During the mid to late twentieth century (1940s to 1980s), it was common practice for babies of unwed mothers to be adopted by married couples. Many of the infants were taken from their mothers at childbirth as a result of extreme pressure and coercion that they experienced from family, social workers and hospital staff. The practices sometimes extended to ‘undeserving’ married women. The adoptions that occurred in this way have been termed ‘forced adoptions’. Not all of the forced removals or separations between parents and children resulted in adoption; some children grew up in institutions. It has now been recognised that the separation of a child from its mother in this manner was neither moral nor legal (Gillard, 2013) – a practice for which the nation has offered its apology (Mushin, 2014). Many of the practices have similarities with those to which Indigenous children of the Stolen Generations were subjected, with children forcibly removed from their families under acts of parliament and sent either to institutions or adopted by non-Indigenous families (see article Dark chapters in Australian history: Adopted children from the Stolen Generations for discussion of this aspect of forced adoption practices in Australia).
The past practices of forced adoption have resulted in life-long consequences for the majority of those directly involved, particularly for mothers and adopted persons, but also for other family members (Higgins, 2010). This article distils recent research conducted by the Australian Institute of Family Studies (AIFS)1 and discusses the implications for service delivery, particularly psychological practice.
Investigating the past
Although there is a wealth of primary material, there has been little systematic research on the experience of past adoption practices in Australia. In recent years, research in the area of past adoption practices, including forced adoptions in Australia, has become a key area of focus for the AIFS. Three seminal pieces of work have been undertaken since 2010: a review of the literature, looking at the effects of past adoption practices (Higgins, 2010); the National Research Study on the Service Response to Past Adoption Experiences (Kenny et al., 2012), which examined the effects of forced adoptions, including the psychological, emotional and social impacts; and the Forced Adoption Support Services Scoping Study (Higgins et al., 2014), which focused on the ways in which service providers – such as psychologists – can most appropriately respond to the current needs of people affected by forced adoption practices including the need for information, counselling and reunion services.
Forced adoption experiences
In 2012 the AIFS completed the National Research Study on the Service Response to Past Adoption Practices, which examined past adoption experiences to inform development of best practice models or practice guidelines for the delivery of supports and services for individuals affected by their adoption experiences (for details of the study, see aifs.gov.au/institute/pubs/resreport21/index.html). More than 1,500 individuals took part in the study, comprising: 823 adopted persons; 505 mothers; 94 adoptive parents; 94 other family members; 12 fathers; and 58 service providers.
Some of the disturbing adoption-related experiences reported by study participants included:
- Mothers being used for the training of medical students
- Mothers being sexually assaulted by medical professionals
- Mothers experiencing medical neglect or maltreatment
- Mothers being tied to beds, forcibly held down, having pillows placed over their faces and having sheets held up to shield the view of their newborn son/daughter during labour
- Mothers being administered drugs that caused impaired judgement/capacity to make informed decisions
- Mothers and fathers being informed that their newborn son/daughter was deceased when they were not
- The unethical and illegal obtaining of consent to adopt (or no consent obtained at all)
- Adoptees as babies being used for medical experimentations
- Adoptees being placed with abusive adoptive parents
- Adoptees being lied to regarding the circumstances surrounding their adoption, including the obtaining of consent from their parents
- Fathers being excluded from information and decisions about the care of children.
Findings from this study again highlighted the long-lasting effects on not only mothers and fathers separated from a child by adoption, but also on the now adult children who were adopted as babies. The most common impacts of forced adoption were found to be psychological and emotional, and included mood disorders, grief and loss, PTSD, identity and attachment disorders, and personality disorders.
The study found a range of poor mental health and wellbeing outcomes. Mothers had a higher than average likelihood of suffering from a mental health disorder, with close to a third showing a likelihood of having a severe mental disorder at the time of survey completion, and over half having symptoms that indicated the likelihood of having posttraumatic stress disorder. Around 70 per cent of adopted individuals agreed that being adopted had a negative effect on their health, behaviour and/or wellbeing while growing up, regardless of whether the experience with their adoptive families was positive or negative. Of the few fathers who participated (n = 12), a third had poor mental health and almost all participants showed some symptoms of PTSD (64% had severe PTSD symptoms).
