Surrogates: Another Day at the Office--- A Guest Post

My thanks to Lili Miller, a social psychologist, for contributing the following intensely practical view of what happens when a woman agrees to be a surrogate mother and have a baby for a couple to rear as their own:

In most cases when the topic of surrogacy comes up, it is first put in terms of family, growing choices that couples have when trying to have a baby, questions about adoption, and more. These topics—and most others surrounding surrogacy—tend to focus on the emotional and philosophical implications of surrogacy as an option for the couple. What is often left out of the mix are underlying discussions about the financial implications of surrogacy for the surrogate mother, and what putting a price on this type of service actually means for her. Analyzed through this viewpoint, surrogacy is only a business, much like any other type of business. The surrogate therefore simply becomes a service provider. Her role inevitably changes when money comes into the equation.

Just in the United States, surrogacy continues to be a multi-million dollar business, and while some don’t like to look at it as a question of dollars and cents, it must be treated as such by surrogates, because there are a range of financial issues that must be understood and taken care of during the process.

Many of the financial implications of surrogacy have to do with taxes. In many cases, surrogates work as independent contractors, and as independent contractors, there are a number of tax breaks that they could be entitled to. Most surrogates have a range of business expenses they have to deal with—many of which can be used towards deductions when tax time comes around.

Before even delving into taxes, costs, potential earning, and financial planning for surrogates, it helps to take a look at the process that potential surrogates can follow to ensure that they are working in a safe, organized environment.

Surrogacy Agencies
Like a number of jobs on the market, surrogacy can be made much easier with the help of a professional organization or agency. While we don’t like to think of surrogacy agencies as being exactly the same as an agent that an actor or an athlete might have, the agency does serve some of the same types of functions for the surrogate, and they can be crucial allies every step of the way.

“Surrogacy agencies choreograph the entire process, from matching of the surrogate and intended parents to administration and enforcement of contractual matters.” (from When Your Body is Your Business)

When working with an agency, the surrogate is freed up to take care of herself and to deal with the physical aspects of the process without having to worry about the minutia of the business end of the process. Surrogacy agencies are also there to ensure that both parties are suited for the process and for each other.

Not everyone is qualified to be a surrogate. There is great risk involved, as well as physical and emotional strain. Surrogacy agencies take major steps to ensure that both the surrogates and “intended” parents are uniquely qualified for the process and that they are the right match for each other. This involves good old fashioned advertising (agencies conduct searches for both surrogates and potential parents) and serious screening.

Once a connection between a surrogate and intended parents has been made, the surrogacy agency starts to truly earn its keep. Extended contracts between surrogates and intended parents can be incredibly complex, with altering payment scales, multiple disbursements, and a range of caveats. They can also help define the manner in which business will be conducted between the intended parents and the surrogate. Contracts can include types of behavior that surrogates cannot engage in, as well as rate of communication between the parties, and much more. At the end of the day, the agency is there to ensure professional behavior on the part of both parties.

Once a birth takes place, the agency continues to manage the payment process and to make sure that the surrogate’s contract is honored in full. This is key for surrogates. If financial or legal issues arise, it’s crucial that the surrogate is not taking all of this on by herself.

Financial and Tax Options for Surrogates

While payment for surrogates varies, income can be considerable. However, costs for surrogates can be considerable, too. As was said earlier, there are a number of tax options and deductibles that surrogates can qualify for.

If a surrogate is working as an independent contractor, which many do, it’s important to keep thorough records of all job-related expenses. It’s also important to work with a professional in the field who can give you a clear picture of what types of products and services surrogates can legitimately “write off” on their taxes. Some surrogates can even qualify for the earned income tax credit.

Surrogates engage in single contracts that last a long time, and for health or just plain life reasons, contracts can be few and far between. A surrogate must explore all financial options and engage in a level of serious financial planning to make sure the money earned from surrogacy goes as far as it can.

Surrogates face health risks, physical strain, and a range of emotional elements that most people will never face on a job. For some surrogates, those risks and strains are worth it to help potential parents achieve their dream of having a family. In the end, surrogacy is still viewed as a business. Surrogacy is stripped of all its expressive motivations, and honed as another service for proactive consumerism.

Bio: SimplyLili is a PhD student in Social Psychology, and the eccentric author of Simply Lili Blog; created to disperse knowledge on a plethora of topics in a minimalist and humorous way. She is a self-proclaimed nerd and her 3 fave things are blogging, copywriting, and pugs.
 'Knowledge-Simply'

 Google+

Canned Punishments: Apps, Advice, and Erroneous Assumptions

People are really committed to the idea that punishment is the best form of child guidance, aren’t they? Yesterday two interesting messages about this came across my virtual desk. One was the suggestion of a nanny website that phone apps will make punishment easy and effective. The other was the blog of an adoptive mother who recounted how her “attachment therapist” had advised methods like locking a teenage daughter in the bathroom for several days as ways to a) make her attached to the adoptive mother, and b) behave the way the mother wanted her to.

In both cases, the adult action was clearly a punishment, whether or not anyone wanted to use the term “consequence”. The child did something that the adult disliked; the adult responded with an action that was expected to be unpleasant for the child; the expectation was that the child would not do the disliked act again. If the child did do the disliked thing again, the plan was to escalate the punishment. I refer to this strategy as “canned punishment”, because it is not shaped particularly to the situation, the individual, or the all-important time factor that determines whether punishment effectively reduces an undesirable behavior. Its “canned” nature is evident in the idea that when the punishment is ineffective, the adult simply does more of the same thing, rather than examining the situation to see whether a different approach might be more effective.

The nanny outfit has been in touch with me before, as have several others. I think this is the one that suggested Tabasco sauce on the tongue as an appropriate method for nannies to use. They seem eager to have their website mentioned, even though when I’ve mentioned it in the past I’ve criticized it unmercifully. (Parents, if you employ a nanny, you may want to make sure that she is not reading their advice!)

