"Robbed of Your Child's Childhood"

A recent article in the New York Times (http://www.nytimes.com/2010/11/13/business/13missing.html?_r=1) commented on the difficulties of locating children who had been abducted by one of their parents. Noting that abducting parents may later claim tax exemptions for children, but that the IRS does not provide information on the whereabouts of the missing children, the Times article estimated that there are about 200,000 such abductions in the United States each year. (Obviously, not all of them are permanent or even long-term.) The reporter, David Kocieniewski, wrote sympathetically of the anguish of the bereft parents, and quoted one as saying, “… when you’re the parent who is left behind, it is devastating… you’re being robbed of your son’s or daughter’s childhood.”

Astonishingly and discouragingly, however, the article failed completely to mention the impact of their experience on the abducted children. Their abrupt separation from a familiar caregiver may in many cases be as traumatic as the death of a parent or as kidnapping by a stranger, however good the intentions of the abducting parent may be. As seems to have been the situation for so many recent reports of disrupted adoptions, though, discussion of parental abductions has often focused on the needs and rights of the adults. "Robbery" of the children seems to be of little interest.

I have to wonder whether the media’s failure to consider the effects of these experiences on the abducted children has any influence on the abductors themselves. Without public statements deploring the impact of parental abduction, do the abductors feel free to imagine that they are doing something acceptable-- even that their action is “in the best interests of the child”?

It is difficult to imagine any scenario in which abduction by a parent would be without negative effect on a child. In the case of older children who are capable of asking questions, the abducting parent has few choices except to offer distressing explanations. Refusing to answer questions at all establishes an atmosphere of implied threat and fear. Promising future contact with the other parent-- but not following through--- adds mistrust to fearfulness. Lying about the situation can be devastating. “Your mother is dead” or “Dad told me he doesn’t want you any more”-- how can the abducting parent offer the comfort that is needed for children who have received this kind of “news”? And speaking the truth (“Your father wants you back, but I’m not going to let him find out where you are”) creates concerns about the bereft parent, as well as destroying the cherished fantasy of children of divorce, that the parents will be together or at least cooperate in some way.

For children too young to ask questions or understand answers, abduction and abrupt loss of contact with a familiar parent will be equivalent in impact to the sudden death of that parent. In the best case, the abducting parent will have been in close contact with the child and will be familiar with the child’s routine as well as with ways to offer comfort. But even in that case, the sudden absence of a familiar home and caregiver will result in the child’s grieving over the loss. A young child’s grief for loss of a familiar person includes disturbances of sleep and eating, social withdrawal, reluctance to play, and sadness and irritability, and these may be very challenging for an abductor, even one who knows the child well. By the way, far from being “too young to know what’s happening”, older infants and toddlers will be most intensely affected of all by an experience like abduction.

An unfamiliar parent abductor of a young child will find himself or herself in an even more difficult position than one who knows the child better. Imagine, for example, a parent who has never actually lived with the child, but who for his or her own reasons (perhaps to punish the other parent) has decided to abduct. The young child placed in these circumstances has all the problems of grief mentioned earlier, as well as fear of an abductor who although genetically related is in practical terms a complete stranger. In addition, the child is in the hands of a person who may have little skill or knowledge about child-rearing, and who in anxiety or stress may respond with punishment to the child’s grief.

I don’t know whether parent abductors usually give much thought to the outcome of their taking the child. In one case described in the Times article, the abductor had obviously planned the abduction carefully over months, but whether he had considered the child’s reaction is not known. If anyone is making such a plan, I would beg him or her to think over carefully what the experience of abduction will mean to the child, and to consider how appropriate goals might be met by acting within the law. I do recognize that there are circumstances in which fear for a child’s safety, and the apparent failure of courts to consider existing threats, may motivate a parent to take a child and run. All I am suggesting is serious consideration of the outcome of abduction.

In a less obvious way, the same kind of consideration might be advised for parents who are seeking custody of children who have for whatever reason not been available to them for some time. I talked a while ago with a father whose former wife had taken their children to a distant state, re-married, and brought what were apparently baseless accusations of sexual molestation against her former husband. His contact with the children had been very limited for some years, but an investigation had shown no evidence of wrong-doing on his part, and he was now asking for full custody of the children, who were approaching their teens. This father planned that as soon as he had custody he would immediately take all the children a couple of thousand miles away (although they said they wanted to stay at their old schools) and set up a new home where their mother could not easily influence them. While adults will sympathize with a person who may have suffered a good deal under serious accusations, and who may have had good reason to despise the influence of his former wife, we can easily predict the anguish of the children being forced to give up their familiar lives, schools, and friends at the behest of a father whom they barely knew. If he had received custody, the father would have had the right to do this, but I would argue strongly that he would have been in the wrong if he had followed the plans he had made. As a matter of fact, custody remained with the mother, and in spite of her apparently problematic behavior, I believe that this was probably the right decision.

Reforming Adoption: Some Incomplete Thoughts

I’ve heard a lot recently about the need to reform adoption laws, and I strongly agree that it’s time to do this. There are a number of circumstances in which the rights of children and the rights of adult parents or caregivers are in conflict, and adoption, as we now manage it, appears to be one of the situations in which this problem is most evident.

As Ellen Herman shows at http://pages.uroegon.edu/adoption/timeline.html, it’s only since about 1850 that adoption laws and practices in the United States have focused on the needs and rights of children, and it’s much more recently that family relationships have become a matter of concern (as in some aspects of “the best interests of the child”). If we go back farther in time, we see that on the whole adoption practices were oriented toward assuring transmission of property and hereditary titles, or toward improving the adoptive parents’ income. Guardianship often hinged on this issue-- as in the frequent use by Gilbert and Sullivan of the concept of “wards in chancery”, heiresses whose guardians had the job of preventing them from being married for their money (though some of those guardians had the idea of marrying the girls themselves). Among poorer people, caring for “someone else’s child” often had the goal of rearing some farm help or collecting fees from the parish for doing this job.

As a result of this connection with property, much of adoption law was created in parallel with property laws. This parallel included absolute rights of possession; just as a car cannot belong simultaneously to the buyer and to the seller; an adopted child cannot legally speaking be simultaneously the child of the birth parents and the adoptive parents.

The equation of adoption with property rights may have worked well enough for its original purpose, which was property-oriented. Such laws may also have been adequate when adoption most often took place within a limited geographical area and within a limited group of people, although even then there were concerns about what was owed to an adopted child (see Jane Austen’s “Mansfield Park”, where there is discussion of the possible unfairness of bringing up a niece “as a lady” when she will not be able to inherit --- but, reader, she married him, so it was okay). However, we can hardly expect the same laws to be adequate for adoptions from thousands of miles away, from different cultures and language groups, with the mediation of government agencies rather than private contacts and decisions. Nor can we expect the same laws to work when most people expect caring for a child to cost them a good deal of money, rather than helping them accumulate property. In addition, I have no doubt that many readers will say those laws have had horrible effects, and no doubt they sometimes have-- I’m just trying to get at general reasons why, if once adequate, they are not adequate now.

It’s time to re-formulate the reasons for adoption and the ways law should protect all human rights as well as possible. Providing ways to mediate when rights of family members are in conflict would be part of this. I am by no means ready to suggest how this reformulation should be done, and I know that it will take a long time to do when it happens.

However, I would like to suggest a few things that could be accomplished without actual legislative changes, and which I think would be advantageous to adoptees, birth parents, and adoptive parents. I believe that it would be possible to make some of these improvements without legislation, but through education of judges, attorneys, and social workers, as well as potential and actual adoptive parents.

The first issue I have in mind has to do with large adoptive families and with circumstances in which adoptive parents accept more children from an institution than they had intended to adopt. “Mega-families”, especially those that include numerous at-risk children, are becoming known for an unusual frequency of child abuse and neglect. While there are a few adults who have the training and financial resources to take good care of a dozen or more children, some of whom have special needs, most of us cannot do this effectively. Yet these enormous groups are sentimentalized and romanticized by the press and by some caseworkers, whose attitudes influence adoptive parents. I do not suggest that legislation should forbid adoption of more than some small number of children, but I do suggest that social workers, adoption agencies, and child protective services staff should be extremely vigilant about insuring the health and safety of mega-adoptions. The idea that rearing children is “cheaper by the dozen” does not necessarily mean that it is safer by the dozen. Part of the task would involve caution about responses to whistleblowers (a visiting nurse who reported serious abuse in a Tennessee mega-family a few years ago was the focus of a lawsuit that was financially and personally potentially crippling).

A related second issue is increased caution by authorities about informal changes of adoptive homes and about the use of respite care. While normal family life in the United States can involve sleepovers of various kinds, or going to stay with a relative or friends for a few days or even weeks, there are adoptive families who go beyond the usual expectations by “dropping off” a child with others for convenience, perhaps to go on vacation or simply because they are tired of coping with the adoptee. In the case of the Tennessee family mentioned above, there were “dropped off” children living in the home whose legal guardians were unknown and for whom no legal transition had been made. A similar problem has to do with the use of “respite families”, often recommended by attachment therapists, to whom children are sent for the purpose of experiencing an austere and demanding environment that will motivate them to co-operate and be allowed to stay in the adoptive home. Respite care is certainly very legitimate when provided for handicapped children, for example by organizations like United Cerebral Palsy, which train people to do a few hours of care for children whose parents could not otherwise find qualified caregivers to use suction or monitor the eating of a child with oral problems. This is a very different matter from the “respite home” which is claimed to have a therapeutic goal, but which is not monitored in any usual sense. In these situations, adopted children and their families need the help of well-educated judges, attorneys, CPS workers, and caseworkers.

A third issue has to do with transfers of custody from one set of adoptive parents to another. More caution is needed in this area, and it would not require legislation to encourage it. In a case I was recently involved with, a child had been adopted from Russia at age 4. Her adoptive parents did not feel happy with her, sought unconventional therapy, and sent her to a respite home for periods of time. Eventually the respite family, in discussion with the adoptive parents and the therapists, decided that it would be better to have her adopted by the respite family-- and they did this, against the wishes of the child, who was 8 years old by that time. I’m talking here about legal adoption, not about an informal arrangement, so social workers and at least one judge were presumably in the picture. If this child had been with her birth parents, and they had relinquished her for adoption, essentially abandoning her, there would have been an impact in terms of their custody of other children in the home as well. In this case, there was no apparent investigation of the motives for this change or of the rest of the family situation. Once again, appropriate training and education of people involved in these decisions could make a great difference.

