Not-Quite-Forever Families: The Reuters Investigation Into "Re-homing" of Adopted Children (Part I)

There is a remarkable report at www.reuters.com/investigates/adoption/#article/about. This document describes an investigation into the ways some American adoptive parents seek informally or privately to disrupt the adoptions and place the children in others’ homes, permanently—a process they call “re-homing”.

The Reuters report is remarkable in more than one way. As an investigation of  adoption disruption, it moves beyond the limits of anecdotes and looks at one of a number of Internet bulletin boards that carry ads offering adoptees to new families. It provides an interactive graphic that allows the reader to examine over 200 such ads and to see at a glance how many boys and how many girls were “offered”, how many children had special needs, whether they were adopted from the U.S. or from abroad, and what their birthplaces were. (There are a number of other interesting questions to be asked about these ads, and I hope to be able to provide some information about these in the near future, as well as to suggest some conclusions that might be drawn from the information collected by the Reuters investigators.)

The Reuters report is also remarkable in terms of one of the responses it’s received. At http://www.pbs.org/newshour/bb/nation/july-dec13/adoption_09-11.html, Adam Pertman of the Evan B. Donaldson Adoption Institute, a leading U.S. adoption advocate, stated that he had never heard of this practice! (This reminds me of the advice to Alice that she should be able to believe six impossible things before breakfast.)

Perhaps Mr. Pertman was not paying attention when this issue came up in the past, but others of us had noticed it. For example, the USA Today reporter Wendy Koch described in 2006 the situation of the Schmitz family in Tennessee, a “megafamily” with 11 adopted children, many with special needs, whose mistreatment of the children led authorities to discover that most of the “adoptions” were informal. The children came from different states, which were paying for their care, and at least one child’s origins were not known (www.usatoday.com/news/nation/2006-01-18-swapping-children_x.htm). In a recent comment on the Reuters story, a member of the megafamily, now grown up, told how she was made to dig a large hole and told that it would be her grave. She had been re-homed to the Schmitzes after her original adoptive family decided to disrupt her adoption, but no legal formalities or investigations occurred (http://investigations.nbcnews.com/_news/2013/09/09/20389254-adopted-girl-says-mother-forced-her-to-dig-her-own-grave?lite).

There are many anecdotes in circulation about adoptive families who “handed off” unwanted children to others at highway rest stops or in fast food restaurants. I can give more details of one case where I provided some testimony, but naturally I will conceal names and places. This story involves a couple in a Southern state who went to Russia seeking to adopt about seven years ago. They wanted to adopt a boy, and had decided on a specific boy who was about 8 years old at the time, but were then informed that if they took the boy, they must also take his 5-year-old sister, whom I’ll call Irina. The adopting couple agreed to do this (and, by the way, there was a similar situation in the adoption of Maxim Kuzmin, the Russian 3-year-old who died in Texas last winter.) They took both children home and cared for them for a couple of years, but in fact they did not like Irina and complained that she did not attach to them and they could not bond with her (what people mean by these terms is an issue that needs much discussion with respect to the Reuters report). They sought the help of two social workers who identified themselves as attachment therapists and who stated in court that they had received training paid for by the state. One of their recommendations was that Irina spend time in respite care, in the home of another family, leaving the adoptive parents and brother to relax on their own.

After several intervals of respite care, Irina’s adopters decided that they did not want her to return. They communicated their decision to the social workers, who told Irina that she was to stay at the respite home; the adoptive parents did not see her even to say goodbye. The respite family was licensed to do foster care, and after a while they agreed to adopt Irina. In the state where they lived, it was possible to do this by direct consent, with a notarized statement from the original adoptive parents, and because the respite family was licensed for foster care I would guess that a home study was waived. In any case, Irina stayed with the respite/adoptive family and did well in school for a couple of years, but at about age 10 she ran away. She was soon brought back by a sheriff’s deputy. After her second attempt to leave, the deputy who brought her home made an excuse to come into the house. He noticed some unusual things, for example that there were very few furnishings in Irina’s room and that there was an alarm on her bedroom door, and he reported these matters. A prosecutor who was aware of some of the unorthodox and potentially harmful parenting methods associated with Attachment Therapy began an investigation.

However, the respite/adoptive parents knew how to move quickly to get Irina out of that jurisdiction. They sent her to a boarding school run by their church in another state--  a school that had been investigated for abusive treatment in the form of physical restraint of children, but had argued successfully that guidelines about restraint and seclusion did not apply to schools. It was, and probably still is, a school where a number of Russian adoptees waited to be 18 without visits to their adoptive homes or even from their adoptive parents.

Perhaps this story will help flesh out some of the statistics of the Reuters report. But those statistics, and some further analysis, are worth looking at, and we’ll come back to them.

    

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Banning a Pseudo-therapy: A One-Off, or a Breakthrough?

A New York Times editorial this morning commented on the unanimous upholding  of the California law prohibiting “conversion therapy”, aimed at changing the sexual orientation of minors, [ without that comma this reads very oddly indeed] by the Ninth Circuit Court of Appeals (www.nytimes.com/2013/09/08/opinion/sunday/banning-a-pseudo-therapy.html?partner=rss&emc=rss&_r=0). According to the Times, the panel of judges concluded that the law did not violate the free-speech rights of therapists and minor patients or the fundamental rights of parents, because it did nothing to prevent licensed therapists from discussing the pros and cons of conversion therapy with their patients. The law regulates conduct, not speech, the panel reasoned, and lies well within the power of the state to prohibit practices it considers harmful to minors.” (Not to change the subject, but this does make me wonder whether contributions of money will no longer be protected as political speech, or whether the Citizens United decision will somehow be twisted around to declare that conduct is speech and therefore is protected under the First Amendment…. We’ll see.)

How did this legislation get passed either in California or in New Jersey? Organizations of licensed mental health practitioners of all stripes have usually resisted any state regulation of their practices and have made clear their sense that professionals were best regulated from within their own professional group, but in this case professional organizations were highly supportive of the bills.

The Times editorial commented that the California legislature “relied heavily on professional reviews of the scientific literature” , but in fact very little systematic research on conversion therapy has ever been published and hardly amounts to enough for a meaningful review. Reports of adverse events have been anecdotal and in many cases were supplied by former conversion therapy patients, many of whom were quite justifiably angry at the whole experience. The reports of harm included depression, suicidal thoughts and behavior, and substance abuse, all of which also occur outside conversion therapy.

So, am I saying that conversion therapy for minors should not be prohibited? No, certainly not, and I testified in favor of the New Jersey bill, rejecting the treatment on the grounds that it borrowed unsupported beliefs and methods from other alternative psychotherapies which I would also like to see prohibited. What I am saying is that the science, although supportive of the legislation insofar as it could be, was not a serious factor in passage of these bills, but simply a decorative feature brought in as an extra talking point.  

How, then, did the bills really get passed? I am convinced that the actual motivating force was the enthusiastic organized pressure exerted by the LGBT community and the current groundswell of approval for LGBT freedoms. Essentially, LGBT groups argued that therapists ought not to try to change young people’s sexual orientations--  that whether such attempts “worked” or not, they were an intolerable interference with the rights of the individual, and many who had experienced the treatment had reported how unhappy it made them. The fact that the science, such as it is, supported these claims was simply a useful addition to the basic argument.  

