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Adoption as an Issue in Casework with Adoptive Parents
Adoption as an Issue in Casework with Adoptive Parents
Katherine G. Kent, M.S. and Julia L. Richie, M.S. W.
Abstract, By describing in derail the process of one case and elaborating theoretical formulations gleaned from various authors , we attempt to illustrate that adoption is a complicated proccss-i-that the tasks of adoptive parenthood are more complex and demanding than the usual work of parenting. An effort is made to show that a primary ta sk of adoptive parents is that of coming 10 grips with their loss of reproductive function. The extent to which the parents accomplish their "grief work" is directly related 10 the quality of relationship they Gin achieve with their adopted child .
For many years, professional people have evidenced an interest in the impact of adoption on the emotional life of families. Various studies have reflected divergent conclusions. Some studies (e.g.. Jaffe and Fanshel, 1970) conclude with the fact that most adoptions work out well, and imply that the fact of adoption actually makes no difference in the kinds of relationships that develop in the family. On the other hand, Schechter (1960) and Toussieng (1962) point out that a disproportionately large percentage of adopted children are seen in ps ychiatric clinics, when compared to the number of adopted children in the general population. How do we understand these discrepant points of view? It is possible to assume some validit y in the conclusions reached by all of these investigators. to acknowledge that most adopted children are well adjusted, but to maintain that there is a risk factor involved in adoption. This was the position taken by Mech et al. (1965) in a recent survey of adoption research. The purpose of this paper is to examine in detail a case example, which we consider to reHect commonalities often seen in work with adoptive families. and from that point to venture hypotheses regarding understanding of and work with adoptive parents. It is important to note that the theoretical Mrs . Kent is a staf] social worker , ami Mrs. Richie [ormerly W{l.\ a staf] social worker, of the
Children's Division of the Merl1linger Foundation , Topeka, Kansas . Th is paper W(L' presented at the annual meeting of the A mm((l1I Association of Psychiatric Services for Children in W(L,hinglon , D.C ., on November 4, /972. Reprint" 1IUly be obtainedfrom Mrs. Kent at The Ml'1lllinger Foundation , Box 829, Topeka . KS
66601.
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statements in this paper are intended to apply only to nonfecund adoptive parents.
A
CASE EXAMPLE
Mr. and Mrs. S. brought Eric, age II, for a psychiatric evaluation in the spring of 1962. The parents had adopted Eric one week after birth and had two other adopted boys, ages 7 and 6, brothers who had been adopted at an older age. The parents were selfreferred and saw themselves as coming primarily because of Eric's school difficulties. According to teachers, he daydreamed, did not follow instructions or complete his work, had difficulty in group activities because of "bad words" and mild physical tormenting of other children. The parents saw him at home as frequently unhappy, sullen, negative and unpredictable. He was afraid of large crowds and tended to clown inappropriately in social situations. He became depressed at bedtime and had many aches and pains for which no physical cause could be found. The parents' concern about Eric had begun when he was about 3 years old. At that time, he seemed "immature and stubborn." In second grade, the school psychologist had seen him as a very fearful child who was extremely threatened by anger. During the initial evaluation, the parents tended to minimize, if not deny, the significance of adoption to them and to their boy. Such comments as, "There is no difference in loving children, no matter how you acquire them," and, "It makes no difference that Eric was not born to us," were typical of these parents. In fact, efforts to convince the examiners of the insignificance of the adoption led to comments regarding the extra benefits of adoption, such as, "Adoption is a beautiful thing" and, "Eric knows he was a chosen child and we got just what we wanted." Eric had supposedly known he was adopted since early childhood, but had never raised questions about it. The parents had read the child several books about adoption, to which he seemingly showed no reaction. The father, age 40, was a short, wiry man of Scandinavian descent who initially presented himself in a calm, warm manner; he had a tendency to be witty and sarcastic in the face of anxiety. During the evaluation process, he seldom, if ever, evidenced strong emotion, and it became quite dear that the father masked chronic depression related to a deprived childhood with his even-tempered, rational, intellectual facade. His underlying depression was evident in slow speech and thought, sensitivity to loss of any kind, and frequent introduction, without affect, of depressive themes.
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The mother, age 32 and also of Scandinavian descent, was a short, very obese woman who initially appeared anxious and eager to please. Her anxieties showed in restless body movements and pressured, rapid speech. She became particularly distressed and tearful when she spoke of angry feelings toward her son and struggled constantly with a punitive sense of guilt. She frequently read psychological articles in popular magazines and used the ideas to torment herself as a "bad mother." She perceived herself as physically unattractive, despite pretty features, and was especially concerned about her weight problem. This couple immediately impressed the examiners with their sense of bewilderment about their child's difficulties-"When we have tried so very hard." They had always carefully sought the advice of physicians and teachers in the face of any small problem and followed it conscientiously, to the best of their ability. Their approach to this evaluation was the same, as they cooperated in strenuous fashion, to the point of staying lip late at night to discuss their child's early years and try to recall minute details of his early development. Despite a very limited income, they readily accepted the recommendation for the boy to be in psychoanalysis and themse lvcs in casework Io r an cxtc nclccl , iuclcfmitc pc rior! of rime.
