Twin Loss & Bereavement
Anne M. Horvath
Madonna University

HSP5010
Dr. K. Rhoades
4-15-03

     People ask me, "What is it like to be a twin?" After a few moments of thought, I usually 
respond with, "Being a twin is like no other experience; it is having a constant companion 
with whom you can share your deepest thoughts; it is having a connection with another 
person so like yourself that it is indescribable".
     For some odd reason, I feel that I have never been able to explain it in such a way that 
I am not being looked at as if I just stepped off another planet. It is at this point that I 
am usually bombarded with such phrases as "psychic connection" and "feeling each other's 
physical pain".
     "By George, I think they have it", but not all of it, by far. I am not sure why it is 
such a hard concept to explain. Maybe it would be just as difficult for a singleton to 
explain to a twin what it is like to be "one".

     Many people are often fascinated with twins, especially identical twins who are 
genetically the same. It strikes one's curiosity and leaves them captivated when they are 
able to witness the interaction that takes place among the two. It is a twin's unspoken 
ability to communicate and interact with each other that leaves one in awe. As twins mature, 
they eventually separate and form their own identity, but the bond that they share continues 
throughout  their lifetime until one of the twins inevitably dies. 
     Even through the inherent bonds that twins share, rarely shared is the idea that 
someday one twin might be without the other. The thought of being without one another is a 
devastating and often avoided subject altogether. For a twin, it is not only the loss of the 
physical presence of their twin, but it is the loss of their "twin identity". One of the 
first thoughts of many bereaved twins is "How can I be "me" when all I have ever been is 
"we"?" "Twinship can be one of the most enduring of family relationships - and can be the 
longest. The effects of its disruption through bereavement are generally underestimated"
(Segal, Wilson, Bouchard & Gitlin, 1995).

     The following excerpt, taken from a letter written by a bereaved twin to her deceased 
twin, sheds some light on the magnitude of twin loss:

        When you left, I thought the world had stopped. Nothing mattered any more. 
	My thoughts were this: we came into this world together, so we should leave 
	together. You left me here all alone. I will never be the same again. Half 
	my heart, my spirit, 	and soul is gone. My wholeness is gone; it is no 
	longer "we" and I don't know how to be a "me". I miss you so painfully! 
	(Brandt, 2001, p. 44)

     Unfortunately, I have come to the understanding through my own grief experience that 
most singletons are not aware of the depth of the loss that a surviving twin faces upon the 
death of their twin. After all, how could they be? They can only base their knowledge on 
their singleton experience. It would be a ridiculous assumption to expect singletons to know 
and to understand the depth and uniqueness of the loss of a twin.

      Upon sharing the story of losing our sister (my identical twin), to cancer with an 
acquaintance, my little sister once told me, "Whenever I tell someone that Mary had a twin, 
they all of a sudden lose interest in me and want to know what her twin's experience was". 
This is not unusual as many singletons are intrigued by the deep physical and psychic 
connection that twins often share. Because of this connection, twins are often viewed as 
having greater validity and credibility in their grief experience of losing their twin. 
Singletons are willing to listen because it is not threatening for them. It is as if they can 
almost hear it better. They say to themselves, "I can listen to this. It is a twin thing". 
     While it may be interesting for a singleton to hear of a twin loss story, it is often a 
very unfavorable subject in the presence of a twin who has yet to experience the loss of 
their twin. A twin cannot fathom losing their "other half". Twins who have yet to experience 
such demise, while understanding the depth of the twin relationship that is lost, can never 
know the extent of a surviving twin's grief until they experience it for themselves.
     One very important and often underestimated reason that twin loss is unlike any other 
loss is due to "Utero-Bonding". Twin fetuses, unlike singleton fetuses, begin to bond together 
from the day of their conception. Brandt (2001) defines twin utero bonding as "the medical 
phenomena which occurs between multiple fetuses in the same womb during gestation. The 
fetuses interface through tactile activity" (p. 55).

