Why Has the Mental Health Community Been Silent on Adoption Issues?

Douglas Henderson. Handbook of Adoption: Implications for Researchers, Practitioners, and Families. Editor: Rafael A Javier, Amanda L Baden, Frank A Biafora, Alina Camacho-Gingerich. Sage Publication. 2007.

For much of the mid-20th century, the process of adoption was shrouded in secrecy, largely based on the assumption of shameful pregnancies and “illegitimate” births. The professed intent of the secrecy was the protection of all those involved in what came to be seen as a private transaction. For detailed reviews of the history of adoption in the United States, see Chapters 2 and 3 in this volume as well as the comprehensive work of Holt (1992), Wegar (1997), O’Brien and Zamostny (2003), and Zamostny, O’Brien, Baden, and Wiley (2003). As societal values changed during the 1980s and 1990s, much of the historic secrecy began to be stripped away. Adoption has now become a topic of public discourse, and in several states adoptees have gained the right to access their adoption records and thus their history. Unfortunately, while society has begun to talk about adoption, particularly about postadoption issues such as search and reunion, the mental health community has remained largely silent. An understanding of the reasons for this silence may assist in ending it.

Recent research has documented what many in the adoption movement have long suspected: Information about a variety of adoption issues is sadly lacking in the education of members of the mental health community. Research on the adoption education of psychologists has been presented at meetings of the American Adoption Congress (AAC) by Post (1999), Sass and Henderson (1999), and Sass, Webster, and Henderson (2000) and appears in the Fall 2000, special adoption issue of the Journal of Social Distress and the Homeless (Post, 2000; Sass & Henderson, 2000). In a survey of licensed psychologists listed in the National Register of Health Service Providers in Psychology (Sass & Henderson, 2000), 90% of the respondents thought they needed more education about adoption, and less than a third of the respondents rated themselves as either “very well prepared” or “well prepared” to treat adoption issues. Roughly two thirds of these licensed psychologists reported having had no graduate school courses that dealt with adoption issues, and 81% indicated an interest in taking a continuing education program about adoption.

Fisher (2003) decries the relative absence of adoption in the field of sociology. Adoption received little coverage in text and reading books on marriage and the family from 1998 to 2001. Space devoted to adoption in 21 texts averaged 2.4 pages, and 3.7 pages in 16 books of readings. The information contained about adoption was also likely to emphasize the problems associated with adoption. During the entire 1990s, The Journal of Marriage and the Family contained only six articles and four reviews of books related to adoption. That journal’s extensive 2000 review of research on the family in the 1990s did not even mention the word adoption in the keyword index (Fisher, 2003).

This silence becomes particularly glaring when one considers the statistical base rate of adoption in comparison with the frequency of occurrence of other issues of interest to the mental health community. Estimates of the number of adopted persons are difficult to obtain, especially given the historic secrecy surrounding the adoption process. Even the U.S. Census did not, until 2000, ask about the number of adopted children. The 2000 census reported that there were 2,058,915 adopted children living in households in the United States (U.S. Census Bureau, 2003), representing about 0.7% of the total U.S. population, and 2.5% of the U.S. population 17 years and under. It is generally believed that, including adult adoptees, approximately 2% of the U.S. population is adopted (Brodzinsky, 1990). Each of these adoptees has two birth parents and (typically) two adoptive parents. After adding in birth and adoptive grandparents, siblings, and other close relatives, the proportion of the public related to an adoptee by birth or adoption rises to between 20% and 30%. The Evan B. Donaldson Institute (1997) asked in a telephone survey whether the respondent, or a close friend or family member, was a member of the adoption triad (consisting of adoptees, birth parents, and adoptive parents). They determined that 58% of all Americans have had personal experience with adoption. It is estimated that adoptees represent some 5 to 6 million Americans, with adoption directly affecting a total of 40 million Americans (Brodzinsky, 1990; Pavao, Groza, & Rosenberg, 1998). Data from 2000 and 2001 (Child Welfare Information Gateway, 2004) indicate that recently there have been over 127,000 new adoptions per year in the United States. According to Fisher (2003), 39% of Americans thought seriously at one time in their life about adopting a child but ultimately changed their mind.

Given that the adoptee base rate is 2% of the American population, consider that the relative frequency of occurrence of schizophrenia in the United States is approximately 0.07% (Kessler et al., 1994), autism affects approximately 0.05% of children, and 1% of the population may suffer from dissociative identity disorder (Ross, 1991). However, despite their lower frequency of occurrence, all these conditions are the subject of much more attention than adoption in the literature of both psychology (Post, 1999, 2000) and sociology (Fisher, 2003).