Beginning in the fall of 1962, the parents were seen for an hour per week in casework, in conjunction with their son's treatment. It quickly became apparent that this couple had a long-standing pattern of overprotecting their boy. There were repeated references, by both parents, to the "extras" Eric had always received. They had always found it difficult not to give him more than he needed or even wanted. For example, his gifts at birthdays and Christmas had always been a little better or more expensive than those of his two brothers. Even people outside the family appeared to give Eric more attention and "second chances." The parents repeated mention of these "extras" represented, in part, their efforts to avoid feelings of being bad parents by reminding themselves how much they had given the boy. Only gradually did they begin to acknowledge anger, to admit how frustrating it was to give so much to a child who was so aloof and rejecting. With anguish, they spoke of trying to please the boy in return for some sign of warmth, but all to no avail. Their ability to give so much in the face of the boy's rejecting attitude was repeatedly questioned. As their anger at Eric became more apparent to them, they were stricken by guilt, without regard to their son's provocativeness. Despite the social worker's effort to help them understand and modify their long suffering behavior, the parents' stoicism prevailed. Four months after the
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beginning of treatment, the day finally came when the parents were able to afford themselves a glimpse at the deeper problem. The caseworker had again pointed to repeated evidence of the father's oversolicitude toward his SOIL Mr. S. finallv abandoned his usual air of calm reserve and announced with exasperation that he expected himself, as an adoptive parent, to do a better than average job. He felt he had a "grave duty" and had "taken an oath" with the adoption agency to be a good parent. He noted that adoption agencies were very careful to choose the "right kind of parents," and he felt he had failed them and his son. Perhaps, he noted angrily, they were not so smart after all. This interview heralded the beginning of a growing awareness, by social worker and parents, of the profound meanings adoption had to this family. Over the ensuing months, the parents spoke frequently of their long-standing feelings of owing Eric a great deal. They saw Eric's rejection as his reproach of them for not being adequate parents, and it became clear that they were furious at Eric for this judgment. Yet, in every way they invited Eric's contempt by conveying to him themselves that they had very little to offer, and that he had a right to be demanding and scornful. When the boy's analyst was away on vacation for a few weeks, the parents were consumed with anger at this "neglect" of their son, still another example of their expectation that others, as well as themselves, should give "extra" to Eric. Approximately six to eight months after beginning treatment, there was a brief periodwhen the family reported some lessening of tension in the horne., On one occasion, Eric commented to his mother that she was a "good mom," and she was Hooded with relief and gratitude. However, the feeling of "progress" proved to be short-lived, as it was not long before the family took the plunge into a deeper struggle with conflictual feelings. The boy's peer relationships were improving somewhat, and as he began to venture away from home, Mrs. S. found herself dismayed by the change she thought she had wanted, as she felt rejected when he left home to play with friends. In the face of the social worker's concentrated effort to understand the source of the parents' irrational worry, mother and father gradually found themselves recalling the insecurity of their first year with Eric. They reminisced about their original apprehension of not being given a child by the agency, and then their later fears of his being taken away before they could legally claim him, at one year of age. It seemed to the social worker almost as though they were still waiting for the agency to come and get him. To this comment, Mrs. S. responded bitterly that perhaps
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they should come for him, since the parents had done such a poor job. By this time, it seemed increasingly obvious that in a deep sense the parents rejected not only themselves as parents, but the boy as their son, as reflected in their various fear-wishes that they might lose him. Though the parents were beginning, at this point. to be somewhat more tolerant of the boy's growth toward independence, their struggle with themselves and Eric was by no means resolved. In fact, the crux of the work remained to be done. At the outset of his second year of treatment, Eric gave signs of approaching adolescence, an event which prompted strong parental reaction. Suddenly there were intense arguments between the pal'ents and Eric as to what and how much he should eat. This seemed to be a new pattern, and at first they could only explain that they were concerned about Eric's "health." Further discussions led the{lI to reveal their long-standing fear that Eric's genitals would not develop properly. Initially they related this concern to the fact that they had worried for several years because the boy had undescended testicles. However, normal growth and development had since resolved the problem and they had difficulty explaining why their fear persisted. Mr. S. fantasied that the boy would be st c ri lc, im potc nt ,
OJ·
bot h , Mis. S. co mrucrucd lnicf lv on
how difficult it would be to have no grandchildren. and thus opened the door to many weeks of discussion about what it had been like to find they could conceive no natural children. Until this point. the parents l{ad denied any significant feelings about their infertility; and as they again recalled the period of discovering it, they had difficulty recalling any reaction. Mrs. S. was eventually able to remember feeling very "tired" for many months after tests revealed her infertilit y problem, yet she recalled staying very busy in spite of her fatigue. The parents' decision to adopt was made within a half hour after their discovery that they would have no children. The absence of any grief or "working through" of this crisis was significant, and yet it seemed that these feelings were finally descending upon the parents as they faced their son's adolescence. For a number of months, as Eric matured, the parents grappled with envy of him, and exacerbated anxiety and sadness related to their own sense of inadequacy. Of course, Mrs. S. had already made dear the connections in her mind between eating and genital function. The worker learned that her weight gain had come after she learned of her infertility and that one of her expectations of treatment was that the social worker could help her lose weight. Mrs. S. had lost weight by the time the treatment terminated, an accomplishment which can seemingly be attributed to her
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increased awareness of the link between her need to eat and be "healthv" and her wish to conceive and bear a child. This wish for a child b~came quite pronounced during this period of struggling with her anguish about genital in lc rio rit y, even to the point that she found herself wishing for another child when she had long considered her family complete. As the parents relived in treatment the long-unresolved, repressed feclings regarding their infertility, it became clear that despite the mother's obvious inability to bear a child, the father held himself at least as responsible for the problem. He had the unrealistic belief that a childhood bout with mumps had left him sterile, though fertility studies had shown this was not the case. He remained adamant in his conviction that even without his wife's problem, they would not have been able to conceive, a stand which was seen in part as his effort to preserve the stability of the marriage by not blaming his wife for the problem. His feelings about his damaged image of himself came out more slowly and in a somewhat more subtle fashion than those of his wife. He reacted with shock and dismay upon discovering that his adopted son was the only one of several nephews not mentioned in the will of a deceased uncle. When this incident occurred, he spoke forlornly of not being able to give his son a "birthright." He chastised himself bitterly for feeling self-conscious that his tall, dark-haired son did not share the blond Scandinavian appearance of himself and his wife. In this context he remembered his conflict over whether or not to ask the agency for a child likely to "look like us." These examples clearly illustrated the crisis MI". S. experienced about not having a male child to preserve family blood lines. The period just described was a sad, turbulent time for this family. It was quite easy at home for feelings to become intense and distorted. For example, a shouting, stomping family argument ensued over whether the family dog should be "fixed" so that he would not have puppies. In the midst of all this turmoil, Eric became increasingly secretive and dishonest at home. He stole items from his father's desk and hid them in his room. The parents were startled on one occasion when the boy responded to their confrontation by shouting that they, too, were dishonest. In reflecting on his statement, the parents recognized that in a sense they had been dishonest, even with themselves, about their feelings regarding adoption. They pondered Eric's need to search their belongings and suddenly remembered that his adoption papers were locked in a chest in their bedroom. After some initial disbelief, they conceived the possibility that the secrets of adoption might be what
