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Research
Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry 2023; 15(Suppl 1):406-419
doi: 10.18863/pgy.1363516
Being A Child Born After Loss: A Qualitative
Research
Kayıptan Sonra Doğan Çocuk Olmak: Nitel Bir Araştırma
Fazilet Neslişah Boro
1
, Ersin Uygun
1
, Gül Dikeç
2
1Istanbul Bilgi University, Istanbul
2
Fenerbahçe University, Istanbul
ABSTRACT
The loss of a child is one of the most traumatic experiences a person can go through. Parents who have suffered
the loss of a child may bring another child into the world after or before completing the grieving process. Children
born after the loss are referred to as subsequent children. The reality of loss and the attitudes of the bereaved
parent affect the identity and mental state of the child born after loss. This study used the qualitative research
method to understand the life experiences of children born after loss in depth. In line with the determined
research method, semi-structured individual interviews were conducted with ten participants born after loss. The
data obtained in the study were analyzed by thematic analysis. As a result of the thematic analysis, the main
themes of "about the lost child", "the effect of being born after loss on life", "being a child born after loss", and
"grief" were determined. The main theme "about the lost child" included information about the deceased sibling,
objects and photographs, the cause and manner of death, images and fantasies about the sibling, emotions, and
contact needs. Under the main theme of "the impact of being born after the loss of life", both the identity and
psychological development of individuals, the impact on their career choices and their parents' attitudes were
found. Under the main theme, "being a child born after loss", participants talked about being a scapegoat, a
comforting child, or a gifted child. In the last main theme, "grief", participants gave information about their
parents' grief, their grief, and their experiences of coping with this grief. It has been shown that coming into the
world after loss affects individuals' identity, mental state, and choice of profession, and they may face negative
parental attitudes. It may be recommended to monitor the grief processes of parents with child loss and to guide
the planning of new children.
Keywords: Children, grief, death, qualitative study
ÖZ
Çocuk kaybı insanın deneyimlenebileceği en ağır travmatik deneyimlerden biridir. Çocuk kaybı yaşayan ebeveynler
yas süreçleri tamamladıktan sonra veya tamamlamadan dünyaya yeniden bir çocuk getirebilirler. Kaybın ardından
dünyaya gelen çocuklar kayıptan sonraki çocuk olarak adlandırılmaktadır. Kayıp gerçeği ve yaslı ebeveynin
tutumları kayıp sonrasında doğan çocuğun kimliğini ve ruhsal durumunu etkilemektedir. Bu araştırmada kayıp
sonrasında doğ
an çocukların yaşam deneyimlerini derinlemesine anlamak üzere nitel araştırma yöntemi
kullanıldı. Belirlenen araştırma yöntemi doğrultusunda kayıp sonrasında dünyaya gelen on katılımcı ile yarı-
yapılandırılmış bireysel görüşme gerçekleştirildi. Araştırmada elde edilen veriler tematik analiz ile incelendi.
Tematik analizin sonucunda “kayıp çocuğa dair”, “kayıptan sonra doğmanın yaşama etkisi”, “kayıp sonrasında
doğan çocuk olmak” ve “yas” ana temaları belirlendi. “Kayıp çocuğa dair” ana temasında ölen kardeş ile ilgili bilgiler,
eşya ve fotoğraflar, ölüm nedeni ve şeklini öğrenme, kardeş ile ilgili imge ve fanteziler, duygular ve temas
ihtiyaçları yer almaktadır. “Kayıptan sonra doğmanın yaşama etkisi” ana teması altında kayıp sonrasında
doğmanın bireylerin hem kimlik ve ruhsal gelişimlerine hem de meslek seçimlerine etkisi ve ebeveynlerinin
tutumları bulgulandı. “Kayıp sonrasında doğan çocuk olmak” ana temasında bireylerin günah keçisi, teselli çocuk
ya da armağan çocuk ile ilgili ifadeleri yer aldı. Son ana tema olan “yas”ta ise, katılımcılar ebeveynlerinin yası, kendi
yasları ve bu yas ile baş etme deneyimleri ile ilgili bilgiler verdiler. Kayıp sonrasında dünyaya gelmek bireylerin
kimlik, ruhsal durum ve meslek seçimine etki etmekte; bireyleri olumsuz ebeveyn tutumları ile karşı karşıya
bırakabilmektedir. Çocuk kaybı olan ebeveynlerin yas süreçlerinin izlenmesi ve yeni çocuk sahibi olma süreçlerine
rehberlik edilmesi önerilebilir.
Anahtar sözcükler: Ölüm, yas, çocuk, nitel çalışma
Introduction
When individuals experience the loss of an object, they tend to recreate the loss in their fantasies (Ainslie and
Solyom 1986). Parents in this situation may choose to have another child to keep their mental image of the
Address for Correspondence: Gül Dikeç, Fenerbahçe University, Faculty of Health Sciences, Department of Nursing, English
Nursing Program, Istanbul, Türkiye E-mail: guloban@hotmail.com
Received: 22.09.2023 | Accepted: 24.11.2023
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Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry
deceased children alive and help themselves in their grieving process. The desire of parents to have another child
in order to preserve the memories, mental image, and life of a deceased child forms the foundation of the concept
known as the replacement child (Temizel and Hocaoğlu 2022). The term "replacement child" was first introduced
by Cain and Cain in 1964. A replacement child refers to a child born shortly after the loss of a previous child to
fill the void left by the deceased child (Cain and Cain 1964). Vamık Volkan (2014) defines replacement children
as those who are tasked with psychologically preserving and maintaining the mental image of a deceased
individual for protection.