Although I do not wish by this logic to equate adoption with psychopathology (see below), there would seem to be little doubt that the adoption experience creates at least a risk factor for future developmental and life-adjustment problems. Knowledge about the bonding and attachment process (Crouch & Manderson, 1995; Hoyle, 1995; Smith & Sherwen, 1988a; Watson, 1997) and the importance of prenatal nutrition and health care for the developing fetus (Schroeder, 1988; Streissguth, Barr, Sampson, & Darby, 1989) indicates the potential effect of prenatal and early-life disruptions experienced by many adoptees. Studies of the increased use of mental health services by adoptees (Levy & Orlans, 2000; Miller et al., 2000) suggest that these risk factors result in actual problems for many adoptees.

There are several possible reasons for the underrepresentation of adoption in the mental health literature. These include both cultural and moral values (particularly those related to bad behavior, shame, and privacy) and economic factors (in particular, the social status of many birth parents, the “business” of providing adoptions, and the expense of obtaining a child).

In the view of the general public, as well as the mental health community, the process of adoption as it was practiced for most of the 20th century was seen as a “win-win-win” situation for the three sides of the triad (Henderson, 2000). An adoption was typically portrayed as producing only a happy new family skipping off together through a field of flowers toward a bright future. The birth parents were virtually absent from this pretty image. I would suggest that this image might be called the “feelgood” model of adoption. Smith and Sherwen (1988b) also point out that much of the literature on adoption has historically made light of the difficulties experienced in the process while overemphasizing the joys of being a “forever” family for both the adoptee and the adoptive parents.

In the “feelgood” model, birth parents, with birth mothers often characterized as “bad girls,” were burdened by a challenging, typically unplanned, and frequently illegitimate pregnancy. In this model, birth parents “won” by being freed of parenting responsibilities for which they were (often repeatedly) told they were unprepared. An adoption, especially if the whole process was kept secret, could minimize, or prevent altogether, the “bad” reputation. Birth parents, after a “feelgood” model adoption, were typically told that they could, and should, resume their prepregnancy lives. Because the entire pregnancy was often kept a secret, they could be free of any consequences of their actions, and free to “just have another child” at a better time or under better circumstances.

Adoptees, facing a future in which they were typically “unwanted” and “illegitimate” children, “won” by being placed in a (presumably) better home than the one their birth family could have provided. Adoptees, seen in the “feelgood” model as the “lucky bastards,” also “won” by being sheltered from the effects (real or imagined) of the presumed sins of their birth parents. Although this view has softened in the last 30 years, there is still a widespread cultural belief that sex outside marriage is wrong, and that birth parents, particularly birth mothers, are “bad.” The adoptee, as the “bad seed” of this “bad behavior,” is seen as benefiting from a new start in a “proper” family.

Parents adopt for two main reasons. The majority (69%) adopt due to infertility, while 27% report they adopt for altruistic reasons (Fisher, 2003). The infertile adoptive parents, often in pain from wanting a family they could not create themselves, “won” by being able to raise the child they had long desired. Those parents who adopted for altruistic reasons “won” by basking in the positive light of “saving” a less-than-fortunate child. In most cases, adoptive parents were, and still are, held up by many as “superparents.”

The story of a “feelgood” model adoption was believed to end with the phrase “and the baby was adopted,” much as other stories were seen to end with the phrase “and they lived happily ever after.” And, of course, in the “feelgood” view, adoptions did end with everyone involved living happily ever after and never looking back. The adoptee and adoptive parents were supposed to spend their lives as a family indistinguishable from any other family. The birth parents were supposed to return and resume their previous lives again, as if the pregnancy had never happened. Everyone gained something, everyone “won,” and nothing was “lost.”

Another, and it is hoped unintended, result of the belief that adoption ended with the new family skipping off happily together was that time became frozen at this point. The adopted “child” was never allowed to grow into an adult. Virtually all adoptees, though they may be of parent or grandparent age, have been called an “adopted child.” People are likely to say, “Oh, so you are an adopted child!” as opposed to “you were adopted!” or “you are an adoptee!” Many laws concerning adoption refer to the rights of “adopted children” long after the adoption process has been completed. Some states even require adult adoptees to obtain the permission of their adoptive parents before being given information about their adoption or about their birth family. In an American society obsessed with “political correctness,” we examine the implications of the language we use to label everything from minorities to sports teams to people displaced by hurricanes, and the persistence of the term “adopted child” is not only interesting, it also suggests some of society’s underlying feelings about adoption.

Birth parents also suffer from the same difficulty with time, often remaining forever frozen in the eyes of the public as the “irresponsible boy” who left his pregnant girlfriend, who is perceived as, if not the “bad girl,” at least as the “unfortunate girl” who was left with the burden of an illegitimate pregnancy. As with many traumatic experiences, the birth parents themselves sometimes remain frozen in this state at some psychological level. The fact is that the birth parents do continue with their lives and as adults may be very different from what they were at the time of the surrender, and their feelings about the entire adoption and their part in it may be very different from what they once were. The continuing perception of birth parents as a “boy and girl who got in trouble” can prevent the healthy resolution of their past, both inhibiting their sense of entitlement to learn what became of their child and allowing society to continue to “protect” the rights of that unfortunate boy and girl, even when all adult parties to an adoption wish to share information about it. When one is frozen in the past, both a reexamination of one’s past in light of one’s present experiences and moving forward are silenced.