This time, the nanny site suggests “10 iPhone apps that help with discipline” and describe them as “most popular and useful for keeping up with kids’ behavior”. Here are a couple of the goodies :

“Timeout—Ultimate discipline tool—Tracking the length of a timeout to provide kids with a visual representation of how long they are sentenced to this punishment is a snap with this application….”

“Tymoot--  Designed by a parent for parents…  The Wheel of Discipline feature that allows your children to spin the virtual wheel in order to be ‘sentenced’ to one of eight customizable punishments”.

Think about the “timeout” method first. Timeout is not intended to be used as a punishment and would not necessarily be effective if it were used that way. The points of timeout are first to remove the child from any social situation that is rewarding bad behavior (like other kids laughing), and second, to interfere with a behavior sequence and help the child move to different behavior. Because these are the goals, “time-in”, in which the child stays close to an adult for a period of time, may be as effective as timeout, or even better. The length of the timeout or its discomfort is not the point. Neither is it the goal of timeout to  exert adult authority or to encourage wrangling with an adult about how much longer it is to go on--- the adult needs to display warmth, sympathy, and an interest in helping the child gain control over behavior. For the adult to use a “canned” approach is to remove the personal and emotional support that is key to working with young children.  

Second—about this Wheel of Discipline. Such a method delays the punishment,which needs to be immediate if it is to be effective. In addition, it makes the situation into a game, inserting a reward period before the punishment and thus effectively reinforcing the undesired behavior. It is worrisome to think of naïve nannies or parents trying to use this method to quell genuinely concerning behavior like running into the street or leaning over a banister, where ineffective guidance can put the child into serious danger.

All right, enough about the nannies. Let’s go on to my second “canned punishment example”. This is to be found at http://www.adoptionblogs.com/weblogs/author/donnav.  Donna V. has three adopted children, siblings 16, 14, and 9. And she has an “attachment therapist” who is instructing her about how to handle the children’s sometimes undesirable behavior, which she naturally attributes to Reactive Attachment Disorder.  You will understand where we are on this when I point out that the children ride horses every week to treat their RAD (see http://childmyths.blogspot.com/2011/02/clever-hans-rides-again-equestrian.html.) Donna and her attachment therapist believe that  the children must give up their wish to be in control in order to “bond”, and that only “bonding” (undefined) will correct such behavior problems as lying and stealing. Donna had been confining the 14-year-old girl to her bedroom when she did not meet the standard of being “respectful, responsible, and fun to be around”, but the therapist felt this wasn’t working because the girl was too comfortable. The isolation was then moved to the bathroom, where the girl spent 6 days and 2 nights. Then she said she was happy, was cooperative, etc.

Most interestingly, in her Aug. 20 blog post, Donna V. describes the treatment as if it is a form of behavior modification that is withholding reinforcement for behaviors that were previously reinforced. She remarks that “as my kids start to respond to the new techniques and to the horse therapy, some of their behavior is actually getting worse. Some days I think that the extinction bursts are going to kill us.” She then accurately defines an extinction burst as “the temporary increase in the frequency, intensity, and/or duration of the behavior targeted for extinction”. Apparently the assumption is that any undesired behavior is occurring because it was rewarded in the past in some way, and that now withholding the reward will eventually cause the behavior to disappear (“extinguish”, in behavior mod terms).  How this relates to needing an isolation area to be uncomfortable, or to bonding, or to horseback riding, is far from clear. It’s also unclear how an extinction (non-reinforcement) procedure can influence any behavior that is self-rewarding--  and maybe that’s why she has turned back to attempts at punishment by taking away comfort or gratifying experience like having a cellphone. In spite of the canned punishment suggested by the therapist, such punishments are very difficult to employ because of the essential timing factor. By the time the mother has discovered a lie or theft, the effective time to use punishment has passed.

Maybe a good start would be to abandon the goal of being “fun to be around”, which is an ill-defined set of behaviors. Certainly punishment for not being fun is difficult to work out, because there are so many ways not to be fun.

My suggestions? Stop worrying about how to make the child more uncomfortable. Don’t look for a punishment that will do the job in a simple way. Seek a knowledgeable therapist who practices evidence-based methods. Realize that effective child guidance does not come in canned, frozen, or evaporated varieties, but must be worked out in individual ways within a specific family context. Keep in mind that teenagers are naturally working on the establishment of autonomy, and asking them to relinquish all control is not developmentally appropriate. Don’t think that a teenager can “bond” to a mother in the sense that a toddler forms an attachment to an adult.  And, if you want to ride horses, have a good time, but don’t imagine that this is therapy--  any more than any other pleasurable activity that helps modulate moods.

When Psychologists and Others Abandon Ethical Principles: Child Custody Issues

Like physicians, psychologists are expected to follow the dictum primum non nocere--  first, do no harm. Ethical principles like beneficence, respect for people, and justice all seem to me to follow from that original rule.

Psychologists who teach, do clinical work, or concentrate on research all have obligations to pay attention to ethical guidelines and to do no harm. But, of course, there are tasks done by psychologists where the possibility of doing harm--  and the importance of avoiding harm—is especially great. One of these is child custody evaluation, in which a psychologist assesses children and parents with an eye to making a recommendation about primary custody, about visitation, or even about termination of parental rights. Such recommendations walk a fine line between possible errors, and always involve some risk of causing harm to the child and/or interfering with the rights of parents to retain a relationship with a child. Inaccurate assessments may cast serious aspersions on the characters of parents and interfere with their professional lives as well as personal relations with the child or with other people—or, on the other hand, they may expose a child to continued harm from an abusive parent.

We usually hope that psychologists making custody recommendations will pay heed to ethical standards and will not deliberately flout them, even though they may still, being human, make mistakes in their assessments. Unfortunately, these hopes are not always realized. One story of an apparently intentional abandonment of ethical principles is told at www.dpdlaw.com/Kleinman.html. In writing about this situation, I will refer to the psychologist as Dr. X, which seems a bit fatuous because anyone who reads about this can identify her, but somehow it seems appropriate to me.

