replacement child, fabric, imprinted with flowers and multiple slashes

Childhood trauma: replacement child syndrome — correcting an error

Replacement child syndrome: New perspectives on coping with trauma and emotional development in families

The concepts of the “replacement child syndrome” are often based on Kristina E. Schellinki’s ideas, which are, however, characterized by her theoretical orientation towards the psychoanalysis of C. G. Jung.

According to this theory, “replacement children” suffer from an identity disorder due to their position in the sibling line. This disorder is said to be caused by the parents, who would impose an alien identity on the offspring. How these parents are supposed to know this identity into adulthood if the older sibling has died early, and how the transfer of this identity to the younger sibling is supposed to take place, Schellinski explains incompletely at best.

Rather than a fated position in the sibling line that cannot be changed by any effort, André Green’s concept of the ‘dead mother’ allows for a much more practical and profound understanding of childhoods in families that have experienced loss. This article explores the complex interactions between the unresolved grief of parents and the resulting emotional distress for children.

1. Introduction

Infant mortality has changed significantly from ancient times to modern times. Here is an overview of the historical development.

Infant mortality

In ancient times, infant mortality was extremely high. It is estimated that around 30% to 50% of children did not reach adulthood. Diseases, a lack of medical care and hygiene, as well as high birth rates, contributed to this high mortality rate.

Child mortality remained high in the Middle Ages, similar to the situation in antiquity. Epidemics such as the plague, poor nutrition and hygienic conditions were the main factors behind the high mortality rate.

In the early modern period, from the 16th to the 18th century, living conditions improved slightly, but infant mortality remained high. It is estimated that around a third of children died before the age of five.

With the industrial revolution, living conditions slowly began to improve in the 19th century. Nevertheless, infant mortality remained high, especially in urban areas, due to poor housing conditions and a lack of hygiene.

The 20th century saw a dramatic decline in infant mortality, particularly in the second half of the century. This was due to improvements in medicine, hygiene, nutrition, and general living conditions. Vaccinations and antibiotics played a crucial role in reducing mortality rates.

Today, infant mortality has fallen to historically low levels in most parts of the world, especially in developed countries. However, there are still considerable differences between different regions of the world. Infant mortality in Germany has fallen enormously for both sexes. In 1990, it was still eight boys and six girls per 1,000 live births. By 2008, these figures had halved. In 2018, it was still around 3 per 1,000 live births for girls and 3.5 per 1,000 live births for boys.

Birth rate

At the same time, the number of children per family in Europe also changed significantly over the centuries and varied considerably between the elite and the poorer population. Here are some estimated figures: until the early modern period, aristocratic and wealthy families often had many children, sometimes up to 10 or more, not least to secure heirs to titles, land, and wealth. However, infant mortality was also high in these circles. In the poorer population, large families with six or more children were common. Children were considered a source of labour, especially in agriculture, and contributed to the household income. However, high birth rates were also a reaction to the high infant mortality rate.

In the 19th century, the number of children in aristocratic and wealthy families fell slightly, but was typically still four or more. Among the poor population, large families remained the norm.

In the 20th century, family size among the elite continued to decline, partly due to changing lifestyles and increased access to family planning. Three to four children were common. During this period, the number of children per family also began to fall among the poorer population, particularly in the second half of the century. This was due to improved education, access to contraceptives and changes in economic conditions.

The historical development of the birth rate and infant mortality shows how closely both are linked to factors such as medical progress, socio-economic conditions, nutrition, and public health care. To assume that all parents, or even just the majority, were unable to cope with the early loss of several children in the past, and that children born later all suffered from identity disorders as a result, would be to assume that one third to one half of adults in Europe would have struggled with mental health problems in the early period simply because of their position in the sibling line. This assumption does not even make sense if we admit that it is impossible to make a reliable estimate of the frequency of psychological trauma, considering epidemics, wars and famines, as well as religious beliefs about the earthly fate of human beings.