Finally, I want to make one simple suggestion, one that would contribute to the dignity and sense of continuity to be felt by adoptees. I suggest that we need a change in attitude about name changes connected with adoption. If a baby is only a few months old, a new given name might be selected, but I would propose one or both birth parent family names as middle names, with the adoptive family name added. If a child is old enough to recognize his or her given name (perhaps 6 months of age, ordinarily), the given name should not be changed, and family names should be kept if known. Certainly more than one change is out of the question, but the girl I mentioned in the last paragraph had her name changed both on her first adoption, at 4, and again by the second set of adoptive parents, at 8. I don’t argue against nick-names, but simply that children and adolescents who are establishing a sense of identity can benefit from knowing that the self at least has a consistent name. No one needs to wait for legislation to do this-- it’s a matter of individual attitudes and what they convey to the children and to others.

Yes, the laws need to change, but everyday practices can change much more quickly.

Updated CV, In Case You're Interested

CURRICULUM VITAE

JEAN MERCER*


Richard Stockton College
Pomona, NJ 08240
E-mail: Jean.Mercer@stockton.edu

*Name was legally changed from Gene Alice Lester, 1977

EDUCATION:
Mt. Holyoke College, 1959-1961
Occidental College. 1961-63; A.B. in Psychology, 1963
Brandeis University, 1963-67; Ph.D. in Psychology, Feb. 1968

EMPLOYMENT:
Assistant Professor, Wheaton College, Norton,MA. 9/67-6/69
Assistant Professor, State University College, Buffalo, NY 9/69-6/71
Assistant Professor, Richard Stockton College, Pomona, NJ 9/74-9/77
Associate Professor, Professor, Richard Stockton College, Pomona NJ 9/77-2/81
Professor of Psychology, Richard Stockton College, Pomona, NJ 2/81-2006
Professor Emerita of Psychology, Richard Stockton College, 2006--

PROFESSIONAL ACTIVITIES:
Consulting reader, Infants and Young Children,1992-
Editor, The Phoenix (NJAIMH Quarterly Newsletter), 1994-1999; Editor,
Nurture Notes (NJAIMH Newsletter), 2000-2001.
Vice President, New Jersey Association for Infant Mental Health, 1996-2000
President, New Jersey Association for Infant Mental Health, 2000-2005
Past president, ex officio Board of Directors member, NJAIMH, 2005-
Member, Prevention and Early Intervention Committee, New Jersey Community
Mental Health Board, 2000-
Consulting editor, Scientific Review of Mental Health Practice, 2002-
Member, New Jersey Better Baby Care Campaign Advisory Committee,
2002- 2003

Fellow, Council for Scientific Medicine and Mental Health, 2003-
Faculty member, Youth Consultation Services Institute for Infant and Preschool Mental Health, 2003-
Chair, Board of Professional Advisors, Advocates for Children in Therapy, 2003--
Expert witness, Utah Division of Occupational and Professional Licensing, 2005
(license revocation matter)
Expert witness, Middlesex NJ Family Court, 2005 (best interest hearing)
Member, "Critical Pathways" teleconference on training and credentials (formed after ZTT/Mailman Foundation Infant Mental Health Systems Development Summit Conference, September 2005)
Expert witness, Thibault vs. Thibault, Pasco County, Florida, 2006 (child custody and discipline matter)
Expert witness, California vs. Sylvia Jovanna Vasquez, Santa Barbara County, CA, 2007 (child abuse matter)
Reviewer, American Journal of Orthopsychiatry, 2008.
Testimony, Robertson vs. Mannion, Montgomery County, PA, 2008 (child custody matter)
Founding member, Institute for Science in Medicine, 2009—
Reviewer, Choice: Current Reviews for Academic Libraries, 2009-
Board of Directors, Delaware Valley Group of WAIMH, 2010—

PUBLICATIONS:

Lester, G., & Morant, R. (1967). Sound localization during labyrinthian stimulation.
Proceedings of the 75th Annual Convention of the American Psychological
Association, 1,19-20.
Lester, G. (1968). The case for efferent change during prism adaptation. Journal of
Psychology, 68, 9-13.
Lester, G. (1968). The rod-and-frame test: Some comments on methodology. Perceptual
and Motor Skills, 26, 1307-1314.
Lester, G. (1969). Comparison of five methods of presenting the rod-and-frame test.
Perceptual and Motor Skills, 29, 147-151.
Lester, G. (1969). The role of the felt position of the head in the audiogyral illusion. Acta
Psychologica, 31, 375-384.
Lester, G. (1969). Disconfirmation of an hypothesis about the Mueller-Lyer illusion.
Perceptual and Motor Skills, 29, 369-370.
Lester, D., & Lester, G. (1970). The problem of the less intelligent student in the introductory psychology course. The Clinical Psychologist, 23(4), 11-12.
Lester, G., & Lester, D. (1970). The fear of death, the fear of dying, and threshold differences for death words and neutral words. Omega,1, 175-180.
Lester, G. (1970). Haidinger’s brushes and the perception of polarization. Acta
Psychologica, 34, 107-114.
Lester, G., & Morant, R. (1970). Apparent sound displacement during vestibular stimulation. American Journal of Psychology, 83, 554-566.
Lester, G. (1971). Vestibular stimulation and auditory thresholds. Journal of General
Psychology, 85, 103-105.
Lester, G. (1971). Subjects’ assumptions and scores on the rod-and-frame test.
Perceptual and Motor Skills, 32, 205-206.
Lester, G., & Lester, D. (1971). Suicide: The gamble with death. Englewood Cliffs, NJ:
Prentice-Hall.
Lester, D., & Lester, G. (1975). Crime of passion: Murder and the murderer. Chicago:
Nelson-Hall.
Lester, G., & Rando, H. (1975). No correlation between rod-and-frame and visual
normalization scores. Perceptual and Motor Skills, 40, 846.

Lester, G., Bierbrauer, B., Selfridge, B., & Gomeringer, D. (1976). Distractibility,
intensity of reaction, and nonnutritive sucking. Psychological Reports, 39, 1212-1214.
Lester, G. (1977). Size constancy scaling and the apparent thickness of the shaft in the
Mueller-Lyer illusion. Journal of General Psychology, 97, 307-398.
Mercer, J. (1979). Small people: How children develop and what you can do about it.
Chicago: Nelson-Hall.
Mercer, J. (1979). Personality development and the principle of reciprocal interweaving.
Perceptual and Motor Skills, 48, 186.
Mercer, J. (1979). Guided observations in child development. Washington, D.C.: University Press of America.
Mercer, J., & Russ, R. (1980). Variables affecting time between childbirth and the establishment of lactation. Journal of General Psychology, 102, 155-156.
Mercer, J., & McMurphy, C. (1985). A stereotyped following behavior in young children.
Journal of General Psychology, 112, 261-265.
Mercer, J. (1991). To everything there is a season: Development in the context of the
lifespan. Lanham, MD: University Press of America.
Mercer, J.,& Gonsalves, S. (1992). Parental experience during treatment of very small
preterm infants: Implications for mourning and for parent-infant relationships.
Illness, Crisis, and Loss, 2, 70-73.
Gonsalves, S., & Mercer, J. (1993). Physiological correlates of painful stimulation in preterm infants. Clinical Journal of Pain, 9, 88-93.
Mercer, J. (1998). Infant development: A multidisciplinary introduction. Belmont, CA:
Brooks/Cole.
Mercer, J. (1999). ‘Psychological parenting” explained (letter). New Jersey Lawyer, July 12, 7.
Mercer, J. (2000/2001). Letter.Zero to Three, 21(3), 39.
Mercer, J. (2001). Warning: Are you aware of “holding therapy?” (letter). Pediatrics, 107, 1498.
Mercer, J. (2001). “Attachment therapy” using deliberate restraint: An object lesson on the identification of unvalidated treatments. Journal of Child and Adolescent
Psychiatric Nursing, 14(3), 105-114. This paper is posted at
http://www.bpkids.org/learning/reference/articles/index.htm#journals_#
with permission of the publisher to the Child and Adolescent Bipolar
Foundation.
Mercer, J. (2002). Surrogate motherhood. In N. Salkind (Ed.), Child Development
(pp. 399). New York: Macmillan Reference USA.
Mercer, J. (2002). Child psychotherapy involving physical restraint: Techniques used in four approaches. Child and Adolescent Social Work Journal, 19(4), 303-314.
Kennedy, S.S., Mercer, J., Mohr, W., & Huffine, C.W. (2002). Snake oil, ethics, and the First Amendment: What’s a profession to do? American Journal of
Orthopsychiatry, 72(1), 5-15.
Mercer, J. (2002). Attachment therapy: A treatment without empirical support. Scientific
Review of Mental Health Practice, 1(2), 9-16. Reprinted in S.O. Lilienfeld, J. Ruscio, & S.J. Lynn (Eds.), Navigating the mindfield: A user’s guide to distinguishing science from pseudoscience (pp. 435-453). Amherst, NY: Prometheus Books.
Mercer, J. (2002). The difficulties of double blinding (letter). Science,297, 2208.
Mercer, J. (2002) Attachment therapy. In M.Shermer (Ed.), The Skeptic Encyclopedia of
Pseudoscience (pp. 43-47) .Santa Barbara, CA: ABC-CLIO.
Mercer, J., & Rosa, L. (2002). Letter on Attachment Therapy. New Jersey School
Psychologist, 24 (8), 16-18.
Mercer, J., Sarner, L., & Rosa, L. (2003). Attachment therapy on trial: The torture
and death of Candace Newmaker. Westport, CT: Praeger. (see also reviews in Scientific American, PsycCritique, Scientific Review of Mental Health Practice).
Mercer, J. (2003). Letter to the editor. APSAC Advisor,15(3), 19.
Mercer, J. (2003) Attachment therapy and adopted children: A caution. Readers’
Forum. Contemporary Pediatrics, 20(10), 41.
Mercer, J. (2003). Violent therapies: The rationale behind a potentially harmful child psychotherapy and its acceptance by parents. Scientific Review of Mental Health
Practice, 2(1), 27-37.
Mercer, J. (2003). Media Watch: Radio and television programs approve of Coercive Restraint Therapies. Scientific Review of Mental Health Practice, 2(2).(see also letters in subsequent issues)
Mercer, J. (2004). The dangers of Attachment Therapy: Parent education needed.
Brown University Child and Adolescent Behavior Letter, 20(10), 1, 6-7.
Mercer, J. (2005). Bubbles, bottles, baby talk, and basketty. Early Childhood Health Link
(Newsletter of Healthy Child Care New Jersey), 4(1), 1-2.
Mercer, J. (2005). Coercive Restraint Therapies: A dangerous alternative mental health intervention. Medscape General Medicine, 7(3). (see also letters in subsequent issue). http://www.medscape.com/viewarticle/508956.
Mercer, J. (2006). Understanding attachment: Parenthood, child care, and emotional development. Westport, CT: Praeger.
Mercer, J. (2006). IEPs and Reactive Attachment Disorder: Recognizing and addressing misinformation. Scope (Newsletter of the Washington State Association of School Psychologists), 28(3), 2-6.
Mercer, J., Misbach, A., Pennington, R., & Rosa, L. (2006). Letter to the editor (age regression definition). Child Maltreatment, 11, 378.
Mercer, J. (2007). Behaving yourself: Moral development in the secular family. In D..McGowan (Ed.), Parenting beyond belief (pp. 104-112). New York: Amacom Books.
Mercer, J., & Pignotti, M. (2007). Letter to the editor (neurofeedback research critique). International Journal of Behavioral and Consultation therapy, 3 (2), 324-325 (http://www.behavior-analyst-today.com/BAR2007/BAR-VOL-2.pdf ).