Dr. X specialized in child custody evaluations in divorce cases, so her job was to assess children and divorcing parents and to make recommendations to the court about appropriate parenting plans, including primary custody, visitation, and supporting procedures like psychotherapy. In one case, when a divorcing mother thought that her former husband might have sexually abused their toddler daughter, Dr. X conducted play therapy sessions with the child and used them to put together a report to the court claiming that the child’s play and statements indicated that the sexual molestation had taken place. Dr. X refused to let the father speak to the child on the telephone and told the child that the father did not want to talk to her. She also told the father that he could speak to the child only if he admitted wrongdoing and apologized to the child.

The father maintained that he had never molested the child, and hired another psychologist, the well-respected Dr. David Martindale, to review Dr. X’s report and the videotapes she had made of the play sessions. Dr. Martindale concluded that the videotapes did not support Dr. X’s claims and that she had reported to the court only statements that she had coached or elicited from the child, and not the child’s actual uncoached comments. In other words, there was no evidence that the father had been abusive in any way.

A second complainant against Dr. X came into the picture by accidentally overhearing Dr. X’s name discussed with respect to the situation just described. She filed her own complaint, which stated that when she sought Dr. X’s help during a divorce, and when it was known that her former husband had been treated for sexual addiction, Dr. X suggested that to accuse the husband of molesting their infant would be an excellent ploy to make sure she retained custody of the child. She also reported that Dr. X said that she herself had done this during her divorce and had succeeded in terminating the father’s parental rights.

Dr. X denied all these allegations, and has argued at http://thetruthaboutdrkleinman.com that she is the victim of a politically-motivated attack by father’s-rights groups. Nevertheless, the court concluded that Dr. X “has engaged in gross and repeated malpractice which damaged or endangered the welfare of [a child] and threatened [the child’s] relationship with her father. [She] misused her influence in a manner that exploited [the child’s] trust and dependency, resulting in the creation of great distress and confusion for the child… [In addition, she] created a situation whereby law enforcement would have been unable to conduct a criminal investigation had such action been appropriate. She isolated the child from all outside help had it been warranted.” Dr. X was also concluded to have deliberately misled the court and misrepresented her training, and in particular to have improperly acted as both therapist and forensic psychologist. The court recommended the revocation of Dr. X’s psychology license by her state’s board of professional licensing.

There are several points I would like to make about this egregious situation, in addition to noting that videotaping of the therapy sessions was the key to unraveling this set of twisted claims. One important consideration is the extraordinary ease with which mental health practitioners can state that if someone denies an action, this is proof positive that they actually committed it. If it appears that they genuinely believe they did not do it, the argument becomes all the stronger--  look, he’s even repressed it because it was so bad! Whether the accused person confesses (perhaps untruthfully and in order to bring an ordeal to an end) or denies guilt, it doesn’t matter; either outcome is interpreted as indicating wrongdoing.

Because men are somewhat more likely to approach children sexually than women are, it is not surprising that fathers are more often the targets of this strategy than mothers . However, mothers too may be accused of physical abuse. In one case I’ve recently been observing, the children are in the custody of a stepmother who has placed them in an unconventional treatment. The therapist is acting as an evaluator, and the mother has been told that she cannot have contact with the children unless she admits to having abused them physically and apologizes to them. Medical records exist that show no evidence of the children having been abused while in their mother’s care, but part of the unconventional therapy in use involves extracting from children statements about their mistreatment by an adult. Although being accused of sexual abuse carries much greater penalties in our society than accusations of physical abuse, this mother has already been denied a professionally-related activity because of her legal situation.

One more point here: as Dr. X’s case shows, it is considered improper for psychologists to act both as evaluator and as therapist, and this was one of several concerns that caused the court to recommend license revocation. As far as I am able to tell, however, there are no similar restrictions for social workers. The therapist and evaluator in the case I described in the last paragraph is a social worker, so the mother appears to have no way to demand correction of this situation. In cases where courts accept recommendations from other types of mental health professionals, the same problems may well exist.

Not only do psychology licensing boards need to take special care about these child custody issues, but other mental health professions need to set standards and demand that they be observed.

"My Adopted Girl": Many Issues, Many Interventions

An organization I belong to recently received an e-mail from a mother with the subject line, “my adopted girl”. The mother, whom I will call M, tells her story and asks if there is a good book to read to help with the troubles the family is having.

M’s daughter is now 8 and ½ and has been with M’s family since she was 17 months old. She was severely neglected by her 15-year-old parents, according to M. Daughter was angry when first brought into M’s family and M describes her situation by saying “it was hard for us to attach” (although she does not explain exactly what she means by this).  The biological mother was not only very young but was said to have had ADD and bipolar disorder and to have used and cooked meth in the home where M’s daughter lived with her.

M says she has always been very firm and consistent with this child, but is now concerned because the daughter steals and lies and does not seem remorseful. M is puzzled about what consequences might curb these behaviors and is worried that as the daughter gets older she will discover even more serious and dangerous behaviors.

There are some other interesting features to the situation. One is that M’s family also adopted three of this daughter’s siblings, one of whom came to them at 9 months after five months of foster care and a brief return to the biological mother. According to M, none of the siblings have any of the same issues that the daughter she is concerned about has.

M also brings up briefly the possibility that she herself has been overwhelmed by the demands of this family, and states that the daughter’s own problems may be only part of the picture. (This is an important insight and makes me feel optimistic about M’s ability to think through and handle whatever is happening.)

Finally, M states that her husband keeps asking if they should get the daughter therapy or not. She doesn’t mention what is meant by this, exactly.

I am going to make some comments and suggestions, but before I do so let me say that I have never met any member of this family and cannot make specific statements about them. In addition, I am not a clinical psychologist and am not presenting myself as such or offering any services.