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Eric felt they were withholding from him. The social worker suggested that it would be important for them to think through what they knew about the facts of Eric's adoption, with the goal of eventually being able to share these facts with their son. At just this point, Mrs. S. frowned and asked if Mr. S. and the social worker heard an "alarm buzzer" like a fire alarm ringing in the hall. A fast check proved the noise to be a figment of her anxiety about the "alarming" task of helping her child cope with the meaning of his adoption. Thus, at this point, the parents began the work of sorting out their reactions to the specifics of Eric's background. Mr. S.'s memory of being told that the natural mother was a "sexy Spanish girl" was entirely erroneous and served to revive again the issue of sexuality and feelings about it. This explanation of Eric's natural background brought forth long-standing concerns from the parents about what their expectations should be of him. They agreed that they did not expect Eric to graduate from high school, despite the fact that Mr. S. had attended college. In this context, Mrs. S. recalled the agency's telling them that the natural father had not completed high school. When the social worker commented that in some ways they seemed to feel that Eric was still the child of his natural parents, the adoptive parents suddenly recalled having wondered how the natural mother had felt about releasing her child. Mr. S. remembered wondering if she had been reluctant to do so, and if they had, in a sense, "stolen" a child. The themes described thus far proved to be basic ones which appeared again and again in the course of the treatment. The repeated working through of these issues did not become less intense for a long time. Despite the parents' resolve to relate more directly to Eric regarding his adoption, they could only do so in a very gradual way, and at each step had to cope with very anxious feelings. Six months before the termination of treatment, on the anniversary of his placement in their home, the parents presented Eric with a box containing mementos of his infancy, including the announcement of his adoption and a letter from the agency giving the specific facts of his parentage. To the parents' relief, Eric was curious and elated with their gift and not at all bothered by what they considered the more disturbing aspects of his background. Over the next six months, the family made rapid gains in their ability to talk openly about Eric's background and other issues, and it was not long before the boy began his bid to terminate treatment. The parents began to feel more hopeful about Eric's academic future and to be more firm and positive in their general expectations
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of their son. Thus, they seemed to be saying that perhaps this child was their own, after all, despite the recognition that they would have to continue for a long time to help him integrate those parts of his identity which were contributed by his natural parents. Certainly, the more open communication in the family heightened the possibility that this integration could eventually take place. SOME THEORETICAL FORMULATIONS REGARDING ADOPTIVE PARENTHOOD
Defensive Patterns It is our experience that a number of adoptive parents who come for help, such as the ones described, typically demonstrate a great deal of difficulty in expressing displeasure with or disciplining their child. At best, their discipline seems to be inconsistent. Our hypothesis is that the apology they frequently feel they owe the child is, in essence, an apology for the anger and rejection they feel toward him on a deeper level. The pattern is reminiscent of the type of defensiveness seen in parents of unplanned and/or handicapped children, who also struggle with a sense of loss regarding their child. Schechter (1970) and Kirk (1964) noted one interesting phenomenon of adoption-that adoptive applicants select girls rather than boys to a statistically significant degree. They offer various theories of causality, and Kirk has attempted some research, which has led him to the conclusion that non fecund fathers have great difficulty resolving the narcissistic blow of not having a male heir to carryon the "blood line" of the family. Kirk maintains that wives are sensitive to the blow their husbands feel, and thus for a variety of reasons couples often tend to reach a compromise solution of asking for a girl. Taking the available literature into account, one might then speculate that of the adopted children seen in psychiatric clinics, a significant number will he males, especially in comparison with the percentage of males in the general adopted population. We would further hypothesize that the adopted children seen in clinics would also tend to be the oldest children in their families, the latter assumption being a subjective one based Oil experience and the impression that parental conflicts around adoption seem to be particularly played out in the upbringing of the first adopted child. In a 1967 panel on adoption, Neubauer stated his impression that the second adopted child seemed to have less difficulty than the first (see Schechter, 19(7).
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One aspect of adoptive parents' difficulty in expressing negative emotions to their child is reflected in their frequent denial of any regret about not having natural children. In this regard, Kirk (1964) has described the "role handicap" which accompanies infertility and has carefully researched the ways in which adopting couples cope with the handicap. Essentially, he has identified two styles of coping, the first being "acknowledgment of difference" (p. 6:~) in which the parents squarely face and admit their handicap and feelings about it, and thus are able to empathize and offer support for the child's concerns about being "different." The second coping pattern noted by Kirk is "rejection of difference" (p. 59), a style in which parents take the stand that adoptive families are not different from biological families and proceed to handle the matter through denial and repression. Kirk points out that such a defensive pattern, by definition, stifles communication and leaves children at sea with the doubts and confusion they must inevitably struggle with in regard to adoption. Kirk also maintains that the more deprived a couple feels in relation to their nonfecund state, the more likely are they to demonstrate the pattern of "rejection of difference" (p. 59). We would make Kirk's point a bit more specific ill terms of psychiatric practice with our conjecture that adopting parents seen in psychiatric clinics would be inclined, to a significant degree, to use the coping pattern of "rejection of difference." It should be remembered that this concept is not absolute, and that all adoptive families show a mixed pattern in one direction or the other. To Grieve or Not To Grieve
We next come to the question of the factors which determine why a couple chooses one coping style or another. Kirk (1964) makes a good case for his hypothesis that the denial of difference regarding adoption varies directly with the "original deprivation and the degree of role handicap suffered" (p. 81). To develop his point further, we would maintain that in addition to the reality of physical handicap and social and cultural influences which may reinforce the sense of inadequacy, that coping style is also related to the basic psychological strengths and weaknesses of the individuals. Thus many factors affect a couple's reaction to infertility, and the first evidence of coping style appears long before they receive a child. In many interviews with adoptive parents in clinics, adoption agencies, study groups, and other settings, we have come to the conclusion that there are two coping patterns which appear almost at the moment at which a couple discovers their infertility. Most of the
Adoption as an Issue with Adoptive Parents