Pignotti, M., & Mercer, J. (2007). Holding Therapy and Dyadic Developmental Psychotherapy are not supported, acceptable social work interventions: A systematic research synthesis revisited. Research on Social Work Practice, 17 (4), 513-519.

Mercer, J. (2007). Systematic child maltreatment: Connections with unconventional parent and professional education. Society for Child and Family Policy and Practice Advocate (Division 37 of APA), 30 (2), pp.5-6.

Mercer, J. ( 2007).Media Watch: Wikipedia and "open source" mental health information. Scientific Review of Mental Health Practice. 5(1), 88-92.

Mercer, J. (2007) Destructive trends in alternative infant mental health approaches. Scientific Review of Mental Health Practice, 5(2), 44-58.

Mercer, J., & Pignotti, M. (2007). Shortcuts cause errors in Systematic Research Syntheses: Rethinking evaluation of mental health interventions. Scientific Review of Mental Health Practice, 5(2), 59-77.

Mercer, J. (2008). Minding controls in curriculum study (letter). Science, 319, 1184.

Mercer, J. (2009).Child Development: Myths and Misunderstandings.Los Angeles,CA: Sage.

Mercer, J., Pennington, R.S., Pignotti, M., & Rosa, L. (2009). Dyadic Developmental Psychotherapy is not "evidence-based": Comments in response to Becker-Weidman and Hughes (2009). Child and Family Social Work, 15, 1-5. http://www.wiley.com/bw/journal.asp?ref=1356-7500 . DOI:10.1111/j.1365-2206.2009.00609.x.

Mercer, J. (2009). Child custody evaluations, attachment theory, and an attachment measure: The science remains limited. Scientific Review of Mental Health Practice, 7(1), 37-54.

Mercer, J. (2011). Attachment theory and its vicissitudes: Toward an updated theory. Theory and Psychology, 21, 25-45.

Mercer, J. (2010). Themes and variations in development: Can nanny-bots act like human caregivers? Interaction Studies, 11(2), 233-237.

Mercer, J. (in press). Reply to Sudbery, Shardlow, and Huntington: Holding therapy. British Journal of Social Work.

Mercer, J. (in press). The concept of psychological regression: Metaphors, mapping, Queen Square, and tavistock Square. History of Psychology.

UNPUBLISHED/ IN PREPARATION:
Lester, G. (1968). Some investigations of the audiogyral illusion. Unpublished Ph.D. thesis, Brandeis University.
Mercer, J. (1993) The successful single parent. Unpublished book-length ms.
Mercer, J. The developing child in
changing times: Infancy through adolescence Unpublished book-length ms.
Invited comments on the New Jersey Children’s Initiative proposal (March 10, 2000);
with Gerard Costa and Elaine Herzog.
Invited comments on the U.S. Bright Futures children’s mental health proposal (July 5, 2000); with Gerard Costa.
Mercer, J. (2000). Notes on Attachment Therapy: Relevant Research and Theory. Prepared for use by the prosecution in the trial of Connell Watkins, Colorado, Aril 2001.
Sarner, L., & Mercer, J. (2003). Statement to Human Resources Subcommittee of House Ways and Means Committee. http://%20waysandmeans.house.gov/hearings.asp?formmode+view&id+1342.
Mercer, J. (January, 2005). Expert witness report. State of Utah Division of Occupational and Professional Licensing. Case number 2002-223.
Mercer, J. (April, 2005). Expert witness report. Child custody case, Middlesex Family Court, New Brunswick, NJ.
Mercer, J. (October, 2006). Expert witness report. Child custody case, Pasco County, Florida.


BLOGS:

http://www.psychologytoday.com/blog/child-myths/ (June 2009-June 2010)
http://childmyths.blogspot.com/

RECENT PRESENTATIONS:
Various presentations on child development and parenting issues to parent groups and
training workshops, including CASA.
“Law, policy, and attachment issues”; presentation at the Second Annual Conference on Attachment of the New Jersey Psychological Association. June 9, 2000, Newark, NJ.
“Custody changes and their effect on children’s development”; presentation at New Jersey State Child Placement Advisory Council conference, April, 2001.
“Bad language: How the professions confuse each other with words,” welcoming address at conference on Attachment, New Jersey Association for Infant Mental Health,
Piscataway, NJ, April, 2002.
“That cranky, crying baby”; presentation at National Association for Education of Young Children Conference on Health in Child Care, Princeton, NJ, May, 2002; repeated May, 2003, May, 2004.
“Warning Signals: When parents consider unusual mental health treatments for their children”; presentation at Third Annual Multicultural Health Conference, Richard Stockton College, Pomona, NJ, Sept. 2002.
“Misuse and abuse of attachment theory”; keynote speech at 2002 Annual Meeting, New Jersey Association for Infant Mental Health, Piscataway, NJ, Nov. 2002.
“Attachment Therapy: Science adversaries appeal to scientific evidence.” Institute of Contemporary British History conference, “Science, Its Advocates and Adversaries”, London, July 7-9, 2003.
“Analyzing Attachment Therapy”, at “Right From the Start: Supporting the Earliest Relationships and their Impact on Later Years,” professional conference presented by Youth Consultation Services Institute for Infant and Preschool Mental Health, Newark, Sept. 24-25, 2003 (continuing professional education credit-bearing).
“Principles of Infant Mental Health”, at “What Does Infant Mental Health Mean to Me?”, professional conference sponsored by New Jersey Association for Infant Mental Health, Gateway Maternal-Child Health Consortium, Northwest Maternal-Child Health Consortium, Piscataway, NJ, Nov. 13, 2003 (continuing professional education credit-bearing).
“Attachment and Attachment Therapy: The Good, the Bad, and the Ugly”, at annual meeting, Gateway Maternal-Child Health Consortium. East Orange, NJ, March 25, 2004 (Continuing professional education credit).
“Attachment.” Annual conference of New Jersey Association for Education of Young Children, East Brunswick, NJ, Oct. 16, 2004 (continuing professional education
credit)
Discussion of Attachment Therapy. “All in the Mind”, Australian Broadcasting Company, Dec. 18, 2004. Transcript available at http://abc.net.au/rn/science/mind.
“Attachment: Social and Emotional Development from Birth to Preschool.” Conference of Coalition of Infant and Toddler Educators, East Brunswick, NJ, March 18, 2005.
“Attachment Therapy: Concerns on Unvalidated Treatments.” Institute for Infant and Preschool Mental Health Didactic Series, Youth Consultation Service, East Orange, NJ, May 12, 2005.
"Violent therapies with children: History and theory.” 9th International Family Violence Research Conference, Portsmouth, NH, July 11, 2005.
Invited state delegate and New Jersey presenter, Infant Mental Health Systems Development Summit conference, sponsored by Mailman Foundation/Zero to Three. Washington DC, Sept. 22-24, 2005.

New Jersey Perinatal Mood Disorders training program presentations, 2005-2006.

“Dangerous therapies”, with Alan Misbach. LCSW. Independent Educational Consultants Association conference, Philadelphia, Nov. 14, 2005.

"Attachment Therapy". Institute for Infant and Preschool Mental Health Didactic Series, Youth Consultation Service, East Orange, NJ, April 27, 2006.

"Attachment Therapy" comments, Paula Zahn show, CNN, Nov. 14, 2006.

"Attachment Therapy" comments, Court TV, Nov. 27, 2006.

"Understanding attachment." Delaware Valley Group, WAIMH. Dec. 1, 2006.

"Strategies for picky eaters." Jan 31, 2007, NJ WIC training, Ewing, NJ.

"Just the facts, ma'am: Asking and answering the right questions about evidence-based treatment." May 17, 2007. Florida Association for Infant Mental Health, Ft. Lauderdale.

Panel on secular parenting, moderated by Dale McGowan. Atheist Alliance International,
annual conference, Arlington, VA, Sept. 29, 2007.

"Circumstantial Evidence: Evaluating Design and Details of Outcome Research" (poster presentation). Dec. 1, 2007. Zero to Three National Training Institute, Orlando, Florida.

"Theory of Mind: A New Approach to Attachment." Conference of Coalition of Infant and Toddler Educators, New Brunswick, NJ, March 14, 2008.