I’m thinking about this in some detail because I wonder whether the conversion therapy legislation will open the doors for prohibition of other “pseudo-therapies” (to use the Times term) for children and adolescents. Legislation prohibiting treatments like “holding therapy” has rarely been passed, probably because mental health professionals who do not approve of these treatments are almost as likely to oppose such legislation as those who do approve. As I said before, generally speaking, organizations of mental health professionals have feared and fought efforts to regulate their practices. When therapists have injured patients (cf. John Rosen, Jacqui Schiff, Connell Watkins, etc.), legal proceedings against them have handled the events as examples of assault or of child abuse, not in terms of the use of potentially harmful therapeutic methods. In most cases, the state has no option for proceeding against a professional whose methods may do harm, and in mental health circles there have been few cases where a professional organization has disciplined someone for potential injuries (although sexual acts are always a reason for discipline even when no definite injury can be demonstrated).   The upshot of all this is that  legislation is the most powerful way to regulate potentially harmful practices, but the legislation opposing conversion therapy is a rare success in achievement of such regulation.

If the conversion therapy legislation is a breakthrough, it is possible that prohibition of other potentially harmful psychotherapies for children can be realized. The science is there, in better quality and quantity than what was brought into the conversion therapy discussion. It’s possible that professional groups, having swallowed the oft-rejected option of regulation by the state in the one case, may accept it in other cases as well. But, where is the enthusiastic, highly organized  group who will apply pressure on legislatures as the LGBT community did? This I don’t see, and I believe that organized pressure was the major reason for successful legislation.

There is increasing concern among psychologists and psychiatrists about the possibility of adverse reactions to various forms of psychotherapy, and research is much more likely than it once was to look for such problems. Unfortunately, some treatments for children are not likely ever to undergo formal reviews for safety and effectiveness, nor are therapists using these methods likely to be disciplined if a problem occurs. The reason for this is that alternative psychotherapies for children increasingly have parents do the actual treatment; if there are adverse events, the parent is at fault. All the therapist does is to instruct the parent and provide information, in return for payment, and since 1976 such commercial speech has been considered to some extent protected under the First Amendment.

It’s discouraging, all of this. But it reminds me of a statement whose source I used to know: “The day is short, the workmen are lazy. The task is difficult. It is impossible to succeed. Nevertheless, we are forbidden not to try.”  

Stop Spanking Children? First, Let's Stop Intruding On and Frightening Them

Like many other people, the psychologist Elizabeth Gershoff is opposed to spanking children, and she argues strongly against the practice in an article called “Spanking and child development: We know enough now to stop hitting our children” (Child Development Perspectives, 2013, 7(3), 133-137). Gershoff points out the unlikelihood that parents will manage to use physical punishment effectively and discusses spanking as a human rights violation.

But interestingly, a foremost evidence-based intervention program for at-risk foster children does not  tell parents not to spank. ABC (Attachment and Biobehavioral Catch-Up), the program created by Dr. Mary Dozier of the University of Delaware, does not include suggestions about spanking in its coaching of foster parents of infants and toddlers. Answering questions about this at an infant mental health organization’s meeting yesterday, Dr. Dozier said the research group had decided to omit this issue rather than destroy their credibility with parents by coming across as “weird psychologists” telling people not to spank--  when in fact most parents world-wide do  occasionally spank their toddlers.

ABC is most concerned with encouraging sensitive and responsive caregiving for infants and toddlers with backgrounds of serious neglect or abuse. These at-risk children need foster parents who can provide the optimum environment for improved development by understanding their needs and sensitively reading their signals.  ABC coaches foster parents to be aware that these children need nurturance although they don’t appear to want it. In one video clip, a toddler was seen falling down, starting to get up, then lying down again--  all without crying or calling to his foster mother. But the mother had been made aware that he needed nurturing even though he did not seem to “say so”, and she went to pick him up; both smiled and the pick-up had clearly been what he needed. ABC also coaches foster parents to behave contingently by imitating a child’s movements or by following the child’s lead in play rather than doing something that is instructional or “more interesting” and ignoring the ideas that have engaged the child.

Parents who increase their nurturing behavior, who read signals sensitively, and who follow the child’s lead are less likely to get into situations where they see no option but spanking. In that sense, ABC follows the old behaviorist model of reinforcing desirable behavior and leaving less time or opportunity for undesirable behavior. And even though the ABC program does not mention spanking, it does focus specifically on some undesirable behaviors and try to  diminish them.

Even parents who have increased their level of nurturing and contingent behavior toward young children may still have habits of approaching the children in undesirable ways that disrupt progress toward good communication and biobehavioral regulation. One problematic behavior is intrusiveness. Intrusive parents tickle, chase, or tease young children excessively and fail to pick up cues that the children are distressed--  cues that are often subtle or difficult to read in infants and toddlers who have been neglected or abused. Intrusive parent behavior can be dysregulating, especially if the unobservant parent does not realize that the child has been pushed to the point where some calming and nurturing is needed. (Parental intrusiveness over the years has been related to later mood and behavioral disturbances by the psychologist Brian Barber.) Certainly, parents who are habitually intrusive will have a hard time following the child’s lead as the ABC program encourages them to do. Yet, just as it is hard to get children to stop doing things we don’t like, it is hard to have any success in telling intrusive parents to stop being so intrusive. For ABC coaches to try to do this would be likely to frighten or anger parents and damage their alliance with the coaches, so the approach required is to wait for non-intrusive behaviors and comment on them positively, pointing out how well the child responds to this.

In addition, to undesirable intrusive behavior, parents may habitually behave in frightening ways. These may involve yelling, looming over the child, giving angry looks, or even giving intentional frights by jumping out of hiding or threatening to leave. Parents may act frightening in order to intimidate a child and keep him uncertain in ways the parents think will increase compliance--  but in fact the dysregulating effects of fear and uncertainty may make it even more difficult for the child to stay calm and understand what is wanted of him. Some parents may behave in frightening ways simply to “get a rise out of” the child, who seems to them unsatisfyingly unresponsive or inattentive, and others may do so simply in imitation of adult behavior they have seen or experienced. Increasing empathy and sensitivity to child cues can help parents reduce their frightening behavior, especially if they also discover that nurturing and contingent parenting can help the child be more responsive to them.

Which would be better, a parent who never spanked, but often behaved intrusively and frighteningly, or one who occasionally spanked but rarely intruded or frightened in other ways? My bet would be that the better outcome would result from the second way of parenting—and we do have evidence that people can be helped to stop intruding on and frightening children. Concentrating on spanking gives a lively topic for unending discussion, but perhaps is not of much help with respect to actual improvements in parenting.

P.S. A query: what do you think many neighbors and family members would say to the mother in the ABC program who picked up the child who had fallen but was not crying? “You’re spoiling him” is what I hear in my imagination. And perhaps this would be an unwise move for a healthy child from a stable, caring family background--  but don’t forget, we’re talking here about infants and toddlers who are in foster care, very possibly because they have been neglected and abused. Nevertheless, we can learn a lot about parenting in general from seeing what works for foster parents of at-risk children. 

Attachment Disorders Versus Depraved Hearts: Further Adventures with Unconventional Mental Health Perspectives

On many occasions, I’ve posted on this blog comments about “attachment disorders” in adopted children--  not Reactive Attachment Disorder as described either in DSM-IV-Tr or in DSM-5, but a notional set of problems posited by proponents of Attachment Therapy. The symptoms of these disorders include disobedience, a love of blood and gore, cruelty to animals, “crazy lying”, making eye contact only when lying, the absence of conscience, aloofness, ingratitude, etc. Such disordered moods and behaviors, according to supporters of Attachment Therapy, occur because the children had emotional attachments broken by separation or were never given an opportunity to attach, because they were taken from their birth mothers early, or because they were abused or neglected, or because they experienced many changes of caregiver. With the rationale that a missing early experience can be supplied at any time during development, proponents of this approach claim that they can create the missing and vital attachment at any point in later development. In this stance, they ignore facts of developmental change, as well as a variety of social, genetic, and biological factors that are at work in determining personality and mental health.

