Albert C. Cain continued:


In 1964, Professor Albert Cain and his wife Barbara Cain wrote the sentinel article “On Replacing a Child” following their pioneering research. They referred to the characteristic cluster of symptoms as the “replacement child syndrome” (Cain & Cain, 1964, p. 454). 

Cain & Cain defined the replacement child as “a disturbed child who was conceived shortly after the death of another child, his parents’ specific intention being to have this child as a replacement or substitute for their child who died” (p. 443), and this with “potentially severe pathological consequences”.

Though “The syndrome . . . is sufficiently dramatic . . . there is reason to believe that there can be basically intact, well-functioning children raised even against backdrops similar to those described here” (p. 454). 

They cite grief, guilt, identity and attachment as major areas of concern;  they found “the substitute . . . born into a world of mourning” (p. 445), that parents had “not adequately work[ed] through . . . grief ” (p. 444), “imposed the identity of the dead child upon his substitute, and unconsciously identified the two” (p. 446).

They “hyperidealized . . . the dead child” and made comparisons “unfavourable” to the substitute child (p. 447) and noted a “hostile-dependent tie of the mutually ambivalent mother and child” (p. 449).

History of Research

Psychoanalytic research on the replacement child started according to Porot (1996) with studies on survivors and descendants of the Holocaust, after the Second World War. Streznzcka (1945) and Papanek (1946 ) worked in the USA with children saved from Nazi concentration camps. Further studies on the second and third generation of survivors of the Holocaust include Bergman (1978 ), Epstein (1979 ), Kestenberg & Kestenberg (1980/1982 ), Jucovy (1992 ), Wardi (1992 ), Kogan (1995 ), and Yehuda and Bierer (2008/) and Yehuda et al. (2016) with new findings on Holocaust Exposure Induced Intergenerational Effects, and many other authors.  

Cain and Cain, as well as Sabbadini, emphasize the negative consequences of a pseudo-resolution of mourning by conceiving a substitute child as they also call it. Poznanski (1972 ) gave a first full observation of a case (“Susie”) describing the family atmosphere surrounding such a child. Poznanski observed, “replacing a child with another allows parents to partially deny the first’s child’s death” (see: Volkan and Ast, 1997, p. 93). 

Volkan and Ast note that substitute child Susie “could not escape the idea of death that had been imposed on her. Her mind and life-style seemed to focus on death-related topics” (Volkan and Ast, 1997, p. 93). Etchegoyen (1997) pointed out that child loss can be “experienced as a catastrophic narcissistic trauma. The [subsequent] pregnancy thus represents a desperate attempt to ward off primitive anxieties of psychic disintegration and overwhelming depression in the mother” (1997, p. 199).

Porot defined the replacement child as any child born after the death of another child in as far as it is invested with parental expectations and fantasies that were once projected onto the deceased child (Porot, 1993, p. 171); he conceived of the condition as a handicap for life (ibid., p. 12).

Cain and Cain wrote that “parallel situations” were brought to their attention: “replacement . . . via adoption, . . . [or] surviving younger siblings, with results strikingly similar to those described” (p. 452). The concept was further expanded by Rosen (1982) when he presented a case report on “a family that considered having a replacement child after one of their children was diagnosed as having a developmental delay.” Freedman (2018) notes, “Anisfeld believes the concept may be extended to many other situations in which a child is put in the place of someone else in the family system” ( p. 417).

Coles (2011) devotes an entire chapter to “Sibling Ghosts” exploring “the repercussions that a sibling death might have upon the whole family, including any surviving siblings . . . In particular, if the loss of a sibling is hidden or never adequately mourned and remembered, its voice can be heard in future generations” (p. 27). Battat Silverman and Brenner (2015) found replacement children also among those who were adopted and in cases where one twin died in utero, at birth or later on. An image of the missing twin can appear in products of the unconscious, or traces of it may be found in form of incorporated tissue from the non-developed twin. 

(Cited from Schellinski, Individuation for Adult Replacement Children, 2019)

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