     Recently, there has been a new science interest in the study of in-utero multiple 
fetuses. This is due in large to the increase in multiple pregnancies, which comprise mostly 
of twins. The study looks at what is really happening between the two fetuses and gives 
insight to the awareness and interdependence that exists amongst the twin fetuses.  Due to 
advanced technology, we are able to view the interactions between identical twins that 
occupy the same sac. Such interactions include reaching out, touching, hugging, pushing and 
even thumb-sucking. Twins in separate sacs experience limitations, although the awareness of 
the shared presence and the interdependence upon each other still exists. In a twin loss 
article published by The New York Times Nov. 24, 2001, Dr. Louis G. Keith, President of the 
Center for the Study of Multiple Births and an identical twin himself, stated the following:
       
	Anecdotally and intuitively, this is considered the strongest bond that exists 
	between human beings. One need only see a sonogram of twins in the womb, kissing 
	or hitting each other, to understand that this is a reality of a different sort, 
	a relationship "uncontemplatable" to those who have not experienced it (p. B1).

     Even for those who lose their twin in-utero, there is an evidence of bonding before 
birth as they describe their experience of feeling "half" of a "whole". While it has 
previously been thought that twin bonding begins at birth, recent studies have led us to 
believe that bonding begins from the time of conception. Twins often refer to one another as 
"womb-mate", a concept derived from utero bonding. According to Brandt (2001), unlike single 
birth fetuses, a twin's primary bonding is with one another while their secondary bonding is 
with their mother. 

     Of the stories that I have asked my mother to share of my identical twin and I, she 
always tells me of one story in particular. She said that when Mary and I were babies she 
would put us in separate cribs and that we would shake the cribs until they were close 
enough that we could reach out and touch one another. My mother has never been able to share 
such stories of my singleton brothers and sisters. This is confirmation for me that there is 
a unique bond that begins at conception and that this bonding continues throughout a twin's 
lifetime.
     Another reason that twin loss is unique is due to the fact that it does not follow the 
established societal norms and procedures for grief-management. Due to the initial bonding 
that a twin experiences, a surviving twin is unable to let go. It is the never-ending pain of 
separation that is so intense. Because of limited family, friend and professional twin loss 
knowledge and support, the surviving twin experiences ups and downs throughout their 
lifetime until their own death. 
     A third reason has to do with the "me" rather than "we" syndrome. Often, because twin's 
lives are so intertwined, they live in a constant "we" state of mind. Choices are often made 
with both twins taken into consideration and it is devastating for the surviving twin to face 
the decision-making process without their twin.
    Twin loss is different because it is the loss of a sharing and trust, unlike any other.
 Even for those twins who have their differences, there is an innate loyalty to each other 
that always prevails. Twins often define their relationship as "one in which they share their 
deepest secrets and feelings". It is a sharing that goes beyond  the norm. It is a sharing 
that began in-utero. 

    Twin loss is also a different experience for family and friends, for it does not follow 
the norms of a grieving individual, which they are accustomed to. It is crucial for family 
and friends to understand the bond that has been broken and to know that this twin is 
grieving "differently". Many surviving twins linger in their grief due to lack of support 
and understanding from family members and friends. Surviving twins may also have an 
extremely difficult time facing holidays and birthdays without their twin. 
    Lastly, twin loss is unique because there is a constant struggle to overcome the 
overwhelming pain of the loss and separation. The first thought of many twins upon the loss 
of their twin is to commit suicide in order to be with their twin again. They struggle daily 
at the thought of making it in the world as "one", without the "other". A bereaved twin who 
lost his twin to an airplane crash, wrote the following:

        After his death, I contemplated suicide thousands of times. I pleaded and prayed to 
	God to take me too.  I wanted to be with Jim more than I wanted to live. Those 
	feelings are still with me after five years of his being gone (Case, 2001, p. 29).

     What I have found in talking with bereaved twins, and through my own personal experience, 
is that the single most cause of prolonged grief for the surviving twin is the inability of 
family and friends to understand and support their loss. One of the most helpful ways for a 
bereaved twin to validate and support their feelings is to reach out to others who have lost 
their twin. This will not fill the void, but serves as a support system and reminds the 
grieving twin that they are not alone in their grief journey. 
I found this to be true in my own search for grief counseling.  Although I received 
one-on-one counseling and attended support groups, I was still unable to validate my feelings. 
It was only after I read a book entitled "Living Without Your Twin" by Betty Jean Case, that 
I was able to validate my thoughts and feelings as a surviving twin. Validation affirms our 
feelings and is an essential part of moving forward in grief-management.
     The following is a list of suggestions that was compiled from a survey completed by 
fifteen bereaved twins and is designed to help family, friends, and professionals better 
understand and support a surviving twin:


  	Acknowledge that the loss of a twin is a complex and unique loss and that the 
	surviving twin grieves different than other family members.