There are some reasons to think that Attachment Therapy and its associated views are to come extent connected with evangelical religious beliefs (as I have pointed out at http://thestudyofnonsense.blogspot.com). But I have discovered to my surprise that people of more extreme evangelical beliefs actually consider Attachment Therapy to take an excessively worldly perspective. They reject the idea of attachment disorders as causes of childhood mood and behavior problems and instead seek Biblical explanations.

In a 2006 master’s thesis, for an M.A. in Biblical Counseling, entitled “The Biblical View of Reactive Attachment Disorder” (www.lincolnchristian.edu/library/tren/091-0077.pdf), Linda J. Rice set out a view of disturbing behavior in children that is at odds both with Attachment Therapy and with conventional understanding of child development and mental illness. According to Rice, the problem with the children in question is not that they have suffered a lack of attachment, but that they have depraved hearts.

Although Rice includes the term Reactive Attachment Disorder in her thesis title, and although she begins her second chapter with a description of Reactive Attachment Disorder as given in DSM-IV –Tr, she quickly shifts  gears to bring in symptoms of attachment disorders as proposed by Attachment Therapists. Noting that the DSM description is too vague, she writes that “practicing mental health professionals have supplemented specifics to aid in diagnosis”. Rice follows this comment with a list of symptoms drawn from the work of well-known Attachment Therapists such as Magid and McKelvey, among them the problems I alluded to in the first paragraph of this post. In an interesting departure, she refers to a child with Reactive Attachment Disorder as “a RAD”, apparently subsuming the individual identity in the diagnosis--- which may or may not be a step forward from the habit of calling such children “RADishes”.  She also refers to the children as “dissociated” but apparently means by this that the child is emotionally disconnected from others, not that he or she has moments of dissociation and lack of awareness of the environment. At the end of the chapter, however, she draws back from the frightening picture she has been painting and acknowledges that not all children with early behavioral problems will be criminals.

Rice’s next chapter explores possible causes of the problems she refers to as Reactive Attachment Disorder. Beginning with the psychological view of attachment, she refers in the same paragraph to John Bowlby, founder of attachment theory (not therapy) and Robert Zaslow, initiator of therapies that use coercive restraint in attempts to change moods and behaviors; although Zaslow apparently believed he was following Bowlby’s view of attachment, most of his approach was not based on attachment theory, but it has been the foundation of  various complementary and alternative holding therapies and attachment therapies. In this and the following chapter, Rice goes on to a freewheeling summary of ideas about attachment and childhood mental illness, mixing conventional and unconventional ideas from “attunement” to the “bonding cycle”.

Chapter 5 continues in a similar manner with information about brain development and chemistry. Here, too, there is an idiosyncratic use of the word “dissociation”, apparently to mean social inhibition. There is a certain sense in this chapter of tidying up the picnic and closing the tailgate before getting down to the real business of the thesis, an analysis of children’s mood and behavior difficulties in terms of Biblically-sanctioned ideas.

In her chapter on the Biblical approach to Reactive Attachment Disorder (so-called), Rice begins with a list of objections on Biblical terms to the explanations offered in the previous chapters. Here is her list:

Human beings are not evolved mammals, but are created in God’s image, so it is a mistake to consider  human problems  without a focus on human moral desires, consequences, and laws.

The mind is not the brain, and moral choices occur in the heart (spirit; the inner thoughts and desires of the immaterial part of man ), not in the neurons.

Genetics and brain damage cannot cause misbehavior or wrong moral choices, because bodily events are not involved in moral choice.

Responsibility is not in factors outside the child, but has to do with the fact that he is a sinner whose own lusts and rebellion create conflict; children are not innately good and are responsible for their own selfish behavior.

Hope is not in man’s ways; attachment therapy cannot transform the heart; a relationship with God can do so.

True change is not temporal, and a child who is a therapy success has simply become a well-behaved sinner rather than a dysregulated sinner.

Having rejected the “psychological” approaches described in her previous chapters, Rice goes on to discuss Reactive Attachment Disorder in Biblical terms as a problem resulting from fear, anger, and a desire for control rather than submission. She makes it clear that according to Biblical definitions of love as self-sacrificing, a baby cannot love its mother, and quotes St. Augustine to the effect that the apparent moral innocence of infants is simply a matter of their weakness and inability to carry out their selfish desires. Acknowledging that young children do not know about good and evil, she nevertheless point out that ignorance does not cancel guilt, and that true compassion will punish wrong behavior rather than letting it pass.

Harsh though Rice’s Biblical view of infants may seem, she also examines the Biblical view of parents and their appropriate behavior. They are not to provoke children to anger or to alienate them by harsh treatment, but instead should behave lovingly and kindly in order to comfort the baby and allow him to be attracted and persuaded to their beliefs. Helping the child to feel comfortable and to behave well, Rice says, prevents him from becoming habituated to angry, rebellious ways.

In a final chapter, Rice pursues her position that only redemption can cure reactive attachment Disorder. She argues against the efforts of therapists to cause children to trust their parents and thus to achieve attachment. Instead, she comments, “This emphasis distracts from the real problem, that the child does not trust God…. Shifting the child’s trust to parents keeps it misplaced on mankind.” Thus, “Teaching and inducing trust in God is where the energy of counselors and parents should be directed.” Rice further notes that “Brain damage cannot destroy the conscience because the brain is not the conscience organ. Conscience is a moral capacity. Therefore, even mentally handicapped people can know right and wrong, and confess sins, and can trust Christ for salvation. Everyone has a conscience. The problem with a seeming lack of conscience is not absence but to what direction it was trained…. Through salvation, instruction, and discipline exercised with compassion, there is hope for a hardened child to choose to heed his conscience and practice obedience and compassion.”

I am fascinated by a number of aspects of Rice’s presentation--  not the least of them being the awareness that Attachment Therapy is under attack both from conventional psychology and from a religious position. Rice’s examination seems to me (a freethinker with Quaker leanings) to make Reactive Attachment Disorder (as she defines it) fit perfectly into a fundamentalist Christian world-view. In making it fit, of course, she rejects the tenet of conventional psychology that human beings can be understood without the assumption that they have any non-material components, and instead posits a motivating principle that operates independent of brain functioning. She also commits what psychologists call the fundamental attribution error by focusing on the nature of the individual rather than taking into account events in the environment. But of course, she knows she is doing these things, and believes that she is right and the  psychologists she references wrong.  Unfortunately for those of us who are genuinely interested in vernacular beliefs about psychological issues, Rice is vague about exactly how she thinks children with behavioral disorders should be treated. Like some proponents of Attachment Therapy, she believes that children can make moral choices for obedience and compassion; whether she includes in this the voluntary control over vomiting and defecation that Keith Reber’s 1996 paper suggested, is not at all clear to me. Certainly she has presented a framework that is closed to outcome research by any researcher outside Rice’s belief system.