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couples we have seen in clinical practice describe a matter-of-fact reaction to discovering their infertility, followed by an automatic decision to adopt. They recall experiencing little affect around the issue. In contrast, we were struck by the difference in the experiences described by most of the couples interviewed or observed in discussion groups geared to "normal" adoptive parents. These couples, particularly the women, recalled a long period, usually six months to a year, of low moods, crying jags. and periodic anger at situations which reminded them of their infertility. One woman described her effort to fight back tears in a supermarket every time she encountered a mother with a small boy in a shopping cart. Others told of their inability to tolerate feelings stirred up by being around pregnant friends. These husbands and wives recalled crying and talking together about their problem, and only gradually beginning to think of adoption as the depression subsided. In essence, they seemed to describe a process of grieving for their loss of reproductive function and for the loss of the natural children they had expected, but who would never come. The decision for adoption did not come until their deprivation had been struggled with and accepted. From this point, we would suggest that perhaps a very vital function of adoption agencies as preventive mental health agents is to help prospective adopting parents to do their grief work, and thus set the stage for an effective coping style with their children. In terms of treatment, it hardly seems risky at this point to theorize that most adoptive parents who present themselves and their child at a psychiatric clinic will never have dealt sufficiently with the meanings of their infertility. Thus, one of the major, if not the most important, casework tasks is that of helping them do their long overdue grief work. Legal Adoption versus Emotional Adoption It is standard adoption procedure in this country for a child to be placed in an adoptive home as soon as possible after birth, and for the legal adoption to take place at approximately one year of age. However, clinical experience seems to bear out the fact that there is not necessarily a connection between the time of placement or legal adoption, and the time when a parent is able to make a full emotional commitment to the child. We have already made our point about the necessity of effective grief work as preparation for gratifying adoptive parenthood. It is an established psychological fact that a person suffering a loss cannot accept or love a substitute object until he has grieved and come to terms with the loss of an ob-
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ject. Everyone is familiar with the pathological consequences which ensue when an individual tries to circumvent the natural grief process by impulsively seeking solace in a new relationship. Such unions do not Hourish, whether they be marriages of husband and wife or unions of adoptive parents and their children. Thus our hypothesis is that emotional adoption can take place only when adopting parents have done their grief work, accepted their loss of natural children, and therefore worked to cultivate an emotional ground where adopted children can take root. Unless this happens, their cathexis remains with the fantasied natural children and it is not available for the adopted ones. Ideally, emotional adoption can take place very early, at least from the parents' side; but in some cases it becomes a major task of treatment to help parents and child to transact finally the emotional adoption which has never taken place. Our belief is that the full transaction never fully takes place anyway until the child's adolescence, when he finally comes to grips with his identity in its natural and adoptive aspects, and in a final sense chooses to identify with or adopt his parents. This would explain why adolescence seems to be an especially difficult time for adoptive families. Of course, the child's resolution of his concerns about adoption is
made infinitely easier if the parents have resolved their loss and made their wholehearted commitment to the child. Then they are free to empathize, acknowledge the differences in problems of adoptive status, and help him come to grips with the loss in his background. This is Kirk's (1964) concept of "shared fate" (p. 156). There are aspects of current laws and adoption agency practice which greatly complicate transaction of emotional adoption between parents and child. Cady (1952) and Winter (1956), both adoptive parents who have written accounts of their experience, have described the profound anxiety of the period between placement and legal adoption. As Cady states, "you will never feel that you are entirely out of the woods until the decree is issued" (p. (9). Certainly it is a staggering task for any parent to make » full emotional commitment to a child who could legally be snatched away at any moment. Agency personnel known to us have candidly stated on many occasions that parents have great difficulty using their services in the postplacement period prior to legal adoption, and even tend to perceive them as threatening intruders. I For parents who have plumbed the depths of their souls and grieved their loss, how difficult might it be to face even a hint of losing the child for I We wish to express appreciation to the stall of the Kansas Children's Service Leag-ue, Topeka. Kansas and Hope Cottage, Dallas, Texas, for sharing- their impressions with us.
Adoption as an Issue with Adoptive Parents
5~1
whom they have worked so hard to make a place in their hearts. No wonder the emotional adoption is such a complicated issue. What are the indications in a treatment process that parents have in a deep sense not really claimed their child, despite a legal adoption transacted years before- In our experience, in the case described in this paper, as well as many others, an important clue comes from the parents' immediate and long-term expectations of their child. We have seen in every case thus far that these troubled adoptive parents have expected their child to be like their image of the natural parents-that is, promiscuous and unreliable. In some cases where the image of the biological parents has not been so negative, they have simply expected the child to share the original parents' choice of education, career, and life style, though these traits are not generally considered to be inherited characteristics, in such a specific sense. In short, our impression is that those adopting parents who have not really been able to accept the substitute child who confirms their lack of physical integrity will continue to maintain on the deepest level that they are raising someone else's child and will expect that the child identify with these shadowy images rather than themselves. It has been startling on occasion to observe how specifically these parents expect the child to be like what they know about the natural parents. As they move closer to transaction of the emotional adoption, their progress can often be seen in their increasing tendency to expect the child to be like themselves, in personality traits, and in level of success. As a closing thoughi, we might share a bias that work with troubled adoptive families. seems to be a tedious, complex task. It is "different," and these families fight strenuously against confronting the taboos which society constantly reinforces for them. We are convinced that adoption is alwa)ls a vital issue for families with adopted children, and must always be taken up very seriously in the treatment process.
REFERE;'I;CES E. J &: Ih~EllEh, '1'.. eds. (1970), Parenthood. Boston: Little, BroWI1. Cxnv, E. (19.'i~), WI' Adopted Til/H. :\ew York: william Slo.uu-. Ih:t'TSCII, II. (1!14;,), The P.\yr)w{"I,')· "I W"II/I'II, Vol. ~. :\ew York: Grune &: St ratton. JAFFE, B. &: FA~SIlU., D. (1970), HOI,' The» Fared ill Adoption. :\ew York: Columbia Univ. Press. KIRh, H. D. (19li4), Shared Fate. !\ew York: Free Press. Mt:l:I1, E. V., CARLSO~, 1'. V., YARROW, L, J, &: BRIU.A~Il, D. (I !Jli.'i), Perspertiues "" Adoption Research, New York: Child Welfare League of America. RAYMONll, 1.. (I !1.'i5), Adoption and A/in. New York: Harper. A),;TIIO~\',
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ROI\'E. .J. ( I !Ilili). Parents, Children alii/ Ai/II/)(ilili. London: Routledge & Kegan Paul. S<:IIECHTER. :\1. D. (I !Ilii). Report of Panel: Psvrhoanalvric thcorv as it relates to adoption. j. .1/11n. Psvchoanal. A.\.\II., l:j :li!I;,-iOH. - - - (191iO), Ohservarions on adopted children. Arch, Gen. Psyrhial., :I:~ I-:I~. - - - (I !IiO). About adoptive parenls. In: Anthonv & Benedek (I !liO). pp. :1:}:I-:I7~. - - - CARLSOI'. P.. SI~f~fO~S . .J.. & WORK. H. (1!1li-t). Emotional problems of the adoptee. Arch. (;"11. Psvchiat., 10::li-41i. SMITH, E. (I !lli':I). Readings 1111 Adoption. :\ew York: Philosophical Lihrarv. TOl'SSIE:-;(;. P. (1!lli~), Thoughts regarding the eliology of ps\'chological difficulties III adopted children. Chili/ Wpl[fm, 41 :5!I-li5, WINTER. :\1, (1!151i). Fill' J.III'P II{Marlha. :\ew York: .Julian Messner.