The logical conclusion from widespread ideas about the replacement child syndrome would be to advise parents not to have another child after the early loss of a child or a miscarriage to protect later born children from harm. However, this would be equally illogical and inhumane. Being born after a sibling who died young or bearing their name is not necessarily associated with impaired development. Traditionally, children were given names of living or deceased family members. This explains, at least in part, why children were also given names of deceased siblings. There was usually no “expectation of rebirth” attached to this naming tradition.

Replacement children: the pathological grief of parents

The position in the sibling line and the name of a deceased sibling are therefore far less significant for the replacement child syndrome than unresolved family grief. Pathological grief, also known as complicated grief or persistent complex grief disorder, refers to a form of grief that is more intense and longer lasting than the usual grief response. It is defined by the following characteristics:

  1. Intensity and duration: Pathological grief is characterized by an unusually strong and long-lasting grief reaction. While grief normally diminishes over time, pathological grief remains intense and can last for years.
  2. Functional impairment: This form of grief significantly impairs daily functioning. Those affected may have difficulty completing their daily tasks, withdraw from social activities, and have problems at work or school.
  3. Intrusive thoughts: Constant, intrusive thoughts of the deceased that do not subside and interfere with daily life are another characteristic of pathological grief.
  4. Emotional numbing: An intense feeling of emptiness or numbness that goes beyond what is common in normal grief.
  5. Avoidance: People with pathological grief may avoid places, people, or activities that evoke memories of the deceased.
  6. Physical symptoms: Sleep disturbances, loss of appetite and other physical symptoms can also occur and are often more severe than with normal grief.
  7. Intense longing or desire: An overwhelming longing for the deceased or the feeling of not being able to live without the deceased person.
  8. Negative self-image: feelings of worthlessness or guilt that go beyond normal feelings of grief guilt, especially when associated with death.

The replacement child syndrome occurs when a child is born into a family that is characterized by unsuccessful efforts to cope with a loss. As we will see, this does not only apply to later-born siblings, but also to older ones. The burden on the child is rooted in the emotional dynamics in the family.

Different types of dynamics can occur in families affected by the replacement child syndrome. These are characterized by the incomplete coping with the parents’ grief and the resulting emotional absence. The following patterns describe such unhappy family constellations:

  1. Overprotective dynamic (the “bound child”): In this dynamic, the parents react in an overly concerned and protective manner towards the child. They try to protect the child from any potential harm, which must naturally limit the child’s independence and desire to be adventurous.
  2. Expectation-laden dynamic (the “resurrected child”): Here, the parents project their unfulfilled expectations and dreams onto the child. The child is unconsciously considered a replacement for the lost sibling, or as the bearer of the parents’ unfulfilled hopes. This can lead to high pressure on the child to perform.
  3. Neglectful dynamic (the “enchanted child”): In this constellation, the parents withdraw emotionally and neglect the child’s emotional needs. The child often feels overlooked and inadequately supported, which can lead to feelings of isolation and neglect.
  4. Conflictual dynamics (the “healing child”): In some families, unresolved grief leads to ongoing conflict and tension. The child can be forced into the role of mediator or scapegoat, which can impair their development.
  5. Ambivalent dynamics (the “double child”): Here, the child experiences a mixture of closeness and distance, support and rejection. This ambivalence can be confusing for the child, and they find it difficult to establish a clear and secure bond with their parents.
  6. Survivor guilt (the “unwanted child”): the child is rejected and experiences itself as not good enough to deserve love. In the worst-case scenario, the child is accused of being alive while the poor deceased sibling was denied life.

Each of these dynamics has traumatizing consequences for the emotional and psychological development of the child, regardless of whether it was already alive at the time of the loss or was only born afterwards, and regardless of whether the cause of grief in the family was the loss of a sibling or something else. Unresolved grief in the family and its effects on children are decisive for development. In therapy, it is therefore crucial to recognize and deal with the traumatic consequences to help those affected to develop a healthy self-image and functional relationship patterns.