  

Un-Universities: Don't Waste Your Money on Their Degrees or Their Graduates

Diploma mills, “wannabe unis”, or un-universities--   whatever you call them, we seem always to have with us on the Internet organizations that will sell what appears to be evidence of undergraduate, master’s, even doctoral degrees in range of subjects. They claim to be accredited, and no doubt are--  by an accrediting board of their own devising. They rake in a chunk of their clients’ hard-earned money (although of course nothing like the cost of taking years to work on a legitimate degree) and provide in return documents that are easily identified as fraudulent by any knowledgeable reader. Unfortunately, they don’t just defraud their clients, but enable those clients to work a similar trick on the unsophisticated purchaser of their ill-trained services.   

A reader recently sent me some correspondence he had had with Ashwood University (www.ashwooduniversity.net) about a doctoral degree (“with thesis”). Wikipedia clearly identifies Ashwood as an unaccredited organization that provides degrees on the basis of life experience. Life experience evaluation is not always fraudulent, as witness New Jersey’s Thomas Edison College; an individual who has worked in bookkeeping may have mastered the material of a first accounting course, and someone who has worked under supervision with young children may have mastered information that would be learned in an introductory course about early childhood education. However, when an organization claims to evaluate life experience at the level of an undergraduate education, not to speak of a doctorate that would normally require 2 years or more of work after a master’s degree and the writing of a dissertation, it becomes difficult to imagine how any life experience could possibly provide an equivalent. (Unless, I suppose, you are one of the Rothschilds and carried out research privately following a private education.)

Material at  www.geteducated.com/diploma-mill-police/degree-mills-list/ashwood-university-accreditation confirms the Wikipedia assessment of Ashwood. Ashwood is not accredited by the Council on Higher Education or the U.S. Department of Education. (Incidentally, one of the ways you can know whether a U.S. institution is accredited is to examine its website to see whether students are eligible for loans or grants for which the FAFSA application is required. Unaccredited institutions cannot correctly state that their students are eligible.) Although many un-universities state that they are accredited, the real question is, accredited by whom? Accreditation by a shadowy self-appointed accrediting agency is for practical purposes not actual accreditation. The geteducated site points out that several states have specifically noted that Ashwood is not what it makes itself out to be.

The geteducated site also noted that there are two genuine, accredited, distance learning institutions with similar names: Ashford University of Iowa and Ashworth University of Georgia. It’s characteristic of un-universities to choose names that resemble those of respectable institutions--  for example, “Columbus” sounds all right to people who are really thinking of “Columbia”.

The reader who sent me his correspondence with Ashwood had asked the organization about a doctoral degree (I don’t know what the subject was to be). Here was part of the reply, apparently written by someone who had no editor at hand:

“This is in reference to your doctorate degree. As you do understand that the documents were awarded to you on the basis of your working experience and you never wrote any thesis to earn this degree but traditionally a student has to write thesis and do a lot of research to earn a PhD or Doctorate degree, that is why we wrote thesis on your behalf and forwarded them to the relevant authorities and on the basis of which you will get a Thesis approval letter for the  Doctorate degree and it will also be Notarized, Attested and legalized for you to easily use it. Traditionally, when a student is awarded with a thesis approval letter he/she also needs to get his/her title of “DOCTOR (Dr) and PhD” registered in front of his/her name, but as per your records this formality is not yet completed, that is why we need to get your title registered as Dr xxxxxx PhD with the higher authorities for you to officially use it with your name on your business cards, resume, driving license, passport etc. this will be the last requirement as far as your Academic profile is concerned and once this process is completed there will be no requirements from you whatsoever. This requirement is mandatory for the Educational Department and once this process is completed you will  receive your documents in the next 25-30 days time.”

The paragraph above is absolutely sic except that I omitted a number of uses of bold print. Capitals and the paucity of punctuation marks are as I found them.

I must say that this Ashwood statement gave me some degree of pause. Do they think I have a real doctorate, I wonder, even though I did, in the traditional manner, write my own thesis? I have never had any title “registered” and would not know who the higher authorities who do this might be. My diploma and the signatures of my dissertation committee were never Notarized or Attested or even legalized, yet I have “easily” used them to get jobs since I was 25 years old. As for using my degree on a business card--  I can do that, and so can anyone else, whether they have such a degree or not, as long as they do not use it to defraud. I could have named my cat Dr. Hicks Mercer and did once have a pet named James B. Klee, Ph.D. but informally referred to as J.B. (For that matter, there is the story of Dr. Zoe D. Katze, a handsome animal who became a diplomate of the American Psychotherapy Association, but that’s a different kind of fraud.)

By the way, I wonder whether communications like this letter from Ashwood are responsible for people calling or even signing themselves Dr. Naïve Person Ph.D. You don’t need both! The name is followed by Ph.D., and the degree-holder may be addressed as Dr. Person, but probably should not be in situations where someone needs first aid. I feel suspicious when I see this redundant use of the credential.

However, back to our Ashwoods. The Ashwood un-university has posted a rejoinder to criticism at www.ashwooduniversityscam.com. Cleverly and deceptively, they have chosen that “scam” title to make it appear that the site contains further negative evaluation--  but it doesn’t. On the contrary, it reports “research” showing that Ashwood is legit. This consists of a survey asking two questions: a) Do you think Ashwood University is a diploma mill?  And b) Is Ashwood University scam or not? (sic, as usual). The conclusion was that 99.9% of an unspecified number of Ashwood degree recipients thought Ashwood was fine.  So, “Research shows that it is safe to take degree from Ashwood University. Though there are negative feedback but satisfied people won the argument. Myths surface when you are don’t know something and believe rumors. This document must have helped considerably in removing misconceptions that you may have about Ashwood University.” (And indeed it did help considerably; I hadn’t realized quite how bad it was.)

Why is it a problem that organizations like Ashwood offer faux advanced degrees? The thing is that however feeble and silly some dissertation titles sound to the general public, in fact one learns a great deal in the course of writing such a document. The only comparable “life experience” would be writing a professional book or long journal article and having it reviewed, revised, edited, and published, which only a very few people do without having first earned an advanced degree (and those who do so can be respected and employed without that degree). It is almost invariably the case that a person who has not written a dissertation in a subject knows much less about the subject than someone who has done the study and writing.

In addition, there are some very special considerations when an individual has bought a degree (from $1399 at Ashwood, it appears) that puts him or her in a position to deal with others’ mental illness or social problems. Not only does the student at a legitimate university learn much in the way of scholarly work, but he or she also receives the mentoring of highly qualified people in the field, and is required to master the ethical guidelines accepted in a profession. I myself would not care to put myself under the treatment of a psychologist or clinical social worker who had avoided the intensive training in professional conduct that is part of training in an accredited institution. I would also be most concerned about the ability of such a practitioner to understand the evidence that does or does not support the safety and efficacy of a treatment.

The morals of the story are these: if you are tempted to appear to qualify for a job by buying a degree, please realize that you may well be identified as cheating, and your money will not be refunded to you when things don’t work out as planned. (Besides, what if they taught you to write like that Ashwood paragraph!)  If you are a person looking for a psychotherapist and you see that a person’s degree is not from a legitimate university, no matter how nice and sympathetic you think he or she is—look elsewhere, and do this especially if you are seeking treatment not for yourself but for a child or some other dependent person. That practitioner is attempting to defraud you and other potential clients.

Child Starvation Death in Qatar: Intentional, Accidental, or Ill-Advised?