"Novel Unsupported Therapies: Pseudoscientific and Cult-like". With Monica Pignotti and James Herbert. International Cultic Studies Association conference, Philadelphia, June 27, 2008.

"Attachment Theory, Evidence-based Practice, and Rogue Therapies: Using and Misusing the Concept of Attachment." With R.S. Pennington, L. Rosa, and L. Sarner. Wisconsin School Psychologists Association conference, LaCrosse, WI, Oct. 29, 2008.


"Are There Research-based Child Custody Evaluations? An Ongoing Case and an Ongoing Discussion." Annual Conference, New Jersey Association for Infant Mental Health, Dec. 12, 2008, North Brunswick, NJ.

“A Problematic Parenting Pattern Associated With Child Deaths.” Eastern Psychological Association, March 7, 2009, Pittsburgh, PA.

“Personalities and Power Struggles: Discipline, Temperament, and Attachment.” Coalition of Infant and Toddler Educators Annual Conference, March 14, 2009, Somerset, NJ.

“Don’t Be So [Un]critical! Using Critical Thinking to Foster Mastery of Child development Concepts.” Developmental Science Teaching Institute, Society for Research in Child Development, April 1, 2009, Denver, CO.

“Psychological Concepts and Measures in the Family Court”. Judicial Orientation, Essex Vicinage (NJ). Princeton, NJ, Oct. 2, 2009. (With Michelle DeKlyen, Ph.D.)

“Are There Research-Based Child Custody Evaluations?”. Conference on Infants and Children in the Courts, sponsored by Youth Consultation Service and NJAIMH; Clara Maass Medical Center, Belleville, NJ, March 19, 2010.

Symbiosis, Intersubjectivity, and Early Relationships

When people concerned about adoption discuss relationships between babies and mothers, they sometimes refer to a period of symbiosis, in which the identities or “selves” of mother and child are somehow fused, so the baby cannot tell the self from the mother effectively. As I’ve pointed out before, this idea is derived from the work of Margaret Mahler and other psychoanalytically-oriented thinkers, who considered this symbiotic period to last from about the second month to the seventh month or so. It’s important to note that Mahler herself did not think the symbiotic period included the first weeks of life or that the events of that period would have any effect on babies who were separated early from their birth mothers and adopted into different families.

Daniel Stern, in The Interpersonal World of the Infant, refers to symbiosis and discusses the concept in detail, but points out that modern research on early development has revealed a number of phenomena that contradict the possibility of early symbiosis as “fusion”. I want to review a number of facts that suggest that babies have an early concept of “self” versus “other” that makes a sense of fusion unlikely for the baby (although mothers may feel that their “selves” include their babies). This sense has been referred to as “primary intersubjectivity”.

One thing that suggests that young babies already “know” (or act as if they know) the difference between the self and another is that shortly after birth they will imitate the facial expressions of others, opening their mouths, even sticking out their tongues (Meltzoff, A., & Moore, A. [1989]. Imitation in newborn infants: Exploring the range of gestures imitated and the underlying mechanisms. Developmental Psychology, 25, 954-962). It is difficult to imagine that a baby would imitate itself (which brings to mind some infinite progression of mirrors), so the great majority of developmental psychologists today would interpret imitation as some primitive awareness that there are other people “out there”. Incidentally, this newborn imitation is not confined to the mother’s facial expressions as we might expect if the birth mother already had overwhelming importance for the infant.

Another point contradicting the possibility of “fusion” and symbiosis is the infant’s response to the so-called “still-face” situation. In this situation, an adult (the mother or someone else) faces a baby, but does not make eye contact and maintains a blank and unresponsive demeanor (this is not easy to do when the baby is signaling that it wants attention, by the way). From a few months of age, babies are distressed by this and become disorganized in their behavior, whimpering, averting the gaze, looking at their hands, even hiccupping. Babies who are in the developmental period where symbiosis had been thought to occur change their behavior in response to the still-face rather than accepting the unresponsiveness as a part of the “fused selves”.

At the same time, though, mothers or other primary caregivers continue to act as if they feel fused with their young babies. They interpret baby sounds, looks, and gestures as if they (the mothers) know the babies’ intentions. They talk to the baby about his or her needs and feelings. When talking to other adults, they may “speak for the baby”, voicing what they feel to be the babies’ opinions and answering questions or comments made to the baby by other adults. Sometimes they begin their baby remarks by saying “Say” in a lower voice, then switching to a high voice for the words the baby is supposed to mean to say (“Yes, I’m sleepy, Grandma”). As so often occurs, the mothers’ feelings and behavior are parallel to and supportive of the babies’ actions, but are by no means the same.

It’s notable that mothers’ sense of fusion fosters good infant development at the same time that it is not actually in line with reality. The mother who interprets her infant’s signals fairly accurately is encouraging the development of communication, followed by speech and eventually by other cognitive abilities. If she felt “unfused”, was convinced that the baby did not intend to communicate or that she could not understand, and did not try to respond, the mother would not do such a good job and the baby’s development might well be slowed. Problems are likely to occur when the mother is too depressed, tired, or sick to be responsive, or when there are too many young children to care for at once (as in low-quality group care for infants).

Even infants of a few months notice differences in adult emotional facial expressions, but they don’t respond with concern for the worried or frightened adult. By 8 or 9 months, they are interested in the meaning the adult’s emotions have for the child (is there something to be afraid of?). But it’s not until 12 months or so that they begin to have “theory of mind”-- the assumption that other people have their own separate feelings and knowledge, and that those adult facial expressions indicate feelings inside the adult. Without theory of mind, infants can hardly feel a sense of intimacy, much less symbiotic emotional fusion, with adults.

It’s a problem to assume that mothers’ and babies’ feelings about each other are mutual, with each a mirror of the other. We can’t make good guesses about infant abilities just from knowing how adults function. Research on infant abilities tells us that no matter what mothers may feel, babies don’t experience symbiosis. However much adoption reform is needed, it would not be wise to make reforms based on the assumption that mothers and young infants are in symbiotic relationships.

Symbiosis: More Fun with Metaphors

There was annoyance expressed by a reader last week when I was perceived as saying that something was “just a metaphor”. I didn’t say that, and I plan to not say it again today. In the study of mental health and other aspects of psychology, metaphors are extraordinarily important because they can guide our thinking into useful-- or useless—channels. A useful metaphor is one in which the psychological event can accurately be “mapped” onto the better-understood event we’re comparing it to, so a lot of things about the psychological event are like aspects of the comparison event. A useless or even harmful metaphor is one where the reality of the psychological event is very different from the reality of the comparison event.

Why am I bringing this up? I’m interested in the metaphor of symbiosis, so much bandied about in discussions of adoption. I believe this is a useless, even a harmful, metaphor. It was used by the psychoanalytically-oriented infant-toddler expert Margaret Mahler, and later by Daniel Stern as well as by others. They used the term symbiosis to describe a period of early life, beginning not at birth but at a few months of age, and going on until about the time that attachment behavior begins. For these authors, the word “symbiosis” was chosen to express the deep intimacy, physical and emotional, that often prevails between mothers and babies at this time in the baby’s life.

The word symbiosis, literally “a living together”, deceives us by looking as if it might be a good word to describe the best mother-infant relationships between about 2 and perhaps 6 or 7 months. But it’s not a word that was invented for this purpose. It describes another, more easily understood phenomenon, and because of this introduces a metaphorical usage into the discussion. Symbionts, or animals that live in symbiosis, are not uncommon in the natural world. They belong to different species but live near each other and behave in ways that are mutually beneficial. For example, pilot fish and sharks benefit each other and contribute to each other’s survival, as the fish eat the parasites that can infest the shark’s skin.

Real symbiosis does not provide a good metaphor for any stage of the mother-child relationship, because mothers and babies are not mutually beneficial to each other’s survival, either before or after birth. Mothers take care of babies; babies do not take care of mothers. On the contrary, aspects of motherhood are so potentially damaging to the mother that we have to look to evolutionary advantages for the species before we see any survival-related reason for having children. (I’m not talking about love, fun, or cultural pressures here, just plain survival of the kind that symbiosis aids.) Aside from a few possibilities like reduction in breast cancer caused by breastfeeding, we see virtually all the benefits of the relationship going to the baby, while the mother serves as an auxiliary immune system as well as an auxiliary ego.

What would be a more suitable metaphor, drawn from the natural world, to guide our thinking about young babies and their mothers? If we’re going to choose a comparison to animals living together, a better choice than symbiosis would be parasitism. A parasite, like a tapeworm living in a human gut, takes what it needs from the host, but usually does only slight damage, as it benefits from the host’s continuing life. Unborn babies function like parasites to a considerable extent, sometimes endangering or even killing their host[ess]. During the first year, or even longer, the long slow maturation of human beings makes them require constant care which they are completely incapable of reciprocating and keeps them in a parasitic relationship to adults.

Well, this is really an ugly metaphor, isn’t it? Babies as tapeworms is a pretty disgusting idea. But they’re not pilot fish either, and look at the problems we get into with the symbiosis metaphor. That way of thinking leads us to believe that the early mother-baby relationship is mutual, a two-way street in which the feelings and needs of one partner reflect the feelings and needs of the other one. We can make a lot of mistakes with that metaphor. One is to assume that anguish of a mother separated from her baby is necessarily mirrored by the anguish of a young baby separated from the mother, though observation of babies of a few months tells us this assumption is false. Another is to confuse the mother’s and child’s feelings as attachment develops and to think of “bonding-and-attachment” as if they meant the same thing. The parasite metaphor actually works much better as a description of the early mother-child relationship because it protects us from making mistakes about mutuality.

Of course, one of the difficulties of choosing a good metaphor for mother-baby relationships is that, like other aspects of development, those relationships don’t follow the same rules throughout life. Babies function in different ways at different points in their development, and within the second year will become less parasitic and more capable of reciprocating care and affection in a faintly adult-like way. Mothers, too, operate differently at different times in their own and their babies’ lives. As time passes, new metaphors need to be chosen to help us understand social and emotional development. It’s possible that symbiosis could be a good metaphor for some kinds of adult relationships, but I doubt that it ever works well for relationships between parents and their children of any age.

Autism Treatments: Science, CAM, or None of the Above?