2. Replacement children: the “dead mother” according to André Green

In his theory of the “dead mother”, André Green describes the experience of a child with an inwardly absent, depressed and withdrawn mother. She looks after the child, cares for it, but remains emotionally trapped in her grief. (In contrast to the psychoanalytical perspective, the gender of the parent does not actually play a role here. It is actually about the emotional availability of the primary caregiver. At an age when the child’s mother is no longer the most important attachment figure, this can also be transferred to the other partner. Green defines partner interaction in bereavement and its impact on a child in a legitimate but very particular way).

This inner absence of the parent and limited emotional closeness forms what Green calls “white grief”. The result is an unintentional form of emotional neglect. It leaves the child with “psychological holes” instead of the comforting inner image of the parent in question, which helps the baby to cope with the physical absence of the parent, for example. In this way, “white grief” damages the child’s basic trust, with profound effects on its emotional development.

In such a family constellation, the child experiences a kind of inner emptiness and absence in the mother (or the parent in question). Instead of the internalized comforting image, the child is left with an unconscious image that shows the mother as physically present but emotionally “dead”. However, this image cannot fill the unbearable psychological hole. The very first comforting image of the mother, with its unconditional love, actually provides the frame of reference in which the endearing self-image must be built up after the baby has been detached. If successful, this “I” can treat both itself and others with love. If children experience a trauma such as “white grief” before they have built up this framework in a sufficiently secure form, what emerges as the “I” is not an available psychological space. Although the frame structure limits the “I”, a conflictual space is created in which everything is about holding on to the maternal image and fighting against its vanishing. Traces of memories of missing love and the experience of loss emerge alternately — as longing or the sensation of a painful emptiness.

The experience of “frozen love” and the “curse” of unsuccessfulness of those affected is not due to a supposedly imposed foreign identity, but to this conflictual inner space instead of a stable “self”. Trust in the intimacy of a relationship is then just as impossible as trust in one’s own career choice or one’s own needs in general.

The experience of an emotionally unavailable attachment figure leads to a comprehensive difficulty for the child to build secure and stable relationships — with themselves, their environment and with others. The fragility of relationship experiences causes an insurmountable internalized fear of rejection and abandonment in every relationship.

On the other hand, in an effort to fill the image of the “dead parent” with life, a child also develops strategies to gain attention and recognition, often through excessive conformist behaviour or perfectionism. However, in an attempt to compensate for the lost parental attention, a child can develop excessive self-reliance and independence.

Green’s theory emphasizes that the effects of this experience can be profound and long-lasting, extending not only to childhood but also to adulthood. The “psychic holes” barely concealed by fragile images result in persistent feelings of emptiness, lack of self-worth and difficulty in allowing emotional closeness.

3. Dynamics of the replacement child syndrome

In relationships, people who have grown up with ‘dead parents’ tend to choose partners who reflect their unconscious emotional needs. They may select partners who are emotionally distant or unattainable, and unconsciously repeat the original trauma of the “dead mother”. On the other hand, their “inability to love” leads them to withdraw from closeness and intimacy almost in a panic. This results in various toxic relationship patterns, such as dependent or co-dependent relationships, a difficulty in allowing closeness or a tendency towards repeated separations and reconciliations.

In professional life, this pattern can manifest itself in overcompensation through excessive striving for success and recognition. People who are characterized by “dead parents” may throw themselves into work to compensate for the feeling of emptiness and lack of emotional fulfilment. This can lead to extreme perfectionism and a high level of professional achievement, often at the expense of personal relationships and their own mental health. At the same time, it is just as difficult to identify with a chosen job as it is to identify with a different type of relationship.

In both cases, the central theme is that those affected have difficulty making genuine and fulfilling emotional connections with others. Their relationships and professional endeavours may be characterized by an unconscious attempt to fill the emotional void created by the experience with the ‘dead parents’. As a result, relationships and careers can feel unsatisfying and unfulfilling, as if they are under a “curse”.

