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That Loving Feeling
--by Margaret Talbot
Morning Herald September 19, 1998
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For more information, read Roy Maynard's "Disposable children: Ceaucescu is no longer a legitimate excuse"
Reared in extremes of emotional and physical deprivation, the children adopted from eastern Europe's orphanages are growing up disturbed and disconnected. And their trauma is raising broader questions about the separation of mother and baby.
On a bright, cold winter day, at a clinic in the mountains outside Denver, a mother sits with her arms folded across her chest and a polite, bewildered smile on her face. She is talking about her adopted son, the boy whose troubles have brought her here to the Attachment Centre at Evergreen, where she hopes he can be taught to love her. It's just that the boy is so "strange", she says, his emotions so "artificial". When she and her husband brought him home from Romania in June 1991, the boy was 4 and his sister, whom they also adopted, was 8. Their mother was dead, the Romanian adoption broker had said, and their father was an alcoholic and nearly blind. When he wasn't forcing them to beg in the streets or looking for ways to fob them off on childless foreigners, he neglected them.
"We knew all that,"the mother says, "so don't think for a minute that we headed down this path naively."She was well into her thirties when she travelled to Bucharest, and though she had been unable to conceive children, she and her husband had been foster parents for "difficult children"from the United States. They weren't wealthy people - he drove a truck for a living, she kept house - but they came from a small town in Ohio where they felt they could rely on their friends and neighbours and where they were deeply involved in their church.
And yet everything was so much harder than they had imagined. While the girl seemed to settle in and find some comfort in the ordinary routines of domestic life, the boy could neither accept his new family nor control his overwhelming anxiety. He was clumsy and awkward and subject to night terrors and, at the same time, oddly reckless. He would deliberately ride his bike in front of cars, darting into traffic at high speed. He lied - instinctively, it seemed, and extravagantly. He couldn't stand it when his mother touched him, but he sought creature comfort in more oblique ways - sneaking into the refrigerator in the middle of the night to "steal" food, for instance. He was rarely invited twice to a schoolmate's house and the boys he called his best friends never seemed to think they were friends at all.
Yet his mother knows that in some ways they are lucky. Her son is unusual in that he was never in a Romanian orphanage, one of those warehouses where, so she has heard, babies lay in their cribs for 18 or 20 hours a day, curled against feeding bottles, their heads flattened and their faces peaked. So many of the children here at Evergreen did come out of such places, and she has heard some of their stories. There was, for instance, the woman whose five-year-old daughter, adopted from a Moscow orphanage, arrived at her new home so angry at herself and everyone else that she crawled around on the floor for three months until her knees were bloody, refusing to stand up when anyone was looking. One night, the girl threatened to kill her new mother and father and her 3 new siblings while they slept. This boy, on the other hand, is not violent and can even show genuine tenderness. He loves to hold babies, he loves the marzipan softness of their skin and their buttery smell, his tactile remoteness seems to dissolve in their presence.
FOR EVERY THEORY OF HUMAN BEHAVIOUR, there is a diabolically perfect experiment that can never be performed - or, anyway, by ethical scientists in a democratic society. To test human tolerance of extreme cold, you cannot immerse a naked human subject in freezing water. To test the effects of maternal and sensory deprivation on infants, you cannot take a population of newborns and confine them to cribs in a gloomy ill-heated orphanage with a small, rotating staff of caretakers who might spend an average of 10 minutes a day talking to them or holding them. But let's say that such an experiment has already occurred - in nature, as it were, far from the laboratory. And let's say that assessing its impact on the children who endured it would not only help them but might also shed light on an issue that has long intrigued developmental psychologists and tormented so many working mothers.
This is precisely the experiment being carried out today with many children adopted from eastern Europe - chiefly Romania- and the former Soviet Union since the collapse of Communism in 1989. There are more than 18,000 of these adoptees in the United States, and the most traumatised among them - roughly 20 to 30 per cent, according to researchers - are becoming one of the most scrutinised and therapeutically manipulated populations in the annals of psychology.