There are plenty of non-evidence-based treatments aimed at ameliorating autism. Holding therapy was once used for this purpose, and may still be used by some practitioners. Chelation therapy is known to be not only ineffective but potentially harmful to the child. But what about the most famous treatment, Applied Behavior Analysis (ABA)? And what about the new treatment on the block, Developmental, Individual-difference, Relationship-based therapy (DIR), or Floor Time, based on the approach of the late Dr. Stanley Greenspan? ABA is often stated to be scientifically supported, even “proven”. DIR, on the other hand, has been included as a complementary and alternative treatment by Lisa Kurtz in her book Understanding controversial therapies for children with autism, attention deficit disorder, and other learning disabilities (Jessica Kingsley Publishers, 2007). The CAM designation generally means that a treatment lacks rigorous research support, and may indicate that the treatment is not plausible in terms of orthodox thinking about psychology or medicine.

ABA is based on behavioristic views of learning, which are well substantiated for both human and animal learning, and for all periods in the human lifespan. This treatment is related to operant conditioning, a method that involves reward or reinforcement of desired behaviors like talking, and the prevention of reinforcement of undesired behaviors like the autistic child’s tendency to flap hands or to become fascinated with objects. (At one time, ABA used punishment as well, but as this seemed ineffective it has been dropped from the method.) Operant conditioning is well-known to change behaviors effectively when the behavior chosen occurs from time to time and when a suitable reinforcer can be identified. It is less easy, but possible, for ABA to encourage a behavior which rarely or never occurs in the desired form; in order to do this, ABA specialists use a method called “shaping” in which they initially reinforce related behaviors (like making sounds with the mouth) and gradually limit reinforcement to the desired behavior (for instance, saying a word). ABA thus has a foundation that is plausible in terms of conventional understanding of human functioning.

There’s plenty of evidence that operant conditioning can alter behavior according to well-understood rules. But is there strong evidence that ABA successfully moves autistic children toward significantly more age-typical behavior? Some years ago, Morton Ann Gernsbacher discussed this issue in some detail (Gernsbacher, M.A.[2003]. Is one style of early behavioral treatment for autistic children “scientifically proven”? Journal of Developmental and Learning Disorders, 7, 19-25). In her article, Gernsbacher pointed out that the 1987 work of Ivar Lovaas, the developer of ABA, which reported a significant effect of the treatment, in fact failed to use a design that is needed for the highest category of research support for an intervention. Lovaas’ study did not assign participants randomly to an ABA treatment group or to another type of treatment. Instead, assignment to groups depended on the availability of a therapist, a method which brings in unknown confounding variables like the effect of holidays. The few similarly-designed, good-quality studies also had assignment to groups determined by practical factors rather than true random assignment. As a result, the strong effects those researchers reported need to be interpreted cautiously. A study in 2000 randomized participants, but reported much weaker positive effects than had come from the non-randomized studies (Smith, T., Groen,A.D., & Wynn, J.W. [2000]. Randomized trial of intensive early intervention for children with pervasive developmental disorder. American Journal of Mental Retardation, 105, 269-285).

As a result of these facts, we can conclude that although it may be appropriate to say that ABA is the best-supported method for treatment of autism, it is not appropriate to speak of it as “scientifically proven” or even as evidence-based at the highest level. To the best of my knowledge, no adverse events attributable to ABA have been reported, so this treatment does not belong in the “potentially harmful” or “of concern” category.

What about DIR? Unlike ABA, DIR is not based primarily on principles derived from empirical research, but instead has its foundations in a theory derived by Stanley Greenspan from a variety of sources: psychoanalysis, Piagetian theory of learning, the sensory integration theory of Jean Ayres, and studies of language development. DIR emphasizes an essential connection between emotional development and motivation to communicate with other people, and the capacity for language, thought, and problem-solving. This method focuses on the normal sequence of developmental change, on the formation of social relationships, and on individual differences between children. DIR is thus plausible in terms of commonly accepted ideas about developmental change, although its greater complexity of sources makes it less likely to have the type of support that is foundational for the simpler ABA approach.

Like practitioners of many other treatments for young children, DIR advocates have done little so far to test the efficacy of their preferred intervention. Devin Casenhiser, a psycholinguist in Toronto, has been carrying out a randomized trial study of DIR, but has apparently not yet published it. A number of doctoral dissertations have examined various effects of DIR, including attitudes of parents and of teachers about its use, but have not systematically investigated child outcomes.

It would be impossible to conclude that DIR is evidence-based when so little has been done to examine the outcomes of the treatment. As usual, however, we have no way of knowing whether there are unpublished studies with negative results, or even with the conclusion that DIR had a worse effect than another treatment used as a comparison. Like ABA, DIR appears to have been without reported adverse events.

Should we, then, agree with Lisa Kurtz and describe DIR as a complementary and alternative treatment? I confess that I was shocked to see this classification, as so much of the background of the treatment is highly plausible and conventional in nature. I would see DIR as an little-examined intervention of a conventional type-- a genuinely “experimental” treatment-- as opposed to CAM treatments that are not only without a basis in evidence, but are implausible and incongruent with existing information about development. It may be that plausibility is as important as empirical evidence in determining whether a treatment belongs to the CAM group, but in many ways plausibility is more difficult to determine than evidence, as it requires close examination of the premises and reasoning foundational to a treatment, rather than the simpler analysis of research designs and statistics.

It seems that neither statement about these methods for treating autism is clearly substantiated. ABA has much weaker scientific support than is often claimed. DIR, which makes few claims for research support, may not be correctly designated as complementary and alternative in nature, but I wish DIR proponents would comment on the inclusion of their method in the Kurtz book. I’d like to know whether they too accept the CAM categorization.

When is a Five-Year-Old Older Than Another Five-Year-Old?: Interesting News About ADHD

It wouldn’t surprise most of us if a baby of 6 months acted a lot different from a one-year-old, and a one-year-old a lot different from a two-year-old. Those age differences eventually smooth out, of course, so someone who is 23 probably doesn’t behave much differently from someone who is 22. But when does that smoothing-out occur? We usually treat school-age children as if their grade level is more significant than their actual age in years and months, but this may be a mistake. A recent health economics research article suggests that it may be wrong to assume too early that exact age is irrelevant ( Elder, T. [2010]. The importance of relative standards in ADHD diagnosis: Evidence based on exact birth dates. Journal of Health Economics, 29, 641-656. www.ncbi.nlm.nih.gov/pubmed/20638739).

Elder’s work used a group of almost 12,000 children and examined the proportion of children diagnosed with attention deficit/hyperactivity disorder (ADHD) in groups that were the oldest in their grades or the youngest in their grades. Because public schools have an age/ birthday cut-off for school entrance and enforce this strictly, looking at a child’s birth date tells us whether he or she entered public school soon after the required birthday and thus was among the youngest in a class, or did not enter until almost a year after that birthday and was among the oldest in the class. If the cut-off date was September 1, children with August birthdays would enter kindergarten at no more than 5 years and one month, but a September birthday would mean that the child waited a year for school entry and came in at no less than 5 years and 11 months of age. Both August and September-born children would be 5 years of age, but the oldest children would be nearly 20% older (and more developed) than the youngest children.

Elder’s study showed that in fact the nearly-20% age difference had significant effects on the children’s ability to cope with the demands of school. About 10% of the “youngest” children (with birthdays shortly before school entrance) were diagnosed as having ADHD, compared to only 4.5% of the “oldest” children (birthdays almost a year before school entrance). In addition, there are long-term consequences of this diagnosis, and by fifth grade almost twice as many of the “youngest” children were taking stimulant medications intended to treat their attention problems.

This pattern was the same for states with a late-summer cut-off as they were for states that set their cut-off later. In all cases, younger children within a group were more likely to be diagnosed and treated for attention problems than older children were. Looking at teachers’ and parents’ assessments of children, Elder found that teachers were very likely to evaluate younger children as having more attention problems, as they compared them to other children in their class; parents were less likely to do this.

Elder’s work suggests that evaluation of attention problems in kindergarteners is influenced by the child’s maturity relative to that of other children in a group. An accurate diagnosis for a child of this age requires comparison to others who are close in age, not to those who are 10, 15, even almost 20% older than the child in question. A child who is 5 years and one month old is as much less mature than one who is 5 years and 11 months old, as a 13-year-old is in comparison to a 15-year-old. Teachers need to be aware of these facts, as their recommendations and evaluations can play a major role in diagnosis of children.

Elder’s work is of great importance in understanding diagnosis of ADHD, one of the most common mental health diagnoses for children (http://www.mchb.hrsa.gov/nsch/07emohealth/index.html). It is also relevant to the frequent use of medications that have the potential for adverse side effects, and to the creation of adverse expectations in adults who are aware of a child’s diagnosis-- both situations that may worsen the child’s developmental outcome.

The demonstration of relative-age factors for ADHD should also serve as a red flag with respect to various on-line checklists offered for diagnosis of other problems. For example, at http://reactiveattachmentdisordertreatment.com/ssi/checklist.html, a checklist is presented, purporting to be appropriate for children from age 5 through teen-age. It includes the item “has frequent or intense angry outbursts” without noting that what is “frequent” or “intense” for a 5-year-old may be quite different from what is defined in those terms for a teen-ager.

When making decisions about what a child needs, the question “how old is the child?” is always of primary importance. School systems show that they understand something about this by setting age cut-offs for school entry, but teachers, parents, and professionals need to remember that the details of age can make a big difference in a child’s needs and abilities. One 5-year-old can be a lot older than another 5-year-old.

Using and Abusing Metaphors: Attachment, Bonding, and Primal Wound

Several posts ago, I referred to ideas like the “Primal Wound” (a posited psychological injury caused by separation of a baby from its birth mother) as metaphors that could be helpful in therapy or in thinking through personal problems. One reader felt insulted by this statement and equated it with saying that proponents of the Primal Wound approach are “stupid”. I certainly didn’t intend to say that, although I think that if they considered the facts of infant development they would be aware that the Primal Wound is a socially constructed concept rather than a “natural kind”. I did mean just what I said-- that thinking metaphorically can be one of our best ways to figure out puzzling and complicated problems.

