Dr Thomas Stuttaford on multiple births, psychiatric disorders, 
stress, Alzheimer's and asthma.

In a memorable interview, Enoch Powell described his sense of guilt and sorrow that he 
returned from the war while so many of his contemporaries were killed.  How much more 
disturbing for a surviving twin who has lived with a brother or sister in the enclosed world 
of the womb, only for the sibling to die in the last weeks of pregnancy, during delivery or 
later in the nursery.

Surviving twins start life with a sometimes unbearable sense of guilt, for they blame 
themselves for their sibling's death and subconsciously, or even consciously, suspect that 
their parents also see them as murderers who have killed the other baby by taking more than 
their fair share of the nutrition, or of the available space, in the uterus.

 Surprisingly, the emotional and psychological problems felt by the surviving twin, which are 
often expressed as depression and sometimes as behavioural disorders,are more intense if the 
child has no recollection of the death of the other twin.  Sometimes surviving twins also 
have a sense of insecurity, for they reason that if the parents couldn't keep their brother 
or sister alive, are they likely to do any better with them?

Coupled with the feeling that he or she is guilty, the twin who lives may also sense that 
they have been deserted by the dead sibling, who has left them with an immense obligation to 
make it up to the parents for the family loss.  Thereafter they believe that they have to do 
better, and be better, because of the death - emotions which can put a great burden on 
shoulders which are not always strong enough to carry them.



 In a report in the journal Advances In Perinatal Medicine, the author describes the state 
of being a twin of a stillborn baby as a psychological catastrophe.  This may be an 
overstatement, but several research projects have demonstrated that these children have an 
increased chance of suffering from depression in adult life.

The advice given to parents in the authoritative work on twins, Multiple Pregnancy, suggests 
that a surviving twin should be told about the dead baby from the start.  Parents, other 
members of the family and teachers should not only talk about the lost twin, but should show 
that they are ready to listen to a confused young child's delusions, however bizarre, about 
their supposed murderous foetal life, and should be prepared to provide the necessary 
reassurance.

 Not all women are equally liable to have twins.  In the Western world, twins are conceived 
more often when the sun is shining, for the sun is thought to influence ovulation through 
its effect on the pineal gland.  Certainly there is a slight increase in the number of twins 
conceived during the summer months.  The rate of twin pregnancies varies throughout the world
 - in some parts of West Africa it is four times greater than in Britain, which has a rate of 
12.4 per thousand.  Larger, taller women have twins more often than do those who are short 
and petite, and there is a strong familial tendency to produce twins.
  
When twins run in a family, the babies are usually not identical and it seems that 
inheritance comes down on the mother's side.  There is also a very slight familial tendency 
to have identical twins, in which case either parent may transmit the appropriate genes.

It is difficult to be certain how many twins are actually conceived as opposed to being born,
 as twins are very vulnerable in the early days of a pregnancy.  Many die during the first 
stages of development.  Since the use of ultrasound has become standard, it is apparent that 
twins are conceived much more often than was hitherto supposed.  It now seems likely that at 
least 3 percent of all pregnancies start as twins, but that, in nearly a quarter of cases, 
one twin disappears.

 The loss of a twin at this very early stage of pregnancy does not have the same long-term 
psychological implications for the surviving twin as it would do if the death occurred 
later.  The mother, too, is probably unaware that the second foetus ever existed.


Headline: Ghost of the Missing Twin; Body and Mind
Byline: Dr Thomas Stuttaford
Source: The Times
Issue Date: Thursday August 08, 1996
Page: 14

*Multiple Pregnancy, edited by Humphrey Ward and Martin Whittle, is published by 
the Royal College of Obstetricians and Gynaecologists, Pounds 48.