Many of the adoptees constitute a unique sample group: babies who were surrendered to the kind of institutional care that few other countries practise on a large scale any more and then adopted, usually as toddlers and usually by people prepared to lavish on them the kind of affection and sensory stimulation they had almost entirely lacked.
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The orphans from Romania and the former Soviet Union are "by far the biggest group of deprived babies"available for study so far, Michael Rutter, a child psychiatrist at the London Institute of Psychiatry, told Science magazine. Or, as Victor Groza, an adoption specialist who has conducted several studies on the emotional development of Romanian adoptees, put it in a recent paper, "The children adopted from Romanian institutions represent an opportunity to examine the effects of deprivation on child development"comparable to "experimental research conducted on primates". Which is to say, those studies familiar to all psychology students demonstrating that infant monkeys, separated for 6 months from their mothers, became anxious and then remote, and, as adults, show persistent signs of psychological distress.
Above all, the eastern European orphans have become Exhibit A in the emotional debate over the body of thought known as attachment theory. It might seem self-evident that human babies, notoriously helpless creatures that they are, need parental love or something much like it in order to thrive and develop emotionally and cognitively. "Continuity of affectionate care by one or a small number of care givers who can give of themselves emotionally, as well as in other ways, originates the development of the child's love relationships,"wrote Linda Mayes and Sally Provence, both professors of child development at Yale University. "Having repeated experiences of being comforted when distressed,"for instance, "is a part of developing one's own capacity for self-comfort and self-regulation and, later, the capacity to provide the same for others."
But the fact is that in certain hands, a bland and clinical phrase such as "continuity of affectionate care"can be loaded. If that continuous affectionate care is to be provided primarily by a mother, as so many attachment theorists seem to think, can she be a working mother? Does day care count as a discontinuity? How small is "a small number"of caretakers?
The original attachment studies found a startling consistency in the psychological and even physical reactions of very young children separated from their parents. But those studies - done by people like the British psychiatrist John Bowlby and the French psychoanalyst Rene Spitz in the late 1940s and '50s - were of modest scale, conducted in a foundling home here or a hospital there.
Moreover, Bowlby and Spitz were publishing their findings at a time when there were fewer working mothers with whom they might resonate.
Now, though, many more of us want to know what happens to children for whom the bonds of attachment have snapped, because many more of us fear that those bonds are being pulled and stretched. Mother-child separations are part of the warp and woof of life these days, and so are our worries about them. The research on eastern European adoptees matters not only to them and their parents but also to many of the rest of us as well.
Some of the more fervent attachment therapists do not hesitate to draw these connections. "Child care - especially when it's not the best - going back to work at 6 weeks: these are all risk factors for insecure attachment of the kind, if not the degree, that the orphans display,"says Paula Pickle, the soft-spoken, rather sombre director of the Attachment Centre at Evergreen.
But even if you regard such statements as ideologically suspect, even if you recognise that a vast gulf separates the experience of a baby in an orphanage from that of a toddler in day care, there may still be observations that apply to both.
As studies on post-institutionalised children help to isolate precisely which aspects of orphanage life hamper a child's development, it becomes possible to consider how these factors, in more moderate form, might affect young children who spend many hours in poor quality day care or who have a frequently shifting cast of parental surrogates in their early years. And it also becomes possible to think anew about what it is that good parents and caretakers do to nourish children emotionally.
MANY FEMINISTS HAVE LONG CRITICISED attachment theory as a sentimental scheme for shooing mothers back home. But to write it off as that would be to misconstrue it. Above all, the theory argues that emotional engagement is the necessary precursor to healthy development, engendering trust in the world and the ability to make sense of it.
"Without someone specially oriented to his needs,"wrote the psychoanalyst D.W.Winnicott, whose work helped inform attachment theory, "the infant cannot find a working relation to external reality. Without one person to love and to hate, he cannot come to know that it is the same person that he loves and hates, and so he cannot find his sense of guilt, and his desire to repair and restore."
Without what prominent psychologist Mary Ainsworth called a "secure base"- a reliably loving person to whom a toddler can return periodically for emotional refuelling - the child will not feel free to explore. And though attachment theorists generally assume that the person with whom a baby is figuring all this out will be her mother, nothing in the theory excludes a loving father from filling the same role.
