Characteristics & Experiences
Which are Warning Signs

The "Replacement Child Syndrome" is mentioned frequently throughout this site and information regarding it may be found on the Page for Parents and in the handbook, "Counseling Parents Experiencing Perinatal Death". The syndrome, or pattern of behaviors refers to parents who attempt to replace the Child who has died with a substitute: while parent s readily identify that the next child is different, they still often 'define' the child in terms of the former sibling who died. This may take the form of renaming the child with the same name, or trying to over-idealize the first child and insist on the second child being stellar-like the one who died relatively unknown. Since children who die at birth are a little less known, they are often attributed with characteristics of perfection in the parent's eyes, and an ideal child is a very difficult child to be compared to, especially in an unconscious manner over a long period of time. The most critical 'emotional' task for a parent, is to clearly and cognitively separate the two children, defining the second not as the first child's replacement but as a child with another identity in the family. Parents I have spoken with sometimes refer to "the first time 'Baby B' tried to be born---indicating the idea that their soul was not connected with their physical self. This little discussed confusion can lead to even pathological dealings with the second child. Examples of 'replacement children' include Elvis Presley and Vincent Van Gogh. In Van Gogh's case, the syndrome was so severe that it is reported his mother named the first child Vincent, and when visiting the grave with the well-known Vincent would remark about the child who 'would have been'.

A related phenomena is the 'vulnerable child syndrome' which is really a description of how replacement children are often treated, but may also refer to other children, usually in the family as well. In this pattern, after a death of a stillborn or other child, parents 'redefine' children still living as 'at risk': they are constantly concerned about them becoming ill, even with a cold, or suffering some mishap or calamity. In extreme cases, a parent may be so hovering that they keep the child from all social interaction, or cause them to live in a suffocating environment of over-attention. Today, with high crime rates, school shootings, diseases and other violent happenings, it may be a little difficult to discern between a 'pathological' pattern and parents exercising 'due' concern. Caring attention to the matter by caretakers can usually detect the difference.

Physicians and hospital personnel often get blamed for unavoidable deaths as parents seek to psychologically or 'emotionally' 'avenge' the baby's death---the best physician is helpless against many causes of death. Ultrasound has greatly aided physicians in knowing what they face ahead of time, but sometimes things go wrong and cannot be predicted, sometimes even during the birthing process. A cord accident undetected ahead of time, is going to confront even the best ob-gyn sometimes. While there really occasionally is a neglectful physician, the blaming of doctors is severely disproportionate to the number of real cases. The greatest help to parents in the early months, is to first separately discern whether there are issues of blame when the other partner is not present, and if there are, to carefully explain and discern the understanding of why neither parent 'caused' the death. Sometimes if it is handled carefully and well, it does not have to be handled with both parents present: if it becomes necessary in counseling or crisis-intervention to confront both together, utmost care and listening must be used. Some parents get angry and turn on the care-giver, and others, appearing toheal may take the discovery of blame home, where it has its most lethal effect. Care must be used to detect also the emotional maturity and stability of the two, but culpability,blame and guilt can be dealt with by the facile understanding of a loving caretaker. Handled badly in can be the death of the marriage, a horrible tragedy added to already unbearable loss.

Occasionally just the opposite is true: some parents may overburden their partners to be sexual so that they may rush into a subsequent pregnancy, thinking that this will cause the pain to subside. This often puts a stress on the other partner who may feel the opposite: a wife desperate for an immediate next child may tax the patience and understanding of a husband who is mourning differently, and who needs time and space to heal.

"Magical Thinking" is a psychological term which refers to a disorder of thinking in which a person copes with a crisis or set of disturbing events or cognitions by arranging their thinking to meet the problem, even if it is fanciful or odd and highly unrealistic. An example of this is believing that the babies were really switched in the hospital such that the parent's live baby went somewhere else: however this is not the best example, for many normal parents momentarily entertain this idea. Some parents though, may seriously believe and even search, unwilling to accept the finality of the infant's death. Another example of 'magical thinking' would be believing that the baby would still be alive if only a certain event had not taken place. One parent , a 17 year old I interviewed once said that a week before the baby was stillborn she had to dissect a frog in biology, and she was sure the trauma from that contributed to the baby's death. What aids in 'magical thinking' is leading parents [or yourself] through careful logical and ordered attention to what happened. For example, one could discuss whether anything so mildly traumatic would even have much of a stress effect, and how babies in the womb while maybe mildly affected would not be overwhelming touched in anyway by even a deep emotional trauma. [A long term stress such as grief might affect the care of the preborn infant, but not most life stresses]. When thinking is ordered and set right, often where there is no other severe problem, 'magical thinking' can be healed.