An early 1990s revision of the Wisconsin Adoption Search Law, specifically designed to apply to rights of access to information about themselves for adoptees over the age of 21, described the process as applying to “the adopted child.” The information, which had previously been free, was scheduled to begin to carry a minimum fee of $50. At a hearing of the Joint Finance Committee, I testified against charging adoptees for this information, but I began my testimony by identifying myself as an “adult adoptee” and, after looking around the room, saying pointedly that I saw no “adopted children” present. Before I began talking about the proposed fee, I asked to be given the respect of being addressed in state law as an adult.

While the fee ultimately became part of the budget bill, the bill’s language was changed to refer to “adult adoptees.” Some weeks later, I received a letter from the Senate Cochair of the Committee, an African American man who undoubtedly knew something himself about labeling, thanking me for calling their attention to the issue and crediting the language change to my testimony.

The more contemporary and realistic view of adoption, of course, is that every adoption represents both gains and losses, that adoption is a multigenerational and ongoing process that permanently affects the lives of all involved, and in which the final adoption is only a midpoint. We know that the story of an adoption does not “end” the day the adoptive parents and their new child walk out of court as a legal family. The adoption does not “end” the day that the birth parent becomes legally childless, or the parent of one less child. The adoption experience for the adoptee only begins with the adoption process itself, and likely never really “ends” (Zamostny, O’Brien, et al., 2003). Because of this knowledge, adoption agencies are now beginning to offer postadoption services in response to the lifelong needs of members of the adoption triad (Brooks, Allen, & Barth, 2002; Fahlberg, 1997; Ryan & Nalavany, 2003).

The “feelgood model” of adoption as a win-win-win solution makes it appear to be a successful social services/mental health intervention. Unfortunately, social services and mental health are fields where failure, or at least the absence of clear success, is all too common, and so an apparent success is a welcome event. Acknowledging that there are problems with the adoption process may be seen as an admission of failure, thus tarnishing the reputation of adoption as a successful social program. Looking the other way when problems arise and ignoring their existence may be seen as a form of (perhaps understandable) professional denial.

Another reason for silence about the issues of adoption is related to professional pride, particularly for social workers. As public- or private-agency adoption has long been practiced in America, before an adoptive family is approved for adoption, the parent(s) must undergo a home study. All manner of questions, some worthwhile, some of doubtful validity, are posed. Character, religion, relationships, income, and home environment are all evaluated, and the family must be “approved” by a social worker. Once this process has been completed, and the child is placed with these “superparents,” any evidence of parenting problems suggests the approval process (the home study) may have been faulty. No profession wants to be reminded of its mistakes.

Adoption is widely seen as a favor that society has done for all three sides of the adoption triad, who are often viewed as being in a “one-down” position. To acknowledge that a favor, once it is given, may have some negative consequences is difficult for both the giver and the recipient. The giver of a favor may be more reluctant to give again in the future. The recipients of a favor may be loathe to “look a gift horse in the mouth,” and if they do so and find problems they may be equally loathe to complain. Should the recipients of the favor of adoption complain, both society and the mental health professions may perceive them as ungrateful for the favor they have received. It is bad enough to be a bastard. Being an ungrateful bastard is even worse. Complaints from the beneficiaries of adoption might force members of the mental health community to consider whether they have done damage in the name of doing good. Putting it in a simpler way, adoption is supposed to solve problems, not create them.

In fact, reluctance to pathologize adoption by identifying problems in those who have experienced the process is likely another factor behind the silence about adoption. The controversy surrounding Kirschner’s (1990, 1992) proposed “adopted child syndrome” may be a case in point (Brodzinsky & Schechter, 1992; Lifton, 1994; Smith, 2001). Even setting the considerable methodological issues aside, those who have intimate connections to the adoption process are understandably reluctant to accept a label suggesting pathology, automatic or otherwise. Adoptee psychiatrist Bob Andersen (Andersen & Tucker, 2000) reports that he sees similarities between being part of the adoption triad and the combat experiences shared by many Vietnam veterans. Andersen suggests that both adoption and combat are unique and challenging experiences that, in and of themselves, are likely not pathological. They are, however, both stressful experiences that can lead some participants to develop pathological adjustment patterns. As noted by Zamostny, OBrien, et al. (2003), there is wide variability both in the levels of stress in the adoption experience and in the resilience to stress. It is probable that both these variabilities contribute to the wide variety of results obtained when the outcome of adoption is examined. We must distinguish between the valid assumption that a stressful process that people have experienced may lead to adjustment difficulties in some of these people and the invalid assumptions that all those who have experienced a stressful process are made pathological by it and that, therefore, the process itself is pathological. And, of course, we need to be open to the undesired possibility that the adoption process might in fact be pathological, which, if true, will not disappear because of our silence or our denial.

