction. Thus, they may mistakenly label many such reactions pathologic if they deviate from the rigidly prescribed "norm." 4) Lecturing the bereaved: Telling parents the "right" thing to do may deprive them of a crucial aspect of the process that empowers parents after they experience the helplessness associated with perinatal loss--that of making their own decisions. These problems are illustrated by a clinical vignette, and alternative approaches are explored.