Katherine G. Kent, M.S. and Julia L. Richie, M.S. W.
Abstract, By describing in derail the process of one case and elaborating theoretical formulations gleaned from various authors , we attempt to illustrate that adoption is a complicated proccss-i-that the tasks of adoptive parenthood are more complex and demanding than the usual work of parenting. An effort is made to show that a primary ta sk of adoptive parents is that of coming 10 grips with their loss of reproductive function. The extent to which the parents accomplish their "grief work" is directly related 10 the quality of relationship they Gin achieve with their adopted child .
For many years, professional people have evidenced an interest in the impact of adoption on the emotional life of families. Various studies have reflected divergent conclusions. Some studies (e.g.. Jaffe and Fanshel, 1970) conclude with the fact that most adoptions work out well, and imply that the fact of adoption actually makes no difference in the kinds of relationships that develop in the family. On the other hand, Schechter (1960) and Toussieng (1962) point out that a disproportionately large percentage of adopted children are seen in ps ychiatric clinics, when compared to the number of adopted children in the general population. How do we understand these discrepant points of view? It is possible to assume some validit y in the conclusions reached by all of these investigators. to acknowledge that most adopted children are well adjusted, but to maintain that there is a risk factor involved in adoption. This was the position taken by Mech et al. (1965) in a recent survey of adoption research. The purpose of this paper is to examine in detail a case example, which we consider to reHect commonalities often seen in work with adoptive families. and from that point to venture hypotheses regarding understanding of and work with adoptive parents. It is important to note that the theoretical Mrs . Kent is a staf] social worker , ami Mrs. Richie [ormerly W{l.\ a staf] social worker, of the
Children's Division of the Merl1linger Foundation , Topeka, Kansas . Th is paper W(L' presented at the annual meeting of the A mm((l1I Association of Psychiatric Services for Children in W(L,hinglon , D.C ., on November 4, /972. Reprint" 1IUly be obtainedfrom Mrs. Kent at The Ml'1lllinger Foundation , Box 829, Topeka . KS
66601.
510
Adoption as an Issue with Adoptive Parents
511
statements in this paper are intended to apply only to nonfecund adoptive parents.
A
CASE EXAMPLE
Mr. and Mrs. S. brought Eric, age II, for a psychiatric evaluation in the spring of 1962. The parents had adopted Eric one week after birth and had two other adopted boys, ages 7 and 6, brothers who had been adopted at an older age. The parents were selfreferred and saw themselves as coming primarily because of Eric's school difficulties. According to teachers, he daydreamed, did not follow instructions or complete his work, had difficulty in group activities because of "bad words" and mild physical tormenting of other children. The parents saw him at home as frequently unhappy, sullen, negative and unpredictable. He was afraid of large crowds and tended to clown inappropriately in social situations. He became depressed at bedtime and had many aches and pains for which no physical cause could be found. The parents' concern about Eric had begun when he was about 3 years old. At that time, he seemed "immature and stubborn." In second grade, the school psychologist had seen him as a very fearful child who was extremely threatened by anger. During the initial evaluation, the parents tended to minimize, if not deny, the significance of adoption to them and to their boy. Such comments as, "There is no difference in loving children, no matter how you acquire them," and, "It makes no difference that Eric was not born to us," were typical of these parents. In fact, efforts to convince the examiners of the insignificance of the adoption led to comments regarding the extra benefits of adoption, such as, "Adoption is a beautiful thing" and, "Eric knows he was a chosen child and we got just what we wanted." Eric had supposedly known he was adopted since early childhood, but had never raised questions about it. The parents had read the child several books about adoption, to which he seemingly showed no reaction. The father, age 40, was a short, wiry man of Scandinavian descent who initially presented himself in a calm, warm manner; he had a tendency to be witty and sarcastic in the face of anxiety. During the evaluation process, he seldom, if ever, evidenced strong emotion, and it became quite dear that the father masked chronic depression related to a deprived childhood with his even-tempered, rational, intellectual facade. His underlying depression was evident in slow speech and thought, sensitivity to loss of any kind, and frequent introduction, without affect, of depressive themes.
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The mother, age 32 and also of Scandinavian descent, was a short, very obese woman who initially appeared anxious and eager to please. Her anxieties showed in restless body movements and pressured, rapid speech. She became particularly distressed and tearful when she spoke of angry feelings toward her son and struggled constantly with a punitive sense of guilt. She frequently read psychological articles in popular magazines and used the ideas to torment herself as a "bad mother." She perceived herself as physically unattractive, despite pretty features, and was especially concerned about her weight problem. This couple immediately impressed the examiners with their sense of bewilderment about their child's difficulties-"When we have tried so very hard." They had always carefully sought the advice of physicians and teachers in the face of any small problem and followed it conscientiously, to the best of their ability. Their approach to this evaluation was the same, as they cooperated in strenuous fashion, to the point of staying lip late at night to discuss their child's early years and try to recall minute details of his early development. Despite a very limited income, they readily accepted the recommendation for the boy to be in psychoanalysis and themse lvcs in casework Io r an cxtc nclccl , iuclcfmitc pc rior! of rime.