The first point I’d like to make is that on the basis of M’s description it does not appear that the daughter has Reactive Attachment Disorder, in spite of her troubled early history. Stealing and lying, though very disturbing and problematic behaviors, are not aspects of Reactive Attachment Disorder. I think it would be a mistake to seek therapy that concentrated on attachment issues as a major cause of these behavior problems. If M and her husband seek treatment for this child, it would not be sensible to look for a practitioner who focuses on attachment therapy or on attachment as a primary problem. The fact that the other siblings do not share this daughter’s troubles indicates that this is not simply a problem of separation and adoption.

A second point is that the biological mother’s ADD may have been passed on genetically to this child, and she may be impulsive and lack self-control for that reason. Why do the other siblings not have the same trouble? Genetic transmission does not give the same results every time, and what’s more it isn’t necessarily the case that all these children have the same father. If ADD is a factor in the daughter’s behavior, she may benefit from medication.

Children who have been exposed to drugs either before or after birth have usually been exposed to alcohol too. Effects of fetal alcohol exposure may or may not be apparent in the child’s appearance, but a medical examination might help on this. If alcohol exposure is an issue, the daughter may need special education and may also benefit from medication.

The story of the daughter’s early life also suggests that she may have had little early language experience and may have had language delays with which she has not yet caught up. These would make her easily frustrated, especially in school, and could result in undesirable behavior and poor understanding of other people’s wishes and the consequences of what she does. I would suggest a speech and hearing assessment and speech therapy if recommended.

M’s recognition that she may be overwhelmed is an important one. A mother’s frustration, anxiety, and depression can have devastating effects on children’s development. In this case, it seems that the troubled daughter was adopted first and the other siblings later--  M does not make this completely clear. It is easy to see how even very competent parents could be thrown by dealing with one angry toddler and then having three more young children added to the mix. None of the children may have gotten all the attention they needed at this point, but the troubled daughter may have biological vulnerabilities that gave her real difficulties in giving up the attention she had been getting.  M’s e-mail sounds as if she still feels overwhelmed, and this may be one of the keys to the whole set of issues. A good counselor (well-trained and licensed) for M could help support this mother and enable her to help the troubled daughter as well as the other children (who must be affected by their sister’s behavior). This is not to suggest that I think M is emotionally disturbed --  simply that having some professional support can be very beneficial to someone who has taken on the responsibilities M has.

Finally, I’d like to address M’s question about appropriate “consequences”. I doubt that changing ways of punishing the troubled daughter will be of any use. If punishment is to be used, it can only be effective if it occurs very quickly after the undesirable behavior, and this is hard to do with stealing and lying, where the problem is usually not detected until later. In any case, the first question should be whether any of the points I mentioned before can be of help in correcting these disturbing behaviors. More attention, more guidance, and the use of cues to remind a child about what to do are more likely to be effective than any specific “consequences”. Although this child is a little older than most for whom this treatment works, some of the ideas of Parent-Child Interaction Therapy can be very helpful.

I hope M and her family will be able to find a good outcome for this very challenging situation.

Holding Therapy as an International Problem

Some readers of this blog will be aware of my years-long concern about Holding Therapy (also called Attachment Therapy, Z-therapy, soul therapy, rage-reduction therapy, etc.). Holding Therapy, which I’m going to abbreviate as HT, is an alternative psychotherapy---  the psychological version of  complementary and alternative medicine (CAM). By this I mean that it is based on implausible assumptions, at odds with conventional understanding of personality and early development, and is also without a systematic evidence basis with a foundation of randomized controlled trials or well-designed nonrandomized trials. HT is used primarily with children, although some of the “sexual conversion” proponents have employed it, and its practitioners are more often social workers or licensed mental health professionals than they are psychologists or physicians. Child injuries and deaths have been associated with HT.

When most people see the word “psychotherapy”, they assume that the treatment in question is some form of talking therapy. They may think of highly-directed cognitive therapies or of psychodynamic approaches that seek basic motivations and may explore memories of early life, but they have in mind an intervention that relies on discussion between the therapist and the client. Even when people consider treatment of young children, they expect psychotherapies to focus on communication, perhaps through play methods rather than through speech.

HT, however, is a talk therapy only in the most minimal sense. It has strong physical components, including physical restraint of the child, demands that the child kick on command or do push-ups or jumping-jacks, and painful grasping and prodding of the child’s body. Children in treatment are required to shout statements like “I hate my mother! I want to kill her!” at the command of the therapist. The originator of this treatment, one Robert M. Zaslow, a California psychologist whose professional license was revoked after he injured an adult patient, suggested that clients sign a waiver noting that bruising was to be expected from the treatment.

Discussions of HT have often attributed the practice to a sort of American backwoods mentality, associated with religious fundamentalism and an approval of the use of force to achieve desired ends. In fact, people outside the United States have essentially said “it can’t happen here”.

But in the last few years it has become plain that although HT is not common, it does happen in England, as has been described at http://invisibleengland2.wordpress.com and in the book Invisible England. In fact, HT has a long history in Great Britain, as I have described in a paper recently accepted by the British journal Adoption & Fostering.

A recent e-mail from the Czech Republic alerted me to the fact that the HT practitioner Jirina Prekopova , who had practiced for many years in Germany, has returned to her homeland and is advocating and practicing HT. Here are two videos of the proceedings:

http://www.youtube.com/watch?v=dHI1hvBEKo4

http://www.youtube.com/watch?v=jqj_mLYKmxo

{Note-- 10/16/12-- these videos now come up as unavailable. If you want to see them, try searching Jirina Prekopova youtube, because there were a number that could be seen yesterday.}

But BE WARNED: THESE ARE VERY DISTURBING! ON NO ACCOUNT PLAY THEM WHEN CHILDREN CAN HEAR THE AUDIO. The language is Czech, but you will get the picture all too well without understanding the words.

One of my correspondents has said that Prekopova uses these methods with children who have tantrums, including, according to her, an infant under a year of age. The correspondent has complained to the Association of Czech and Moravian Psychologists but has received no answer.