4. Ways out of the replacement child trauma

In cases where trauma victims struggle with a replacement child syndrome or a “dead mother complex”, as Green called it, forms of therapy such as schema therapy, mentalisation-based therapy (MBT) or dialectical behavioural therapy (DBT) are often more effective than cognitive behavioural therapy (CBT) or classical psychoanalytical approaches.

Schema therapy

   – Identification and processing of deeply rooted emotional, mental and behavioural patterns (self-beliefs) that emerged in childhood.

   – Work on resolving dysfunctional beliefs and coping styles that negatively affect relationships and self-image.

   – Integration of techniques to promote healthy adult mode to develop better coping strategies.

Mentalisation-based therapy (MBT)

   – Focus on developing the ability to mentalize, i.e. to reflect on and understand thoughts and feelings — one’s own and those of others.

   – Work on improving emotional regulation and interpersonal relationships through a deeper understanding of inner states.

   – Promoting a more secure bond and a better self-image.

Dialectical behavioural therapy (DBT)

   – Focus on coping with emotion regulation disorders and impulsive behaviour.

   – Integration of mindfulness techniques to improve present awareness and reduce stress.

   – Development of skills in the areas of stress management, emotion regulation, interpersonal effectiveness and mindfulness.

Goals for replacement children

Self-care and building a positive relationship with oneself

   – Develop a routine of self-care and self-compassion.

   – Use of relaxation techniques and activities that increase personal well-being.

Integration of creativity and emotional expression

   – Use of art therapy or creative forms of expression as a means of processing emotions and trauma.

   – Encouraging creative expression as a path to self-discovery and emotional healing.

Breaking the repetition compulsion

   – Reflection and processing of unconscious patterns that lead to repeated toxic relationship dynamics.

   – Psychoanalytical or depth psychology-based approaches can be helpful here.

Building mature relationships

   – Focus on developing healthy boundaries and communication skills.

   – Work on the ability to build and maintain intimate and supportive relationships.

Regardless of the chosen approach, psychotherapy must be constantly reviewed and adapted to the needs and progress of those affected. This flexibility aligns the application of various therapeutic techniques with the current situation and the reaction of the person concerned.

5. Summary

This article takes a critical look at the idea that postnatal children who replace a sibling who died at an early age automatically suffer from identity disorders. Instead, André Green’s concept of the ‘dead mother’ is emphasized as a more practical approach to explaining emotional distress in families who have experienced loss. The text discusses various family dynamics that can result from unprocessed grief. Finally, therapeutic approaches such as schema therapy, mentalisation-based therapy and DBT are presented as effective methods for coping with these traumas.

6. Literature

Cain, Albert C., and Barbara S. Cain. 1964. “On replacing a child.” Journal of the American Academy of Child psychiatry3 (3): 443–56.

Glaser, Johanna. 2021. Federn haben eine starke Mitte: Aus dem Leben eines Ersatzkindes. Hamburg: Marta Press.

Green, André. 2004. Die Tote Mutter: Psychoanalytische Studien zu Lebensnarzissmus und Todesnarzissmus. Gießen: Psychosozial Verlag.

Greenberg, Tamara McClintock. 2020. Treating Complex Trauma: Combined Theories and Methods. Springer Nature.

Krell, Robert, and Leslie Rabkin. 1979. “The effects of sibling death on the surviving child: A family perspective.” Family Process 18 (4): 471–77.

Sack, Martin. 2010. Schonende Traumatherapie: Ressourcenorientierte Behandlung von Traumafolgestörungen. Stuttgart: Schattauer.

Schellinski, Kristina. 2019. Individuation for Adult Replacement Children: Ways of Coming into Being.

Schwab, Gabriele. 2009. “Replacement Children: The Transgenerational Transmission of Traumatic Loss.” American Imago 66 (3): 277–310.

Walker, Pete. 2013. Complex PTSD: From Surviving to Thriving: A Guide and Map for Recovering From Childhood Trauma. Createspace Independent Publishing Platform.

Walker, Pete. 2015. The Tao of Fully Feeling: Harvesting Forgiveness Out of Blame. Createspace Independent Publishing Platform.

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