Beginning in the fall of 1962, the parents were seen for an hour per week in casework, in conjunction with their son's treatment. It quickly became apparent that this couple had a long-standing pattern of overprotecting their boy. There were repeated references, by both parents, to the "extras" Eric had always received. They had always found it difficult not to give him more than he needed or even wanted. For example, his gifts at birthdays and Christmas had always been a little better or more expensive than those of his two brothers. Even people outside the family appeared to give Eric more attention and "second chances." The parents repeated mention of these "extras" represented, in part, their efforts to avoid feelings of being bad parents by reminding themselves how much they had given the boy. Only gradually did they begin to acknowledge anger, to admit how frustrating it was to give so much to a child who was so aloof and rejecting. With anguish, they spoke of trying to please the boy in return for some sign of warmth, but all to no avail. Their ability to give so much in the face of the boy's rejecting attitude was repeatedly questioned. As their anger at Eric became more apparent to them, they were stricken by guilt, without regard to their son's provocativeness. Despite the social worker's effort to help them understand and modify their long suffering behavior, the parents' stoicism prevailed. Four months after the
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beginning of treatment, the day finally came when the parents were able to afford themselves a glimpse at the deeper problem. The caseworker had again pointed to repeated evidence of the father's oversolicitude toward his SOIL Mr. S. finallv abandoned his usual air of calm reserve and announced with exasperation that he expected himself, as an adoptive parent, to do a better than average job. He felt he had a "grave duty" and had "taken an oath" with the adoption agency to be a good parent. He noted that adoption agencies were very careful to choose the "right kind of parents," and he felt he had failed them and his son. Perhaps, he noted angrily, they were not so smart after all. This interview heralded the beginning of a growing awareness, by social worker and parents, of the profound meanings adoption had to this family. Over the ensuing months, the parents spoke frequently of their long-standing feelings of owing Eric a great deal. They saw Eric's rejection as his reproach of them for not being adequate parents, and it became clear that they were furious at Eric for this judgment. Yet, in every way they invited Eric's contempt by conveying to him themselves that they had very little to offer, and that he had a right to be demanding and scornful. When the boy's analyst was away on vacation for a few weeks, the parents were consumed with anger at this "neglect" of their son, still another example of their expectation that others, as well as themselves, should give "extra" to Eric. Approximately six to eight months after beginning treatment, there was a brief periodwhen the family reported some lessening of tension in the horne., On one occasion, Eric commented to his mother that she was a "good mom," and she was Hooded with relief and gratitude. However, the feeling of "progress" proved to be short-lived, as it was not long before the family took the plunge into a deeper struggle with conflictual feelings. The boy's peer relationships were improving somewhat, and as he began to venture away from home, Mrs. S. found herself dismayed by the change she thought she had wanted, as she felt rejected when he left home to play with friends. In the face of the social worker's concentrated effort to understand the source of the parents' irrational worry, mother and father gradually found themselves recalling the insecurity of their first year with Eric. They reminisced about their original apprehension of not being given a child by the agency, and then their later fears of his being taken away before they could legally claim him, at one year of age. It seemed to the social worker almost as though they were still waiting for the agency to come and get him. To this comment, Mrs. S. responded bitterly that perhaps
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they should come for him, since the parents had done such a poor job. By this time, it seemed increasingly obvious that in a deep sense the parents rejected not only themselves as parents, but the boy as their son, as reflected in their various fear-wishes that they might lose him. Though the parents were beginning, at this point. to be somewhat more tolerant of the boy's growth toward independence, their struggle with themselves and Eric was by no means resolved. In fact, the crux of the work remained to be done. At the outset of his second year of treatment, Eric gave signs of approaching adolescence, an event which prompted strong parental reaction. Suddenly there were intense arguments between the pal'ents and Eric as to what and how much he should eat. This seemed to be a new pattern, and at first they could only explain that they were concerned about Eric's "health." Further discussions led the{lI to reveal their long-standing fear that Eric's genitals would not develop properly. Initially they related this concern to the fact that they had worried for several years because the boy had undescended testicles. However, normal growth and development had since resolved the problem and they had difficulty explaining why their fear persisted. Mr. S. fantasied that the boy would be st c ri lc, im potc nt ,
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how difficult it would be to have no grandchildren. and thus opened the door to many weeks of discussion about what it had been like to find they could conceive no natural children. Until this point. the parents l{ad denied any significant feelings about their infertility; and as they again recalled the period of discovering it, they had difficulty recalling any reaction. Mrs. S. was eventually able to remember feeling very "tired" for many months after tests revealed her infertilit y problem, yet she recalled staying very busy in spite of her fatigue. The parents' decision to adopt was made within a half hour after their discovery that they would have no children. The absence of any grief or "working through" of this crisis was significant, and yet it seemed that these feelings were finally descending upon the parents as they faced their son's adolescence. For a number of months, as Eric matured, the parents grappled with envy of him, and exacerbated anxiety and sadness related to their own sense of inadequacy. Of course, Mrs. S. had already made dear the connections in her mind between eating and genital function. The worker learned that her weight gain had come after she learned of her infertility and that one of her expectations of treatment was that the social worker could help her lose weight. Mrs. S. had lost weight by the time the treatment terminated, an accomplishment which can seemingly be attributed to her
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increased awareness of the link between her need to eat and be "healthv" and her wish to conceive and bear a child. This wish for a child b~came quite pronounced during this period of struggling with her anguish about genital in lc rio rit y, even to the point that she found herself wishing for another child when she had long considered her family complete. As the parents relived in treatment the long-unresolved, repressed feclings regarding their infertility, it became clear that despite the mother's obvious inability to bear a child, the father held himself at least as responsible for the problem. He had the unrealistic belief that a childhood bout with mumps had left him sterile, though fertility studies had shown this was not the case. He remained adamant in his conviction that even without his wife's problem, they would not have been able to conceive, a stand which was seen in part as his effort to preserve the stability of the marriage by not blaming his wife for the problem. His feelings about his damaged image of himself came out more slowly and in a somewhat more subtle fashion than those of his wife. He reacted with shock and dismay upon discovering that his adopted son was the only one of several nephews not mentioned in the will of a deceased uncle. When this incident occurred, he spoke forlornly of not being able to give his son a "birthright." He chastised himself bitterly for feeling self-conscious that his tall, dark-haired son did not share the blond Scandinavian appearance of himself and his wife. In this context he remembered his conflict over whether or not to ask the agency for a child likely to "look like us." These examples clearly illustrated the crisis MI". S. experienced about not having a male child to preserve family blood lines. The period just described was a sad, turbulent time for this family. It was quite easy at home for feelings to become intense and distorted. For example, a shouting, stomping family argument ensued over whether the family dog should be "fixed" so that he would not have puppies. In the midst of all this turmoil, Eric became increasingly secretive and dishonest at home. He stole items from his father's desk and hid them in his room. The parents were startled on one occasion when the boy responded to their confrontation by shouting that they, too, were dishonest. In reflecting on his statement, the parents recognized that in a sense they had been dishonest, even with themselves, about their feelings regarding adoption. They pondered Eric's need to search their belongings and suddenly remembered that his adoption papers were locked in a chest in their bedroom. After some initial disbelief, they conceived the possibility that the secrets of adoption might be what