Another factor in understanding the silence is also likely related to some level of denial of race and class issues, and of sexuality, or stated less pathologically, to avoiding these sensitive topics. Race and class issues are difficult ones for all of us to discuss. Historically, as the availability of healthy White infants has declined, adoptees have become a much more racially heterogeneous group. Many more recent adoptees do not match the racial background of their adoptive families, and the term transracial adoption (TRA) has been used to describe these adoptions. Unfortunately, for many years, far too many of the adoptive parents of these children, and the mental health professionals who served them, have neglected to address the loss of cultural and racial heritage that can occur in these situations. No matter how noble the motivation behind the adoption, children of color adopted into a family of Scandinavian descent are not well served by being named Kristen, Heidi, or Lars and raised as if they were just like the rest of the blond-haired, blue-eyed children in their upper-class White neighborhood. By adhering to the historic belief that adoptive parents needed only to love their children “as if they were their own” to make them their own, the mental health community has been silent too long on the problems of adoptees who do not look like the rest of their adoptive family.

It is beyond the scope of this chapter to present a detailed review of all the issues in TRA, and readers are referred to the comprehensive work of Baden and Steward (2000), Baden (2002), Lee (2003), and Fensbo (2004) for detailed information on this topic. However, racial identity is one surprising area of silence in many of the studies of TRA. Burrow and Finley (2004) reported that in the widely respected National Longitudinal Study of Adolescent Health, many variables had been studied, including adoption. For TRA, mixed results had been found for measures of academic progress, family relations, psychological adjustment, and physical health. However, a measure of racial identity had not been included in the data set, and it was therefore not addressed. Lee (2003) noted the frequent failure to examine racial identity in other TRA studies. Grotevant (2003) noted that a difficult time for many TRA adolescents is the passage from their home community, where they are well-known, to a college or university, where they initiate a new network of social relationships.

One of the most angry adoptees I have ever encountered, sadly exemplifying this problem, was “Alice,” an African American woman in her late 20s who I met in the basement coffee shop of the Wisconsin State Capitol building early one winter morning. We discovered we were both waiting to testify in favor of a bill giving adult adoptees the right to access the records of their adoption. When Alice learned I was the president of the statewide adoption search and support organization that she had recently joined and that I was a clinical child psychologist, she shared with me her feelings about having been adopted by a White family.

For a similar perspective on American adoptees of Korean birth, see Fisher (2003). Sexuality is a topic about which there is great ambivalence in society. Despite its ubiquitous presence and despite the lip service we pay to sex education, for many, sexuality is an uncomfortable subject to discuss. Adoptive parents, knowing, or fearing, that their adopted child was conceived by young unmarried birth parents, may become concerned as their children reach puberty that the birth parents’ early and uncontrolled sexual activity may be repeated by their child. Birth mothers may also experience sexual and intimacy dysfunctions related to their surrendering a child. These and other issues for adoptive and birth parents were raised in a workshop entitled “Sexuality and Adoption,” which I chaired at the American Adoption Congress (AAC) National Convention in April of 1994 (Henderson, 1994).

For adoptees, discussion of sexuality is especially awkward, since they may be aware even as children that the sexual activity that created them was likely “illegitimate” and not part of a natural and socially acceptable sequence of events. When adoptees reach adolescence, their emerging sexuality reminds them of their own particular origins in sexual activity. Potential negative aspects of puberty for the adoptee include awareness that the sexual activity that conceived them may have occurred outside the framework of marriage; fear that sexual activity, and the pregnancy resulting from this activity, may have driven their birth parents apart; and fear that sexuality was what led to their own separation from their birth family. Adolescent adoptees’ thoughts or fantasies about each of these issues may lead them to develop feelings about their sexuality that are very different from those of nonadoptees. When adopted adolescents consider their sexuality, they may have questions such as the following: Will I repeat my birth parents’ (presumed) active and early sexual activity? How will my adoptive mother react when I become pregnant if she was infertile? What is the relationship between trust, intimacy, and sexuality in my life? Unfortunately, although I raised these questions on behalf of adoptees more than 10 years ago (Henderson, 1994, 1995), the questions seem to have been met with silence.

Privacy of the birth family is another reason for the silence of the mental health community on issues of adoption. The private act of childbearing was, for much of the past century, assumed to take place properly only within the confines of a marriage. Women who were pregnant out of wedlock were expected to hide themselves, and their shame, away. Pregnancy in general, not to mention the pregnancy of a single woman, was not considered a topic for polite conversation. Much of the historic secrecy in adoption was associated with sending pregnant single women away to have their babies where no one could see them or find out about their pregnancy. With their daughter in another town, often under an assumed name, the family could escape the stigma of public knowledge of their daughter’s transgression. The pregnancy was to be treated as if it had never existed, and the mental health professions bought into this silence.