A reader kindly suggested that I should comment about a recent case in which an 8-year-old girl died of apparent starvation in Qatar (http://www.nydailynews.com/news/world/u-s-couple-jailed-qatar-starving-daughter-article-1.1418610). Gloria had been adopted from Ghana at age 4 by a Los Angeles couple, Matthew and Grace Huang; they had been living in Qatar for about a year while Matthew worked as an engineer on preparations for the 2022 World Cup. Their case is briefly discussed by supporters at www.freemattandgrace.com, where it is stated that the California Innocence Project, an organization that defends wrongly imprisoned persons, is working in support of the Huangs, and a law firm is taking their case pro bono. They have sought the testimony of a pathologist well known for working with parents accused of child abuse. The Huangs have been described as “Christian” at www.worldmag.com/2013/08/american_christian_couple_accused_of_killing_adopted_child_in_qatar, and this presumably means that they are members of an evangelical group rather than, say, Roman Catholics or Presbyterians.

Did Gloria literally starve to death? Probably not, at least in the exact sense. She was said to have been without food for four days--  not long enough to produce death in and of itself, but perhaps sufficient to do some organ damage in a child with a history of potentially damaging undernourishment. It is also possible that her death occurred as a result of ingesting food after a period of starvation. Refeeding syndrome (see www.ncbi.nlm.nih.gov/pmc/articles/PMC2440847/) can result after five days of starvation, especially in those who are chronically undernourished.  

Newspaper reports described Gloria as periodically refusing food from her parents and then (depending on the report) either going through several days of anorexia or eating from garbage cans. Between these events, she was said to eat normally. The reports presented the anorexic periods as occurring spontaneously.

I have been unable to find any reference to such spontaneous alterations of eating behavior in searches of Google, Academic Premier Search, PSYCinfo, or PubMed. I’ve asked the Spoon Foundation (www.spoonfoundation.org), a reputable source for information on feeding adopted children, for a comment about this sort of eating behavior but have not heard back from them yet (I will report what they say if I hear from them.) [See comments below this post for responses from SPOON.]

It is certainly true that individuals who have experienced starvation can remain fragile in their appetites, responses to food, and rates of weight gain, when plenty of appropriate food is available to them. Children who were in rough-and-ready group care early in their lives may have experienced being fed as frightening or even painful and may be reluctant to eat. Gloria is said to have been small in size even several years after her adoption, and may have been somewhat difficult to nourish. However, these lingering problems, insofar as they were a continuing feature of Gloria’s life, would ordinarily be expected to be about the same from day to day, rather than showing the intermittent difficulty as it is described.

However, it is true that in some cases where there has been a period of poor nutrition, either a child or an adult who seems to have recovered can respond to an experience by loss of appetite. For instance, someone who has been anorexic for psychological reasons but has recovered may be thrown into a new anorexic episode by an infection that causes gastrointestinal problems. In children who are anxious about eating, an increase in general anxiety could affect the fragile appetite. For example, being pressured to eat a particular food, or other distress surrounding eating, could lead to a period of anorexia.

There are thus some possible explanations for Gloria’s periodic failure to eat--  although the implication that these events “just happened” is probably not correct. It is less easy, though,to explain the reported eating from garbage cans or accepting food from strangers (and surely this would have to mean begging food from strangers or at least watching them eat in a hungry way). Some references have been made to pica, the eating of unusual non-food substances like clay, in some cases in response to dietary insufficiencies, in others simply to cultural practices. However, the most parsimonious explanation for getting food in these ways is that food is not readily available to the child. When children in the U.S. are seen to take food from the garbage, the most likely situation is that they are not being fed at home.

Speculating with very few facts, I would put forward the following hypothesis: Gloria periodically did not eat what her parents offered her because of circumstances that made the food itself inappropriate for her, and/or other circumstances that made it too difficult for her to behave in ways that would give her access to the food.  

Why would this happen? Why would the parents create such circumstances, and why would they then fail to seek expert advice about unusual and potentially life-threatening problems?

Were the Huangs’ actions intended to starve Gloria and bring about her death? This seems most unlikely. Even sadistic parents do  not generally mean their ill-treatment to kill a child, although they may fail to give normal care or seek medical care, in ways that common sense would predict would be fatal.

Were the Huangs’ actions an accidental cause of death? This might be the case if the last anorexic episode was the only one, and the parents simply did not realize that there was a serious problem. But the reported history of eating problems, dating back to early malnutrition, surely indicates that they were aware of her difficulties.

Were the Huangs’ actions ill-advised? Please note that this is a very different question from asking whether they are culpable in Gloria’s death.  I’m simply considering whether the Huangs had a belief system that would lead them to act in ways that made it difficult for Gloria to get the food she needed, or that triggered her food aversion; I name both of these because the reports make it difficult to know whether Gloria did not eat at all or whether she sought food outside the family table.  

There are belief systems in the United States that recommend manipulation of food as a tactic of child-rearing. Such beliefs rarely become public knowledge, although the case of Roxanne Heiser in Texas about ten years ago showed that a child who was eating from the garbage can at school was actually being deprived of food at home by a stepmother who demanded that the 7-year-old hold weights over her head for minutes at a time before she was allowed to eat.  The stepmother believed that such treatment would cause Roxanne to form an emotional attachment to her. Advice to this effect continues to be given by the “parent educator” Nancy Thomas, who stresses that children should not be allowed to get their own food, but must receive it from the hand of the parent in order to cause attachment; she also recommends limitation of the amount and variety of the child’s diet in order to bring about complete compliance by adopted and foster children.  (Once infamous for having declared that peanut butter and jelly sandwiches with milk are a perfectly balanced diet, Thomas has now softened her views slightly.)

At the beginning of this post, I mentioned that the Huangs had been described as “Christian” in a context that suggested that the real meaning was “evangelical”. I alluded to their personal beliefs because there appear to be connections between the acceptance of Nancy Thomas’ advice and membership in evangelical groups, especially those of Pentecostal or charismatic flavor. (I have discussed the broader issues elsewhere http://thestudyofnonsense.blogspot.com/2013/06/religious-beliefs-and-alternative.html.) For these groups, as for some religious thinkers in the U.S. even during the colonial period, a parent’s duty is to make a child obey at all costs; those who disobey as children will be disobedient to God later and will be damned. In addition, evangelicals have in recent years identified adoption as part of the Great Commission (see Kathryn Joyce’s book The Child Catchers) and have focused their energies on supporting adoptive families in ways congruent with evangelical beliefs. These views presumably made the Huangs more likely to adopt Gloria, and may have made them more likely to use her diet as a control measure.

Obviously, I am in no position to say how the Huangs behaved toward Gloria or exactly how she died. I am simply putting forward some possible explanations other than accident or deliberate cruelty.

When Attachment Therapists Don't Understand Attachment Theory, Bad Decisions Are Made

In several posts in the last few months, I’ve mentioned “Eve Innocenti”, a mother who has not been allowed contact with her children since they were brought to an attachment therapy clinic in Colorado, apparently at the desire of a stepmother. These school-age children were said to suffer from mental health problems that were attributed to their early experiences with their mother, although no inappropriate experiences were ever documented. Like little boys with hammers, attachment therapists are inclined to see attachment problems everywhere, and especially focus on attachment when children have been separated from early caregivers. Attachment therapists also believe that they have methods that can cause children to become attached, or to transfer their attachments from one person to another. These beliefs are in contradiction to well-established evidence about what attachment is and how it develops and changes with age.