Cain and Cain (1964) asserted that replacement children are born into a world overshadowed by grief, where
their parents' attention is fixated on the past, idealizing a deceased mental image. To perpetuate their departed
children's narratives, parents may bestow upon the child born after losing the identical name, dress them in
matching attire, and display similar behaviours. This parenting style is geared towards preserving the bond
between the deceased child and the family, as the replacement child bridges the loss and the family (Temizel and
Hocaoğlu 2022). Being born to fill the void is considered a developmental disruption. In addition to being born
in a grieving environment, children after loss may have to shape their own identities in the shadow of another
identity projected on them (Legg and Sherick 1976). The child who takes the place of the unconscious child is
tasked with preserving the mental image of the deceased child (Temizel and Hocaoğlu 2022). Children whose
parents attempt to turn them into replicas of the dead child are deprived of their sense of individuality. These
children, who unconsciously adopt their parents' fantasies, may experience confusion about their identities
(Schwab 2009). It is predicted that children will encounter difficulties in separation-individuation after loss,
particularly during adolescence. In summary, research shows that being a child after loss poses risks in terms of
identity development and may lead to psychological difficulties (Vollman 2014, Temizel and Hocaoğlu 2022).
Efforts of parents to intentionally forget or avoid remembering the deceased child while attempting to
compensate for the loss of another child may manifest as enduring symptoms of complicated grief. This situation
places the child born after the loss at risk of not receiving the emotional care needed during the growth process
(Üstündağ-Budak 2015). In a recent study conducted by Vollman (2014) on children after loss and replacement
dynamics, some participants mentioned that they were embraced, adopted, and occasionally rewarded by their
families, serving as a favourable substitute for the deceased sibling. These children, characterized by their
parents as a blessing for reuniting the family through their birth, were commonly perceived to hold a privileged
status within the family. Another group of participants, who had the contrasting experience of being born after
a loss, recounted negative memories, such as persistent feelings of disappointing their parents and being subject
to comparisons with the deceased child.
Several studies have explored this concept based on Cain and Cain's (1964) definition of the replacement child.
Despite being labeled with various terms by researchers, these children are commonly recognized as "children
after loss" (Testoni et al. 2020). Research in this field is primarily confined to case studies (Reid 1992, 2007) and
studies conducted in clinical settings or pathology with limited sample sizes. Upon reviewing the literature, no
studies have been identified in our country that investigate the impact or experiences of children born after a
loss on their lives. Given the multicultural nature of our country, it becomes crucial to explore the adult life
experiences of these children born loss, particularly in the context of infant and child deaths. Such insights could
serve as valuable guidance for developing counselling programs tailored to the needs of children born after loss
and their parents. Consequently, this study aims to scrutinize the impact of the experience of being born after
the loss on the lives of these children. This research is anticipated to contribute valuable information to the
literature on being a "child after loss," an area with limited existing knowledge in Türkiye.
Method
In this study, which aims to examine the impact of the experience of being born after loss on the individual, the
phenomenological design, one of the qualitative research methods, was used.
Sample and Procedure
The study employed non-probability purposeful sampling methods. Inclusion criteria were established as having
experienced the loss of a sibling before one's birth (with no intervening siblings between the loss and the birth),
the birth of the deceased sibling (excluding cases of miscarriage or abortion), volunteering to participate in the
study, and being above 18 years old. Given the distinct impact on parents of losing a newborn child versus death
due to miscarriage or abortion (Zeanah 1989), the cases involving the loss of a sibling due to miscarriage or
abortion were used as exclusion criteria.
Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry
408
Table 1. Constructed interview questions
Within the scope of this research, my goal is to comprehend the experiences of individuals who were born after the loss
of a child. To achieve this, I am interviewing adults, such as yourself, who have this background. I will be posing questions
aimed at gaining insight into your unique experiences. It is important to note that there are no right or wrong answers to
the questions I will be asking.
1. Introduction
a. What would you say if I asked you to introduce yourself briefly? (Age, education, place of residence, marital status, etc.)
b. What is your occupation?
c. What made you choose this occupation?
d. Do you have any leisure time activities or hobbies? (Focus on helping-oriented activities)
2. Family life/growing up process
a. What comes to mind if I ask you to discuss your family? (This question is asked separately for the current family and
the family in the past)
b. What kind of household where you born in? What kind of environment was your childhood like?
c. Were you born from a planned and desired pregnancy?
d. How would you describe your relationship with your mother when you were growing up? What is your relationship like
now?
e. How would you describe your relationship with your father when you were growing up? What is your relationship like
now?
f. Do you have any siblings? (Pay attention to whether or not the deceased sibling is included)
g. What are your sibling relationships like?
h. How would you describe your relationship with the sibling you lost? (Asked separately for now and while growing up)
3. About the lost sibling
a. If I asked you to tell me what you know about your deceased brother/sister, what would come to your mind? (Gender,
age, etc.)
b. Were there any materials belonging to your deceased sibling (photographs, clothes, etc.) in the house where you grew
up?
c. What kind of life did your family have before the loss? What do you know about it?
d. Do you know what your parents experienced in the aftermath of loss?
e. Did your parents talk about this loss? How did they tell you about your dead brother or sister?
f. How was the reason for this loss conveyed to you?
4. The impacts of this loss on the growth process
a. What were your parents' parenting styles like when you were growing up? Can you share some of your experiences?
b. Do you think this loss has affected the way they approach you?
c. When you needed emotional support, how did your parents meet those needs?
d. Was your parents' behaviour predictable for you?
5. The experience of coming into the world after loss
a. What does it mean for you to be born after loss?
6. Thoughts on loss
a. How did/do you feel about your lost sibling?
b. What is the experience of being a sibling of ...... (name of the lost child)? What does it mean to you?
7. Process of separation and individuation from the family
a. What issues have you had conflicts with your parents about in the past?
b. (If living in a separate home) What was it like living in your own home, leaving your parents?
c. How much influence do your parents have over your life now?
d. How does the decision-making process occur for you? Do you feel the need to consult others when making decisions?
e. What are your ideas about what you want to do and how you want to live?
8. Identity formation
a. Can you describe the kind of person you believe yourself to be and discuss your personality traits?
b. Have you noticed any changes in this self-description from the past to the present?
c. How has the experience of loss influenced the person you are today?
d. Can you share your experience of being yourself and navigating individuality?
e. Have you ever experienced confusion regarding your sexual identity?