It is certainly true that John Bowlby took a dim view of day care, and indeed of almost anything else that kept mothers apart from their babies and toddlers. "This whole business of women going to work,"he told the psychologist Robert Karen in 1989, a year before he died,"... I do not think it's a good idea. I mean, women go out to work and make some little bit of gadgetry, which has no particular social value, and children are looked after in indifferent nurseries."
For Bowlby, attachment was monotropic: that is, it occurred with a single other person. But later attachment theorists have argued that young children live comfortably within a hierarchy of attachments. Maybe an 18-month-old's mother is the apple of her eye, but an affectionate father is a close runner-up, followed by other relatives, a nanny or a particularly attentive day-care worker. The important thing is that these be empathetic people, consistent presences "attuned", as the theorists like to say, to babies in general and to one baby in particular.
If further refinements of the theory have made feminist objections irrelevant, they have hardly shut down the criticisms. Psychologist Diane Eyer, author of Mother-Infant Bonding: A Scientific Fiction , has made a career of denouncing attachment theory and its more simplistic variants as a new and ingenious version of an old game: pinning the blame on Mum when a child grows up insecure, or worse. Placing too much emphasis on the early relationship between mother and child, she argues, allows society to abdicate its role in shaping children. "Children are profoundly affected by an array of people who interact with them," Eyer writes, "by the foods they eat, by the music they hear, by the television they watch, by the hope they see in the adult world and by the institutions - especially schools - they attend."
From another angle, critics like Jerome Kagan, a Harvard University child psychologist, have argued that while attachment theory is intuitively appealing - it sounds right to parents who find it agreeable to their own style of child-rearing - it is extremely difficult to measure the emotional content of relationships. Inborn temperament, Kagan contends, is at least as important as early experience in determining whether a child will morph into a happy and secure adult or a miserable one. Some children are simply more susceptible to separation and loss than others.
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IT MIGHT BE TEMPTING TO DISMISS ATTACHMENT theory altogether. Yet after talking to some parents of eastern European orphans, I felt otherwise. What they told me about the ways their children seemed to struggle every day with the legacies of early deprivation made the tenets of attachment theory real in a way that they had not been to me before.
Consider, for example, a woman named Thais Tepper. Tepper is an adoptive mother who turned herself into an advocate and, like a lot of advocates, she can be blunt and ornery and single-minded. Some of the adoptive parents she claims to represent consider her an alarmist. But there is no doubt that she knows the research in this field intimately, and she has talked to hundreds of parents who, like her, adopted children from institutions in eastern Europe. "You know, you read in the newspaper all the time about mothers who locked their kids in the basement in a crib, and somebody found them and, lo and behold, the kids turned out to be eggplants,"says Tepper, who brought her son Drue home fro a Romanian orphanage in 1991 when he was 18 months old. "Well, think of that on an industrial scale."
Tepper is 45, a former health inspector with a degree in environmental science. She is an energetic, choleric sort who boiled over when she discovered that her son suffered from all sorts of health problems that she felt the adoption agency should have warned her about.
"His head was flat as a pancake and his neck flopped over,"she says. "At 18 months, he couldn't walk, he couldn't talk, he couldn't hold a baby bottle and he couldn't make eye contact."A year after they brought him home to the suburbs of Pittsburgh, when he still didn't talk and darted away from her at every opportunity, she began to read Bowlby and others on the behavioural and biochemical fallout of early neglect - the rocking and other self-comforting behaviours that reminded researchers of autistic children, the tangle of cognitive delays, the distrust of new caretakers, often accompanied by an inappropriate charm and effusiveness with strangers.
In 1993, Tepper founded a support organisation called the Parent Network for the Post-Institutionalised Child, which now has about 1,500 members. "These kids don't just have psychological problems,"Tepper says. "They have cognitive problems. If you don't have a mother to sit there and read to you, or coo at you, or, if you're in Pago Pago, to plop you down next to a hole in the ground and show you how to eat termites off a stick, then you're going to be way behind cognitively."
