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.
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.
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."
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.
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."