9. General Evaluation
a. What are your thoughts on our conversation today?
b. Do you have anything else you would like to share?
c. Is there anything specific you would like to inquire about?
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Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry
Permission to conduct the study was received from the Ethics Committee of İstanbul Bilgi University, dated
02.02.2023, with project number 2023-20507-017. The participants gave written and verbal consent. The study
complied with the Personal Data Protection Law (2016).
The study announcement was prepared into a poster and disseminated across the first author's social media
platforms and through email groups of mental health professionals specializing in trauma. Individuals meeting
the participation criteria and expressing voluntary interest were informed about the research. Interviews were
scheduled with people whose signed informed consent was obtained via email and completed a socio-
demographic form. A reminder email was sent to the participants a day before the interviews, containing the
information required to connect to the interview. Participants were reminded of their right to end the interview
at any point or not to answer questions they did not feel comfortable answering. Fourteen individuals reached
out to participate in the research, and interviews were conducted with ten of them. One person cited that the
loss was due to miscarriage, while three others expressed a decision not to partake in individual interviews. As
the literature suggests, there is no standard number for qualitative research, with an expected range of 5-25
participants, and interviews can be concluded upon reaching data saturation. In this study, interviews were
concluded once data saturation was achieved, following the methodology outlined by Braun and Clarke (2013).
Individual interviews were conducted through the Zoom platform to facilitate participation from individuals
residing in different cities and to achieve the desired number of participants. At the beginning of each interview,
confidentiality rules were verbally explained, and after obtaining verbal consent, the interviews were recorded
as videos. Participants were consistently reminded of their right to terminate the interview at any point or
decline to answer questions that made them uncomfortable. The interviews took place between March 25, 2023,
and May 12, 2023, with durations ranging from 42 to 87 minutes. The recorded sessions were transcribed into
written text to be used in the analysis phase. A semi-structured guide was utilized during the interviews,
comprising questions regarding the participants' childhood experiences after the loss (Şahin 2022). Initially, two
pilot interviews were conducted to test the prepared guide. Following feedback from the pilot interviews, no
changes were made to the guide, and the pilot interviews were integrated into the study. The final version of the
guide had nine primary sections and 38 questions (Table 1). The questions were designed to progress from
general to specific, in line with the principles outlined by Braun and Clarke (2013). Within this guide,
participants were queried about their family life, growth processes, the deceased sibling, the impact of loss on
their lives, individualization processes, and identity development. The researcher conducting the interviews
took notes to capture facial expressions, emotions, and notable trigger points during the sessions.
Statistical Analysis
In this study, thematic analysis was used to explore the common experiences of individuals in their experiences
with being born after loss. The six-step analysis framework proposed by Braun and Clarke (2013) guided the
process. (1) Initially, the interviews were transcribed, and a familiarization process with the data ensued. (2)
First codes were established by aggregating notable data. Subsequently, the generated codes were organized
under potential themes, and the content and alignment of the themes with the dataset were analyzed. (3) To
enhance the validity and consistency of the findings, two researchers independently developed codes and themes
and then made comparisons with each other's decisions. (4) The main theme and sub-themes were finalized and
presented to another researcher involved in the study. Following this stage, the analysis progressed; themes
were distinctly defined and labelled. (5) The coded content was reviewed and documented in the final stage of
the analysis. (6) To assess whether the findings accurately reflected the participants' experiences, the identified
themes were shared with the participants via email, and their feedback was sought (Lincoln and Guba 1985).
Two of the nine participants responded, confirming that the themes reflected their experiences.
The study's data was gathered by a psychologist studying for a master's degree in disaster and trauma studies.
The analysis was conducted by an academician with expertise in qualitative studies, a mental health and
psychiatric nurse, and the first author responsible for data collection. Additionally, another researcher who was
not directly involved in data collection and analysis provided feedback throughout the study.
Results
Nine women and one man participated in the study. The average age of the participants was 34.9 years. Nine of
the participants resided in Türkiye, and one resided in France. Five of the participants reported receiving
psychological support actively or at some point in their lives. Two of the participants had lost two siblings before
birth (Table 2).
Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry
410
Thematic Analysis
As a result of the thematic analysis, four main themes were determined. These main themes were labelled as
"about the lost Child," "the impact of being born after loss on life," "being a child born after loss," and "grief." The
main theme of "about the lost child" included details about the deceased sibling, including their belongings and
photographs, understanding the cause and manner of death, mental images, and fantasies about the sibling, as
well as emotions and physical contact needs. Under the main theme of "the impact of being born after loss on
life", findings were obtained on the influence of individuals' birth after loss on their identity, psychological
development and career choices, and the attitudes of their parents. The main theme of "being a child born after
loss" covered expressions from individuals about being perceived as a scapegoat, a consolation child, or a gifted
child In the last main theme, "grief," participants provided information about their parents' grief, their grief, and
their experiences in coping with this grief (Table 2).
Table 2. Demographics of participants
Age
Gender Identity
Level of Education
Job Description
City of Residence
K1
21
Female
Highschool
Und. Student (Psychology)
İstanbul
K2
38
Male
Highschool
Officer
Bursa
K3
47
Female
Ph.D.
Lawyer
Paris
K4
35
Female
Master’s Degree
Teacher
İstanbul
K5
53
Female
Bachelor’s Degree
Retired (Media Organization)
İstanbul
K6
22
Female
High school
Und. Student (Sociology)
Ankara
K7
42
Female
Master’s Degree
Teacher
İstanbul
K8
24
Female
High school
Engineer
İstanbul
K9
48
Female
Master’s Degree
Counsellor (Psychology)
İstanbul
K10
19
Female
High school
Und. Student (Int. Architect)
Mersin
Table 3. Results on main and sub-themes
Main Themes
About the
Lost Child
Impact of Being Born
After Loss on Life
Being Child Born After Loss
Grief
Sub- Themes
Knowledge
Career Choice
Scapegoat
Parental Grief
Mental Images
Impact on Identity and
Psychological Status
Replacement and Consolation
Participant’s Grief
Emotions
Parental Attitudes
Gift Child
Coping with Grief
About the Lost Child
Within this main theme, participants shared their experiences concerning the siblings they lost, from growing
up to the present day. Participants' various narration, knowledge, traces, emotions, and rituals related to the
lost child formed this main theme. In their narratives, the participants included the knowledge they had about
their siblings, how they learned about this loss, mental images, dreams, fantasies, emotions and their need for
contact with their deceased siblings. In line with the participants' narratives, "knowledge", "mental images and
fantasies", and "emotions" were identified as sub-themes.
