Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Friday, February 6, 2015

An Observable Problem for Adopted Children, and Why We Need Not Look for a "Primal Wound"


Periodically, I receive complaints and vituperation from readers who insist that any emotional discomfort they feel as adoptees is evidence for a “primal wound”--  damage posited by authors like Nancy Verrier to result from the breaking of a prenatal emotional attachment when an infant is separated from the birth mother. I’ve pointed out repeatedly that there is no evidence that attachment of baby to mother occurs prenatally, although obviously many, even most, women develop preoccupation with and love for their baby during the course of the pregnancy. There are plenty of factors other than a “primal wound” that could account for the distress reported by some adoptees when they reach adulthood.

As a general rule of critical thinking, it’s better not to assume that there exist more factors than are needed to account for an event. This is a rule often called the law of parsimony, or “Ockham’s razor”. This rule does not say that there could never be any causal factors other than the ones you know about--  just that it’s wiser not to think that there are unless you have really good evidence to support the idea. That’s why I follow an old tradition of scientific thought in saying that if there’s no evidence for a “primal wound” except that some adoptees feel distressed, and there are other factors that appear to cause that distress, the best decision is to reject the idea of the “primal wound”.

The decision that’s made about the “primal wound” idea is one that has many practical implications. One is that if the PW exists as an insurmountable problem, there is no point considering other issues about adoption, fostering, and the way children are cared for or transitioned between caregivers. Accepting the PW idea means that there should be no adoption except in cases where all of a baby’s relatives are dead or incapable of care. Yet it’s clear that there are many cases where birthmothers and others are very much alive, but have social, emotional, or medical reasons for choosing not to care for a child. There are also many cases where birthmothers or relatives want to care for a child but are not safe people for the child to be with. Although there are strong arguments against allowing adoptions to be “brokered” by people whose agendas push for separation of parents and children (see Kathryn Joyce’s Child Catchers), either adoption or institutional care continues to be needed for numbers of children across the world, and we continue to need to know more about how best to handle this situation.

A recent article in the journal Adoption & Fostering is very relevant to that need (Boswell, S., & Cudmore, L. (2014). “The children were fine”: Acknowledging complex feelings in the move from foster care into adoption. A & F, 38, 5-21). The authors, two British child psychotherapists in the Child and Adolescent Mental Health Service,  focused on what happens as children who have been fostered move into adoptive homes. Boswell and Cudmore point out that “Adoption involves huge long-term gains for children, but leaving the care of their previous home will also involve a major loss”--  the loss of a foster parent, who may be the only caregiver a young child can remember, and who is very likely to be the only stable caregiver he or she has known.

Boswell and Cudmore noted that “In order for children to feel safe enough to settle into their new family and start the process of forming a trusting relationship with their adoptive parents, they will need adults around them who recognize that they are experiencing a major loss [the loss of the foster parent—JM], and who are able to support them emotionally by remaining attuned to what this loss means for them. This involves holding in mind the loss of a meaningful relationship while doing everything they can to nurture a new one.”

Boswell and Cudmore stressed the lack of research or other sources of guidance on how these transitions were best made.  Looking at current practice in Britain, they found that “children are usually moved within seven to 14 days of meeting their new parents  and once moved, generally do not see their foster carer again for at least three months, often longer, and some not at all. Younger children and babies tend to be moved more quickly.” Some agencies stated that a child’s strong attachment to the foster parent was a reason to avoid contact, not to encourage it.

Part of Boswell and Cudworth’s research focused on the attitudes and expectations of foster parents as they prepare to let an infant or toddler whom they experience as “theirs” go to an adoptive family. “Although a great deal of attention was paid to the continuity of routine—food, toys, smells, bedtime arrangements, life story books—it seemed much harder for the adults to remain fully in touch with the children’s emotional state and the fact that they would be losing a very  significant relationship.” Foster parents were told, and told themselves, that they must keep a professional perspective and not allow their own feelings to dominate. This was “to protect adoptive parents from being burdened with the child’s attachment and impending loss… [The adoptive parents] already in a state of high anxiety, … felt they could not have coped with the foster carer bombarding them with her own feelings of loss, or with the level of attachment between herself and the child”.

According to Boswell and Cudworth, deep emotions about the transition from the foster to the adoptive homes were usually seen as belonging to the adults, not to the children, who were generally considered as “fine”. This was taken as a reason not to encourage early contact with the foster parent--  “the prospect of a premature contact with the carer raised fears of an uncontained outpouring of distress, images of a clinging, sobbing child... there seemed to be a shared belief among adopters, foster carers, and social workers that old attachments needed to be broken and forgotten about before new ones could be made, leaving any underlying grief to subside as quickly and as quietly as possible.” 

This report about adoptive transitions in Britain jibes with events in the United States, where adoption caseworkers may also feel that their object is to break whatever connection has been made with the foster parent in order to facilitate a new attachment, and where one occasionally hears of such things as a caseworker picking up a sleeping one-year-old from the foster home and placing her still asleep in bed at the adoptive home, to awaken later completely bewildered.

As Boswell and Cudworth point out, and as Mary Dozier has also shown, both theory and research emphasize that gradual transitions in care are best for young children and for their caregivers. In fact, an old attachment does not have to be “broken” through abrupt separation in order for new attachments to occur; that old idea seems to have hung on from the days when John Bowlby posited monotropy of attachment, with a single attachment figure. We know now that attachments to several adults and perhaps some children are normal parts of young children’s emotional development, and one attachment does not have to be wrenched away in order for others to thrive. Considering the course of human evolutionary development, it’s difficult to see how else things could be.

When transitions to adoption are abrupt, young children have experiences with foster parents who withdraw from the relationship out of their own adult grief and the fear that they will be unprofessional, as well as with adoptive parents who can’t bear to face what the newly-resident child might actually be feeling. Neither set of adults can possibly offer the emotional support the young child needs in the face of overwhelming change, These are just facts of life, not ways of blaming either foster or adoptive parents. In order to help the parents help the child, we need to provide them with serious professional support--  which can be brought to bear only when everyone in the picture has a better understanding of the realities of attachment. That hasn’t happened yet.


It certainly won’t happen if the focus is on the “primal wound/”

4 comments:

  1. Made up garbage on attachment knows no bounds:
    http://instituteforattachment.org/how-an-adoptive-mom-becomes-a-nurturing-enemy-the-unfortunate-effects-of-reactive-attachment-disorder/

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    1. Thanks so much for sending along this discouraging example. Unfortunately, we are also moving from attachment-means-whatever-you-want-it-to-mean, to trauma-means-whatever-you-want-it-to-mean.

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  2. Hmmm lost my previous comment I think. Anyway, I will try again. Thank you Jean for continuing to raise an eyebrow at the damned Primal Wound Theory. It provides a detrimental excuse for adoptive parents so that they need not look at what they may be doing wrong as parents to cause their children to struggle. They can instead simply chalk it up to their child being irreparably damaged by virtue of being adopted. I think the theory was designed to absolve adoptive parents of any responsibility for adopted persons' unhappiness.

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    1. Thanks Campbell-- sorry about that, mine mysteriously disappear sometimes too.

      More on this topic tomorrow if I get a chance.

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