December 7, 2008Where to start: We thought we'd have biological kids with no issues and instead are home with (soon) three trans-racially adopted children who were born with medical or genetic conditions which will impact their entire lives. Ta da! Where do I buy a ticket.
The information below is what I have gathered, researched, and distilled from countless sources on adoption, attachment, trauma, and race. The presentation stems from a conversation (a five-hour conversation) I had with my mother 18 months after our first child came home. For those 18 months, we were living in a reality so foreign to our expectations, so all consuming, that we didn't much communicate with anyone who didn't Get It ... who didn't have a traumatized, wary, beautiful child of their own. I have talked about loss on this blog. We were not the only ones whose expectations were not met. I figure that our need to therapeutically parent our children has resulted in more loss (emotional and financial) than we care to quantify. Because of this, we are keenly aware of, and grateful for, those friends and relatives who have stayed by our side and who continue to support our family vision.
There are many reasons why folks entering into an adoption may not understand the complete emotional impact of their future child's former life. When we were considering adoption we did a fair amount of research on countries (including the US) and programs with various agencies and groups and never once were offered information on attachment, grief, or trauma. Though it is every individual's responsibility to understand the contracts they are signing, and nothing forgives our initial naivety about international adoption, everyone along the chain should claim responsibility for the health of the children and families involved.
[Before I go on: I have thought through the wisdom of posting this now, while we wait for China to approve our final adoption. As you read through these posts, you may feel I am placing blame or pointing fingers at governments and countries of origin. Not so. Humans are biological beings, driven by DNA to need specific input for growth. No one country, or one childcare situation, has a monopoly on good or bad caretaking. I know of children who are not attached to their biological parents due to ineffective parenting skills or in-utero drug and alcohol use. It has twice been our humble honor to adopt a child from China, and we will be forever grateful that the country entrusted us with their children. I truly believe that, in the majority of cases, governments are doing the best they can with the children left to their care. My mother once asked why China, with its great wealth, could not care for more children better. I wondered, as she asked, why America (with its great wealth) cannot do the same. Why American elementary school teachers do not earn a living wage, for example. Why newborns continue to be left in dumpsters. Why America has the highest infant mortality rate of any other developed country on the planet. The short answer is: They can, they simply choose not to. I do not understand the reasons, and I still do not place blame.]
International Adoption into the United States is a business. The home study agencies, placing agencies, facilitation agencies, and t-shirt producers are all in the business of making money. Relatively few are non- or not-for-profit. Because everyone along the entire chain needs to be paid for their work (just as every doctor, midwife, anesthesiologist and RN needs to be paid after you give birth in a hospital), the entire system relies on maintaining a large enough group of people who are willing to make a cultural, emotional, and financial (there is no insurance co-pay for adoption) leap that is only possible when the destination is presented as attractive and safe. This is why it is rare to read about the difficulties in adoption unless you're in a position to need that information (e.g.: your new child intentionally hurts the family pet then you look up "Nancy Thomas").
When we were beginning our third (current) adoption I did more research into the US foster/adopt system. Because we had a child in mind, my search parameters included kids in our waiting son's demographic and excluded infants of any race. As you read what I have to say about the impact of pre-adoption care, keep in mind that this deprivation and trauma is not exclusive of back-woods, under-financed orphanages in third-world or emerging countries. In the US, the bulk of the healthy (no birth conditions) seven-to-twelve year old boys I saw available for adoption were described with euphemisms like "would be best as the youngest child in the household" (possible meaning: acts out sexually or abusively), "very active, loves the outdoors" (ADD, ADHD), "is looking for a strong father figure" (defiant), and "needs someone willing to advocate for his needs" (FAS, PTSD).
Luckily, we've learned. We've researched, read, listened, listened, listened and found someone to talk to specifically about our children's emotional needs.
How does it happen? How do children born on this beautiful and lush planet become angry, withdrawn, beings intent only on emotional and physical survival? I'm writing here of three specific topics: Control & Anxiety, Trauma, and Grief and have divided the information in to three parts: Before You Meet Them, How They Respond, and How You Can Help. This post will only cover the first part. It is important to remember that all experience lies somewhere on a spectrum. Not all orphanages are bad ... or good. This series will talk about what I consider to be the "average" experience.
Part I: Before You Meet ThemWebster's defines trauma as "a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury, an emotional upset." In China, as in many countries participating in international adoption (IA), children are housed in group care facilities we refer to as orphanages. In China, the children are technically foundlings, children found after unknown parents have abandoned them. Regardless of how well the children are treated in the orphanages (and some are treated well), there can be a reasonable assumption of "emotional upset" if not "severe ... emotional stress" associated with the abandonment and institutionalization of a pre-pubescent child.
Grief, "deep and poignant distress," can also be assumed. Distress comes from the child's losing known faces, sounds, smells, tastes, and both physical and emotional feelings.
Anxiety ("painful or apprehensive uneasiness of mind usually over an impending or anticipated ill, fearful concern or interest") is the result of this grief/trauma combination.