Knowledge
Under this theme, participants shared knowledge about the deceased child, including the name, presence, date
of birth, appearance, manner of death, cause of death, the process of learning about the death, and photographs
and belongings. Some participants reported having minimal information about the deceased sibling, while
others provided detailed accounts. Alongside information about the deceased child, various materials and
photographs of the sibling were preserved by some participants. They mentioned possessing a photograph, a
box containing materials, or a suitcase with the belongings of the deceased sibling. Several participants noted
that information about the deceased child often surfaced by comparing themselves. One participant highlighted
that characteristics typically attributed as positive for them were perceived as unfavourable in comparison to
their deceased sibling:
"The talk was that she was a charming child. For example, I was hideous when I was born. Somehow? Then my
aunts would say, 'Oh, you were so ugly, we used to say how could we love you, but you became so beautiful.' (...)
She was a lovely child. I mean, she was so white, so overweight, well... That is how they describe her. For
example, I was skinny." K5
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Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry
Some participants could not remember how and when they learned, while others said they learned this
information from a family member other than their parents. One participant, who learned about their missing
sibling from their grandmother, detailed how they received this information. They described the profound
impact of learning about the sibling and shared feelings of guilt, particularly after their grandmother's cheerful
recounting of the situation;
"I do not remember the first time I learned about it, but I know and remember what she said. I do not remember
exactly how she said it, but my grandmother told me a story about K. He was a smart boy. One day, work
happened when we travelled on the road in our village. He said, "Look, grandma, they are going to erect poles
here, and there will be lights on those poles. He told me that there would be electricity in the village. My
grandmother told me a memory of him when he was three. This memory is very... It has a very, very big place
in me. Because it is like this... That brilliant and special person was not supposed to go, and I felt guilty. As if
he left because I came. Alternatively, if he did not go, I would not go; if I did not come, he would not. No, it is
the other way around. Quite the opposite. I remember it made me feel like I was trying to take his place like I
had done something wrong, like he should have lived, I should not have lived, I should not have come into the
world. Furthermore, I was angry about that." K3
Mental Images
Participants detailed the mental images that surfaced when they thought of the deceased sibling, often acquired
through family narratives. While some mentioned lacking vivid mental images, others described visualizations
based on the sibling as a baby or an adult. One participant shared that when thinking about their deceased
brother, a silhouette would appear before their eyes, prompting various descriptions;
"For some reason, I think she looks like my mother, someone like my mother, like my mother when she was
young. (...) For example, I always have these things in my head, like, I do not know. She has gold bracelets; her
head is covered. After that, I imagined her as close to tradition, like a peasant woman. Maybe I am confusing
her with my mother. I confuse her with my mother's youth." K5
Some participants explained that they could not visualize their siblings in their minds. Two participants,
however, portrayed their deceased siblings using superhuman terms. One participant recounted how her mother
positioned the deceased sibling as an intercessor and herself as an angel. Another participant described the
deceased sibling as a guardian angel. Participants seemed to hold mental images of a life where the deceased
sibling had not passed away, imagining the possibilities of what that life might have been like. Expressing
curiosity and a longing for the potential of their deceased sibling's life, some participants fantasized about the
lost sibling serving as a bridge between them and other siblings. She is offering protection from difficulties and
becoming a close friend. One participant wondered about the physical appearance and relationships of their
deceased sibling, believing they would get along well due to a slight age difference. Another participant expressed
the desire for a close relationship with a sibling of the same gender, expressing a wish for an older sister.
Participants emphasized the importance of establishing a connection and relationship with the deceased sibling.
They shared that they try to fulfil this need through various methods and rituals, including visiting the grave,
painting, roasting halva, praying, and even expressing a desire to have a tattoo in memory of the deceased
brother. One participant expressed her desire to carry the brother she could not meet on her body as follows;
"For example, when I was little, I told you I used to draw pictures of him. Maybe in the future, I want to get a
tattoo about him. I want to carry it on my body. I can talk about that. Being his brother has always stayed with
me, something I have always wanted to meet because I have never met him. When I was little, I always believed
that I was this age. How old would my brother be? He would be this age. I wish I knew him. I wish he were my
brother. I think it is a nice feeling. It makes you feel special. Nevertheless, at the same time, what do you call it,
being unable to meet him all the time inside? Sad..." K6
Emotions
Participants shared their feelings towards their deceased siblings during the interviews. It was noted that some
participants faced difficulty in articulating their emotions. The loss of the deceased child evoked a range of
emotions in the participants, with predominant feelings including sadness, guilt, incompleteness, and anger.
One participant noted that emotions evolved, while another emphasized a feeling of lack. Three participants
expressed feelings of guilt related to their siblings' deaths. One participant described the guilt of being alive in
the following way:
"For many years, I felt, as I said, guilt towards my brother K. I felt guilty because he should have lived. I should
not have lived. At some point, I started to feel longing for him. I felt like I wished he was alive, that he would
Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry
412
have protected me, that we would have spent time together, etc. Then, there was anger for a while. Why did
you leave, why did you choose this path, why did all this happen? In the meantime, it is pure love; I respect him
and what happened. I guess you go through this mourning thing?" K3
Impact of Being Born After Loss on Life
Under this theme, participants shared how being born after loss affected their lives during the interviews. Three
sub-themes emerged from their responses: "career choice", "impact on identity and psychological status", and
"parenting attitudes".