Across the country, in a prosperous Los Angeles suburb, a woman named Nancy Back has helped to start a smaller support group for adoptive parents of eastern European and Russian children. Five years ago, when Beck brought Alexander, 4, and Natasha, 5, home from Moscow, her biological children were 11,18 and 21. "I feel embarrassed and a little trite telling people why I adopted,"she says. "I didn't have a career that was all-consuming. I didn't have a niche in the world. I looked around and said, "What do I do best? Well, I have three wonderful children.'"
From the beginning, though, it seemed to Beck that nothing she had learned or felt as a mother applied to the rearing of these 2 children. The first night in the hotel room in Moscow, Natasha rocked back and forth so violently that the bed shook. On the plane home, she talked to herself in a low, soft voice that got louder and more frantic, until other passengers started saying, "Can't you stop her?""Maternal deprivation,"Beck says, "just matters so much - not getting fed when you need to be fed, not hearing language come back at you when you begin to babble. In that case, I think there is hardwiring that is meant to happen and doesn't, and there are these little places in the brain that are dead. Maybe if the orphanages had one caretaker for every 2 or 3 babies. But hers had one caretaker for every 10."
Natasha is well enough now to talk sometimes about her memories of the orphanage, but getting to this point has taken years of therapy; special schools, the sale of the family home to pay for it all and, Beck says, her own willingness to put nearly everything else in her life aside. "And what she remembers is being in a crib - she calls it her cage - with another child. A nurse would walk into the room and put a bottle in each cage. Then she'd turn around, walk out and close the door. "Some people didn't know how to feed themselves, Mummy,"Natasha will say, "but I did.'"
THE MERE EXISTENCE OF A PLACE LIKE THE Attachment Centre at Evergreen - where the clientele of formerly abused and neglected children includes a growing proportion of eastern European orphans - is a kind of index of the lengths to which parents will go in seeking therapy for these children. The efficacy of the centre's unorthodox stock-in-trade, a method known as holding therapy, has never been demonstrated by any large-scale study. And holding therapy has plenty of fierce detractors. It requires a child to lie prone across the therapist's lap, with the therapist's arms wrapped around him tightly enough so that he will feel "secure"while he shouts out his anger at the people who neglected or abused him. Some critics contend that holding therapy is a form of restraint that risks traumatising children all over again.
To charges like this, Neil Feinberg, a social worker who treats patients at Evergreen and practises holding therapy regularly, replies simply that "It is my experience that these kids are already re-experiencing their trauma all the time, but without any effective resolution."The day I spent at Evergreen I saw a videotape, made 5 years ago, of a holding treatment in which Feinberg cradled a 10-year-old Korean boy. "How could you do that to me?"the boy screams - at Feinberg's prompting - at his pretty, blonde adoptive sister, who wanly acts the part of the teenage mother who abandoned the boy to the Korean foster system. At the end of the session, the boy's real adoptive mother enters the room, and Feinberg urges the boy, his face now gleaming with tears, to climb into her lap, which the boy does, and then says, genuinely enough: "I have been treating you like [expletive]... I want to love you.""I think you've got to learn how,"his mother says softly. "I know how,"the boy replies. "The guy told me."
Later, I ask Feinberg what became of the boy. Unable to live with his adoptive family, he is in a residential placement centre in another State. "It's a measure of our success,"Feinberg says, "when a kid doesn't end up in jail for having committed violent crimes."
The handy label "attachment disorder"favoured by the diagnosticians at Evergreen strikes many other doctors and therapists who work with post-institutionalised children as inadequate. "I don't think we have the proper diagnostic codes to describe these kids,"says Laurie Miller, a paediatrician at the New England Medical Centre's International Adoption Clinic. "I saw one kid who had been in a Russian orphanage until he was 2 1/2 and then was adopted by a single mum in the US. They moved several times, and he'd see new doctors in each new city, and each one would have a new diagnosis: attention-deficit disorder, schizophrenia, autism, Tourette's syndrome, obsessive-compulsive disorder. None of them was accurate, but each had a grain of truth. I'd diagnose it as complex neuropsychological disorder of the post-institutionalised child. Only, insurance doesn't cover that one."