The privacy of married couples is another factor in the silence about the adoption process. The decision to have a child and the process of conceiving one are among the most private acts in which a couple can engage. Happily married couples are presumed to be having intercourse. Intercourse, sooner or later, produces children. The option of remaining voluntarily childless was historically unpopular, in addition to being difficult to carry out, especially before the availability of reliable family planning. Society expected that married couples would have a family and voluntarily childless couples were often labeled as selfish. A couple who was married for more than a certain time and remained childless was considered to be experiencing some sort of “problem.” They were either not having intercourse (or they would have lost the roulette game with the stork), or their relationship was in difficulty of some sort, or there was a problem with someone’s reproductive system. All these explanations for childlessness touch on extremely private matters. In the days when healthy infants were more easily available, adoptees and their families were often matched by adoption agencies for ethnic backgrounds and even physical traits, making it possible to conceal the fact that a child was adopted. Social workers downplayed the importance of adoption and sometimes counseled not telling adopted children of their origin. In particular, if the adoption itself was concealed, a couple who adopted might not have to reveal potentially embarrassing aspects of their most private relationship to others. Mental health professionals likely cooperated in maintaining this privacy by underplaying the importance of adoption both in the parenting process and in the development of the adoptee.

Another reason for denying the importance of problems in adoption lies in the history of the heredity-environment controversy and of the changing acceptance of social Darwinism in the United States. During the early part of the 20th century, social Darwinism became increasingly popular. This model involved the belief that social behaviors, in addition to physical traits, were genetically controlled and differentially heritable, with traits most suitable for survival passed on. The individual defect model, suggesting that causes for mental illness were internal rather than external, was part of this belief system (Albee, 1996). One’s genetic background, thus, was of primary importance in the determination of one’s future, and eugenics-based laws requiring sterilization of the “unfit” were found even in the United States.

As the influence of the early behavioral psychologists became stronger in the 1920s and 1930s, social Darwinism began to lose popularity. Consistent with the desire to repudiate genetics-based racism and sexism, emphasis began to change from genetic determination of behaviors to environmental or learned determinants (Degler & Byrne, 1991). The Holocaust sped the demise of the eugenics movement and made any reference to the importance of one’s genetic background unpopular, if not impossible. Until late in the 20th century, the dominant societal belief, supported by an antiracist, antisexist, and egalitarian value system, was that a child’s gender, race, and genetic background (thus the birth family) were of little to no importance. The important determinants of behavior were the love, nurturance, and presumably superior environment provided by the adoptive family. Thus, the advice given to most adoptive parents during this time was to concentrate on providing the best possible environment for their children, to love them intensely, and not to worry about the relatively unimportant role of whatever genetic background their children carried.

Adoption lies at the heart of the confusing intersection between heredity and environment. If an adoptee is having difficulties, and the problems cannot be laid at the door of “bad genes,” then the cause of the problem must lie either in a faulty adoptive family child-rearing environment or in a faulty societal de-emphasis of the importance of one’s genetic background. Ignoring any problems shown by adoptees is one way of avoiding facing either of these unpleasant possibilities. Although both society and the mental health community now acknowledge that it is an interplay of both heredity and environment that is important, probably no group is more personally aware of this issue than adoptees.

There are also economic reasons why mental health professionals have been silent on the issues of adoption. The almost palpable physical need of many childless couples to raise a child frequently drives them first to increasingly invasive and expensive medical interventions. When these fail, childless couples often look to adoption, and when they do, they find any number of agencies waiting to serve their needs. During the “feelgood” era, before the advent of reliable family planning, and when only “bad girls” got pregnant out of wedlock, there was an ample supply of healthy White infants available. There was, apparently, no shortage of “bad girls.” Birth parents, typically in the one-down position financially and socially, as well as psychologically, usually cooperated with whatever demands were imposed on them in releasing their infants for adoption. Paying the birth mother’s expenses began as an innocent and humanitarian tradition that has become problematic. As the nature of adoption has changed, so, it seems, has the definition of expenses.

Adoption first began as a charity, “rescuing” children from the streets of eastern U.S. cities. However, particularly in the case of the orphan trains, adoption from the beginning was a charity driven by the economic need for farm workers in the American West (Holt, 1992). For-profit adoption agencies were a later development. A sensitive issue for adoptees and adoptive parents alike is the development in some for-profit agencies of a business model of adoption, where adoptive parents are seen by agency staff less as “clients of a social worker” and more as “customers of a business.” Under a business model, the adoptee can be seen as the “product” that is being supplied to the “customer.” The word “sold” and the image of adoptive parents “picking out” their child are uncomfortable for many adoptees. As adoption became an increasingly big business, the process also became correspondingly more expensive.