Career Choice
This sub-theme delves into the impact of being born after the loss on an individual's choice of profession. Some
participants preferred helping-oriented professions, emphasizing their desire to make sense of human existence
and life while contributing to healing. Others chose professions where the acts of creation and art intertwine.
For instance, a participant who initially entered the psychology department by chance discovered a desire to
become a therapist, to connect with people, and to exhibit strength while pursuing further education. Another
participant, a psychological counsellor, mentioned the motivation to touch different lives through her chosen
profession. A participant acknowledged studying law and specializing in human rights. Two participants
completed their undergraduate education in fields where creativity takes center stage. Participants explained
that creation served as both a hobby and a profession that has accompanied them since childhood. One
participant, currently a teacher, shared that she initially studied history to connect with her roots and later
became a teacher to impact the lives of children.
Impact on Identity and Psychological Status
Participants' accounts of the experience of being born after loss and its effects on identity and mental status
formed this sub-theme. Participants stated that being born after loss made them feel inadequate, that their
families had expectations and that they felt a constant need for acceptance from their parents. Two participants
opened up about the defence mechanisms they use to continue their lives. One of the participants stated that
she did not remember what she experienced and felt. Another participant stated that she avoids experiences
such as farewell, death and mourning;
"(....) Those are the addresses I have difficulty with regarding farewells and mourning. For example, I am a very
tearful person. I cry all the time. My tears are ready for everything. Sometimes, I think maybe that is what it is
about. There is something transference there. There is a story. (...) For example, I did not go to her funeral. I
lost my grandmother; I did not go to her funeral. That is why confronting loss scares me and frightens me on
the one hand. (...) I guess tolerance for loss may trigger my fear of death. That is why, for example, when I lost
one of my friends' parents, it was challenging at first to go to the funerals of my friends. In recent years, I have
been going there only when I have to. I mean, I have been avoiding it." K9
Some participants shared the dilemmas they experienced when leaving the family home and establishing their
own lives. One participant associated the difficulty of leaving home with the comfort zone, while another
explained that she perceived staying at home as a role assigned to her. For her, leaving home felt like leaving,
dying, or departing. One participant settled abroad, expressing a strong desire to find peace of mind, while
another described enjoying being on the road constantly. She articulated the situation she defined as an escape
as follows:
"Well, I do not think my brother R positively affected me, except for coming into the world. I do not know any
positive things I said. I love the roads very much, maybe that is to run away from home. You know, I can turn it
into hitting the road. Other than that, I love nature. Again, the things I said are about escaping. Escaping to
nature, escaping to open space. Maybe it is that thing inside the house, the gloom I live in..." K2
One of the participants revealed that she thinks about suicide from time to time. Interestingly, the presence of
a sibling who died before her birth is one of the factors that prevents her from taking such actions. Consequently,
she is concerned about inflicting a second loss on her family. Several participants discussed the impact of being
born after the loss on their mental state and mentioned receiving psychotherapy support. For example, the
participant who lost her brother to cancer expressed grappling with various phobias and anxieties. Another
participant expressed her fear of death in the following manner:
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"Fear of death... I struggled with panic attacks and, well, anxiety for a very long time. It is under control now. I
do not know if it is connected to that. He is like this... On the other hand, I also think it is like a guardian angel
that I do not know, that I do not know, but it is like a guardian angel standing somewhere simultaneously. That
is all I can say." K5
Parenting Attitudes
The sub-theme of different parenting attitudes experienced by the participants emerged. Some participants
detailed inconsistent and overprotective parenting attitudes. One participant who experienced inconsistent
parenting described her parents' frightening discourses, her father's behaviours, and negative messages that she
could not comprehend:
"I mean, my father was always a person with psychological problems. Moreover, he always had the last word at
home. He would slap you, try to kiss you. He would come home at night drunk. There would be such a smell of
alcohol in the house, blah blah blah. It was a smell I loathed. After that, there was, how can I put it? It was a
loveless environment. I mean, it was a loveless environment for everyone. It was a more loveless environment
for me as an older child."
One participant explained that her parents were protective but did not provide this protection when she needed
it. The confusion she experienced as a child triggered various emotions and impacted how she built relationships.
Another participant summarized that her mother was very anxious, constantly calling her and that this anxiety
was transmitted to her:
"Let me say that being born after the death of a child changed my mother a lot. I mean, she pays more attention
to me than the others. I think she has a small amount of fear of loss after losing her child. I mean, my mother
and I have an obsessive relationship. She acts like she is obsessed with me more than she loves me. For example,
she calls me every second, like Where are you or come home. Apart from that, she also has many fears. He has
much fear. He reflects this to me, too. I also feel fear when I do something. It creates anxiety about the future."
K10
While the participants experienced guilt, fear of loss, and empathy due to these attitudes of their parents, they
reported that their parents approached each other with guilt and shame. One participant, who sensed that their
parents blamed each other for their childhood experiences, stated the following:
"Two, one feeling has been vital for us. Maybe for other families, too. Feeling guilty and what happened...
Because my father... For example, my mother blamed my father for many years. Sometimes, she would throw
things like that, like your father did not take me once, but there was something huge in her relationship with
my father. I mean, she blamed him and wanted to punish him. This also spread to us. He always acted like he
wanted to punish me for something. So that was the feeling that he conveyed to us, to me, throughout my whole
life. Crime and punishment and retribution. So yes, the thing of unspent mourning... That is it." K3
Being a Child Born After Loss
This main theme encompasses how participants born after the loss make sense of their existence as children.
The participants question the reasons and consequences of being born and alive under this theme. Some
participants harbour positive perceptions of being born after loss, while others hold negative perceptions and
experiences of it. Accordingly, three sub-themes were identified: "scapegoat," "replacement and consolation,"
and "gift child."
Scapegoat
The first sub-theme of the main theme of being a child born after loss is scapegoating. One participant described
coming into life after loss as being a scapegoat. She stated that she was blamed by her parents and subjected to
negative discourses, and this situation had a profound impact on her.