Prekopova lectures widely, and groups using her methods have been formed in several European countries and in Latin America.

How Prekopova developed her HT methods, and how she received encouragement, is an interesting story with several clear morals. The story goes back to the 1980s, when the New York psychiatrist Martha Welch visited the town of Evergreen, Colorado--  usually thought of as the nursery of HT—and developed her own version of the treatment, which she initially called “holding time” but today refers to as “prolonged parent-child embrace” (PPCE). Welch’s method involved face to face contact in which a small child was held on the mother’s lap, and older children lay supine with the mother lying on top of them, supporting some of her weight on her elbows. Children resisted this strongly and fought to get away, while the mother shouted and cried in expression of her own negative feelings. Eventually, both were expected to calm down and to express tender affection for each other. Welch originally presented this as a treatment for autism.

In the early ‘80s, Welch  met Elisabeth Tinbergen, the educationalist wife of Nikolaas Tinbergen who had received the Nobel Prize for Medicine or Physiology in 1973, together with Konrad Lorenz and Karl von Frisch. Tinbergen’s work involved instinctive responses of animals to specific stimuli, and in his Nobel speech he attempted to bridge that work to work on human behavior and especially on the problem of autism. Mrs. Tinbergen introduced her friend to the Nobelist, who was impressed with the connections between “holding time” and his own ideas about early development and autism. The Tinbergens wrote a book about autism and holding, and although they noted that there was no systematic evidence to show that Welch’s method was effective, they also included a lengthy appendix by Welch, with many photographs. The support from the famous Niko Tinbergen was one of the factors that led to the publication of Welch’s own book, Holding time, and her tour of Great Britain, publicized by the BBC in films that show her guiding groups of mothers to restrain their crying autistic children. (One of the morals here is, just because a person gets the Nobel prize for one thing, that doesn’t mean he knows a whole lot about other things--  cf. Linus Pauling and vitamin C.)

Jirina Prekopova met with Tinbergen and Welch and adopted the Welch method. Apparently also present at this meeting was Bert Hellinger, a German therapist. Hellinger has a method he calls systemic family therapy. Hellinger’s approach includes the idea that one’s soul may be “entangled” with those of ancestors in ways that cause the individual to act out ancestral issues. For example, a boy may be homosexual because of the desires of a deceased sister. Similarly, when incestuous relationships occur, perhaps between father and daughter, both partners are responsible, and the daughter must forgive and respect her father. Prekopova refers to and supports Hellinger’s system, although it is not clear to me in what way she actually uses it.

So, there we are. As a result of various personal contacts, and a lack of guidance from professional and licensing organizations in Europe and elsewhere, HT has spread and continues to do so. Is it not time for an international conference to discuss what can be done about this? “Anya Chaika”, author of Invisible England, what do you suggest?  

Starving and Beating Adoptees in Allegheny County: Some Speculations

Has everybody breathed a sigh of relief that the State Department has got everything fixed for Russian adoptees? No more starvation, no more restraint? Great, let’s move along to the Ethiopian children. No Ethiopian Pavel Astrakhov has yet appeared on the scene, but one is needed.

Last  week, adoptive parents of two young Ethiopian children were arrested in Allegheny County, PA (http://pittsburgh.cbslocal.com/2012/10/04/deputy-attorney-general-wife-charged-with-abusing-adopted-children). One child, a boy of 6, was badly malnourished, and an 18-month-old girl had skull fractures that may leave her blind. The children, who were adopted through a church organization, had been since March in the home of the adoptive parents, Douglas and Kristey Barbour. Mr. Barbour is a Pennsylvania deputy attorney general.

What was happening here? Very little has been revealed so far. I’ve seen considerable Internet speculation that the elite adoptive parents were deliberately cruel to the black children, and although I acknowledge that the children’s ethnicity did not stop the parents from abusing them, there are too many cases of “white-on-white” abuse for me to think that the parents were especially motivated to abuse by the children’s skin color.

There are other possible explanations---  and I don’t bring these forward in an attempt to excuse the Barbours, but because understanding these situations can help us to prevent them from occurring again. Neither do I suggest that a single explanation can do the entire job, so more than one possibility needs to be considered here.

1. The first possibility I want to consider is that the Barbours were in fact encouraged to use certain “tools” in dealing with the children, and that this encouragement gave them permission to go much too far. There are groups like the “No Greater Joy” ministries that advise physical punishment for disobedience for children as young as 4 months (yes, months ). There have been some deaths associated with that sort of treatment, but they have involved shock from being whipped severely, rather than the skull fractures in the Barbours’ case. The key to understanding this will be to find out whether the Barbours were committed to the idea that instant cheerful obedience must be obtained at all costs, and failing to achieve this easily, they turned to blows.

In addition to the physical punishment “tool”, there are various sources for the recommendation that a child’s diet be restricted in order to display the authority that these people claim is the cause of emotional attachment (see the beliefs of Nancy Thomas, for instance). I have discussed this before at http://childmyths/blogspot.com/2010/12/federici-v-mercer-story-behind-lawsuit.html.  To the best of my knowledge, practitioners do not advise parents not to feed a child at all, but just as a mild spanking can turn into a beating when an adult feels the need to escalate, so can food restriction become a starvation situation.

2. A second possible explanation for the Barbours’ abusive behavior is the Post Adoption Depression that has recently been discussed on this blog. Depression in many adults involves irritability and shortness of temper as well as the characteristic sadness. Irritability adds to the potential for physical lashing-out against a child whose normal behaviors are found annoying, who perhaps does not go to sleep as instructed or who drops food by accident. Although maternal depression has often been attributed to hormone changes following pregnancy, it’s pretty clear that it can also depend on the challenge of life with young children. (A reader recently pointed out that adoptive parents tend to be older than biological parents and may have life difficulties associated with their greater age--  perhaps responsibility for care for elderly parents rather than a younger person’s expectation that their own parents may be helpful. Adoptive parents may also have very high standards for themselves and feel depressed at their failure to live up to an unrealistic level of performance.)