Some of the costs of adoption are certainly legitimate. As the supply of healthy White American infants dwindled, the desires of childless parents for a baby were harder to meet. Agencies had to go first to poor (often minority) American neighborhoods and then overseas to find children to place, and a certain amount of real additional expense was created. In some cases, these legitimate expenses are considerable. Staff salary, office expenses, transportation, and insurance are all legitimate costs of doing business. When agency profits are added into the mix, however, the distressing questions about “buying children” become harder to ignore, and discomfort around these questions may cause them, and other issues of adoption, to be ignored by all involved.

As the nature of adoption changed, children often came from less-than-optimal environments, for example, war or famine zones, or from poor countries where birth mothers had inadequate nutrition and medical care. Adopted children began to have extensive histories in orphanages or other institutions. The risks and expenses of raising these children might well be higher than those associated with raising healthy infants from middle- and upper-class American families. Telling the truth about the history of these children, particularly older, minority, or foreign children, might make them less easily adoptable. Silence about the background of a child, and the consequent underestimating and/or underpublicizing of the nature of the problems that the child might encounter, and of the problems that other children from similar environments have experienced, could be seen as good business practice, increasing agencies’ profits if not ennobling their activities.

Another area of silence in both research and clinical literature on adoption involves the roles played by birth fathers (Freundlich, 2002; Zamostny, O’Brien, et al., 2003) and male adoptees (Henderson, 2002). Two recent research papers on birth fathers (Freeark et al., 2005; Miall & March, 2005) begin the investigative process with a confirmation of what many in the adoption movement already knew: Birth fathers are marginalized and generally perceived negatively.

There have likely been many reasons for this particular silence. Perhaps, for reasons of gender role differences, until recently, the adoption support and reform movement has been primarily composed of birth mothers and female adoptees. Birth mothers frequently harbor lingering hostility toward the birth father, who may have deserted them at a time of need, or worse. Adoptees also believe that in many cases had the birth father “done the right thing” there would not have been an adoption, and they would have been raised in their birth family. Male adoptees and birth fathers report that they sense this hostility at search and support meetings and that it is difficult for them to return (Henderson, 2002). Some birth fathers are now making the case that they are no longer the young immature “boys” who surrendered their children.

Male adoptees, sensing the anger at birth fathers, are beginning to ask questions about what it means to be a man and a father themselves. Workshops specifically for male adoptees have been offered annually since the mid-1990s at conventions of the AAC (e.g., Henderson & Hyman, 2001; Henderson & McGowan, 1996; Hyman, 2005). The topics of substance abuse, difficulties with intimacy, and an attraction to dangerous activities seem to be recurring themes in these sessions, but at present these are little more than anecdotal data. Unfortunately, thus far, clinical and research literature on male adoptees and birth fathers, particularly 20 or more years postadoption, is still scarce.

Birth mothers, while they have been significant participants in the adoption search and reunion and adoption reform movements, have until recently also been largely absent in research literature. Silverman, Campbell, Patti, and Style (1988) studied 170 birth mothers in reunion with the adoptee they surrendered. Silverman et al. found that rather than disrupting the birth mother’s life, reunion was by and large a positive experience, whether she searched for or was found by the adoptee. Much of other recent research on birth mothers, however, has been in the context of their participation in open adoptions. Recent work by Wiley and Baden (2005) is beginning to shed light on many aspects of the birth parent experience, addressing both birth mothers and birth fathers.

Finally, over the years, the National Committee for Adoption (NCFA), now composed primarily of adoption agencies that still support the role of secrecy in adoption (and make their profits through the adoption process), has long been instrumental in promoting the “feelgood” model of adoption. As part of their model of the ideal adoption, the NCFA advocates closed adoption, in which the adoptive parents and adoptees receive no identifying information about the birth family. In many states, including Ohio (NCFA, 1995b), Tennessee (Pierce, 1997), Maryland (NCFA, 1997a), and Oregon (Learn & Heinz, 1998), the NCFA and/or its member agencies have advised letter-writing campaigns, offered financial assistance, testified in legislative hearings, or gone to court in support of efforts to deny adult adoptees access to information about the identities of their birth kin. At the same time, the NCFA has attempted to marginalize and pathologize anyone who reports that adoption experiences are problematic.

Members of the NCFA have set themselves up as the national experts on adoption, while actually representing not the adoptees and birth parents who have lived adoption but rather, primarily, the agencies making money on adoptions. The NCFA has long characterized anyone who criticized or suggested change in adoption practices as being “antiadoption.” Included on their list of antiadoption authors have been a wide variety of widely recognized adoption experts, such as Reuben Pannor (NCFA, 1995a) and Betty Jean Lifton (NCFA, 1997b). The NCFA has also characterized major national adoption reform organizations (the AAC and Concerned United Birthparents) as being antiadoption (NCFA, 1997c, p. 3). The NCFA states that when anyone claiming expertise in adoption “participates in an attack on adoption it is legitimate for others to see him as anti-adoption” (NCFA, 1995a, p. 11). The NCFA statement in opposition to a 2004 access-to-records bill for adult adoptees in New Jersey referred to “a small minority who demand the right for adopted persons to identify and contact their birthparents, with or without birthparents’ consent. These activists are not adoption advocates” (NCFA, n.d.). This type of statement is an attempt to silence or discredit those triad members for whom adoption has not been a “feelgood” experience, and likely has also had an effect on members of the mental health community.

