I received an e-mail this morning from a friend and
colleague whom I generally respect, but who occasionally gives me the urge to
beat him about the head and shoulders with a blunt instrument I keep for that
very purpose. My friend had received an e-mail himself, from a third party who
spoke of her experiences with depression following adoption of two children. His
comments to me got up my nose, put my knickers in a twist, etc. (British
readers, please fill in other colorful expressions.)
Here’s what Friend said to me about the e-mail he
had received: “ a new “disorder” to fall back on: Post Adoption Depression! At
least post-partum depression has some hormonal etiology, as I understand it,
and can be considered as real. But PAD seems to me just another
metaphor-as-reality that pervades… much of CAM”.
Let me anatomize this statement. First, I’d like to point
out that the term post-adoption depression has been used for at least ten years
in descriptions of women’s disturbed emotional states that sometimes follow
adoption. Such descriptions have rarely been more than simple case reports, and
as far as I know there are no estimates of the frequency of this problem. It’s
not mentioned in DSM, and I would guess that it’s diagnosed and treated, quite
properly, as depression without requiring any acronym or “syndrome”
description. It’s clear that some women (and no doubt some men too) become
depressed following adoption-- although
whether their condition is because of
adoption is another matter, since people become depressed under many
circumstances. To say this is not “real” strikes me as simple avoidance. The adoptive
mother feels sad and lacks energy, experiences insomnia, may be irritable, and
has difficulty conducting her daily life, including her care of her children.
No physical reason for these difficulties is apparent. … If that’s not real depression,
I don’t know what is.
Second, what about perinatal mood disorders
(post-partum depression is one)? Are these “real” because there are hormonal
changes around the time of birth, but would not be “real” if there were none?
In mood and behavior, women with perinatal mood disorders are very similar to
those who are depressed following adoption, making the two situations equally “real”,
it seems to me. In addition, it’s clear that hormonal change is only one factor
in perinatal mood disorder—it’s more likely in women who have been depressed
before, and may not come on for some weeks after childbirth, by which point any
hormonal turmoil has been moderated. And by the way, it’s not treated by
hormone supplements, which you would think would do the trick if hormonal
changes were the main cause.
Treatment of depression can be effectively done for
most people by a combination of medications and talk therapy. The special problem
for women with perinatal mood disorders is the potential impact of medication
on the baby’s prenatal development and, through breastfeeding, on its later
condition. Except in the very rare circumstance of adoptive nursing, these
issues are not present for adoptive parents, which may have diverted attention
from depression that they may experience.
I think a real issue here is the continuing
reluctance of people outside the mental health field to recognize that a mental
illness may exist and have a drastic impact on lives without any clearly
demonstrable biological reason being known. This is reflected in the emphasis
on hormones with respect to perinatal mood disorders. If your hormones are
messed up, your mood and behavior are not your fault and you deserve help. If
your hormones are not messed up, the problem is your fault and you should pull
your socks up and stop being such a whiner (you wanted that child, didn’t you?
Well, then!). We see the same orientation when national mental health groups
refer to mental illnesses as “brain disorders”. Of course, at bottom they do
involve brain disorders in some form, and are no more under the patient’s
control than Parkinsonism is, but the effects and treatment of mental illness
are so different from those of, say, brain injuries, that the only reason for
blurring the distinction seems to be to defuse public attitudes.
People adopt children. Subsequently, for whatever
reason, some of them experience debilitating depression. I don’t see what’s not
“real” about that. I’d like to see the
post-adoption problem more clearly recognized and studied. Adoptive parents
need to understand that depression is possible for them as well as for
biological parents, and is as harmful to their parenting abilities as it is for
biological parents. I would also put forward the following questions: to what
extent to difficulties in adoptive parenting stem from parental depression,
which goes untreated as long as the mental health focus is on the child’s
condition? Does untreated depression make adoptive parents unnecessarily vulnerable
to the promises of unconventional psychotherapists, who propose to “fix” the
child? Does untreated depression attract adoptive parents to the idea that
adopted children are all grieving for their lost mother and unable to form a
good relationship in the adoptive family? These questions can’t be answered
until we recognize and study adoptive parents who experience unexpected
depression soon after adopting.
Here’s an interesting tidbit that I can’t seem to
fit in above. Frank A. Beach, the late, great, American researcher of
reproductive behavior, found that being exposed to rat pups changes both hormones
and behavior in male and virgin female rats. If they’re not experienced with
pups, the males are inclined to eat the
pups and the females to ignore them when they squeal for help. Put them in a
cage where they see and hear pups for a few days (but can’t eat them), and both
will begin to retrieve a squealing pup the way a mother does when it gets out
of the nest. AND guess what, their hormones change too. As far as I know, no
one has tested post-adoptive hormone changes in humans, and of course different
species can be different in most ways. Makes ya think, though.
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