Siblings of retarded children: A population at risk

Abstract

One of the major tasks of contemporary child psychiatry is to build programs of early intervention to prevent the development of emotional illness in children. In order to construct such programs it is necessary first to identify those groups of children who are frequently seen at child psychiatric clinics and are likely to have emotional problems. Among the many groups of children frequently seen in clinics, the siblings of retarded children comprise one important identifiable group.

There are many factors responsible for the problems of this group: excessive parental attention to the retarded child and relative neglect of the siblings, the identification of a sibling with the behavior of a retarded child, a normal child's anxiety over the meaning of retardation and its relationship to his own sexual and aggressive fantasies. One of the most important factors responsible for the symptoms and symptomatic behavior of this group is guilt. Evaluation of these children and of their parents reveals the importance of unconscious parental guilt about the retarded child, the mechanisms that parents employ to deal with guilt, and the effect of these mechanisms on the sibling's personality, attitudes, behavior, and symptoms.

Parental guilt based on fantasies about the meaning of having a retarded child, unconscious and intolerable, is often projected onto the normal sibling who is then held responsible for the trouble. Parental superegos indict the sibling who is perceived as angry and destructive. Anger at the retardate, which further intensifies parental guilt, is displaced onto the scapegoated sibling whose own conflicts over aggression are intensified. Via the mechanism of introjection and identification the normal child in some cases takes on some of the characteristics of the retarded sibling; this identity both serves a defensive purpose to ward off anxiety and guilt and leads adaptively to parental acceptance. In other cases the child's guilt may lead to overcompliance, nonlearning, or a masochistic search for punishment. The guilt-ridden sibling may further project his own guilt and take on a blaming and attacking attitude toward others including therapists. The family mythology provides clues as to the blending of mechanisms used.

Clinical examples are cited and treatment implications discussed.