“Eve” has recently shared with me a report made by the county Department of Human Services in preparation for a permanency hearing next week. In it, the foster family organization that is taking care of one child is quoted as saying, “At this time his providers at ____   are not recommending that he have contact with his biological mother [Eve Innocenti]. They believe that considering the history that his biological mother would be disruptive to his attempts to gain in attachment [punctuation sic]. They do not recommend any type of contact including written contact.” With respect to the other child, the attachment therapy organization where he is placed is quoted as saying, “ they would be opposed to contact with his biological mother [Eve Innocenti]. They believe that contact with her would set back _____’s developmental progress. They believe that [Eve Innocenti] is a trigger for concerning behavior and that the confusion she brings into his life would prevent him from forming positive attachments. They do not believe it is likely that [he] would be in a good position to have any kind of contact including written and supervised calls with [Eve Innocenti] during the next six months to a year…. It is this caseworker’s understanding that ____’s therapist is recommending no contact, … due to ____’s developmental stage of attachment…”. Eve’s assigned attorney also told her in an e-mail that the boys were not being allowed to see any other family members than the man who is the biological father of one of them and his present wife.

It is hard to know where to begin commenting on the confusion which these therapists and foster care staff are imposing on the established facts and theory of emotional attachment. The first problem is the conflation of attachment with all of personality development and all of behavior. The children have been said to show conduct disorders and aggressive behavior, but these are not symptoms of attachment disorders. In addition, there is no generally-accepted method for diagnosing attachment disorders in school-age children.

One child is said to be attempting “to gain in attachment” and the other to be potentially prevented from “forming positive attachments”. These are meaningless statements. Attachment is not something a child can attempt to gain, nor is there such a thing as a “positive attachment” as opposed to any other kind. One can only assume that the people making these statements are following the lead of authors like Foster Cline and Nancy Thomas, who hold that cheerful, affectionate obedience is a result of attachment, and its absence a symptom of an attachment disorder. In reality, of course, children who are securely attached can be grouchy, disobedient, and unaffectionate, depending on circumstances and on their age. Attempts to correct these behaviors are sometimes justified, but when they are appropriate, the treatment does not involve attachment per se, although it may well focus on the relationship between child and parent.

The age issue is a very important one, and confusion about this is shown in the report’s reference to one child’s “developmental stage of attachment”. It is true that attachment theory, as formulated by John Bowlby, describes stages of attachment, beginning with many months of acceptance of all caregivers, then proceeding to a period of stranger and separation anxiety and intense grief over lengthy separation from familiar people . As toddlers develop better language and understanding of the world, they can more easily tolerate separation and develop excellent relationships with a larger number of adults; toddlers also begin to resist parents’ wishes and negotiate for what they want. By school age, children and parents ideally have developed a “goal-corrected partnership” in which each will make some adjustments in order to maintain a happy relationship. In describing these stages, Bowlby was considering not only maturation of the child’s abilities, but also the results of learning from experience with other people.

However, I would hazard the guess that the people quoted in the report on Eve’s children are not considering  the stages of attachment as Bowlby described them. Instead, I would speculate, they are thinking in terms of notional stages that were invented by Foster Cline and his colleagues several decades ago. These stages are often referred to as the “attachment cycle” (see http://thestudyofnonsense.blogspot.com/2012/08/parsing-attachment-cycle-fox-terrier-of.html). The “attachment cycle” is said to consist of two stages, one in which the child forms an emotional attachment to a caregiver because he or she is completely dependent on that person for the satisfaction of all needs. The second part of the “attachment cycle” occurs when the caregiver displays power and authority to set boundaries and enforce child obedience, once again equating compliant behavior with emotional attachment. Because neither of these stages is actually a part of the development of attachment, they cannot provide a useful way to think about a child’s “developmental stage of attachment”.

In reality, attachment develops because of pleasurable social interaction between a baby and an adult. And, because attachment is a very robust developmental phenomenon, it can and does occur even if pleasurable interactions are relatively few, and even if there is some abusive treatment.  It is important for young children to understand boundaries and rules, and to comply under certain circumstances, but these things have nothing to do with attachment. As children develop attachment, they also learn some things about what to expect from other people, and they may be securely attached to one adult caregiver while insecurely attached to another. As they develop further, they learn more about relationships with other people and may move from insecure to secure attachment or the other way around.

One of the real problems shown in the report on Eve’s children was that attachment was somehow thought of as developing independently of the rest of the child’s development, and being capable of being treated in some independent way. In fact, all aspects of development move ahead in a linked way. Children do not remain “stuck” at an early stage of development, nor can they be made to return to such a stage and rework it by regression and recapitulation. Eve’s son cannot be at some stage of attachment development that is characteristic of a toddler; things just don’t work that way. He may, for all I know, be grumpy or disobedient or worse, but these are not attachment issues. Even children who actually do have concerns associated with attachment need to be treated at their real developmental level, not at a level posited as part of an alternative theory of attachment.

The boys’ therapists apparently believe that they can act as if the children are infants, and by following some rules about how early attachment develops, they can create powerful new attachments. Presumably, this is why they want to exclude from the children’s experience adult contacts other than those with the parents-designate. (Do the foster parents and other caregivers avoid eye contact and so on, as advised by various attachment therapists, so the children don’t accidentally “attach” to them?) They presumably also believe that, like infants or toddlers, the children will grieve over and forget their lost biological mother, and be ready to attach to (i.e. , they mean, love and obey) the persons provided for them. But…  these boys are not infants or toddlers. They understand human relationships in a much more mature way, and although they may develop new and satisfying relationships, they will not forget their mother, but instead will be tormented by their belief that she could contact them but does not want to. Rather than helping them, their present treatment, with isolation from many familiar people and occasional “therapeutic” meetings with the designated parents, simply reminds them of the fearful specter of abandonment, a child’s greatest anxiety.

So far, all decisions about Eve’s children seem to have been made on the recommendation of their therapists. Soon, I hope, an actual judge will consider the facts. I only hope that he or she will have sought some understanding of attachment as it is considered in the world of mainstream psychology and psychiatry, not in the alternative universe of attachment therapy.  

"Words of Knowledge" Versus Evidence-Based Practice

It will be no news to anyone that some religious groups reject the materialistic explanations given by modern science and medicine, and consider human lives to be rightly considered as deeply interwoven with the supernatural. Members of some of these groups reject medical treatment in favor of prayer or other religious practices and similarly seek religious treatment for psychological conditions. They may attribute psychological problems entirely to supernatural events. Jenny McCarthy, the anti-vaccination celebrity, is famous for stating that she saw her autistic child’s soul go out of his eyes as he was vaccinated, a statement apparently based on the idea that autistic children have no souls. (Can this be due to a confusion of “soul” with “emotion”, as in “soul music”? It’s hard to say.)

Scientific medicine and clinical psychology are based on the assumption that all human phenomena are in essence material events, although they may not feel that way to the person experiencing them. There is a further assumption that collecting information about material, observable events can eventually allow us to understand causes and effects in human life, and in some cases to correct problems and bring about healthier physical and mental conditions. Although it is clear that some individuals feel comforted by the practice of prayer, a scientific approach does not assume that any supernatural events are actually involved in the sense of comfort.

The clash between these two views of the world, one characteristic of a fundamentalist Christian mind-set and the other of an approach that rejects supernatural explanations, is almost unresolvable, although there are people who manage to compartmentalize the two even in their most contradictory forms. There are also many who are Christians of mainstream groups and who are no part of this conflict because their beliefs do not involve supernatural influences or phenomena as part of everyday life today.