If any readers are old enough to remember the comic strip “Pogo”, they may recall the time when another character disparaged Rabbit by saying, “Huh! You ain’t nothin’ but a rabbit!”. Incensed, Rabbit declared, “I am not”. When Pogo Possum gently reminded him that he actually was a rabbit, he explained, “Yeah. But not a Nothin’ But A Rabbit!”. When I say the Primal Wound concept is a metaphor, I don’t mean a Nothin’ But A Metaphor.

To say that something is a metaphor is by no means to belittle it. In psychology, especially, it’s so common to deal with events that can’t easily be observed, events that we infer on the basis of other events, that metaphors are a large part of our stock in trade. The Greek root of the word metaphor means “transfer”, and metaphors transfer the characteristics of things we know well to things we don’t know well, in an attempt to understand the latter. Whether this is useful depends on the extent to which the characteristics of the known thing “map onto” (or match with) the characteristics of the unknown thing. Obviously, if the choice of metaphor is not good, this comparison will not be of much help in understanding the unknown, and this can easily happen because, by definition, we don’t really know the characteristics of the unknown.

We can’t do without metaphors, as the work of people like Hacking, Lakoff, and Johnson suggests. But we need to use them cautiously and watch out for misunderstandings that emerge from the metaphor itself. Two good examples of such misunderstandings are the use of the terms “attachment” and “bond”. Transferring all the characteristics of physical “attachments” or “bonds” to psychological relationships (that is, mapping the psychological onto the physical) is useful in some ways, but makes for misunderstandings in others.

When we consider a physical attachment, like a boat tied to a mooring with a rope, or an electronic one like a document sent with an e-mail, we are looking at a situation where each thing is equally attached to the other thing. The boat is tied to the mooring, and the mooring is tied to the boat. The document accompanies the e-mail, and the e-mail carries the document. These situations map onto emotional attachment in the sense that there is a special relationship between the boat and the mooring, and there is a special relationship between a child and an adult caregiver. However, while the boat and the mooring are equally and identically connected, this is not true of the younger and older human beings. The attitude, motivation, and behavior of the child toward the caregiver are much difference than those of the caregiver toward the child, and the two respond very differently to the breaking of the connection. The same is true for “bonding”; Epoxy bonds two pieces of wood equally to each other, but the attitudes of the “bonded” adult are vastly different from those of the child for whom the bond is experienced.

Using the “attachment” or “bond” metaphors is helpful for understanding, but it also carries the danger of misunderstanding. This is evident in the many inaccurate claims made by people who assume that adult and child experience identical and mutual emotional events, and who also assume that once the knot is tied or the glue set, attachment and bonding do not continue to change with development, but retain their original characteristics.

The language of the Primal Wound metaphor maps emotional experience onto a physical phenomenon. The first, second, and third dictionary definitions of “wound” all refer to injury to a physical body, and only the fourth gives the [metaphorical] meaning of an injury to one’s feelings. Characteristics of physical wounds are that they had an onset caused by some external event, that they hurt, that they are potentially dangerous to physical functioning or even to life, that they provide opportunities for infection or further injury-- but also that they usually have at least some capacity for self-healing. How do these characteristics map onto the Primal Wound, as the term is used by Nancy Verrier in her books, The Primal Wound and Coming Home to Self? Verrier and her followers use "Primal Wound" to refer to adult adoptees’ sense of being abandoned, alone, and grieving, and to the events that they believed caused these feelings, just as “wound” might be used to mean both a lingering injury and the initial damage.

The nature of a physical injury does map reasonably well onto the psychological experience reported by some adult adoptees. There is pain, there is potential danger of further related injury, there are reasons why a sufferer might have his or her pain exacerbated by other experiences. But there are some ways in which physical wounds do not seem to map onto this type of psychological pain. An important one is that while a physical wound has an observable onset and cause, the adoptees’ psychological pain does not have an observable onset in infancy; babies separated from their biological mothers at birth do not show distress, slowing of growth, apathy, or any of the other characteristics that signal grief in older children. It’s the use of the “wound” metaphor that implies that there must have been such an onset, rather than an observable onset that supports the use of the metaphor, and this demonstrates another way that metaphors can hinder our understanding--- by leading us to cherry-pick among evidence for the material our metaphor seems to demand. Someone in thrall to the Primal Wound metaphor may say, “Newborn babies must show distress when separated, because that’s what a wound would cause, and if no one has found any evidence of this it must be just because they haven’t looked the right way.”

Abuse of analogies is not just a trivial logical error. By fostering misunderstanding, it can lead to abuse of infants, children, and adults as well. In my opinion, the Primal Wound metaphor, a much-abused analogy, has done exactly that by encouraging mistaken treatments.

"Food for Thought": Dr. Dana Johnson's Webinar on Nutrition and Adoption

Yesterday I watched with great interest a webinar conducted by Dana Johnson,M.D., and organized by Adoption Learning Partners. Entitled “Food for Thought: The Impact of Poor Nutrition in Early Development”, this presentation focused on the nutritional histories of internationally-adopted children, on their nutritional needs after adoption, and on developmental outcomes that appear to be related to diet.

Dr. Johnson was careful to emphasize the difficulty of disentangling nutritional from social factors in development. Infants and toddlers in orphanage settings are likely to be deprived both in their diets and their experience of normal social interactions. For the family child, or for the child in high-quality foster care, mealtime involves far more than simply the ingestion of nutritious substances. It is a “cue-based” process in which the baby’s signals of hunger or satiety are responded to by caregivers. This process involves talking and listening, social communication by facial expressions, turned heads, or open mouths, and anticipation of what another person is about to do (a feature of “theory of mind”). Feeding in the family also involves the pleasures of taste and texture and a sense of gradual mastery of self-feeding, achieved in graduated steps as sensitive caregivers provide food a baby can handle.

In an institution, however, as Dr. Johnson noted, feeding is not cue-based but efficiency-based. Bottle-fed babies have their bottles propped so staff members do not have to sit with them-- thus removing all possibility of social interaction during feeding. Institutional caregivers spoon food into babies’ mouths as rapidly as they can, then go on to the next baby without taking time to socialize or play. Feeding can thus become an unpleasant experience rather than the pleasurable, playful, self-regulated one it ideally should be. By the toddler period, institutional children are expected to be able to feed themselves, and although they eventually become competent at this, months may go by during which they do not have the motor skills to ingest much food. All these problems are intensified for children who have malformations of the mouth or whose motor control is problematic, as might be the case when cerebral palsy is present. Babies who were of low birth weight are particularly affected because of their greater need for calories and trouble absorbing fats and carbohydrates. Fetal alcohol syndrome is another factor determining special needs.

The result of time spent in an institution is very commonly growth failure. Children adopted from institutions are generally undergrown in both height and weight, and may have smaller head circumferences than family children. One of the tasks of the first year after adoption is the fostering of catch-up growth, which is usually rapid when circumstances are good. (However, the tragic news reports of abuse deaths of internationally-adopted children generally note malnourishment of the child; it is hard to know whether this condition is due to failure of catch-up growth to begin with, whether it is part of a pattern of neglect and abuse, or even whether it is due to ill-judged attempts to use food to control the child’s behavior [see, for example, www.ncids.org/Brief%20Bank/Briefs/Salvetti,%20Paul%20J.doc].)

In his webinar, Dr.Johnson recommends a thoughtful approach to the re-feeding of growth-retarded adoptees. First, he suggests establishing a nurturing feeding environment, where eating together can be pleasurable socially and otherwise. As in so many aspects of child development, in the beginning, the relationship between the child and the caregiver is more important than the calories ingested or the parent’s “feeding skills”. A second suggestion is that the adoptive parent begin with foods familiar to the child. The Internet site www.spoonfoundation.org provides information about what children from specific countries may be accustomed to eating and recipes for indigenous foods. Although many adoptive families cook such foods as a way to celebrate the child’s origin, Dr.Johnson’s point is that initially these should not be special holiday foods. They are what the child is accustomed to and therefore will have the greatest appeal for him or her. (And while you might intuitively think that an undergrown child will be famished and ready to eat anything, this is not the case. Chronic underfeeding leads to apathy and lethargy, and these children need to be tempted and encouraged to eat.) This is, by the way, not a time to correct the child’s table manners or make a point of discipline by demanding that the child eat.

Once a child is eating well of a family’s version of familiar foods, other appealing, easy-to-eat foods may be gradually introduced. It’s a good idea to remember that toddlers, even those with excellent care histories, are reluctant to try new things (this is sometimes called neophobia), and will often try foods only after they have seen them a number of times without eating them. Parents should keep an eye on whether a child can handle lumps or other textural differences; if not, a feeding clinic or a speech and language pathologist may be of help in teaching the child to use the mouth and tongue better, which may also minimize later speech problems.

Dr. Johnson also referred to concerns about over-eating and hoarding of food, and recommended treating these issues with sensitivity. A very helpful piece about hoarding is at www.spoonfoundation.org, along with information on other related topics.

Chewing Off the Hand: Demonizing Nathaniel Craver

The Virginia psychologist Ronald Federici has found a new and scary way to blame adopted children for their own injuries. Commenting on the death of a western Pennsylvania boy who had been adopted from Russia, he has referred to another child who “chewed off his own hand” and to children with no sense of pain (http://www.washingtonpost.com/wp-dyn/content/article/2010/10/20/AR2010102004021.html and many other Internet sites). Federici and the defense attorneys for the adoptive parents, Michael and Nanette Craver, argued that the child, re-named Nathaniel, had injured himself fatally. An Associated Press article stated the Cravers’ argument that Nathaniel had suffered from Reactive Attachment Disorder, which, according to the article, “includes a tendency to injure oneself. “

Let’s consider each of these statements. Is it possible for someone to chew off his hand or to feel no pain? Individuals with the genetic disorder Lesch-Nyhan syndrome do chew off their lips and tongues as well as having movement and other problems. Schizophrenic patients have been known to gouge out their own eyes or break off teeth. And there are genetic disorders in which people unfortunately have no sense of pain and accidentally injure themselves as a result, for instance by failing to notice they are touching a hot stove until they smell burning flesh. Individuals with Hansen’s disease (leprosy) lose sensitivity in affected body parts and injure themselves by accident.