  	Acknowledge that the surviving twin needs to be referred to as a "twin". 
	"Once a twin, always a twin".

  	Acknowledge the twin bond that began in-utero and understand that the surviving 
	twin always has a yearning to be with his or her twin.

  	Acknowledge the surviving twin's need to be included in funeral arrangements 
  	(if old enough) and to be included in the division of the deceased twin's property.

  	Talk openly about the loss of the twin and about his or her life.

  	Acknowledge that the twin bond has been broken and the surviving twin must 
	learn to live as a singleton.

  	Avoid trivializing a twin's feeling of loss. The connection is deep and everlasting 
  	and came into existence before birth.

  	Comfort and love the surviving twin. Let them know that he or she is still important.

  	Be aware of the fear of being alone that the surviving twin feels.

  	Do not state the words, "I understand how you feel". Even though another surviving 
	twin can understand the depth of the loss, every relationship is unique and twins 
	are no exception.

  	Do not set a limit on the grief process. There is no way to predict or dictate its 
	process. Bereaved twins experience grief highs and lows throughout their lifetime 
	until their own death.

  	Do not avoid the surviving twin even though they may remind you of the deceased 
	twin. This avoidance and rejection adds more hurt to the already bereaved twin.


     While it might seem like there is a lot to understanding twin grief, it is really a very 
simple concept. What it really boils down to is simply learning, listening and being 
supportive. 
     It is equally important for a surviving twin to understand that friends and family may 
not realize the intensity of grief that a bereaved twin experiences. It is not imperative 
that they have all of the answers. Sometimes, there simply are no answers.  Having some twin 
grief knowledge is a good start. A bereaved twin may help by providing their family and 
friends with literature or suggest a book on twin loss that they find can provide insight.  
     Although limited, there are resources available on twin loss. The Internet is the 
greatest source since it provides us with numerous resource options. Most individuals have 
access to the Internet and if you do not own a computer, most local libraries have them 
available to the public. It is possible to find books, articles, Internet grief support chats 
and various grief websites that provide resources and links on twin loss. It just takes a 
little bit of effort and know-how. 
     There is no doubt that twins possess unique characteristics, which set them apart from 
singleton siblings. So too, is their unique grief experience upon losing their twin. Only 
recently have studies been able to verify the existing bond of twins in-utero and contribute 
this as a major factor in assessing a surviving twin's grief. With the heightened awareness 
of grief-management and the increase in multiple births, it can only be expected that twin 
loss will become a bigger piece in the grief-management puzzle.

	References

	Brandt, R.W., (1998, Summer/Independence Day Edition).	 
	Utero bonding and its effects upon survivor twins. 
	Twinsworld, 4(2), 16-17.

	Brandt, R. W., (1998, Summer/Independence Day Edition). 
	The age of womb discovery. Twinsworld, 4(2), 18-19.

	Brandt, R. W. (2001). Twin loss. Leo, IN: 
	Twinsworld Publishing Company.

	Case, B. J. (2001). Living without your twin. Portland, OR: 
	Tibbutt Publishing Co., Inc.

	Facts & Stats (n.d.). Retrieved February 20, 2003 from 
	http://www.twinsmagazine.com/Facts&Stats.shtml

	Gross, J. (2001, November 24). For twins, a lost double and 
	a missing half. The New York Times, pp. B1, B6.

	McDonald, A. (2002). Bereavement in twin relationships: 
	An exploration of themes from a study of twinship. 
	Twin Research, 5(3), 218-226.

	Segal, N. L., & Blozis, S. A. (2002). Psychobiological and evolutionary 
	perspectives on coping and health characteristics following loss: A twin study. 
	Twin Research 5(3), 175-187.
	
	Segal, N. L., Wilson, S. M., Bouchard Jnr, T.J., & Gitlin, D. G. (1995).	 
	Comparative grief experiences of bereaved twins and other bereaved relatives. 
	Personality and Individual Differences, 18(4), 511-524.

	Steinhauer, J. (1999, November 29). 
	Twin births rising: So is parental stress. The New York Times, p. A25.

	Woodward, J. (1998). The lone twin: 
	Understanding twin bereavement and loss. London: Free Association Books Ltd.