"Well, for example, I was always a very admired and loved child. Even when I was young. For example, the
neighbours greatly loved me because I was a perfect kid. After that, I was like a scapegoat for my mother and
father. For example, the neighbours would say, ay, B. is such a sweet girl. I remember my mother saying, no,
she is not that sweet. She does something at home, you would not know her, and so forth. Stuff like that. I know
that I cried many nights. I prayed and begged God to let me get out of this house as soon as possible..." K5
Replacement and Consolation
Under the second sub-theme of filling in and being consoled, participants explained that they perceived their
Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry
414
reason for being born and being alive as a consolation, brought into existence to fill the absence of the deceased
sibling. One participant mentioned that being born right after her deceased sibling had a soothing meaning,
especially for her mother:
"What kind of life did my parents have when I was born? I mean, I did not ask them this question much, to be
honest. Nevertheless, my mother says, "That year started very badly for me, but it ended very well." Because at
the beginning of the year, my brother passed away. Furthermore, at the end of the year, I was born. So, of
course, my mother's sad, sad state, of course, but on the other hand, maybe I was a small amount of a
consolation for them. (...) It is filling the place of something like that. For example, there is a void that I feel like
I was born to fill. Is that consolation? I do not know, maybe something like that." K6
One participant stated that she was born upon the suggestion of her aunt to her mother, that her parents were
distracted with her after the loss, that the emotional burden of this experience was heavy, and that she labelled
herself as a "giveaway child":
"Being born after a loss, as I said, when you are a child, you do not care much. Then, when you measure what
you have experienced, look back and weigh what you could not experience, it becomes a bit of a thing. It touches
you. On the one hand, it is like trying to ignore my existence. I wondered why my aunt said they immediately
made me, etc. However, it would be nothing if I did not exist. I would not be. (...) How did they cope? I mean, I
think they probably played around with me. I call myself, well, my wife says not to call me that, but I call myself
the giveaway kid as a nickname. This is a nickname I came up with much later." K2
Gift Child
Under this main theme, some participants expressed that they had a positive experience of coming into the
world after loss, valued by their parents, and considered the chance of a lifetime. One of the participants stated
that she was at the forefront among her siblings and was positioned as her mother's most precious one, and
therefore, she never made her mother sad:
"You are always the most precious to me," she says, but she has different values for everyone. I do not remember
ever upsetting her in my life; I do not remember raising my voice. (...) Of course, she loves others a lot, too, but
she is extra fond of me. She shows it, she says it. (...) Even my parents say that I am the most precious one to
my mother. I attribute it to that because I have never upset my mother in any way, at any time." K4
Another participant who positively experienced coming into the world after loss stated that her parents
described her as a chance and that her behaviour was in line with this characterization:
"For example, sometimes when my mother loves me, she uses adjectives such as 'you are my biggest chance,' 'you
are the real beauty that comes after you.' It is also good that my parents position me this way. They could have
thought the opposite. She could have seen me in a much more negative way; she could have resented me.
Nevertheless, on the contrary, maybe she saw hope again. She found another son to devote herself to like this.
So that is good. I have seen many pros and cons of this. I mean, is it because of that loss or something else?" K8
Grief
Under this main theme, participants' grief experiences, observations and perceptions related to both themselves
and their parents were included. Three sub-themes related to grief were identified. These sub-themes are "grief
of the parent", "grief of the participant", and "ways of coping with grief".
Parent’s Grief
Parental grief reactions constitute this sub-theme. Participants described the grief reactions of their parents
that they were able to observe. Some participants stated that they did not have reliable information about the
period of this loss, others described the effects of these grief reactions on themselves, and some participants
stated that their parents, especially their fathers, were unable to grieve.
A participant who witnessed her parents' bereavement also stated that her parents did not attend ceremonies
such as weddings. She also explained the emotional burden she experienced with a memory. She described how
she and her siblings used to take turns wearing the clothes of her deceased sibling during their growing-up
process and an ironing scene that emerged in her mind. She stated that this was the most significant trauma she
carries to this day and that her mother used to lament while ironing the clothes of the deceased child;
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"She has hair at home. She has a lock of hair. I wore all her clothes, Mrs. A. Isn't that already a big problem?
My mother cried every time she ironed. For example, when I go to my oldest memory of my mother, the image
of an iron always catches my eye. She irons with a lament: Here were my son's clothes, this and that, with tears
like that. For example, I would run to another room so she would not see me crying. (...) Yes, we all wore them
in turn. Not just me. My brother N wore them. I wore them too. That is how we grew up." K2
Some participants stated that their parents did not confront grief, that the deceased sibling was never talked
about at home, and was ignored. Denying and not facing death negatively affected the surviving children. One
of the participants stated that she did not know the location of her deceased sibling's grave, that she had never
witnessed a visit by her family, and that her parents did not perform any rituals to commemorate this sibling.