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The truth is that the damage caused by early neglect - or even by physically adequate but emotionally indifferent care - can be deeply intractable, not least because it may have neurological as well as psychological dimensions. Harry Chugani, neurologist at the Children's Hospital of Michigan, has been comparing scans of the brains of 8 apparently healthy Romanian children adopted by Americans with a control group of children reared in normal family settings. Although the results are very preliminary (and unpublished), all eight orphanage children show evidence of abnormal metabolism in a specific area of the brain's temporal lobe thought to be involved in social functioning. "I think we can hypothesise,"Chugani says, "that what we saw in these scans is related to neglect, to a lack of maternal-infant interaction at a critical phase."
In the absence of more physiological studies like Chugani's, the handful of doctors and researchers who have worked with post-institutionalised children are left to reach conclusions as much by hunch as with hard data. "It's clear to me that not only lack of nutrition, but also of stimulation and of emotional contact, can inhibit the development of brain systems,"says Ronald Federici, a developmental neuropsychologist, who has evaluated about 1,000 adoptees from eastern Europe and the former Soviet Union. "Can those effects be undone? Many times, yes. Many times, no. It depends in large part on the age of the child."Federici believes in "moving slow and easy"in treatment, "almost as if you were rehabilitating a brain injury". They have to be taught the ability to recognise emotions by visual and auditory cues, he argues, before they can learn to feel them. "Love is an abstract concept,"he says.
So Federici teaches emotions with the aid of charts, pictures and role-playing: Who's smiling? Who's frowning? What's sad? What's happy? "The emotions of the children may always be a little off, but their behaviour will change,"he says. "They may not be so defensive or afraid."
THERE ARE, TO BE SURE, IMPORTANT CAVEATS to this pessimistic picture. In a study of 229 American families who adopted Romanian children, Victor Groza found that 78 per cent of the parents rated the "overall impact of the adoption on the family"as "very positive", and 97 per cent said they "never thought "about relinquishing the child. Moreover, using the parents own assessments of their children, Groza divided the adoptees into 3 distinct groups, each with a fairly different prognosis. About 20 % of the adoptees in his study were what he called "challenged children"- those who'd been "severely affected by their institutionalisation"and continued to have alarming emotional problems and marked developmental lags up to 4 years after their adoption. Another 60 % were what he called "wounded wonders"- those who clearly fell behind their peers in social and developmental growth, but who had managed to make big leaps forward in their adoptive homes. And a third group, the "resilient rascals", hadn't displayed any obvious ill effects of their institutionalisation at all. Perhaps, Groza speculates, they had been "pets"in the orphanage, charming the staff into giving them more attention.
Moreover, in what many researchers in the field say is the most thorough study yet of adopted Romanian children, a group headed by Elinor Ames at Simon Fraser University in British Columbia concluded that all 46 of the orphanage children in the sample had been able to form some sort of attachment to their adoptive parents.
All of these studies have found that the earlier a child was adopted - that is, the less time he or she spent in an orphanage - the more likely he or she was to develop normally. In the Ames study, a control group of Romanian infants adopted from homes and institutions before they were 4 months old did better on virtually every measure than the children adopted at eight months or older, though the 2 groups had a similar history of prenatal care, environmental stresses and so on.
"Orphanage experience tends to dampen all areas of intelligence,"concluded the Ames study, which found that 78 per cent of the Romanian orphanage children were delayed in "fine motor, gross motor, personal, social and language"skills when they were adopted. Groza's study specified 2 sensitive windows - the second half-year of life and the period between 25 and 36 months - when institutionalisation was especially likely to cause delays in emotional and cognitive development.
Jerry Jenista, a paediatrician who works with foreign adoptees in Michigan, paints a similar picture, but in broader strokes: "I'm most worried about kids who are over 5, least worried about those under 6 months. But there is no single turning point. So much depends on the personality of the child."
LET US SAY, THEN, THAT WE AGREE ON THIS: that for a very young child, the lack of an emotional connection with a consistent caretaker can be deeply damaging. Let us even say that we can agree with the proposition John Bowlby put forward in 1951, namely that "the prolonged deprivation of the young child of maternal care may have grave and far-reaching effects"on a child's "character and so on the whole of his future life."We are still left with the question of what, if anything, this tells us about the emotional lives of children who undergo separations from their parents, but not the stark sensory deprivations of an orphanage. We are still left wondering whether there is anything at all to what one writer has called the "implicit Bowlbian argument"that "since absent mothers lead to disturbed children, ever-present mothers will produce happy children".