Fortunately, the silence on adoption issues has not been complete. A relatively new development in the 1980s was the process known as “open adoption,” a term which refers to the sharing of information and, in some cases, contact between birth and adoptive families (Baran & Pannor, 1993). In traditional “closed adoption,” no information crosses the boundary of the adoption agency or attorney between the birth and adoptive families, and adoptees grow up with little to no knowledge about their birth family, excepting perhaps the canard “your birth mother loved you so much that she gave you up for adoption” (see Sass & Henderson, Chapter 20 in this book for a discussion of the difficulties with this statement). The concept of open adoption implies the sharing of some information between the birth and adoptive families. The continuum of openness varies widely, sometimes only including one-way passage of information, also known as “nonidentifying information,” from the birth family to the adoptive parents. Nonidentifying information might consist of as little as demographics, interest patterns, and health history. In the middle of the continuum is the one-way passage to the adoptive parents of birth-parent identity, and/or social history, including the reasons for surrender. At the more open end is complete two-way information exchange, sometimes including continuing contact with the birth family throughout the developing adoptee’s life (Zamostny, O’Brien, et al., 2003). It is beyond the scope of this chapter to present a complete review of open adoption, but the work of Grotevant and McRoy and their colleagues in the longitudinal Minnesota/Texas Adoption Research Project (Grotevant, McRoy, Elde, & Fravel, 1994; Mendenhall, Berge, Wrobel, Grotevant, & McRoy, 2000), and of Siegel (1993, 2003), are representative of this encouraging break in the silence. Grotevant’s team is gathering data in the third wave of their study, which follows their sample of adoptees into the decade of their 20s (Chamberlain, 2005).


Given the reasons why the mental health community has been historically silent on issues related to adoption, what are the options available to reverse this trend? All those reading this chapter can be part of the solution. Breaking the silence by attending adoption-reform-related conferences is a good start, as is submission of articles about the experiences of adoption triad members to professional journals. The appearance of a special issue on families and adoption of Marriage & Family Review (Vol. 25, 1997), two special adoption issues of the Journal of Social Distress and the Homeless (Vol. 9, October 2000, and Vol. 11, April 2002), and a series of articles on adoption in The Counseling Psychologist (Vol. 9, November 2003) are recent examples of valuable contributions to the literature on adoption and a hopeful sign that the silence is being challenged.

Those with the ability and resources to do research, and those with clinical or personal experience to share, should submit program proposals to their professional organizations. As noted in the work of Sass and Henderson (2000), psychologists believe that they need more information about the effects of adoption, and presenting information on adoption at professional meetings is one way to get this information disseminated. Another avenue is the organization of continuing education programs specifically about adoption for the various mental health professions. Many state licensing boards now require their licensees to attend regular professional development seminars. Encouraging attendance at triad-based adoption conferences (such as those of the AAC) by mental health professionals would also expose them to triad members who are living adoption every day of their lives.

It is clear that actions by one person, in the right place, at the right time, and with the right training, can make a significant difference. As an adoptee in a traditional, closed adoption and a clinical child psychologist, and after surviving testicular cancer in 1981, I realized my need to gain both medical and social history information about my birth family. My search and reunion led me to become active in adoption support groups at the local, state, and national levels in the 1980s and 1990s, speaking and writing primarily for the adoption community about adoption search and reunion issues. Eventually, I became the education director of the AAC and began to involve my undergraduate students in my research on adoption, which we presented at meetings of the AAC.

In the late 1990s, one adoptive parent (Bruce Kellogg) made inquiries as to what his alma mater, St. John’s University, was doing to address the problems he had seen in adoption. He was referred to a psychologist on the St. John’s faculty (Dr. Rafael Javier), who decided to further investigate the issue. As a result, Dr. Javier attended the AAC annual conference in the spring of 1999. There he listened to many triad members, several of whom were mental health professionals. One of them was me. Based on Dr. Javier’s experience at that conference, he and I coedited the first special adoption issue of the Journal of Social Distress and the Homeless.

In addition, Dr. Javier spearheaded the St. John’s University Fall 2000 adoption conference, where an early version of this chapter was first presented. St. John’s University has held additional adoption conferences in 2002, 2004, and 2006, and has committed to holding an ongoing biennial series of conferences on adoption. There has also been a second special adoption issue of the Journal of Social Distress and the Homeless, in which a version of the present chapter appeared.