To understand how these three forces can work together in a small body, one needs to first understand the attachment cycle. For most biological parents, attachment happens without any planning. For adoptive parents, a conscious effort must be made at every interaction with their child until that child is healthfully attached. Children attach with people when those people satisfy basic needs for the child. The pattern is rage (crying, screaming, quietly searching with hands or mouth), satisfaction (diapers are changed, milk/forula is given, blankets are replaced), resolution (body is comfortable, tummy is full, body is warm). By repeatedly having their needs met by primary caregivers, a child emotionally connects with and trusts the folks providing the resolution. Ultimately, the child becomes healthfully attached.
A healthfully attached child believes three things: they are lovable, trust in their parents is wise, and help is available. In short, these are kids that everyone wants to be around. There is a spectrum of attachment, from this healthy attachment to severely unattached (RAD -- reactive attachment disorder -- falls on this end). Along the middle are diagnoses like: insecure, avoidant, ambivalent, anxious, and disorganized. Children who do not have a healthy attachment to a primary caregiver are at risk for never forming attachments.
There are many reasons why children who are in institutional care (including foster care) might not have the attachment cycle completed. (There are also many reasons why a biological family might not form healthy attachments, but that's not my area of focus.) In most orphanages, children are fed and changed on a schedule ... not when they're hungry or wet. There are rarely enough caregivers to give one-on-one attention to each of the children. And, frequently, the nannies are young and untrained. In addition, the child:caregiver ratio is so disproportionate that an institutionalized child almost never learns what it is like to live in a small unit, a family. What they do learn, and quickly, is that people in a position to satisfy needs come for a short time (an eight-hour shift, perhaps) then go. There is no consistency. Older children learn that if nanny tells them something they don't like (don't go on the stairs, no hitting, etc.) it's only a matter of time before nanny leaves and another takes her place
In short, the children are not learning that it is safe and wise to put their trust in adults, they do not learn that help is available to them without question. Because of the uncertainty, the children are at risk for developing low self esteem, figuring that if they aren't worth the effort to satisfy their needs, they surely can't be worth much at all. Infants are especially vulnerable because of their size and inability to meet their own needs. And, if an infant grows into toddlerhood in a situation where needs are consistently unsatisfied, their worldview can become fairly bleak
Institutionalized children also learn to level out their emotions. Crying doesn't work when they're wet or hungry, so the skill is lost. On the other hand, children who are consistently happy and engaging are most likely to be fed, changed, held, and spoken to. A star is born. But, this star has learned to be charming to get what they want at the same time they're learning not to completely trust adults. And, they've learned to be indiscriminate with the cuddles they use to get necessities.
As they become more anxious about having their basic needs met, a child's anxiety begins to skyrocket. As infants, children have a twenty-minute anxiety window before fear and the related chemicals (cortisol especially) begin to, essentially, corrode the brain and shut down the system. In childhood, the brain creates tens of thousands of connections each day, enabling us to learn, grow, and sustain our own life. Cortisol acts as an acid wash in the brain, breaking apart those precious connections. Once the connection is lost, either the skill is lost or it must be relearned at the expense of learning a new skill or making a new connection. Imagine, then, what has physically happened to the brain of a child who was left by their biological parents and found an unknown time later, then brought to group living situation where they eventually learned to not cry.
Also inherent in most group care situations is a fair amount of physical restraint. It would be untenable for a staff of 10 to manage 30, 40, 50 infants if each had freedom of movement. In infancy, most children are kept confined to their (usually shared) crib. As they age, they are frequently put in "walk abouts" for long periods of time or stationed on small toilet chairs as a kind of basic potty training. In the winter, they are bundled so thickly they can't move their limbs. In the summer, hands are tied down so they won't pick at mosquito bites. Most children miss one or two cognitive and physical developmental steps. Many never learn to crawl, and go straight to cruising on their toes. Unfortunately, crawling (the coordination of four limbs for syncopated forward motion) is just one of the ways the brain learns to wire itself correctly. Remove the skill and you've removed the brain functionality. Stimulus, visual and tactile, is at a minimum.
There is also outright physical and emotional abuse at the hands of those the children trust to care for them. They children still learn to trust, and to love, their abusers. But, they also learn that adults will use their superior strength to hurt.
Food is not plentiful. Clothing and toys are shared. Rooms are unheated. In some countries, many of the kids aren't even citizens, they are non-entities living at the grace of the folks who donate money to their orphanages and foster homes.
Have I covered everything? Abandonment or relinquishment by those who were supposed to love them forever, check. Emotional trauma, check. Low-stimulus living environment not conducive to mental or physical development, check. Abuse at the hands of their caretakers, check. For the kids who
At the end of this cabaret of emotional strain, the new parent arrives. What is the most phenomenal day of our life is simply another, unwanted upheaval for our children. They are taken away from every sense memory they have. They lose everyone who is important to them. Gone are the cultural norms they've spent nine months ... two years ... eight years perfecting. In most cases, they are removed from folks that look like them and placed in families where they are the only. Unless they are of legal age, they do not make the adoption decision for themselves. The path of their life takes a most dramatic turn and they have no ability to make impact. They are powerless.
Or so it seems.