There are many times in 'abnormal' circumstances where somatic or 'bodily' sensations or experiences may arise when there is no real cause. This is not only when the cause is not detected, but also when the cause may not even be possible. A general example is a phenomena called 'glove anesthesia' when a person get a total lack of sensation in the hand up to the wrist but not beyond: a physical impossiblity. Hysterical blindness is another example, or amnesia in some instances. An example related to perinatal death which is often reported is still feeling the baby move, even after the delivery and death. This is partly spurred by extreme stress in mourning, and an attempt of the mind to 'find' the baby still 'out there somewhere', and partly has a physical component: as the body settles back to normal, a mother might experience physical sensations in the abdomen such as cramps or 'rumblings' which make be momentarily mistaken after months of pregnancy for fetal movement. Many other 'somatic' experiences may occur, also just as in other kinds of grief. Some experience temporary paralysis or hypothermia, or others. These however are distinguished from stress related diseases which occur during bereavement which really are tied to changes which the stress of bereavement causes. Colin Murray Parkes described increased visits of widows to physicians in the 6 months following a death, not with imaginary illnesses but real stress related illness such as colitis, high blood pressure, migraine headaches and more. Whether there is a real physical base for the disease or whether it is 'psychosomatic' [many believe now that this is an artificial distinction], unusual physical symptoms often appear following a death, including an infant's death.

Anyone facing a loss, runs an increased risk of what we call 'depression' or even suicidal thoughts or actions. Mourning is probably the most intense and sorrowful experience which faces us as human beings: it is a world that is a rough sea, and the people we know and love, especially those we hold close to us, anchor us to face the very difficult events of this life. There are a few relationships though, that as so essential to who we are, people whom we so love and trust, that to lose those people in our lives involves not only the loss of love and happiness, but very often sends a shockwave through our very being, as though our very selves were torn asunder. When we lose people such as a spouse or child, the suffering can be so great, that many consider seriously whether they can continue living at all without that person and the stability and joy that they bring into our lives. For some, even a mere separation can instigate despair, and for others, though they in strength endure many losses will eventually meet with the one loss which they can not withstand, a deathly threshold.

I met and dealt with a few women in the years I worked with grieving parents, who had experienced not just the death of one infant, but of as many as 3 in a row. It is more difficult to understand how those women went on living rather than to understand how they might despair of living. When one has experienced a first loss, it can have all the intensity of multiple losses: the death of an infant involves not only the loss of an expected 'baby' but of motherhood, expectation and joy, physical changes, the future and changes in family relationships. The infant is also a tender object of affection, and vulnerable, and when young children and infants die, guilt is pronounced because we always feel we could or should have done something different and it would have meant the life of the child. Grief in the beginning is so intense, that many normal people consider suicide, more to end the extreme pain than in self-hatred. They are just looking for a way out. For some, it is being unable to envision oneself in the future without the loved person, so integrated are they with that person that it is inconceivable that they could go on without them: they lose meaning and purpose without the deceased child or loved one, and their expectation is dark days without purpose. In this atmosphere it is easy to understand how even usually very normal people could find themselves considering self-destruction.

In the beginning of grief and mourning, sadness and sorrow are expected and tolerated, but as time goes on, the society around us expects parents to 'tough it out' and get over the death of an infant quickly, failing to understand the depth of the lifelong loss. Parents are often tried during those times, unable to merely put aside the grief that holds them, but likewise unable to tolerate the insensivity of others. The primary difference though between normal grief and chronic depression, is that over time, grief dissipates and turns to an understanding of the way life is, with a lessening of of overt sorrow, though heartfelt sorrow for the deceased infant can last a lifetime. When things go wrong, in chronic depression, sadness, helplessness and hopelessness increase and continue without resolution. I hold to the opinion personally, that chronic sorrow and depression have to do with an inability to 'let go' or 'surrender' the infant to God: the grueling depression, while painful and debilitating, serves to in a perverse way keep the sufferer near to the event of the death, clinging to the door the loved person went out of last. By being continually sorrowful and in pain, it is though the event just happened, during a time when though totally unrealistic, there is a feeling of impermanence, that somehow the death might be reversible, although few will articulate these feelings for fear of ridicule and misunderstanding. When parents fall into chronic depression and suicidal feelings some time after the death, after more than 2 years, for example, the first thing which may be essential is to bring closure to the fact of the death, so that the sorrow has some anchor and definition instead of being a horrid treadmill, in which the mourner never moves on. Helping parents to place in order the events of the death, and discussing the meaning and permanance of death may help. Also, aiding parents suffering a loss in planning and establishing a future without the child may aid in healing as well.