3. I have no explanation to offer for the battering of the little girl, beyond what I’ve said so far. But I have to wonder whether starving the boy was associated with poor understanding of the eating habits and nutritional needs of children from other cultures. A 6-year-old is old enough to have strong habits and expectations of what food should be like and how you eat it (hands versus forks, plates versus a communal pot). Adults from the United States suddenly shifted to an Ethiopian diet (delicious but spicy by our standards) might well suffer stomachaches and be reluctant to eat. What was this child’s experience? How did he respond? Did the Barbours take his reluctance as disobedience that had to be nipped in the bud? For other adoptive parents dealing with this kind of situation, I’d like to point out the enormous help that the SPOON foundation (www.spoonfoundation.org) can be in understanding what a child’s past diet and eating habits probably were, and how to make a dietary transition and ensure that nutritional needs are met.

I am hoping that information about these points will emerge in the course of the trial. I would not be surprised to find that all the points mentioned above worked together to cause the terrible outcome. If any reader knows more about this case than has so far appeared in the news, I would like to hear from you.

Adoption and Post-Adoption: A Guest Post

Attachment Therapy Makes Strange Bedfellows

A news story from Washington State raises a multitude of questions in reference to people’s beliefs about attachment. According to this story, the adoptive parents of a 15-year-old girl who had been removed from a polygamous group in Utah were advised to share a bed with her so they could “bond” (http://www.heraldnet.com/article/20120904/NEWS01/709049844#Snohomish-man-sentenced-to-6-years-for-rape-of-girl). The therapist felt the girl had “abandonment and attachment” issues and advised attachment therapy. Somewhere all these good intentions were turned into the proverbial paving stones on the way to hell, though, as the father soon turned the bed-sharing into an even more intimate connection. When the girl resisted, he threatened her with being returned to her biological family and married off polygamously. She complied while living with the adoptive parents, but filed a complaint when she went away to college.

What the father was up to was no doubt largely a matter of letting the little head do the thinking. One hopes that the adoption agency is now a little more sophisticated about some of the possibilities of this kind.

My question is, what did the therapist imagine she was doing when she gave this advice? Where did this misch-masch of ideas about attachment come from?

The therapist (so-called) told investigators that she advised “attachment therapy”.  Although there is no “official” definition of this term, it’s usually used to describe an unorthodox treatment that purports to switch an adopted child’s emotional attachment from a biological parent to and adoptive parent. According to www.attach.org, an organization that promotes the treatment, attachment therapy involves physical holding of the child by therapists and parents; past history shows that some practitioners use a coercive and painful form of holding that has caused injuries and deaths, but presumably others do not. (In neither case is there evidence that these treatments are effective approaches to emotional disturbance.)

It’s possible that the Snohomish County therapist also recommended attachment therapy when she suggested that the adoptive parents and the 15-year-old share a bed. Ordinarily, attachment therapy would not be associated with bedsharing, and for all the serious problems associated with attachment therapy, I have never heard of sexual abuse occurring in the context of that treatment.  Attachment therapists do suggest a great deal of physical contact, rocking, hugging, and so on, and push this beyond what might be developmentally appropriate because of their unconventional beliefs about emotional development, but this would not necessarily imply or lead to overt sexual activity. In any case, such practitioners tend to stress the mother’s relationship with the child much more than the father’s.

So, we have a therapist who’s talking about attachment therapy, but she seems to be recommending something unrelated, whether instead of or in addition to attachment therapy. Where did she get the bedsharing idea?

My guess is that the therapist has become intrigued with some of the beliefs often called Attachment Parenting--  beliefs originally proposed by William Sears, and stressing physical and emotional interactions between parents and children during infancy and toddlerhood. Suggestions made by Sears and others have included an emphasis on skin-to-skin contact, on long breastfeeding, and on the “family bed” shared by parents and children. Fans of Attachment Parenting hold that these activities (which are not part of the “standard culture” of the United States) are needed in order to create a strong emotional attachment of parents and children, to provide an optimal foundation for the children’s later development, and to avoid developmental problems. Proponents of Attachment Parenting don’t regard attachment as a very robust phenomenon, an opinion in which they disagree with developmental scientists.

A small number of advocates of Attachment Parenting may approve of continuing to share a bed with the older children who have slept with their parents since birth. As far as I know, however, none of these advocates, even the most enthusiastic, has proposed that an adopted adolescent be brought into the “family bed”.

That suggestion, made by the Washington State therapist, seems to have been based on a misunderstanding common among those who  practice attachment therapy or derive their understanding of attachment from a few workshops--  the supposition that events that have a particular effect in infancy and toddlerhood will have the same effect on older children or even teenagers. This idea flies in the face of the concept of developmentally appropriate practice, which stresses the differing needs and reactions of children at different stages of development.

Attachment therapists in general--  and perhaps the Washington State therapist in particular—believe that an individual who has had problems in early development (for example, in attachment) will have those problems corrected  in the present if exposed to the kinds of situations that would have produced good development if experienced in the past. This is somewhat analogous to thinking that a 16-year-old whose growth was stunted by a lack of protein during infancy can be returned to a normal growth trajectory by having the diet limited to milk for a while.  Even if bedsharing were needed for attachment in the very young (which it isn’t), this would not be evidence that adolescent attitudes and relationships can be manipulated in the same way.

The therapist in the present case seems to have made two big mistakes. The first was to assume that she could or should make a 15-year-old “attached” to adoptive parents, in the same sense that a toddler is attached to familiar caregivers. The second was to think that the methods used by advocates of Attachment Parenting could harmlessly be generalized from infants to adolescents. Unfortunately, the person most harmed by these mistakes was the girl, with the adoptive mother next in line--  and we  might think that even the father might have behaved better and not be in prison if he did not feel some sort of permission from the therapist for “bonding”.  But, there’s no law against giving bad advice, and that’s how this therapist and others get off without punishment after contributing to family train wrecks like this one.