Participants expressed that they did not receive adequate care and attention from their parents due to the grief
their parents were going through. They also mentioned the difficulties they experienced during the growing-up
process:
"It feels. It makes you feel many things. I mean, as I said, first guilt, then anger, but then acceptance and the
way life is. It felt big... I always felt lonely because my parents were very distracted, and I felt a little bit without
guidance as if he could have provided that to me, but she could not. She did not. Such a loss. I felt like I had lost
something, not my parents but me." K3
Some of the participants reported experiencing an anniversary effect on the anniversary of the birth or death of
their parents' deceased child. It was observed that the anniversary effect was experienced as a change in mood,
written posts on social media, blogging, and commemorating the loss, such as roasting halva. Some participants
stated that loss and grief also affected their roles within the family, and they experienced confusion. Two
participants stated that they had to assume the role of caregiver, while one participant explained her struggle
not to assume the role of caregiver. Another participant stated that her sister assumed the role of the parent and
her sister took care of her. Explaining that the fact that their parents did not face the loss in the process of
growing up had different consequences, the participant described her mother's depressive mood and her father's
addiction and dependent personality as follows:
"It hurt me the most because they both did not face it. I think it hurt me the most. My father, because of
addiction, became a dependent personality. My mother was depressed for a long time; she lived on depression
medication for many years. Furthermore, I did not get what I needed. I did not get the attention and care from
my family. However, of course, while it looked like the opposite—they looked very devoted and devoted to us
from the outside like we do not divorce because of you, we do these things to raise you well, we do everything—
it was the opposite in reality. You know, there is such a phrase as 'hunger amidst plenty,' it was something like
that." K3
Participant’s Grief
Participants' grief reactions formed this sub-theme. During the interviews, participants discussed the processes
and emotions they experienced regarding this loss. While one participant stated that she experienced feelings of
mourning about her deceased sister, another participant stated that she visited the cemetery of her deceased
sister, and it made her feel good. Some participants stated that they thought that grief was transmitted to them
in the womb. Another participant described her experience as taking the pain intravenously:
"Yes, that is what I can say. That is to say, I think that some of my mother's emotions were passed on to me
when she was pregnant. I feel it. For example, when my mother was pregnant with me, she was sad and
melancholic, or she would feel emotional when sad songs were played. She is in that mood right now, to be
honest. I mean, most of the time, I feel a bit, well, I should say I feel bad, or I do not have peace of mind. We are
working on this right now with my psychologist. Here... How else should I put it? My brother passed away due
to cancer. A few years later, my mother had cancer. Apart from that, I also have cancer phobias. Let us say I
was also affected..." K10
Coping Mechanisms
During the interviews, it became apparent that parents and participants employed various coping methods to
navigate this loss. Parents utilized coping mechanisms such as alcohol consumption, a lack of religious faith,
reliance on superstitious beliefs, political engagement, and the decision to have another child. In contrast,
participants chose to create some distance from their parents and sought support from social networks to
manage the impact of grief. For instance, one participant shared that their parents had opted to have a new child
as a way of coping with their grief.
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416
One participant, born immediately after the loss, shared that her parents gave her a different name as a means
of managing their anxiety surrounding the death. Another participant highlighted that the bond between
siblings served a protective function and contributed to reuniting the family. Several participants admitted to
having fears of confronting the truth, avoiding discussions about the loss with their parents for an extended
period, and refraining from actively exploring or addressing the topic. In some cases, participants revealed that
there was an unspoken agreement with their parents to avoid discussing the loss. Notably, a participant with a
mother experiencing intense anxiety and fears disclosed that she distanced herself from her parent as a coping
mechanism for her fear of loss:
"Because she looks like her mother... My mom looks like her mom. So I thought something like she looked like
her mom. I spent much time with her too, and when I saw that I was affected by her... For example, when I saw
her things in myself, I wanted to stay away. I mean, I did not want to accept it. For example, there is some
coding in my brain. H was saying that you are a mother's daughter and so on. After a while, I started to believe
in these things. Then, I did not accept them. I withdrew myself more. (...) He should solve some problems, but I
suffer because he does not want to solve them. So right now, for example, as a solution, I am trying to stay away
more. For example, I am staying with my sisters a lot right now. I am affected every second I am with him
because he injects certain things into my brain." K10
Discussion
This study aimed to investigate the unique experiences of individuals born after loss. Consistent with the
literature, it was observed that the amount of information the participants had about the deceased child varied,
and the information they possessed was primarily derived from family narratives. Previous research suggests
that children born after loss often idealize the deceased sibling. In line with prior studies (Leon, 1986; Reid,
1992), participants in this study were found to have mental images of their deceased siblings, aligning with the
fantasies that, if the deceased sibling were alive, he/she would fill a void in their lives and play a role as a helper,
confidant, or friend. Participants described fantasies that, if the deceased sibling were alive, he/she would serve
as a bridge within the family, protect them from difficulties, and be a friend with whom they could get along
well.
Parents who are not prepared for the birth of a child after the death of another child may attempt to raise the
newborn by idealizing the deceased child. The family might expect the new child to resemble the one they lost,
depriving the child of the chance to form their own identity. This scenario can evoke anger and guilt in the
individual. The sense of guilt in the child can intensify, particularly when the birth after the loss is connected to
the death of the sibling, and the parents' attitudes contribute to the survivor's guilt. Constantly subjecting the
child born after the loss to comparisons, as noted by Cain and Cain (1964), exacerbates feelings of guilt and leads
to anger. In this study, participants expressed being exposed to comparisons with the deceased child as a
situation that fuels inadequacy and anger rather than framing it as a form of competition.
The impact of being born after the loss on a person's life manifests in various ways. Limited research on children
born after loss suggests a tendency for these individuals to choose caregiving-oriented occupations (Leon, 1986),
a trend observed in most participants in this study. Similar to the findings in this study, the literature also
highlights creative responses among individuals born after loss. Historical figures like Vincent van Gogh,
characterized as a replacement child, incorporated death, rebirth, twinning fantasies, and their role as a
replacement child into their art. Beethoven, born a year after his deceased brother, even adopted the name of
his late sibling (Legg and Sherick, 1976). Another historical figure, Mustafa Kemal Atatürk, is considered a
replacement child and responded to this circumstance with aspirations of becoming a saviour (Volkan, 2014). It
is believed that Atatürk harboured unconscious fantasies of rescuing his mother from grief and achieving
immortality, which translated into his role as the saviour of his country (Volkan and Itzkowitz, 2020). While not
as overt as Atatürk's example, it is hypothesized that some participants in this study pursued careers in teaching
to realize their dreams of becoming saviours.
The urge for parents to adopt overprotective and restrictive attitudes towards a child born after loss may stem
from the perception that they made a mistake in safeguarding their previous children, contributing to their loss.