While substance abuse now garners a billion dollar industry, and celebrities every day are taken to exclusive rehab clinics for drug and alcohol problems, it is often the case that the real etiology of the abuse is seldom found, but may often be traced back to death or a loss of another kind. Mourning people use alcohol and drugs, legal and illegal, as self-treatment to escape from the pain of mourning and its inherent destruction of a planned future. Even people who are not in favor of alcohol use at all, may begin after a loss to take prescription medication such as anti-anxiety pills like Librium or Valium, not realizing that they are essentially doing the same thing as the person who imbibes alcohol to erase the pain. A widely known grief counselor once told me that she would much rather deal with AIDS patients who were dying, than with substance abusers. When I asked why, she replied that the substance abusers had an ingrained habit of escaping pain by artificial means and did not like to confront the difficulties of life and loss head-on. They had found an easier way , an escape route , from pain which did not necessitate, they though, soul searching and reasoning or having to confront what was destroying them. The one thing substance abuse does which is troubling in grief, is it sublimates the real events and replaces them with the occurences surrounding the abuse. Instead of dealing with grief, we turn to dealing with drug addition or alcoholism and the irresponsible behavior which damages families. The loss, either of an infant or another person, disappears as the causal event sometimes for years. Substance abuse counselors would be wise always to take a loss history when dealing with those they counsel, paralleling the events with the onset of the abuse. Even years later, dealing with the loss may be the first step in recovery.

When grief gets into a family, it can take all kinds of aberrant patterns. We have already mentioned a few such as replacement and vulnerable child syndrome and substance abuse. Grief can manifest itself in multiple ways in individuals, and likewise in families. Each family member deals with loss in a different way: a mother may find herself in despair with mourning the loss of an infant; the father may feel helpless and alone. Intimacy problems are enhanced after a loss, especially with perinatal bereavement because the act of intercourse is charged with the ever present possibility of conception, which was the beginning of the loss. Many parents separate or have affairs not for lack of love of one another, but because of a deep and painful grief and complex mixed feelings about the spouse and the death.

If we mix this all in with other siblings and relatives, the pattern becomes a complex one: children often express their grief in outlandish ways, such anger, or delinquency. Many children deal with the death of an infant sibling in what we described before as 'magical thinking'. One child believed the baby did not come home because he had left his toys out; another and many believe that it is because they wished there would not be a baby at all. Many children revert back to regressive behaviors such bedwetting, crying, bottles, etc. in the hopes of returning to a 'safer' time when 'mom' wasn't crying, 'dad' wasn't yelling and everything was as expected. All a grieving mother needs is a crying toddler who will not be comforted, a distant husband, and family and friends saying she should be 'over it', in order to really break down. Anxiety producing as it is, though, the early days after a death can make or break afamily: it is estimated after a loss of a child, as many as 70% of marriages end in divorce or separation. Many times it is because grief takes its separate pattern for each person in the family and there is no resolution, what begins as a family confronting mourning ends as children in trouble, a husband having an affair, and a chronically depressed wife or husband who may turn to substance abuse or other coping strategies. Grief in the family is discussed in a forthcoming section on this site. The Warning signs listed here do not indicate by themselves that a parent will not walk through grief in healing way. When people refer to 'healthy grief' or 'unhealthy grief' it is not really helpful, because no one grieves perfectly. All have days and experiences that they cannot deal with even in themselves. Warning signs should be used more like lighthouses warning ships where the rocks are: the grieving person and his or her family may use these to avoid 'running aground'. A great difficulty in setting 'warnings' is that uninformed or naive persons use them to 'diagnose' even normal grief, burdening the mourner with more than they can bear. They should always only be applied when healing becomes impossible without understanding.

© 2006-7 Elizabeth Kirkley Best PhD.