I just have to wonder, though--  did the therapist advise skin-to-skin contact?

Seclusion and Special Education: The Lichtenstein Papers

Following the publication of an op-ed piece by Bill Lichtenstein in the New York Times a couple of weeks ago, describing the subjection of a 5-year-old special needs child to seclusion in a small, poorly-lit room as a behavior management tool, there has been a good deal of he-said, she-said, and they-said. The Times contributed to this an editorial note acknowledging that the child’s custodial parent, her mother, should have been consulted before the article by her father was published.

Lichtenstein, the father, is standing by his statements in spite of considerable criticism--  and I would point out that if any details of his narrative are inaccurate, that’s unfortunate, but the basic story is undeniably true and echoes similar tales from all over the United States. Those tales are predominantly about experiences of special needs students who are in theory protected from mistreatment under the Americans with Disabilities Act, but who in practice may be exposed to unacceptable efforts to manage their behavior.

At http://lexington.patch.com/articles/lps-superintendent-statement-challenges-nyt-oped-alleging-mistreatment-ofspecialneedsstudent#pdf-11299348, Lichtenstein has posted a number of documents that give further information about the events experienced by then-five-year-old Rose. (Some of these appear to me to have agreed to confidentiality, but then I’m not a lawyer.)

I’ll summarize some of the information in those documents. One document, prepared by the Commonwealth of Massachusetts Department of Education Bureau of Special Education Appeals, gives further information about Rose and clarifies that she did have special educational needs and that these had been apparent years before she entered the Lexington public schools. She had had difficulty at age two and a half in a Montessori classroom, where she did not tolerate frustration well and would hit or throw things in response—not unheard-of characteristics in a two-year-old, but intense enough to be noticed by her teachers. Some of the same difficulties were seen in a later preschool and in a Lexington preschool program.

When Rose entered the Lexington school, she had an IEP (Individual Educational Plan) that recognized her delays in both receptive and expressive language and difficulties with self-regulation. (Language delays are well known to be accompanied by age-inappropriate behavior, as children with these problems may fail to understand information and directions adults give them, and may experience extreme frustration when they have difficulty asking for help or communicating other problems.) However, she was mainstreamed into a regular education class and pulled out for occupational therapy and speech/language work.

After a few months, Rose was assigned a 1:1 aide whose previous experience had been with a child who was restrained much of the time.  The aide did not know that Rose had an IEP, had no training about seclusion, and did not see school policies about restraint or seclusion. It appears to have been the aide’s job to take Rose to one of two seclusion rooms, which she did in response to actions like yelling or not following directions, rather than in response to situations which threatened safety (the acceptable reason for use of restraint or seclusion). Rose’s parents were notified that she had been taken out of the classroom to a “quiet room”, but the rooms were not described. Neither did school team meetings discuss the use of seclusion as any part of Rose’s IEP.

When Rose was placed in a seclusion room, the apparent plan was that she would be allowed out when at the end of a five-minute period she could calmly say that she was ready to come out. Because of her receptive language problems, she might not have understood this; because of her expressive language problems, she may not have been able to make the required statement. In any case, it appears that she frequently experienced multiple five-minute periods adding up to as much as an hour, although the school principal stated that the limit was to be 15 minutes in total.

It is difficult to argue that five minutes of seclusion could never, ever be a suitable response to a child’s behavioral difficulties--  although seclusion becomes a wholly different matter if the room is frighteningly dark or if the child does not know an adult is near. The problem here was not necessarily the simple use of seclusion, but seems to have been what Oscar Wilde called “officialism”.  Administrators felt that rules had been established, but did not manage to give appropriate training to those who would actually be in contact with the child or with the parents, or to supervise and be aware of how a “plan” was being applied. This scenario has become so horribly familiar in the many stories of social workers who did not see the foster child they were to monitor and were surprised when the child died at the hands of the foster parents or others.

In the Ohio seclusion cases and elsewhere, failure to supervise or train aides has been the cause of harm to children through inappropriate use of restraint and seclusion. As I pointed out several days ago, organizations that offer restraint training do not teach about seclusion (which someone presumably thinks is harmless). My crystal ball says that at this very moment people across the country are cobbling together seclusion training programs that they will advertise as evidence-based when they see that a few groups report that they liked the training. Please, school administrators, pay attention to what’s going on! Don’t just assume that if you’ve paid out public funds to train teachers and aides about seclusion, and you’ve got policies in place, that you can just forget the whole issue. You yourselves need to know what should be happening as well as what IS happening. Don’t succumb to officialism any longer.

More About Post Adoption Depression

Some recent correspondence I’ve had with an adoptive mother has made me more concerned than ever about the possibility of depression following adoption and its potential impact on the adoptive family as a whole, as well as on the developing adopted child. My correspondent describes her experience with depression as “a living hell” with “three monsters” and states that “I did things then that I would never even consider doing now” (following treatment). She sent the children to her mother’s house because she knew they were not safe at home; she reports that “most of my thoughts were about being overwhelmed, running away, and wanting to die”.

When I searched Academic Search Complete for material on Post Adoption Depression, I was interested to see that many of the papers that came up were on depression in adopted children rather than in adoptive parents. It was over 15 years ago that the term Post Adoption Depression was first used, but a clear description and explanation of the phenomenon are still very much in the works. The common belief that hormonal changes cause post-partum mood disorders made it—and still makes it--  difficult for many people to accept that a post-adoption problem can also exist. A 1999 paper (Gair, S.[1999]. Distress and depression in new motherhood: Research with adoptive mothers highlights contributing factors. Child and Family Social Work, 4, 55-66) reported that about 30% of the adoptive mothers studied scored high on a questionnaire used in assessment of depression. A number of the mothers spontaneously stated that what they had was “post-natal depression”. Interestingly, Gair noted that “Typically, in Western society, the source of discontent in mothering is not seen to have its origins in the tasks of caring and mothering… Rather the fault is seen to lie with individual mothers”--  a belief that minimizes the actual stress of caring for children and may be a cause for depression when new mothers discover how demanding these tasks actually are. As Gair pointed out, this would be intensified by the lack of social support more common in adoption than in pregnancy and childbirth. Gair summarized the evidence that hormonal factors are not a major cause of post-partum depression and argued that the events that cause depression are similar in both birth mothers and adoptive mothers.