Though attachment theorists haven't always liked to say so, their suggested link between what is known as "sensitive"care - that is, care from the mothers who had been observed in the first 3 months of their babies'lives responding quickly when they cried, handling them deftly and affectionately and reading their signals of pleasure and distress accurately - and security of attachment actually undermined pure Bowlby-ism, with its blanket injunctions against mother-child separations. For if it is true that, as Mary Ainsworth, developmental psychologist at the University of Virginia in the late '60s, once put it, "it's very hard to become a sensitively responsive mother if you're away from your child 10 hours a day", it is also true that responsiveness is not an attribute only of mothers and certainly not of all mothers. It is not hard, for instance, to picture a stay-at-home mother who is physically present but emotionally distant. And it is not hard to imagine a father, a grandparent or a baby-sitter who would be more attuned to a particular child - more maternal, if you like - than the child's own mother. If sensitivity is the key, then maternal omnipresence cannot be construed as a good in itself.
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Moreover, the most recent and reliable studies that have looked at the attachment security of children in child care have found that while there are some negative effects, they are quite small - statistical flutters. Am ambitious US National Institute of Child Health and Human Development study of early child care released last year concluded, for example, that "there were no significant differences in attachment security related to child-care participation."Even when children were in day care for especially long hours, or at especially early ages, even if they were in "unstable, or poor-quality care", they were no more likely to be insecurely attached to their mothers.
The study did find, however, that children were somewhat more likely to be insecurely attached if they had mothers whose own care was deemed to be insensitive and if they were also in poor-quality or unstable child-care arrangements. In other words, no feature of child care by itself predicted insecurity, but in combination with certain parental shortcomings it might.
It sometimes seems that that kind of caretaking that attachment theory advocates and, yes, sentimentalises has little place and even less prestige in the current debate about how we ought to rear children. It sometimes seems that we are in the midst of a mini-backlash against the notion that children require a sacrifice of convenience and ambition, that getting to know and understand a new infant can be like a slow courtship that ambles along to its own rhythm. In the popular, tough-love advice of the Christian family counsellors Ann Marie and Gary Ezzo, for instance, you will find new arguments for keeping babies on rigid feeding schedules, letting them cry it out so that they don't develop a "predisposition for immediate gratification"and training them to sleep through the night as early as 5 weeks so that they don't disrupt their parents'schedules any longer than necessary. And from some working parents and some feminists, you hear the steely insistence that child care is just fine for every child, thank you very much, and don't go singing the praises of maternal love like some besotted Irish tenor.
Maybe there is no way to acknowledge publicly what an "ordinary devoted mother"- or father or baby-sitter - does every day without sounding hopelessly soppy. Maybe it will always hover below the radar of any policy debate, in the daily-ness where most of us do for our children what goes without saying. Then again, if you have devoted yourself to a child for whom such things were never done - a child who, as a baby, was not held and jostled just so, or fed just when she wanted to be, or calmed when all the strangeness of the world seemed too much - maybe you can be forgiven for thinking that the ordinary things matter a great deal.
Those thoughts occurred to me as I was sitting in the kitchen of one mother of an east European orphan. She was giving her son, Nicholas, his medication so he could go out and play with neighbours. She told me she would "go to the ends of the earth"for Nicholas. "In some ways I feel I have, and I feel he knows that, and that has brought us closer."But now what we are talking about, in effect, is what somebody didn't do for Nicholas. "If nothing else,"she says, "these past 5 years have made me think about parenthood anew. They've given me an appreciation of all the ordinary, everyday things that mothers do for ordinary infants. I just can't say enough how much those matter."
For more information, read Roy Maynard's "Disposable children: Ceaucescu is no longer a legitimate excuse"
This article brought to you by Laurent J. LaBrie, Romanian Program Director, Go Ye Fellowship
Copyright belongs to the author, Margaret Talbot
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