Notes For Doctors
The following information is a handout I distribute when I speak to pediatricians at Grand Rounds at various hospitals in the San Francisco Bay Area. I also hand out the information provided at the end of the Notes to Adoptive Parents. I hope these hints will be helpful to health professionals, as well as to adoptive parents.
- An adoptive family is different from a biological family.
- An infant knows her own mother at birth
through her senses: smell, voice, heartbeat, resonance, skin, etc.
Adoptive mother doesn’t pass the sensory test.
- The child comes into the family traumatized by the separation from the mother.
- No matter what we call it (relinquishment, surrender), the child feels abandoned.
- The natural order of things is interrupted: may affect child’s understanding of cause and effect.
- Infant cannot make sense or integrate what has happened to him: world unsafe … chaos, confusion.
- The child is grieving. Mother needs to notice signs: seems sad, depressed, daydreams (dissociation).
- Fears another abandonment: anxious, hypervigilant. clingy.
- Somatic responses to anxiety may include: irritability, gastrointestinal problems, projectile vomiting,
asthma, rashes, sleep disturbance, etc. Often an elevation in pulse rate, blood pressure.
- Affect: rage, sadness, fear, numbness, dissociation, constriction, depersonalization.
- Adoptive mother cannot mirror the child as birthmother could have: no genetic markers.
- Bonding with adoptive mother will be difficult: fear of another abandonment. Anxious attachment (clinging) is not same as bonding. Bonding is enhanced by a mother’s understanding, acknowledging, and validating her child’s feelings (rather than discounting, defending against, or giving assurances).
- Lack of genetic markers makes the child feel as if she doesn’t fit, doesn’t belong. Child has to figure out
how to be in the family. Hypervigilant. Tries to adapt.
- As child begins to adapt, he forms a false self. Begins to lose authentic self. Becomes a “chameleon.”
- Child copes with pain of loss in one of two ways: compliance, acquiescence, and withdrawal, or aggression,
provocation, and acting out. If two adoptees in family, there is usually one of each. Behavioral methods of
coping have nothing to do with the child’s basic personality. May trade off.
- Behavior may be difficult, but it is not abnormal. Normal way of responding to an abnormal event: separation
from biological mother.
- Although child with each coping style needs help, parents of the acting-out child are usually the only ones who seek it.
- Family dynamics will be affected. (Families with biological children need to consider this before deciding to adopt).
- Most of the child’s difficulty will be with the adoptive mother: potential abandoner.
- Many parents, not understanding the issues, blame themselves. Feel isolated.
- Children may have difficulties around birthdays (separation day): fussy, sad, angry, ill. Celebrate early.
- Symptoms will fit criteria for PTSD, but more complex(see J Herman, B. van der Kolk).
- Because of trauma many adoptees have difficulty in school due to problems with attention, distractibility, and stimulus discrimination.
- When trauma occurs early, child, in trying to make sense of it, creates a set of beliefs, which seem to become permanently imprinted into psyche ( i.e., blaming self for abandonment: “I was a bad baby.”) This often results in distorted reality and low self-esteem, self-worth, and self-realization.
- Children are not a “blank slate” at birth. Most of personality traits are genetic (but personality must be distinguished from behavioral coping style.) Adoptive parents cannot expect the child to be like them.
- The core issues for adoptees: abandonment, loss, trust, rejection, intimacy, guilt and shame, mastery and
control, and identity.
- Obtain medical records. If it’s important for me, then it must be important for my child.
- More research needed:. Many neurologists and neurobiologists such as Carla Shatz of U.C. Berkeley, Bruce Perry of Baylor, Daniel Siegel of UCLA, and William Greenough of U. of Illinois are studying the effect of early environmental influence upon the brain’s wiring. We have to ask what this means for children whose earliest experience includes separation and loss. Also of interest is the effect of trauma upon the chemical makeup of the body. Scientists such as Judith Herman, Bessel van der Kolk, and James Prescott note elevated levels of adrenaline and cortisol and a drop in serotonin in trauma victims.
Notes For Everyone
The following are messages that will give information about things that I am doing, and facilitate the answering of letters and e-mails.
First of all, I want to thank all of you who have written over the years in response to my first book The Primal Wound. Because of the volume of letters and e-mails, I have been unable to answer all of them and hope that you understand. Your letters, cards, and e-mail messages have encouraged me to continue my work and I have published another book: Coming Home to Self.