In all these situations, the sufferer shows many behavioral and physical symptoms in addition to self-mutilation or frequent accidental injuries. And, it’s clear, none of these problems is caused by adoption, although there’s a minute chance that a child adopted in infancy could have a disorder that is not yet noticeable. By the time any child reached Nathaniel’s age, seven years, ordinary observation and well-child care would have detected a set of problems that were not limited to self-injury, and which don’t seem to be mentioned at the trial . So, when the irrelevant statement about hand-chewing is brought into the discussion of Nathaniel’s death , our response should be, “what do the two things have to do with each other?” In my opinion, the purpose of this scary example is simply to distract attention from the real evidence about the events that led to this boy’s death. The “he did it himself” defense has been seen before in these cases; it was claimed that 2-year-old David Polreis beat himself to death with a wooden spoon, and even the very public videotaped death of Candace Newmaker was claimed by some to have been a deliberate act on the child’s part, for the purpose of punishing her therapists.

To continue the analysis: Is there any truth whatsoever to the statement that Reactive Attachment Disorder involves “a tendency to injure oneself”? Reactive Attachment Disorder is, of course, described in the Diagnostic and Statistical Manual of the American Psychiatric Association. But, no, no such behavior as self-injury is linked with RAD in DSM volumes of any vintage, nor is any such change predicted for DSM-V. This is proof by assertion at work. The Cravers and their attorney have made this statement without the slightest foundation in evidence, which they get to do in their efforts to be acquitted; it’s now up to the prosecution to ask the questions that will reveal that there is no truth to the statement, and the jury to pay attention to the facts.

In an interview with the Harrisburg Patriot-News , Federici also stated that Reactive Attachment Disorder is only a symptom “of a much larger and deeper disturbance”. This statement, like the previous one, would come as a considerable surprise to the committees that work hard to revise DSM periodically. While it’s presumably true that any behaviors, desirable or undesirable, are indications of underlying characteristics, it’s further proof by assertion and further distracting scare tactics to claim that the symptoms of Reactive Attachment Disorder indicate a nameless badness beyond DSM’s ken.

Let’s resist these attempts to depict Nathaniel as a demonic child, one of a group of terrifying, inhuman children who mutilate themselves horribly and cause unfair accusations of their loving caregivers. Let’s focus instead on the reality of this child’s life and the likelihood that he injured and malnourished himself.

And let’s hope the jury focuses on those issues, too.

Things Attachment Therapists Want Adoptive Parents to Think

A very sensible, well-educated, and dear friend of mine and her husband adopted a little boy from another country some years ago. He did not come to them straight from his birth mother, but was with a foster family until he was about ten months old. The new family settled down quite quickly, and the boy has developed nicely in every way. They’ve followed everyone’s directions about his transition, kept a life book for him, and stayed in communication with the foster family.

I was surprised a few months ago when the mother, whom I’ll call Mary because that isn’t her name, told me she was concerned that the little boy was experiencing grief for his birth mother. I asked why she thought that, and she said she had been reading that all adoptees have this problem. She also described conversations in which he had expressed concern for what had happened to his birth mother and why it was that she couldn’t take care of him. But it seemed to me that he expressed a lot of concern about many people, animals, bugs, and caterpillars, and that he didn’t seem especially preoccupied with the birth mother-- nor did he seem greatly worried about the foster family to whom he had had some chance to attach.

Recently I had a chance to visit Mary and her husband and son and to see once again what a great job they’re all doing. And Mary solved a puzzle for me by showing me the book that had caused her concern: Sherrie Eldridge’s Twenty things adopted kids wish their adoptive parents knew. In my opinion, this book would be better titled “A bunch of things attachment therapists wish adoptive parents believed”, because people who hold the beliefs Eldridge proposes would be very likely to accept both the theory and the practice of attachment therapy. As neither attachment therapy practice nor its underlying theory have any support in conventional mental health information, it is not surprising that Eldridge’s “things” are also unsupported claims. It would be excellent if adoptive parents knew about these issues, but they need that information in order to avoid inappropriate choices, not so they can follow Eldridge’s advice.

Let me comment on a few of Eldridge’s twenty things. First, we see that Eldridge is a proponent of the “primal wound” theory, claiming that all adopted children are suffering from the grief of separation from the birth mother, and need treatment that focuses on that loss. However, all the facts about early development and infants’ emotional attachment tell us that babies adopted into a stable family in the first months of life show no sign of distress or grief over the separation from the birth mother. Babies’ attachment to adults takes time to develop, and it’s based on a history of social interactions and emotional maturation, not on prenatal experience or genetic relationships. The birth mother may miss and grieve over her lost baby, but the baby does not respond in the same way, as he or she is physically, mentally, and emotionally very different from any adult. Relationship or mood difficulties in adoptive families benefit from pretty much the same kinds of treatment that would help non-adoptive families. Where a different focus is needed, it may involve the needs of the adoptive parents rather than the children, because a history of infertility or loss of children can cast a long shadow on a family.

A second point is that Eldridge proposes that young babies exist in a form of shared identity with the mother, a state described as symbiosis by Margaret Mahler and others, years ago. Eldridge does not refer to Mahler, and appears to have picked up this idea from Henry Cloud and John Townsend’s 1992 book Boundaries, from which she also took some of Mahler’s language (like the term “rapprochement”). The idea of symbiosis suggests that separation would be traumatic. There are some problems for this argument, though. One was that even Mahler did not propose that symbiosis was in place at birth, so it becomes irrelevant to early separation from the birth mother. Second, much of what we now know about communication between mothers and babies tells us that even the very young have some capacity for intersubjectivity, or knowing that another person is not the same as the self. I’ve recently come across people commenting on blogs who say that “it’s accepted” that babies identify self and mother as the same, but, as I just argued, that acceptance, if it ever existed, is certainly no longer the case, and for that reason it is not “accepted” that early separations are traumatic.

I’ll just add one more item to my list. Eldridge gives the standard checklist for identifying children with attachment problems--- the checklist seen on many an attachment therapy website, the one that suggests that disobedience, lying, preoccupation with blood and gore, and so on, are indications of the need for attachment therapy. This simply is not the case, for two basic reasons. Those behaviors have nothing to do with Reactive Attachment Disorder, and may or may not have to do with other mental health problems. In addition, whatever the family’s problems may or may not be, treatment that focuses on infant attachment alone could not solve the problems mentioned.

A look through Eldridge’s bibliography shows that at least half of the sources she cites are attachment therapists. There are several citations to Foster Cline, who is [in]famous for his claim that “all bonds are trauma bonds” and that a child’s emotional engagement with his adoptive family must involve traumatic experience. It’s clear that, without referring to holding therapy or related practices, Eldridge produced a book that reflects the attachment therapy “party line” as it existed in 1999 when the book appeared.

If Eldridge’s material seems to speak to your condition, use it as you find appropriate. Strange things can help people, I know. But please don’t accept all her statements without careful examination, and don’t assume that there must be problems with your child for which there is no visible evidence.

Hurray! The Baby's Crying!

I recently had an e-mail exchange with a friend. I began by saying “Hurray! When I walked up to my neighbor’s baby, he cried and turned away!” My friend answered, “That’s great!”

I looked at this correspondence and it suddenly struck me-- many people would think we were nuts to say such things. Are we people who enjoy being mean to babies? What could possess us to think it’s good when they cry? Well, there is method in our apparent madness.

I had been concerned about this particular baby, whose family lives on my street. When he was about 6 months old and was outdoors with his mother, I walked up and started a conversation. I noticed that the baby never looked at me and didn’t try to get our attention. But he did seem preoccupied with something he was looking at, so I thought perhaps I wasn’t very interesting in comparison. Then, several months later, I saw mother and baby outdoors again-- and the same thing happened. I recounted this to several colleagues at a meeting, and all expressed concern and asked whether the baby was in an early intervention program. They all felt I should talk to the mother about the matter--- although they conceded that she probably wouldn’t speak to me for two years if I did!

Thank goodness, a week or so later, when I walked up to the family, the little guy clouded up, began to whimper, and turned away from me to look at his parents. They were embarrassed that he was being “rude” to me, but I congratulated them on their good work and assured them that this was exactly what he should be doing.

What was going on here? Why do I think this infant should cry when he sees me-- or any other person who is not very familiar to him? I think so, because this changed behavior is an excellent marker of good development. Babies in the first months of life don’t “make strange”. They respond in about the same way to any smiling, sociable person. Somewhere around seven months the baby becomes wary and looks suspiciously and seriously at unfamiliar people, checking them out in the way Margaret Mahler labeled “customs inspection”. After inspecting a friendly-looking new person for a while, the baby warms up and gets sociable. By 8 or 9 months, most babies who have lived in a stable family or other care situation will respond to strangers with anxiety and do their best to turn away and look for or at their “own people”. A common scenario is that the mother is carrying the baby at the grocery store or other public place, and a friendly stranger approaches to talk to the baby. The baby turns away, puts his or her face against the mother, or moves to look to the mother’s other side. Friendly stranger knows what to do about this, and rushes around to look at the baby from the other direction! (Repeat ad lib until baby is bawling and mother is completely frustrated but trying to be polite to this person, who loves babies but doesn’t really think they’re people.)

These changes in the baby don’t occur because there have been bad experiences, or because the baby is spoiled and willful, or because of emotional disturbance. They are natural developments that take place in almost all babies who have had a normal basic level of adult care and social interaction, and they are good evidence that the baby is on a normal schedule of development. If a family baby of 9 months did not show reluctance to deal with a stranger, we would need to ask what the problem was; there might be difficulties with vision or hearing, or even with mental development in general. If a baby who had been cared for by many different people, or often moved from one care setting to another, and was friendly to everyone, we might well conclude that he or she needed to have a long period of consistent care from a few people, in order to have an opportunity to develop special relationships.

But why is it a good thing for babies to avoid strangers? It seems like a nuisance from a practical point of view. It means we can’t leave them with babysitters or at a new day care arrangement, without a whole lot of fuss. It means that people who care a lot about the baby but don’t see her often may be offended when the baby snubs them. What’s to like about it?