One of the strongest messages communicated in this study was that these experiences had left many feeling they were the victims of a systematic approach to the removal of babies from the ‘undeserving’ (usually unmarried young women) to the care of the ‘deserving’ (married infertile couples). Many participants expressed sentiments to the effect that those who experience past adoption practices are now the living result of a failed social experiment. It is clear that the impacts of past adoption policies and practices are a very current issue for many thousands of Australians. While there were divergent views within specific respondent groups as to how their current needs would be best met, commonly identified priority actions for responding to the needs of those affected included: recognition of past practices (including the role of apologies and financial resources to address current service and support needs); community awareness of, and education about, past adoption practices and their subsequent effects; specialised workforce training and development for mental health carers, mental and broader health and welfare professionals; improvements to services for helping search/make contact with family; addressing accessibility and cost of mental, behavioural and physical health services; and ensuring that lessons from the past are learned from and translated where appropriate into current child welfare policies – particularly in relation to current adoption services.
Support service needs of people affected by forced adoption
In 2012, the AIFS undertook the Forced Adoption Support Services Scoping Study with the aim of developing service models to enhance and complement the existing service system for people affected by forced adoption policies and practices (for details of the study see www.dss.gov.au/our-responsibilities/families-and-children/publications-articles/forced-adoption-support-services-scoping-study).
The research identified gaps in the adequacy of treatment within adoption-specific services as well as more broadly. There is a complexity of reasons as to this inadequacy, including a general lack of awareness by professionals of the history of forced adoption, and lack of sensitivity in raising issues, or responding when clients talk about their history.
Although there is a limited amount of empirical data regarding the impacts of forced adoption, what exists has largely focused on the grief and loss experienced by the mothers and adopted individuals. However, there is an increasing acceptance that the forced adoption experiences of many mothers and fathers has resulted in similar stress responses typically associated with those who have been exposed to trauma, such as depression, anxiety and PTSD. Further, some adopted persons are also experiencing similar stress responses, either as a result of their adoption experiences or because of childhood abuse or neglect growing up (Kenny et al., 2012).
Grief and loss. The very nature of adoption is centred on the concept of loss. Mothers, fathers, adopted persons, extended family members and adoptive parents all experience loss through adoption. Further, individuals who do not undertake the normal grieving process are susceptible to pathological grief – the result of an abnormally prolonged grieving process that has maladaptive impacts (Bloch & Singh, 2010). Mothers subjected to forced removal policies and practices are at risk of experiencing pathological grief. Disenfranchised grief can occur when a relationship is not recognised, the loss is not acknowledged and there is an absence of socially recognised rituals for mourning the loss (Robinson, 2002).
Anxiety. It is evident that adopted persons, mothers and some fathers affected by forced adoption have, or are continuing to experience, symptoms associated with panic disorder, generalised anxiety and other anxiety disorders (Kenny et al., 2012; Senate Inquiry, 2012). Anxiety symptoms and disorders are common responses among people who have been exposed to trauma (Briere & Scott, 2013).
Trauma. The value of a ‘trauma-informed’ or ‘trauma-aware’ approach to service delivery is becoming more recognised when working therapeutically with people who have experienced significant events that affect a person’s sense of self (Wall & Quadara, 2014). This includes people affected by forced adoption and who are separated from family – particularly mothers. Best practice suggests that service providers should approach all clients as if they might be trauma survivors. Integrated, trauma-informed services provide a safe and supportive environment that protects against physical harm and retraumatisation. They are based on an understanding of clients and their symptoms in relation to their overall life background, experiences and culture. Service providers need to collaborate with clients throughout all stages of service delivery and treatment. Services are based on an understanding of the symptoms and survival responses required to cope, and seeing trauma as a fundamental experience that influences an individual’s identity rather than a single discrete event.
| Some dos and don'ts when working with people affected by forced adoption |
- Don't talk about ‘relinquishment’ – most mothers from the period of closed adoption did not freely choose to have their baby adopted; a range of coercive and illegal practices occurred.