Overprotective tendencies can adversely affect the child's socialization, individualization, and identity
development (Temizel and Hocaoğlu, 2023). Pantke and Slade's study (2010) found that adolescents born after
loss were subjected to more protective, anxious, and sheltering attitudes. In line with these findings, the
participants in this study experienced a desire to leave home, associating this desire with escaping and achieving
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liberation. This suggests that the participants may be motivated by a quest for individualization. Additionally,
heightened anxiety and fears related to the prospect of leaving home were observed for some participants.
Participants described the experience of being a child born after the loss as being a scapegoat, a source of
consolation, a replacement, and a gifted child. Vollman's study (2014) reported that some participants felt
inadequate in filling the void left by the deceased child, facing constant comparisons, while others felt rewarded
with love and attention, becoming the focal point for their parents. Vollman (2014) categorized these
experiences into inadequate replacement child and gift child. Although the terminology of the themes varies
between these findings and the present study, the participants' experiences demonstrate similarities.
Families of the participants underwent varied processes after the loss, resorting to different rituals to cope with
the grief. Some participants mentioned that their parents engaged in mourning rituals like roasting halva,
visiting the grave, and praying on the death and birthdays of the deceased child, frequently remembering them.
In contrast, others expressed having fewer memories of the deceased child. This indicates the influence of
cultural norms on the ways grief is experienced and expressed (Martin and Doka, 2000). Becoming pregnant
after a loss is recognized as a coping method (Powell, 1995), but it has been noted to have negative consequences
for both the parent and the child (Temizel and Hocaoğlu, 2023).
Children born after loss may face disruptions in attachment styles due to their parents' prolonged, unresolved
grief (Vollman, 2014). Parents may grapple with the fear of losing another child, potentially negatively impacting
attachment. Many participants in this study described inconsistent parenting attitudes and the unpredictability
of their parents. The apprehension of experiencing child loss again might prevent emotional bonding for
parents, but it is acknowledged as profoundly affecting the child. Additionally, parents having children as a way
to cope with the grief, anger, and feelings of inadequacy from the deceased child or seeking solace from the new
child can be viewed as role reversal (Temizel and Hocaoğlu, 2023), termed as "parentification" (Van Parys et al.,
2014). Some participants expressed that they took on the role of parents because their parents did not fulfil this
role, and in some cases, they even had to care for their siblings born later. One participant mentioned that her
sister assumed a parental role after the loss, stepping into the position of a mother. This phenomenon is believed
to be associated with birth order, which can lead to role differences among siblings (Mendelson and Gottlieb,
1994). The lack of adequate care for individuals undergoing such role changes may contribute to the
development of mental symptoms in the future. Nevertheless, many participants in this study have sought
psychotherapy in adulthood, suggesting a heightened awareness of these issues.
The complicated grief experienced by parents can be passed from one generation to the next. Some participants
reported that grief was passed on to them in the womb, while others grieved as if they had experienced the loss
themselves. Research has observed that children who inherit the effects of loss through intergenerational
transmission make attempts to cope with and integrate it into their life stories; through photographs, stories
and letters, they attempt to piece together and make sense of a past that they did not primarily experience
(Schwab, 2009). Attempts to make sense of loss can be a healing factor for the child born after loss, and this
attempt to make sense of loss is a logical and necessary response (Vollman, 2014).
In line with the participants' narratives, it was observed that information about the grief experience of the father
figure was quite limited, and the participants had relatively weak relationships with their fathers. In many
cultures, fathers are often depicted as forgotten or shadow parents (LaRossa, 1997). This study found that the
participants had limited connections with their fathers and lacked substantial information about them. This
aligns with existing literature indicating that fathers may tend to deny or conceal their grief (Aho et al., 2006),
a pattern reflected in the participants' experiences. Moreover, the literature also suggests that individuals
assuming the father role may resort to increased alcohol and substance consumption as a means to avoid grief
and pain following the loss of a child (Aho et al., 2006). Some participants mentioned that their parents started
to consume alcohol after the loss, showing how deeply this situation affected their mental well-being during
their formative years, with the inconsistency in their parents' approaches adding to the confusion.
There is limited information regarding the impact of being born after a loss on mental well-being and identity
development. Although studies on this topic exist in Western societies, the research is relatively narrow in
Türkiye. Addressing the experiences of individuals born after loss in Türkiye comprehensively may not only
enrich the existing literature but also have implications for the field of psychotherapy. The participants in this
study ranged from 19 to 53 years old, representing a diverse range of life experiences and awareness levels. This
diversity is considered a strength of the study, as it contributes to a more comprehensive understanding of the
subject.
Besides its strengths, this study has some limitations. Firstly, reaching individuals born after loss posed a
Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry
418
challenge. Two individuals born after a loss provided feedback indicating that participating in an interview on
this subject would be challenging for them, and they chose not to participate in the study. The recruitment
process, mainly through social media, may have biased the sample towards individuals who have undergone
psychotherapy, are mental health specialists or candidates, or have a high level of awareness regarding this issue,
approaching their mental processes with curiosity. Another limitation is that the majority of participants were
undergraduate and graduate graduates.
Conclusion
The research revealed that participants openly shared information, mental imagery, and thoughts about the
deceased child, expressing deep emotions toward them. This underscores the profound impact of being born
after such a loss on individuals' sense of self, mental health, career paths, and exposure to negative parental
sentiments. It is advisable to closely monitor the grieving journey of parents who have undergone the loss of a
child and offer guidance when planning for a new child. While some individuals expressed positive experiences
regarding being born after such a loss, others conveyed negative sentiments. Nearly all participants recalled
witnessing their parents' grieving process while growing up. This underscores the significance of assisting
parents through the grieving process after experiencing child loss and stresses the importance of transparent
communication about the departed sibling to alleviate uncertainty for subsequent children. Offering
psychosocial support during the developmental stages of children born after such a loss could be pivotal in
averting potential psychological distress.
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Authors Contributions: The author(s) have declared that they have made a significant scientific contribution to the study and have
assisted in the preparation or revision of the manuscript
Peer-review: Externally peer-reviewed.
Conflict of Interest: No conflict of interest was declared.
Financial Disclosure: No financial support was declared for this study.
