‘Fill the Void’ syndrome

Child replacement syndrome is a real issue, but victims suffering from this can reach the road to recovery.

A worried mother holding her baby 370 (photo credit: Thinkstock/Imagebank)
A worried mother holding her baby 370
(photo credit: Thinkstock/Imagebank)
About a week ago, the phone rang. It was a psychiatrist colleague, but instead of talking about a client, she asked if I had seen the movie Fill the Void. I responded that I hadn’t.
“You must see it. You would like it very much,” she said. Two days later, my wife and I, together with some friends, went to see this movie.
It was indeed an interesting and well made film, a wonderful and warm representation of the religious culture surrounding a haredi family in Tel Aviv. But perhaps even more fascinating than the director’s ability to give the viewer an insider’s look at haredi life was the psychodrama that unfolded. The movie follows the trials and tribulations of a family struck by tragedy when their older daughter dies during childbirth.
Throughout the remainder of the picture, the viewer watches as Shira, the younger and only remaining sibling, comes under pressure to marry her brother-in-law, Yohai, in order to keep him and the baby close by and keep her mother from facing her personal grief over the loss of her older daughter. Shira struggles with the internal conflict and surrounding guilt of whether to take her sister’s place rather than find her own mate.
THE PHENOMENON of parents using a child to replace a loss was identified in 1964 by mental health researchers Albert and Barbara Cain. The Cains focused their research on the effects of conceiving another child to replace a child who had died. They attributed this phenomenon, which they called the “child replacement syndrome,” to unresolved parental grief.
Subsequent research in the family therapy field focused on the family as a system and looked at how that system, if not helped, could turn to maladaptive ways of dealing with a loss, such as pressuring one member of the family to give up his or her individuality and assume a pseudo-identity or non-identity to help the family resolve the grief.
In psychotherapy practice, it is not unusual to come across such cases. Lindy, a young woman of 27, was hospitalized in a psychiatric hospital where I was employed. She was married, had graduated from law school and had held a good job at an established law firm. Prior to her hospitalization, she had become severely depressed and suicidal. She had also developed an unusual symptom, reminiscent of the histrionic patients during the times of Sigmund Freud: She had suddenly become completely dyslexic and unable to read. This resulted in the loss of her job, creating marital tension and making her even more depressed. Medical tests found no physiological cause for her dyslexic symptoms.
When I met Lindy in the hospital, she shared a secret that she had never disclosed to anyone: She had started drinking at the age of four, taking alcohol from her father’s liquor cabinet. Her parents had never known she was a closet alcoholic, nor did her workaholic husband know. Even the staff at the hospital did not know.
In my work with this patient, who was an only child, I learned that her mother had been stricken with multiple sclerosis when Lindy was just two years old. As Lindy grew up, her father, who had lost his own mother at an early age, could not cope with the loss of his wife’s ability to be a strong maternal partner, something he had badly needed when he had married her. To compensate for the loss, he began to turn to his small daughter and place all kinds of adult-like responsibilities on her, such as cleaning the house, cooking meals for her mom and helping her get dressed each day.
This was just the beginning; the father had no awareness of what he was doing to his daughter. He restricted her from seeing and playing with friends or bringing friends home. In essence, she was expected to fill the mother’s role, and perhaps the father’s mother’s role as well.
Lindy married young in order to get out of the house, but her husband, like her father, was insensitive to her needs and was verbally abusive. Her termination from work after developing psychological dyslexia, and severe subsequent fighting with her husband, precipitated her breakdown and admission to the psychiatric hospital.
Therapy helped her understand how her real self had been pushed aside so she could take care of her dad’s needs and cater to her disabled mother. Her breakdown was her cry for help that she could no longer live someone else’s life. As a result of the therapy, she gained insight and awareness of her emotional needs, something she had never done. This was the turning point that began her road to recovery.
Family therapy with her father also helped this family to heal, as her father became aware of how he had used his daughter to replace what both the loss of his mother and his wife’s illness had taken away from him. Her “dyslexia” also disappeared, and her ability to read came back.
Psychotherapy and family therapy can help families dealing with loss to face their grief and get the help they need – a much healthier alternative than filling the void.
The writer is a marital, child and adult psychotherapist practicing in Jerusalem and Ra’anana.