Part I of Coming Home to Self more fully and scientifically explains the consequences of trauma and the deeply imprinted influence it has on the neurological system as an adopted person goes through life. Part II, which is the part I encourage most adoptees to begin with, is about awareness, authenticity, accountability, and some of the misinterpretations adoptees make to ordinary, everyday events and interactions in life. Because adoptees have been coping with separation trauma all their lives, they are usually unaware, not only that these coping skills are not really who they are, but of the ways in which these coping mechanisms are hindering their relationships and life choices. It is my hope that the messages in this book will make adoptees and others in the adoption triad more aware and able to respond differently to others so as to improve relationships and reunions. Part III is a hodge-podge of information for all parts of the triad as well as for professionals.
A word about e-mails: In order not to be deleted as SPAM, please put something in the SUBJECT line that lets me know what you are writing about. Many of my e-mail messages are from people I don’t know, so I depend on the subject line to let me know whether to read the message or delete it before opening it. Please don’t send me forwarded messages unless they are really important. Send attachments only if they pertain to your message. Sometimes I read my messages but don’t have time to answer them at the time. Then later I have forgotten which ones I answered and which I haven’t. If I haven’t answered your message within a week, please let me know. And…take note of my Schedule of Events to know when I will be away and unable to answer phone or e-mail messages. Sometimes I get letters from people which I fully intend to answer. In order to get a quicker response from me, please include your e-mail address in your letter.
One thing which has been brought to my attention, when talking to adoptees and birth parents about reunions, is the issue of cut-off. Cut-off is when one person initiates a search, then when they have all the information they want (or if they have issues with the person they have found), they cut off the other person. This happens with both adoptees and birth mothers. My opinion on this is that if you are not ready to “hang in there” with the person you wish to find, you are not ready to search. It is not fair to open up the emotions and hopes of the person found, the drop them. Think about this before beginning your search. If you have issues or feel afraid, there are people who can mediate your reunion. If there is no one in your area who can help, I do mediations by phone (see SERVICES).
Missing page 376 of Coming Home to Self. Astericks denote where sentence was cut off or interrupted.
It is important for all concerned…
…to recognize that both the original trauma and the response to that trauma by the adoptive parents played a part in the outcome so far as the adoptee is concerned. And everyone has been bamboozled by the societal ignorance of all connected with adoption. It is time to start anew.
The topics covered in this chapter are attunement, projective identification, nature vs. nurture, the differences between personality and behavior, the dual reality of the adopted child, and a sense of belonging. Understanding their child’s dual reality is a must for adoptive parents if the child is to retain a modicum of his own personality and not completely adapt to what he perceives to be the expectations of the adoptive parents. Wherever I go in the world, a sense of belonging seems to be missing from the adoptee’s perspective. This appears to be connected to the lack of genetic markers or reflection of self, which all children who grow up without any biological relatives will face.
These concepts are also important for birthparents to understand because without the understanding of these issues they are apt to blame the adoptive parents for behaviors and attitudes which are a direct result of the trauma of separation and the way in which the neurons in the brain connected as a result of that separation. There doesn’t have to be any blame assigned here – neither for the mother who surrendered the baby nor the mother who didn’t recognize that the baby was grieving. To paraphrase Maya Angelou: We do the best we can, and when we learn more we do better. We are learning more and more every day, so we should be doing better and better.
We need to begin by allowing the biological mother to hold and welcome her new baby into the world and then to say goodbye. The longer the mother can hold and interact with her baby, the better. A vulnerable newborn needs to feel safe in the arms and surrounded by the love of the mother who gave birth to him. The whisking away of the infant upon physical birth is an assault upon this new being. The stress hormones have not had time to recede and the birth is not complete. (This goes for any birth, not just those in which the mother and child are to be permanently separated.) Obstetricians need to be more sensitive to the baby in the birthing process.
Adopted infants and children come into the adoptive family traumatized by the loss of the first mother. They are grieving. Unfortunately, adoptive parents are not made aware of this significant information. This is not because of some malicious intent on the part of doctors and social workers, but because of the ignorance of everyone connected with adoption. What happens then is the adoptive mother is not cognizant of the child’s loss and need to grieve. She is… not attuned to her child’s emotional life.