Friday, September 14, 2012
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.