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Eric felt they were withholding from him. The social worker suggested that it would be important for them to think through what they knew about the facts of Eric's adoption, with the goal of eventually being able to share these facts with their son. At just this point, Mrs. S. frowned and asked if Mr. S. and the social worker heard an "alarm buzzer" like a fire alarm ringing in the hall. A fast check proved the noise to be a figment of her anxiety about the "alarming" task of helping her child cope with the meaning of his adoption. Thus, at this point, the parents began the work of sorting out their reactions to the specifics of Eric's background. Mr. S.'s memory of being told that the natural mother was a "sexy Spanish girl" was entirely erroneous and served to revive again the issue of sexuality and feelings about it. This explanation of Eric's natural background brought forth long-standing concerns from the parents about what their expectations should be of him. They agreed that they did not expect Eric to graduate from high school, despite the fact that Mr. S. had attended college. In this context, Mrs. S. recalled the agency's telling them that the natural father had not completed high school. When the social worker commented that in some ways they seemed to feel that Eric was still the child of his natural parents, the adoptive parents suddenly recalled having wondered how the natural mother had felt about releasing her child. Mr. S. remembered wondering if she had been reluctant to do so, and if they had, in a sense, "stolen" a child. The themes described thus far proved to be basic ones which appeared again and again in the course of the treatment. The repeated working through of these issues did not become less intense for a long time. Despite the parents' resolve to relate more directly to Eric regarding his adoption, they could only do so in a very gradual way, and at each step had to cope with very anxious feelings. Six months before the termination of treatment, on the anniversary of his placement in their home, the parents presented Eric with a box containing mementos of his infancy, including the announcement of his adoption and a letter from the agency giving the specific facts of his parentage. To the parents' relief, Eric was curious and elated with their gift and not at all bothered by what they considered the more disturbing aspects of his background. Over the next six months, the family made rapid gains in their ability to talk openly about Eric's background and other issues, and it was not long before the boy began his bid to terminate treatment. The parents began to feel more hopeful about Eric's academic future and to be more firm and positive in their general expectations
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of their son. Thus, they seemed to be saying that perhaps this child was their own, after all, despite the recognition that they would have to continue for a long time to help him integrate those parts of his identity which were contributed by his natural parents. Certainly, the more open communication in the family heightened the possibility that this integration could eventually take place. SOME THEORETICAL FORMULATIONS REGARDING ADOPTIVE PARENTHOOD
Defensive Patterns It is our experience that a number of adoptive parents who come for help, such as the ones described, typically demonstrate a great deal of difficulty in expressing displeasure with or disciplining their child. At best, their discipline seems to be inconsistent. Our hypothesis is that the apology they frequently feel they owe the child is, in essence, an apology for the anger and rejection they feel toward him on a deeper level. The pattern is reminiscent of the type of defensiveness seen in parents of unplanned and/or handicapped children, who also struggle with a sense of loss regarding their child. Schechter (1970) and Kirk (1964) noted one interesting phenomenon of adoption-that adoptive applicants select girls rather than boys to a statistically significant degree. They offer various theories of causality, and Kirk has attempted some research, which has led him to the conclusion that non fecund fathers have great difficulty resolving the narcissistic blow of not having a male heir to carryon the "blood line" of the family. Kirk maintains that wives are sensitive to the blow their husbands feel, and thus for a variety of reasons couples often tend to reach a compromise solution of asking for a girl. Taking the available literature into account, one might then speculate that of the adopted children seen in psychiatric clinics, a significant number will he males, especially in comparison with the percentage of males in the general adopted population. We would further hypothesize that the adopted children seen in clinics would also tend to be the oldest children in their families, the latter assumption being a subjective one based Oil experience and the impression that parental conflicts around adoption seem to be particularly played out in the upbringing of the first adopted child. In a 1967 panel on adoption, Neubauer stated his impression that the second adopted child seemed to have less difficulty than the first (see Schechter, 19(7).
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One aspect of adoptive parents' difficulty in expressing negative emotions to their child is reflected in their frequent denial of any regret about not having natural children. In this regard, Kirk (1964) has described the "role handicap" which accompanies infertility and has carefully researched the ways in which adopting couples cope with the handicap. Essentially, he has identified two styles of coping, the first being "acknowledgment of difference" (p. 6:~) in which the parents squarely face and admit their handicap and feelings about it, and thus are able to empathize and offer support for the child's concerns about being "different." The second coping pattern noted by Kirk is "rejection of difference" (p. 59), a style in which parents take the stand that adoptive families are not different from biological families and proceed to handle the matter through denial and repression. Kirk points out that such a defensive pattern, by definition, stifles communication and leaves children at sea with the doubts and confusion they must inevitably struggle with in regard to adoption. Kirk also maintains that the more deprived a couple feels in relation to their nonfecund state, the more likely are they to demonstrate the pattern of "rejection of difference" (p. 59). We would make Kirk's point a bit more specific ill terms of psychiatric practice with our conjecture that adopting parents seen in psychiatric clinics would be inclined, to a significant degree, to use the coping pattern of "rejection of difference." It should be remembered that this concept is not absolute, and that all adoptive families show a mixed pattern in one direction or the other. To Grieve or Not To Grieve
We next come to the question of the factors which determine why a couple chooses one coping style or another. Kirk (1964) makes a good case for his hypothesis that the denial of difference regarding adoption varies directly with the "original deprivation and the degree of role handicap suffered" (p. 81). To develop his point further, we would maintain that in addition to the reality of physical handicap and social and cultural influences which may reinforce the sense of inadequacy, that coping style is also related to the basic psychological strengths and weaknesses of the individuals. Thus many factors affect a couple's reaction to infertility, and the first evidence of coping style appears long before they receive a child. In many interviews with adoptive parents in clinics, adoption agencies, study groups, and other settings, we have come to the conclusion that there are two coping patterns which appear almost at the moment at which a couple discovers their infertility. Most of the