More recently (Payne et al., [2010]. Post adoption depression. Archives of Women’s Health, 13, 147-151), researchers concluded that “Significant depression symptoms were relatively common [about 30% of the group] in adoptive mothers within the first year after adoption and were associated with environmental stress”.  Most of the mothers in this study had adopted because of infertility, a condition associated with painful and intrusive treatment and with a sense of shame and loss of self-esteem, possibly making them more vulnerable to the effects of later environmental stress (my statement, not Payne’s—J.M.).  In another recent study (Foli, K., & Gibson, G.C. [2011] . Sad adoptive dads: Paternal depression in the post-adoptive period. International Journal of Men’s Health, 10, 153-162.), the researchers described the occurrence of depression—often expressed as anger--  in adoptive fathers, possibly in response to their wives’ depression.

As for the impact of parental depression on children, there has been an examination of this issue focused on adopted children (Natsuaki, M.N., et al. [2010]. Genetic liability, environment, and the development of fussiness in toddlers: The roles of maternal depression and parental responsiveness. Developmental Psychology, 46, 1147-1158). The concern of this study was of the role caregivers’ responsiveness can play in helping infants grow into toddlerhood with less negative emotion than they might otherwise show. Parents who were responsive to their 9-month-old babies’ signals were shown to have less irritable toddlers when the children were 18 months old. One major effect of depression is to reduce the adult’s responsiveness to child communications, especially when the signals are hard to understand, so depression is likely to be linked to unresponsiveness and later to child fussiness. This and much other evidence points to parental depression as playing an important role in children’s development--  treatment of depression is not just for the comfort of the adult, but for the development (and even the safety) of the child.

Unfortunately, as an article by Foli and Gibson has pointed out (2011; Training “adoption smart” professionals. Journal of Psychiatric and Mental Health Nursing, 18, 463-467), not only is there relatively little research on Post Adoption Depression (and that research has a number of problems that I haven’t mentioned here), but adoption caseworkers do not have much awareness of what is known on the subject, and adoptive parents receive little or no training about it.

I want to voice a particular concern about untreated depression in adoptive parents. I must ask, to what extent does depression create vulnerability to inaccurate statements about adoption--  for example, that even children adopted at birth are grieving for their birth mothers? To what extent does depression make adoptive parents ready to accept stern, repressive, even dangerous regimens claimed to “cure” their children? Does thinking about harming your children (as an aspect of depression) make you more likely to let someone else hurt or endanger them?  I once came across a description of “holding therapy” as what parents can choose when they want someone else to hurt their child for them. Do unconventional treatments like “holding therapy” exploit the undiagnosed and untreated depressions of some adoptive parents? I don’t know the answers, but I believe this topic is one that needs much further exploration. 

Seclusion and Schools: The Times Fact-Checks Lichtenstein's Op-Ed

A week ago, I posted a piece about an op-ed by Bill Lichtenstein that appeared in the New York Times on Sunday, Sept. 9, 2012. Lichtenstein described in his publication an event 6 years ago in which his kindergarten-age, language-delayed daughter was subjected to many episodes of seclusion in the Lexington, Mass public schools. Several readers queried the accuracy of Lichtenstein’s story, some in terms that I did not feel comfortable posting on this blog. I myself asked the Times public editor about the degree of fact-checking associated with op-eds and was told that they were scrutinizing the piece following its publication.

This morning, the “Week in Review” section of the Times includes an editor’s note, as follows:

“An opinion essay last Sunday criticizing the use of seclusion and restraint to discipline students described an episode on Jan.6, 2006, in which the writer’s daughter, then a kindergartner, was kept in an isolation room at her school in Lexington, Mass. Several details of that episode have since been disputed.

“The girl wet herself while being confined in a closet for misbehaving. But school officials, and a 2008 deposition by the girl’s mother, state that she was then cleaned up and dressed while her parents were notified--  and that it was not the case that the parents found her standing alone, unclothed, in her urine.

“The article incorrectly described the closet where the girl was confined. It was on a mezzanine between two classroom levels, not in the basement.

“While the girl’s parents sued the Lexington school district in 2007, and obtained a settlement in 2008, the writer did not notify two Massachusetts state agencies—the Department of Children and Families and the Department of Mental Health—“at the time” of the episode, according to state records.

“The girl’s parents divorced in 2007. If The Times had known before the article was published that the writer’s ex-wife was now the girl’s custodial parent, it would have contacted her.”

One reader had commented on my blog post that she thought there was “more to the story” than was being presented. There certainly seems to be less—only slightly less--  to it than Lichtenstein’s story says. Some details were exaggerated, whether for vividness or because the writer’s memory was inaccurate or because the writer realized that most readers would not put themselves in the child’s place unless forced to. The child was not left alone and wet, the closet was not in the basement.

It’s a shame that these exaggerations were included, because they give people a good excuse to ignore or downplay the whole story. And the story is a serious one. We have inappropriate use of seclusion, for matters other than safety. We have seclusion of a young and language-delayed child whose understanding of the situation must have been minimal. We have the petty officialism that deprives a distressed young child of toilet facilities. We have inaccurate reports to parents about the child’s conduct and achievement in her first year in school.

We also have all these points in the context of a nation-wide concern voiced by the U.S. Department of Education, the subject of legislation in Kansas, and the topic of an investigation in Ohio that revealed a complete lack of staff training in the use of seclusion.

The unregulated use of seclusion in schools is a genuine problem and far more important than Bill Lichtenstein’s apparent misreporting of a personal experience.   

Post Adoption Depression: "Real" or "Not Real"?

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.