- Don’t assume that trying to establish a relationship with family is a simple solution (and for many, it is seen as making contact, rather than having a ‘re-union’, when there was no opportunity to bond or have a union as a mother-child dyad in the first place).
- Do provide encouragement for clients to seek support from others who have had similar experiences (a fairly comprehensive list of services, including peer-support agencies and groups in each State/Territory are listed in Higgins et al., 2014).
- Do understand that for many adopted persons, there are ‘divided loyalties’ or mixed feelings, with loyalty and gratitude to the adoptive family for many, but at the same time, the capacity to be hurt, disappointed, or angry – or simply curious about their biological origins and broader family connections.
- Don’t assume a typical reaction to events from the period of forced adoption: some mothers are highly traumatised, grieving and angry at the injustice of past events; others are resilient, and coping well, but may still welcome assistance working through emotional reactions to current ‘triggers’, or new challenges in life where past events continue to reverberate.
- Do support clients to address difficulties in forming and maintaining positive relationships with others, including partners, parents and children.
- Do explore how your agency, or even your own private practice, can undertake activities that draw on the principles of restorative justice (see Higgins et al., 2014, pp. 40-45).
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Implications for current policy and service delivery
One of the clearest implications from the AIFS research was that participants wanted lessons from past practice to translate into current policy and practice areas. But given adoptions have dropped from their peak of almost 10,000 in the early 1970s to 339 last year (Kenny & Higgins 2014), what are the touch-points for current policy and practice?
Psychologists providing advice and support in relation to a range of other adoption-related areas must ensure they do not risk continuing the mistakes from the past: cutting ties between biological parents and their children; failing to provide young people with information about their heritage, culture and family; prioritising the desires of prospective parents to have a family over the needs of existing (and often vulnerable) parents and children; recognising that family ties are for life; and that the trauma of interrupting the bond between parents and children can have lasting effects for all.
Research participants identified areas of current practice where these practices may continue to occur, such as: child protection and out-of-home care (including permanency practices); current adoption practices (including overseas adoption; local adoption; moves to increase adoption from out-of-home care); surrogacy; and donor insemination. The AIFS has recently published a collection of essays that address each of these topics and confirm the views of the research participants: that there are plenty of opportunities to apply the lessons from past mistakes to our current social policies and everyday professional practices (Hayes & Higgins, 2014). Lessons from the past need to be brought to bear on current child welfare practice issues, as per the examples identified below.
Managing contact with biological family members. The available evidence supports the importance of biological connections, and how these need to be supported and sustained, even in challenging circumstances such as child protection cases. Case managers have described the value of shared training and supports for professionals working with people affected by past adoption alongside workers managing out-of-home care placements and current adoptions – so that they value all family connections and are sensitised to the ways in which practices can cause long-term harm (Higgins et al., 2014).
Examining new trends in family formation. One of the strongest themes from participants in AIFS research was how lessons need to be applied to emerging family formation mechanisms, such as donor insemination and surrogacy (Higgins et al., 2014; Kenny et al., 2012). Cuthbert and Fronek (2014) concluded that “commercial offshore surrogacy represents the latest source of children in a shifting market driven by the needs of adults seeking children for family formation. This market is enabled by new technologies, underwritten by old inequalities and repeats patterns…” (p. 63).
Increasing the stability of placement. Cashmore (2014) questioned whether we have fully explored the potential of alternative practices like shared family care or ‘mirror family’ arrangements, where ‘families’ are fostered, rather than children fostered or adopted, to enhance stability and wellbeing for children who have been abused and taken into care.
Ensuring ‘open adoption’ is truly open. Castle (2014) reflected that court-ordered open adoption does not necessarily secure contact between parents and children who have been voluntarily adopted. She questioned the limits of the law to be able to achieve what she sees as necessary for true openness: namely,
a commitment to shared parental responsibility between parents and adoptive parents.
Questioning the future of adoption per se. The lessons learnt from past practice require reflection on the future of adoption. Mushin (2014) concluded that “the vast majority of people affected by forced adoption would like to see the total abolition of adoption… It cannot be in a child’s best interests to have all aspects of his or her past obliterated from the record” (p. 45).
What does this mean for psychologists in practice?