One good thing is that this situation acts to some extent like an “invisible playpen” and helps to keep babies near adults who care about them even when they’ve begun to crawl or walk. The safety factors that apply in modern times were probably even more important when our remote ancestors reared their children in wild and dangerous settings, and wandering away might lead to becoming a meal for a predator. In addition, though, treating familiar and unfamiliar people differently is a basic aspect of human behavior. A child who did not achieve the ability to do this would be a very odd person indeed and would not fit well into any human society. As a general rule, we give to and take from familiars and not strangers, we tell secrets to and trust familiars and not strangers, and we are more inclined to be sexually intimate with potential mates we are well acquainted with than those we have just met (twenty-something guys, I don’t want to hear about this-- it’s true of most people, anyway!). By about 9 months, babies have usually come to share these kinds of attitudes with the rest of their species.

If I ever designed a greeting card, I would make it one that said to young parents, “Congratulations! Your baby was afraid of a stranger today!”. That leap forward in development is far more significant than the first step or the first word, and it’s worth celebrating.

"Primal Wound" or "The Blight Man Was Born For"

Over the last week or so , discussions at http://osolomama.wordpress.com have centered around the idea of the “primal wound” (even though that was not the blogger’s plan). The “primal wound” in question is the posited emotional injury done to infants separated from their birth mothers. Those who support this idea believe that such an injury occurs even if the baby is placed with other caregivers at birth, and that the “wound” continues to cause pain all through life, unless it is resolved and healed in some way. Adult adoptees commenting at osolomama and elsewhere have made it very clear that they experience ongoing distress in close relationships, that they feel they have had this experience throughout their lives, and that they attribute their sense of distress to their history of early separation. (I am stating this simply and unemotionally for the sake of brevity, but the adult adoptees tell their stories vividly and with intense emotional engagement.)

But here’s the issue: nothing in all the careful work in developmental science done over the last century would suggest that it is possible for early separation to have a lasting effect on children who soon enter a stable, lasting adoptive family. All the information we have says that early-adopted children do very well (for example, Sharma, McGue, & Benson [1998]. The psychological adjustment of United States adopted adolescents and their non-adopted siblings. Child Development, 69, 69,791-802). Later-adopted children may have more problems, especially if they were in institutions for long periods or had risk factors that led to their being institutionalized to begin with, but often show good recovery over some years (for example, Rutter, Kreppner, O’Connor, and the English and Romanian Adoptees [ERA] Study Team of 2001.[2001]. Risk and resilience following profound early global deprivation. British Journal of Psychiatry, 179, 97-103).

In addition, the study of early development shows that infants do not show concern about attachment and separation until they are 6 months old or older. This does not mean that they cannot tell the differences between people, initially by smell and sound and later by looks. However, it does not seem important to the young baby to be close to a familiar person, as long as the caregivers they are with are sensitive and responsive to the baby’s needs (and of course familiar people may do a better job of reading the baby’s cues, first because they know the individual child well, and second, perhaps, because they may be highly motivated to take good care of that baby). It’s not until about 7 or 8 months that most babies will show by their behavior that they are afraid of a stranger, or temporarily disturbed by the absence of a familiar person, or deeply grieved and disturbed by an abrupt, long-term separation. It does not seem plausible that an event that a baby did not respond to at the time it happened would nevertheless cause later disturbance and grieving. The only possible argument that this could happen would seem to be based on the assumption that memories can be repressed and work some mischief from the unconscious, but the evidence is clearly against that idea.

These well-established facts suggest that there is no “primal wound”. The idea that there is such an emotional injury seems to have come out of the writings of a California marriage and family therapist named Nancy Verrier, whose thinking is strongly connected with that of William Emerson of APPPAH (Association for Pre- and Perinatal Psychology and Health). APPPAH is an organization that stresses the belief that unborn infants have conscious understanding of events going on around them, perhaps all the way back to conception or even before (you’ll have to read that part for yourselves). Verrier and her colleagues are committed to the idea that there is a biopsychological attachment between a baby and its birth mother, which when broken by separation creates a lasting emotional injury. This belief is based on some earlier views like those of Otto Rank, who suggested that birth itself is a traumatic experience for the baby; these approaches seem to be basically a reworking of the old “maternal instinct” assumption. Whatever the reasons behind the “primal wound” belief, it does not seem possible to integrate them with anything we can observe about early development.

A number of adult adoptees have found the Verrier viewpoint to make sense for them as more than a metaphor for their life situations. They feel an intense and disturbing sense of loss, which deserves to be treated with respect even though at the same time I argue against the cause they believe is behind it. People with this view of their life events ask, legitimately, “why do we feel like this if it isn’t because of our early losses?”. And of course I can’t really answer that question (certainly not to their satisfaction). I would suggest, though, that a sense of loss and loneliness is part of the experience of every thinking person. Gerard Manley Hopkins spoke of this in his poem about autumn and loss:
“Margaret, are you grieving… Over Goldengrove unleaving?.. Leaves, like the things of man you… with your fresh thoughts care for, can you?... ‘Tis the blight man was born for… It is Margaret you mourn for.”

We may not need to look to a history of early separation to explain why we human beings mourn for ourselves.

On "The Road to Evergreen"

For anyone with an interest in adoption, or in the complementary-and-alternative treatment “attachment therapy”, Rachael Stryker’s recent book The Road to Evergreen is a must-read-- although it’s also a must-criticize, with plenty to concern developmental scientists, clinicians, adoptees, and adoptive parents. Although published in 2010, The Road to Evergreen is based on a doctoral dissertation completed in the early ‘00s and approved by a committee which included Nancy Scheper-Hughes, author of the remarkable participant-observer narrative, Death Without Weeping. Stryker, an anthropologist, followed some of her mentor’s approach, but applied it to a complex topic that lacks the fascinating generalizability of the Scheper-Hughes book. It’s important to note that The Road, though published in book form in 2010, is based on observations and interviews done in the late ‘90s. The book thus gives us a detailed picture of events a decade and more ago, and it is arguable to what extent the practices described are still current. (Proponents of attachment therapy usually say they are not; critics like me cite evidence that they are ongoing.)

Stryker’s interest in her subject matter began with investigation of institutions and adoption in Russia following the collapse of the Soviet system and the beginnings of systematic adoption of Russian children by Westerners. Subsequently, the author became intrigued with the functioning of adoption agencies and the behavior and motives of prospective and actual adoptive parents. These interests led her to the small town of Evergreen, Colorado, then, as now, operating a cottage industry for treatment of children whose behavior and attitudes were uncomfortable for their parents. Most of the children in treatment in Evergreen were adopted, and the intervention most likely to be used with them was “holding therapy” or “attachment therapy”. This physically-intrusive technique was claimed to remove the emotional attachments of adoptees to their birth parents, to create attachments to adoptive parents, and (it was argued,”therefore”) to make the children obedient, respectful, cheerful, and grateful.

Stryker is probably the only person other than attachment therapists, adoptive parents, or children to have witnessed attachment therapy sessions. Other information about these practices has come from descriptions by therapists and adult memories of treated children (see http://stopchildtorture.org), from news reports’ films of children in treatment, and from the 30 hours of videotape showing the treatment that ended in the asphyxiation of the ten-year-old patient Candace Newmaker in 2000 (see Mercer, Sarner, and Rosa, Attachment Therapy on Trial). Stryker’s description matches the other information and confirms the general accuracy of previous descriptions of attachment therapy.

Stryker’s real contribution is in her interviews with adoption staff and adoptive parents. She was able to establish rapport with those individuals, who presumably trusted her as they would not have trusted critics of attachment therapy methods. The material Stryker collected led her to a conclusion that may trouble many, although for different reasons: that the strongest motive for adoption was for the parents to feel like a family, and to be able to play the honored role of parents. In return for the care and material goods offered by the adoptive parents, the children had the job of behaving in ways that supported the adults’ actions and affirmed that they were respected and successful members of the adult community. Attachment therapy at Evergreen offered an assurance of bringing about this desired end in one way or another. If a child did not “improve” or “heal” to the point of going back to the adoptive home, he or she was placed in some other form of care, and this was described as “loving at a distance”. Whatever the outcome for the child, the adoptive parents were guaranteed support for their perceived position as parents of a family.

Stryker presents three cases, with one child “reunited” and the others placed for care outside the family. These families and their treatment are described in some detail. However, some important information is missing. At the time of this study, as today, children receiving attachment therapy were often placed in a “respite family” who provide a milieu reflecting the beliefs behind attachment therapy. The respite home experience includes complete control by adults over the child’s food, drink, and toilet access. Bedrooms are stripped of most furniture and decorations and have an alarm on the door. Children are required to sit immobile for long periods and to carry out tedious, unnecessary tasks like moving stones from one side of the yard to the other, and back again. But Stryker gives little description of these methods or their goals.

Although developmental scientists and clinicians would be interested to see Stryker discuss the poorly-designed outcome research that has examined the effects of attachment therapy, it’s obvious that such topics have no real place in her participant-observer work. However, given the time that passed between the initial observations and publication of The Road, Stryker would have done well to follow up her three reported cases and to note whether there were long-term differences between the “successful” and “unsuccessful” cases. The memories and beliefs of the now-adult adoptees would also have provided a rich source of further investigation.

My great hope, on picking up The Road, was that Stryker would examine any changes in attachment therapy beliefs and practices that followed reports of a number of associated child deaths, the most dramatic being that of Candace Newmaker at the hands of her therapists. The organization ATTACh (Association for the Treatment and Training of Attachment in Children) followed that tragedy within a couple of years by policy statements rejecting physical restraint for therapeutic purposes unless the child is willing (and of course it is highly arguable whether a child can give informed consent to such a procedure).However, some practitioners of attachment therapy apparently continue to use physical restraint, and no practitioner has stepped forward to provide a rationale supporting the change or explaining whether an entire belief system has altered.

Once again, I consider The Road to Evergreen a must-read for people interested in adoption and the attachment therapy issue, or indeed in many aspects of parenting and of complementary-and-alternative mental health interventions. But readers will be disappointed if they expect the book to give an up-to-date picture of attachment therapy or to outline the tortuous history of this unconventional practice.