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couples we have seen in clinical practice describe a matter-of-fact reaction to discovering their infertility, followed by an automatic decision to adopt. They recall experiencing little affect around the issue. In contrast, we were struck by the difference in the experiences described by most of the couples interviewed or observed in discussion groups geared to "normal" adoptive parents. These couples, particularly the women, recalled a long period, usually six months to a year, of low moods, crying jags. and periodic anger at situations which reminded them of their infertility. One woman described her effort to fight back tears in a supermarket every time she encountered a mother with a small boy in a shopping cart. Others told of their inability to tolerate feelings stirred up by being around pregnant friends. These husbands and wives recalled crying and talking together about their problem, and only gradually beginning to think of adoption as the depression subsided. In essence, they seemed to describe a process of grieving for their loss of reproductive function and for the loss of the natural children they had expected, but who would never come. The decision for adoption did not come until their deprivation had been struggled with and accepted. From this point, we would suggest that perhaps a very vital function of adoption agencies as preventive mental health agents is to help prospective adopting parents to do their grief work, and thus set the stage for an effective coping style with their children. In terms of treatment, it hardly seems risky at this point to theorize that most adoptive parents who present themselves and their child at a psychiatric clinic will never have dealt sufficiently with the meanings of their infertility. Thus, one of the major, if not the most important, casework tasks is that of helping them do their long overdue grief work. Legal Adoption versus Emotional Adoption It is standard adoption procedure in this country for a child to be placed in an adoptive home as soon as possible after birth, and for the legal adoption to take place at approximately one year of age. However, clinical experience seems to bear out the fact that there is not necessarily a connection between the time of placement or legal adoption, and the time when a parent is able to make a full emotional commitment to the child. We have already made our point about the necessity of effective grief work as preparation for gratifying adoptive parenthood. It is an established psychological fact that a person suffering a loss cannot accept or love a substitute object until he has grieved and come to terms with the loss of an ob-
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ject. Everyone is familiar with the pathological consequences which ensue when an individual tries to circumvent the natural grief process by impulsively seeking solace in a new relationship. Such unions do not Hourish, whether they be marriages of husband and wife or unions of adoptive parents and their children. Thus our hypothesis is that emotional adoption can take place only when adopting parents have done their grief work, accepted their loss of natural children, and therefore worked to cultivate an emotional ground where adopted children can take root. Unless this happens, their cathexis remains with the fantasied natural children and it is not available for the adopted ones. Ideally, emotional adoption can take place very early, at least from the parents' side; but in some cases it becomes a major task of treatment to help parents and child to transact finally the emotional adoption which has never taken place. Our belief is that the full transaction never fully takes place anyway until the child's adolescence, when he finally comes to grips with his identity in its natural and adoptive aspects, and in a final sense chooses to identify with or adopt his parents. This would explain why adolescence seems to be an especially difficult time for adoptive families. Of course, the child's resolution of his concerns about adoption is
made infinitely easier if the parents have resolved their loss and made their wholehearted commitment to the child. Then they are free to empathize, acknowledge the differences in problems of adoptive status, and help him come to grips with the loss in his background. This is Kirk's (1964) concept of "shared fate" (p. 156). There are aspects of current laws and adoption agency practice which greatly complicate transaction of emotional adoption between parents and child. Cady (1952) and Winter (1956), both adoptive parents who have written accounts of their experience, have described the profound anxiety of the period between placement and legal adoption. As Cady states, "you will never feel that you are entirely out of the woods until the decree is issued" (p. (9). Certainly it is a staggering task for any parent to make » full emotional commitment to a child who could legally be snatched away at any moment. Agency personnel known to us have candidly stated on many occasions that parents have great difficulty using their services in the postplacement period prior to legal adoption, and even tend to perceive them as threatening intruders. I For parents who have plumbed the depths of their souls and grieved their loss, how difficult might it be to face even a hint of losing the child for I We wish to express appreciation to the stall of the Kansas Children's Service Leag-ue, Topeka. Kansas and Hope Cottage, Dallas, Texas, for sharing- their impressions with us.
Adoption as an Issue with Adoptive Parents
5~1
whom they have worked so hard to make a place in their hearts. No wonder the emotional adoption is such a complicated issue. What are the indications in a treatment process that parents have in a deep sense not really claimed their child, despite a legal adoption transacted years before- In our experience, in the case described in this paper, as well as many others, an important clue comes from the parents' immediate and long-term expectations of their child. We have seen in every case thus far that these troubled adoptive parents have expected their child to be like their image of the natural parents-that is, promiscuous and unreliable. In some cases where the image of the biological parents has not been so negative, they have simply expected the child to share the original parents' choice of education, career, and life style, though these traits are not generally considered to be inherited characteristics, in such a specific sense. In short, our impression is that those adopting parents who have not really been able to accept the substitute child who confirms their lack of physical integrity will continue to maintain on the deepest level that they are raising someone else's child and will expect that the child identify with these shadowy images rather than themselves. It has been startling on occasion to observe how specifically these parents expect the child to be like what they know about the natural parents. As they move closer to transaction of the emotional adoption, their progress can often be seen in their increasing tendency to expect the child to be like themselves, in personality traits, and in level of success. As a closing thoughi, we might share a bias that work with troubled adoptive families. seems to be a tedious, complex task. It is "different," and these families fight strenuously against confronting the taboos which society constantly reinforces for them. We are convinced that adoption is alwa)ls a vital issue for families with adopted children, and must always be taken up very seriously in the treatment process.
REFERE;'I;CES E. J &: Ih~EllEh, '1'.. eds. (1970), Parenthood. Boston: Little, BroWI1. Cxnv, E. (19.'i~), WI' Adopted Til/H. :\ew York: william Slo.uu-. Ih:t'TSCII, II. (1!14;,), The P.\yr)w{"I,')· "I W"II/I'II, Vol. ~. :\ew York: Grune &: St ratton. JAFFE, B. &: FA~SIlU., D. (1970), HOI,' The» Fared ill Adoption. :\ew York: Columbia Univ. Press. KIRh, H. D. (19li4), Shared Fate. !\ew York: Free Press. Mt:l:I1, E. V., CARLSO~, 1'. V., YARROW, L, J, &: BRIU.A~Il, D. (I !Jli.'i), Perspertiues "" Adoption Research, New York: Child Welfare League of America. RAYMONll, 1.. (I !1.'i5), Adoption and A/in. New York: Harper. A),;TIIO~\',
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ROI\'E. .J. ( I !Ilili). Parents, Children alii/ Ai/II/)(ilili. London: Routledge & Kegan Paul. S<:IIECHTER. :\1. D. (I !Ilii). Report of Panel: Psvrhoanalvric thcorv as it relates to adoption. j. .1/11n. Psvchoanal. A.\.\II., l:j :li!I;,-iOH. - - - (191iO), Ohservarions on adopted children. Arch, Gen. Psyrhial., :I:~ I-:I~. - - - (I !IiO). About adoptive parenls. In: Anthonv & Benedek (I !liO). pp. :1:}:I-:I7~. - - - CARLSOI'. P.. SI~f~fO~S . .J.. & WORK. H. (1!1li-t). Emotional problems of the adoptee. Arch. (;"11. Psvchiat., 10::li-41i. SMITH, E. (I !lli':I). Readings 1111 Adoption. :\ew York: Philosophical Lihrarv. TOl'SSIE:-;(;. P. (1!lli~), Thoughts regarding the eliology of ps\'chological difficulties III adopted children. Chili/ Wpl[fm, 41 :5!I-li5, WINTER. :\1, (1!151i). Fill' J.III'P II{Marlha. :\ew York: .Julian Messner.