There is a range of functions that can be provided by counselling and mental health care services for those affected by forced adoptions. At a minimum, practitioners should ensure that the services they provide are trauma-informed, aware of grief and loss, and are attuned to attachment disruption issues. Concrete steps to reduce the risk of retraumatising clients can include:
- Reading about the history of adoption and its impacts to provide contextual background
- Undertaking thorough assessment and screening processes to establish an appropriate treatment plan, tailored to meet individual needs and circumstances
- Referring clients for trauma-specific services (for example, trauma-focused psychotherapy interventions) where trauma is not the practitioner’s own area of expertise
- Engaging with clients in a manner that is understanding and non-judgemental of the needs and necessary coping behaviours that were required of the trauma survivor to function in everyday life.
The diverse needs of people affected by forced adoptions frequently require expertise from other services/professionals and practitioners should facilitate access to such services where necessary. Services need to be attuned to the complex symptoms, needs and responses of all those directly affected, and to provide flexible and individually focused care (including intensive and ongoing psychological and psychiatric counselling) across a range of health domains (including mental and physical health, and relationship, social and economic wellbeing).
Conclusion
Many of those affected by forced adoption policies and practices continue to struggle with ongoing mental, physical and social health problems as a result of their adoption experiences. There is now evidence of the wide-ranging psychological impacts, including complex and/or pathological grief and loss, self-identity and attachment issues, anxiety and depression disorders, and symptoms of posttraumatic stress disorder. With careful consideration of the Australian research, as well as attention to learning the lessons from past damaging practices, psychologists can appropriately respond to the current needs of those affected by past adoption and removal practices.
Researcher reflection on a knowledge translation session with psychologists
By Pauline Kenny, Research Fellow, Australian Institute of Family Studies
The research undertaken by the AIFS has identified a need for making better use of both our existing knowledge in relation to the effects of forced adoption, as well as the feedback from affected individuals about the improvements to service delivery that they want to see occur. However, it is increasingly recognised that the provision of information in and of itself (simple dissemination) is inadequate in supporting the translation of research into practice, i.e., improving the quality of services available to those affected by forced adoption. In view of this, we have undertaken a number of direct engagement activities with service professionals in order to provide a more meaningful platform for this knowledge translation.
In April 2014, I was fortunate enough to be invited to speak to members of the APS ACT Branch regarding the findings of the AIFS research and the implications for therapeutic practice. As I commenced my presentation, there were a number of things that became apparent very quickly:
- Few people in attendance were aware of the fact that a National Apology had been given by Julia Gillard in March 2013 for the Commonwealth’s contribution to former forced adoption and removal policies and practices.
- There was a very obvious level of interest in the subject matter.
- There was a very obvious level of disbelief and concern displayed by attendees upon hearing the details of what had happened to so many individuals throughout Australia in our relatively recent history.
The intention of the professional development session was to focus on what we know from the research about the impacts of forced adoption and the mental health issues that are often present in many affected individuals, in order for mental health professionals to more appropriately respond to their clients’ needs. However, there was an additional powerful outcome judging from the response from this group of psychologists, which also affirmed the importance for those of us who undertook the research to ‘tell the story’.
The importance of a meaningful exchange of information that enables interaction, discussion and reflection was truly apparent in this setting. Through adopting an engaged approach to disseminating the findings of our research, what began as a 2-hour continuing professional development activity transpired into a lot more for some of the practitioners who attended. The ‘light bulb’ moments that were shared with me privately regarding current and past clients who ‘ticked’ many of the boxes in terms of presenting symptomology is just one example of the benefit in researchers not just presenting the facts and figures, but providing a context and space for reflection, case review and analysis in a group context around a specific topic.
One of the main findings in the AIFS 2012 National Study was that participants wanted greater public awareness and understanding of their experiences, so that what they went through never happens again. From a researcher’s viewpoint, it is a privileged position to meet with strangers who are willing to share their often-harrowing life experiences in order to contribute to our knowledge base. Participants were willing to expose themselves to the understandably difficult task of disclosing very distressing and personal information if it meant that there was the chance that it would make a difference to the quality of support that was currently available to them and others.
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The author can be contacted at [email protected]