That second special adoption issue was coedited by Dr. Amanda Baden, a psychologist and Chinese adoptee, who completed her doctoral dissertation at Michigan State University on the psychological adjustment of transracial adoptees and whose first academic job was as an assistant professor at St. John’s. She was working with Dr. Javier, and when he learned of her interest in adoption he asked her to join the planning committee for the first (2000) St. John’s adoption conference. Over the years, Dr. Baden played increasingly larger roles in conference planning, and she now heads the planning committee for the conference series. She also publishes and consults regularly in adoption, has an active private practice specializing in adoption, and is a board member of Families With Children From China in New York City. Perhaps most important, the book you are now reading is a product of discussions between Dr. Baden and Dr. Javier!

Who knows whether all this would have happened had any of these four individuals (Henderson, Kellogg, Javier, and Baden) not taken action.

Another way to challenge the silence is a thus-far underused approach to the study of adoption—the identification of a theoretical issue of development, in general, and the subsequent application of the theory to the adoption process (Grotevant, 2003; Zamostny, O’Brien, et al., 2003). Such a strategy has the advantage of relating adoption to other life span developmental issues, potentially increasing the understanding of both. One example of such an approach is the application of attachment theory to the adoption process (see Chapters 5 and 22 in this book; Edens & Cavell, 1999).

Recently, Powell and Afifi (2005) have applied the theory of ambiguous loss (Boss, 1999) and uncertainty reduction theory (Berger & Calabrese, 1975) to the reaction of adoptees to the ambiguous loss of their birth-family members. Powell and Afifi (2005) found that adoptees’ decision to look for their birth family was determined by an interaction between the adoptees’ perception of their adoption and the communication and support system in their adoptive families. The application of these two theories to adoption has contributed to the understanding of why some adoptees wish to search for their birth families while others have no such interest, as well as to why and how the level of interest in searching changes over time. This work has also added to the understanding of uncertainty reduction theory, and specifically to the understanding of how uncertainty may at times be a desirable state.

Finally, an interesting way to improve the visibility of adoption issues in psychology has been proposed by Post (2000). She calls attention to the American Psychological Association’s (APA) Guidelines and Principles for the Accreditation of Programs in Professional Psychology. These principles contain Domain D, “Cultural and Individual Diversity,” which states that to qualify for accreditation, graduate programs in psychology must prepare students for practice or research by providing knowledge and experience regarding the importance of cultural and individual diversity in psychological development (APA, 2005). Based on her own work and that of Sass et al. (2000), Post (2000) argues that adoption triad members, as well as those in their immediate families, represent a group of individuals whose diverse needs are not being adequately addressed. Graduate programs in psychology attempting to follow these accrediting guidelines may wish to devote more attention to adoption-related issues.

Post (2000) also supports the importance of understanding the cultural experience of adoption as found in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; 2000). Information in Appendix I supports the importance of understanding the individual’s ethnic and cultural background, family and kinship networks, and social support system, and stresses the importance of making “culturally relevant interpretations” (p. 898). In the introduction to the DSM-IV-TR, clinicians are advised that they need to understand an individual’s cultural background, lest they “incorrectly judge as psychopathology those normal variations in behavior, belief or experience that are particular to the individual’s culture” (p. xxxiv). Individual mental health practitioners attempting to follow these diagnostic and treatment guidelines may wish to increase their attention to adoption-related issues. Grotevant (2003) also suggests the consideration of cultural issues in the treatment of adoptees and families from diverse cultural backgrounds.

Even though much progress has been made in the early part of the 21st century toward ending the silence of the mental health professions on issues related to adoption, the silence still continues. Zamostny, Wiley, O’Brien, Lee, and Baden (2003) call for mental health practitioners and researchers to break the silence on adoption issues. Fensbo (2004) comments on the lack of attention to attachment and identity development in adoptees and concludes that “well-documented research in the adoption field is necessary” (p. 62). It is time for the silence to end. Continuing the silence will serve the interests of no one and will lead to further difficulties for all those touched by the adoption process.

Case Study

Growing up in an all-White suburb of Milwaukee, Alice said she was always treated “totally normally, and was always accepted” by her family and those who knew her throughout her childhood and adolescence. But when she left home to go to college, where no one knew about her adoption, she experienced a terrible awakening. African Americans, looking at her, expected her to “be Black” and to know the language and culture of the African American community. Having been raised by a loving and well-meaning White family in a White environment, she knew little of what life was like for the vast majority of African Americans. Because of this, many African Americans did not accept her in their circle of friends. Yet when she met many White people, they looked at her and, seeing that she was “not White,” likewise did not expect her to know anything about their language, culture, and background. Thus, she found she was not easily accepted in either the White or African American community.

Her anger (and her sadness) were palpable as she told me she was a person “without a culture, without a home,” and that even though she wanted the rights to meet her birth family and to learn about why she had been adopted, she was fearful of encountering the same rejection from her birth kin that she had received from other African Americans.