The culture conflict just discussed seems to be most serious for  people belonging to charismatic Christian groups such as the Pentecostals. These groups believe themselves to be potential recipients of the gifts of the Holy Spirit described in the New Testament as occurring at the first Pentecost. Recipients of those gifts were said to have shown the presence of the Holy Spirit by “speaking in tongues”, and to have the abilities to detect, identify, and cast out demons who caused physical or mental disorders. While mainstream Christian groups have long held that such abilities, while genuinely given in the early days of Christianity, are no longer part of life even for the most devout, charismatic groups hold that true believers (i.e., themselves) who have shown their baptism in the Spirit by speaking in tongues are also given the abilities attributed to the early Christians by the description in the book of Acts. This belief in supernatural events and abilities as part of ordinary life is completely at odds with attempts to explain and manage disorders on a foundation of scientific materialism.

Beyond this obvious conflict of world-views, there is another issue that further divides charismatics from mainstream Christians and secular thinkers who are committed to a scientific approach to medicine and psychotherapy. This issue has to do with how evidence for any claim of effective treatment is gathered and displayed. In the last few months, two posts on this blog have been related to the evidence issue but have not entered into a full discussion of the question. These were http://childmyths.blogspot.com/2013/06/conversion-therapy-reparative-therapy.html and http://childmyths.blogspot.com/2013/08/behind-kickstarter-request-helping.html. In the first, I commented on a hearing on New Jersey legislation to prohibit the use of “conversion therapy” to change minors’ same-sex orientation, in which members of the Assemblies of God argued that the treatment was an effective way to correct a condition which they predicted would have terrible repercussions if untreated. (This bill became law, by the way.) In the second, yesterday, I referred to a Ukrainian charismatic pastor who has been taking children from the street and treating them in some way for drug and alcohol addiction; I asked whether his methods were known to be safe and effective.

Practitioners of scientific medicine and clinical psychology generally share a viewpoint about how we know whether a treatment is safe and effective, or safe but not effective, or effective but unsafe, or both unsafe and ineffective. This shared viewpoint requires empirical research that identifies a specific treatment, then follows outcomes for persons who have received the treatment and compares them to another group who have received another treatment of known effectiveness. Ideally, people are assigned randomly to one treatment or another, although this is not always practical. Researchers examine not only the immediate outcome, but events several years after treatment, as we want treatment methods to provide long-term benefits.   

Why would charismatic groups not follow the same procedure in making decisions about the safety and effectiveness of treatments? There are several reasons, which I have discussed in a published paper (“Deliverance, demonic possession, and mental illness: Some considerations for mental health professionals.” Mental Health, Religion,& Culture, 2013, 16 (6), 595-611). One is the fact that  charismatic Christians do not expect problems of mental health, mood, or behavior to be cured permanently; attributing these difficulties to the individual’s spiritual condition, and acknowledging the sinful nature of human beings, they believe that most humans will “backslide” spiritually and periodically show symptoms of their problems. The most important part of their cure, commitment to religious beliefs, is accomplished, but the observable outcome may not show this--  in fact, repeated worsening of observable symptoms is very much to be expected. Considering mood and behavior alone as the foundation of supportive evidence  is simply ignoring the essential spiritual change, whose long-term benefits are to be assumed even when observable outcomes are poor.

In addition, charismatic groups reject the traditional scientific view that  investigation is a public process in which communication to and correction by others is essential to the development of reliable evidence. Instead, they are committed to the belief that knowledge is given by God to individuals, who correctly identify it as truth.  Acording to D.H. Boshart, writing in 2006 at www.christcenteredmall.com, such truth may appear in the form of a “word of knowledge”, which is “a definite conviction, impression, or knowing that comes to you in a similitude (a mental picture), a dream, through a vision or by a scripture that is quickened to you. It is supernatural insight or understanding of circumstances, situations, problems, or a body of facts by revelation; that is, without assistance by any human resource but solely by divine aid. Furthermore, the gift of the word of knowledge is the transcendental revelation of the divine will and plan of God.”

One aspect of God-given knowedge is the capacity for “discernment”. This is a form of spiritual diagnosis, and a person with this gift is able to identify whether the spiritual causes behind an event are of God, or whether they are Satanic in nature and thus require treatment by the casting out of demons. Evidence-based practice that does not include discernment would presumably seem to charismatics to be highly ineffective and even dangerous (because of the demonic factors), even though science-oriented practitioners might consider that their evidence shows a treatment to be safe and effective.

It is hard to imagine how this culture war can be resolved or even how skirmishes like the fight about the Ukrainian pastor Gennadiy Mokhnenko will turn out. However, it would be a mistake for the scientific side to assume that their opponents are simply lacking in knowledge, when in fact they are operating within a complex belief system of their own and interpreting the observable world in terms of a posited invisible realm to which only they have access.  

   

   

Behind a Kickstarter Request: Helping "Social Orphans", Evangelizing, and Corporal Punishment

N.B. I thank Yulia Massino for passing on this information and for her remarks at http://www.liveinternet.ru/users/julia_ma/post286118762/

Nobody gives to all kickstarter requests, but when people do give they generally accept that the proposed project is what it appears to be. I would doubt that many people do a serious investigation before giving, and in most cases it would be hard to know what to investigate. But here’s a project that can be looked into: http://www.kickstarter.com/projects/dannyyourd/gennadiy-our-new-documentary, a project that plans to tell the story of Gennadiy Mokhnenko, a Ukrainian who dresses as a priest and “abducts” street children, taking them to an orphanage (so the project description calls it) and detoxing them. The project description does not make it clear how this apparently informal and unofficial rescue effort is funded or why it is tolerated by the authorities, or indeed on what happens to the children as a result of this intervention—whether it is either safe or effective. Instead, it focuses on Mokhnenko’s “heroism” and on the philosophical issues associated with treating people against their will. (The project description does not make clear whether the children pictured in the documentary will have given permission for their names or images to be used.)

So far, we might identify Mokhnenko as a sort of rogue social worker who has tired of the slow grinding of bureaucratic wheels. But Yulia Massino has suggested that he may better be compared to Ostap Bender, the con artist in The Twelve Chairs. For an American comparison, we might go to Elmer Gantry, or to any of many televangelists who have done well without necessarily doing good.

Mokhnenko is the pastor of an evangelical church in Ukraine, the “Church of Good Changes”,associated in the United States with the Pilgrim Orphanage Foundation (http://www.pilgrimusa.org/who_we_are/). According to Internet sources, this foundation was incorporated in 2011 in Houston and has three employees. It is incorporated as a 501c3 entity, so it does not pay taxes, and if it is dissolved must transfer all holdings to another educational or charitable organization. Although Pilgrim does not clearly state its connection with religious organizations, there is a link on its website to www.hopeinternational.org. Hope International, in an on line statement of faith, refers to the complete authority of the Bible and to the indwelling of the Holy Spirit, thus identifying not only with evangelical but with charismatic groups. Kathryn Joyce has discussed the attitude toward adoption of such groups in her book The Child Catchers, quoting a foster mother of more than fifty children as writing: “Your main goal is not to raise well-adjusted children, but to bring the life-changing message of the Gospel to lost souls. If you work with a troubled, damaged child and he never becomes a successful or productive citizen, but he believes the Gospel and has a saving faith in Jesus Christ, you have succeeded. Adoption is a ministry to unsaved souls.”

Mokhnenko is said to be fostering over 30 children, whom he believes he has saved from orphanages, although he does not explain why living in a large group called a foster family is superior to living in a large group in a section of an orphanage. Interestingly, he has also stated his belief in the value of corporal punishment and can be seen at http://megamost.tv/twobriefcases/280.html demonstrating the belt he uses for this purpose. In this video, he also calls attention to a documentary made to criticize the use of corporal punishment in some schools in the U.S., but instead claims that the punishments shown are beneficial. Such punishment has, incidentally, been illegal in schools in both Russia and Ukraine for almost a hundred years.

If I were considering contributing to kickstarter to finance this documentary project, I would certainly like to have some questions answered first:

How does Ukrainian law regard a private individual who  takes children off the streets and keeps them confined?

What happens if parents ask for their children to be released to them?

What methods does he use to treat children who are addicted to alcohol or drugs? Are these methods known to be safe or effective? Are they related to charismatic methods aimed at healing by casting out demons?

Does Mokhnenko employ the corporal punishment that he has advocated?

Presumably Mokhnenko has no medical training. What medical services are available for children being treated for drug or alcohol addiction or for related illnesses or injuries?

What happens to children who have been in Mokhnenko’s care?  Are there any records documenting their physical or mental health or educational progress?

What amount has been donated to Pilgrim Orphan Foundation on behalf of Mokhnenko’s work, and how much has been spent on care for the children?

Perhaps Mokhnenko or his supporters will provide acceptable answers to these questions. Until then, I would keep my wallet in my pocket as far as the kickstarter request is concerned.

  

Why Breastfeed?

Enthusiastic proponents of breastfeeding are constantly bringing up reasons why it’s important to nurse your baby, so I was surprised when looking at a webinar put on by the University of Albany Public Health Department today. The webinar, which was about community support for breastfeeding, spent little time on the good outcomes to be expected from breastfeeding, but went directly to issues like employer decisions that can help or hinder nursing mothers.

Personally, I am a breastfeeding enthusiast, and calculate that I’ve spent about 30 months of my life nursing. I agree strongly with the novelist Eudora Welty’s character who declares that “a woman never feels so good as when she’s got milk in her”. But I’m disturbed when I see claims made about breastfeeding that cannot be supported by systematic research.

So, why is it good to breastfeed? Well, it’s not because it raises the child’s IQ. The differences reported between breast-fed and formula-fed children’s test scores are so small that they are actually less than the variation you’d expect for a single individual to show on two separate test administrations. In addition, because educated mothers in the U.S. are more likely to nurse their babies, and because genetically-determined factors help people achieve high levels of education, it’s possible that breast-fed babies on average carry genetic material that helps to raise their tested intelligence--  thus, we could argue just as well that higher intelligence makes babies more likely to be breast-fed, as that breastfeeding makes them have higher test scores.

And it’s not because breastfeeding causes bonding, attachment, or any combination of the two. There are a number of ideas left over from the 1970s that emphasize skin-to-skin contact as a factor in maternal bonding (“falling in love”) with the baby, and obviously breastfeeding mothers are more likely to be skin-to-skin than formula-feeding mothers. However (and I say this cautiously because measures of bonding are so poorly developed), it seems that mothers’ attitudes toward their babies are about the same after a couple of weeks whether they breastfeed, bottle-feed, or use a combination of the two--  except for some bottle-feeding mothers who have been convinced that they are not doing the right thing for their babies. As for attachment, the great majority of mothers in developed countries have weaned their babies months before any clear signs of attachment appear; naturally, early experiences might influence later development, but there is no evidence that they do so in this case. Bowlby’s studies of attachment were done at a time when breastfeeding was relatively infrequent, but his measures seem to apply in pretty much the same way now as they did then. There are cultural and ethnic differences in breastfeeding in the United States, but no evidence that babies in groups that breastfeed less tend to have less secure or less organized attachment than babies in other groups.

Is breastfeeding physically beneficial for infants?  As is well-known, human milk contains antibodies that help protect against infections that occur through the gut, including not only gastrointestinal disorders but some other diseases like polio. Although babies are born with a supply of antibodies against diseases that their mothers have developed immunity to, in the early months they are not very good at mounting defenses against new diseases they may be exposed to. The mother’s milk allows her body to be an “auxiliary immune system” that is good at developing antibodies against new infections and passing the antibodies on to the baby. This means that breastfed babies have some advantages, especially because it is easy for them to become dangerously dehydrated if they have repeated vomiting or diarrhea. But on the whole, babies in developed countries, with access to modern medical care, clean water, heat for sterilization of bottles, and refrigeration of formulas, are not likely to suffer from being formula-fed--  provided that they do not encounter problems of formula production like those recently in the news from China. Babies in Third World countries, however, may suffer serious, even fatal, health problems if their mothers do not breastfeed.

Is breastfeeding physically beneficial for mothers? The baby’s sucking at the breast does stimulate contractions of the mother’s uterus and helps return the uterus to its pre-pregnant size more quickly than would otherwise happen.  Breastfeeding mothers resume menstruation months later than do bottle-feeding mothers, but this does not necessarily mean that they do not ovulate and cannot become pregnant. Breastfeeding for a year or more seems to reduce later breast cancer rates somewhat. But there can also be mild downsides to breastfeeding, and most nursing mothers occasionally experience clogged ducts (“caked breast”), sore nipples, or breast infections.

How about the family in general? Is breastfeeding beneficial or not? It is certainly cheap compared with formula feeding, and the savings in money can be put to good use by most young families. Breastfeeding involves less extra work during the early months, since there are no bottles or nipples to clean and sterilize. Bottle-feeding can appeal more strongly to fathers who otherwise feel left out of the mother-baby loop, although the bottle can contain the mother’s milk rather than formula. The impact of breastfeeding on the mother’s return to work after some months can depend on her employment and the time and situations that allow for nursing the baby or pumping milk; however, returning to work in the first two weeks, when the milk supply is not yet well established, will probably mean that breastfeeding will not go on for long.

Breastfeeding does provide some assurance that a baby is getting picked up and attended to as much as is needed. Most bottle-fed babies also get all the attention they need, but bottle-feeding does make it possible for parents or caregivers to skimp on attention by propping bottles for the supine baby--  a practice that is illegal in many states that regulate what goes on in infant day care. Only occasionally does one encounter a breastfeeding mother who limits the baby’s nursing time (I once met one who used a stopwatch!), because most nursing mothers know that more sucking means more milk being produced.

Breastfeeding also pretty much assures that parents respond to a baby’s communications. Because adults cannot easily know how much milk a baby has taken, they rely on the baby’s signals to let them know what he or she needs. Bottle-feeding parents can do this too, but they can also pay more attention to how much milk is left in the bottle  and thus have the option of attending less to the baby’s cues. There is one unique situation of this kind associated with breastfeeding: the breastfed baby indicates to the nursing mother when it’s time for the switch from one breast to the other. Most women nurse on both sides at each “meal”, and although they can feel that a breast becomes softer to the touch as it is emptied of milk, they really cannot tell whether the breast is producing the fat-rich hindmilk or whether it is close to dry--   nor do they know whether the baby is hungry for the hindmilk or would like to proceed to the more watery foremilk being produced by the second breast. The baby’s communication, letting go of one nipple and fussing until the sides are switched, is essential. Does this stress on communication during breastfeeding make any difference to the development of gesture and speech communication? As far as I know, this has never been studied systematically, but it’s not implausible.

Most nursing mothers find breastfeeding gratifying (or probably they would stop). It can be a wonderful quiet time during which nobody will bother you, and you and the baby can just peacefully do your thing. There are several other good reasons for choosing to breastfeed, but the extravagant claims about the benefits for babies in the developed world have not been supported by evidence.  Some possible benefits have never been investigated carefully. But, like most other things about infant development, it’s more complicated than it appears, and is not a miracle cure for every infant and family problem.