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When my son was six years old and living in a group home, he attempted suicide by trying to choke himself. This attempt came on the heels of his birth mother cancelling her visit with him for theumpteenth time. He used to sit by the window and wait for her to show, and would be full of manic anticipation the day of her scheduled visit. Each no-show would fuel his increasing rage and deepen his sadness, and finally it erupted in an episode of attempted self-harm. Thankfully his attempt was foiled by one of the staff. Although there might have been a propensity to not take a threat from a six year old as seriously as an older child, my son’s family history of mental illness and domestic violence lent weight to this incident.
According to a 2001 survey conducted by the American Academy of Pediatrics, it was found that attempted suicide is more common among adolescents who live with adoptive parents than among adolescents who live with biological parents. http://pediatrics.aappublications.org/content/108/2/e30.abstract. While the underlying reasons for this association remained unclear in the survey, the findings are significant enough to put adopted children in the ‘at-risk’ category for self-harm. This does not mean that most adopted kids will venture down this route; merely that there are commonalities with adopted children that separate them from birth children and might make them more prone to the causalities of suicide.
I’d like to focus specifically on the clientele I see who all have varying degrees of attachment issues. This population has more pronounced issues which lead their parents to seek counseling. That’s not to say that adoptees who aren’t involved in counseling don’t have their share of issues. The very nature of adoption involves grief and loss, and an adoptee cannot escape this fact. Some have more resilience and skills in order to deal with their grief and others are masters at hiding it and going under the radar. My clients verbalize the same feelings to me about their adoption regardless of where they’re from and what their experience was like. Mainly, why was I abandoned? There must have been something wrong with me because I wasn’t ‘kept’ by my birth mom. I obviously don’t deserve a good life or to be loved if the very person who should have sent me those messages abandoned me.
When dealing with the sensitive issue of abandonment it’s important to clarify the difference between intellectual maturity and emotional maturity. Intellectually, my clients may understand the variety of reasons why they came to be adopted; birth mom was too poor, too young, a drug addict, a victim of abuse herself, wanted a better life for their kid, and a multitude of other reasons. As adoptive parents, we often feed into that rationale by letting our kids know that their birth mothers “loved them and wanted what was best for them”. However, all of that logic misses the importance of what is at the core of abandonment issues – how a child feels about being ‘left’. In my office, my focus is on breaking through a child’s defensive barriers to get at this core so that a healthy expression of those feelings can be brought to the surface. Inevitably, there is always a layer of intense anger about being abandoned. Adoptive parents know this anger well, as it has a great presence in our homes and is often directed towards us. However, the anger is usually a mask for the greater emotion, which is sadness. This is the original feeling the abandoned child felt, but nobody wants to stay stuck in their sadness and vulnerability for long, so it is quickly covered up with anger. Anger feels powerful. I remember my son describing how strong he felt in one of his rage-filled episodes as anger coursed through his veins, a false sense of empowerment that is sure to propagate even more shame and insecurity when it subsides.
I strongly encourage the expression of these feelings in therapy, and give permission for my clients to be angry at their birth mothers. This is important because they often feel torn and confused about their feelings in regards to birth parents. They still love and miss them, but are also angry at them and are scared to admit it. Many of them fantasize about returning to them, taking care of them, and even make excuses for why they were abandoned. I teach them that all their feelings are valid, and they can still love them and be angry at them simultaneously. What they can’t do is project that anger onto other people, and especially turn it on themselves. Unresolved anger and sadness that has no pathway out is often directed inward and can turn into depression as children age and may eventually lead to self-harm behaviors. It is important that we validate these feelings for children and don’t try to rationalize, intellectualize, or try to convince kids of “how lucky they are to be adopted” – it’s not how they feel.
I had an adolescent client this week that for the first time since his adoption eleven years ago began crying about missing his birth mom, and told his adoptive parents he was angry at them for adopting him – destroying his chances of returning to birth mom (not even a possibility, but real in his mind). They did a fantastic job at validating his feelings and not making it about themselves, reaffirming that they love him and accept him for who he is. A pervading sense of peace came over him after this admission, something that they had never witnessed prior to the therapy session.
The work for healthy expression of feelings only begins with the discussion over abandonment issues. Being able to express the deepest of feelings our adopted kids have is the first step to laying the foundationfor being able to trust and develop intimate relationships. The bulk of the work is accomplished every day, as we are barraged with endless tests to see if we will hold the boundaries and not falter in keeping our kids safe. The default for many of our kids is to stuff feelings because they don’t trust that we will be able to handle them. The problem is that a lot of little feelings build over time, so even those kids that can be fairly functional end of sinking into a depressive rut or having an explosion at some point if they haven’t released their feelings.
I place strong emphasis on kids clearing out their feelings daily so that they don’t build. If an adoptive parent is able to regulate their own feelings and properly validate the feelings of their children, the result will be a much more even tempered family life. If a parent is easily drawn into drama, is highly anxious or reactive, and isn’t emotionally present for their kids, the environment will be too unstable for healthy expression of feelings. As a result, kids will then internalize their feelings and they will build over time. Some kids act out in anger and rage, which is at least some way of getting their feelings out. The kids I worry about mostly however are the ones who have no outward expression, and instead try to contain it.
Unfortunately, there is a limit to how much one can handle and this often leads to dissociation. As kids age, they engage in riskier ways of trying to escape their feelings. While video games might have worked when they were eleven, at fifteen they might try drugs and alcohol. Unfortunately this pattern of dissociation can lead them down the road to self-harm behaviors and eventual suicide. This is why it’s incredibly important to establish a healthy flow of communication and expression in a family.
Due to the initial abandonment of my clients and their hesitancy to develop close relationships with parents and peers, many kids express a pervasive loneliness. They desperately want attention and intimacy but are scared of experiencing hurt again like they did when they separated from birth mom. Therefore they spend a tremendous amount of energy trying to control the distance between themselves and others. There are those kids who make it obvious that their guard is up by being rude and caustic to others, mean-spirited and belittling, or even downright abusive. But the population I worry about more are those kids who surround themselves with ‘friends’, but in reality don’t develop any connections with people beyond superficial relationships. They are generally well liked and even popular, but this is because they are chameleons – masters at being able to hide under the radar without anyone knowing who they really are.
The better they are able to hide, the less chance that others will be privy to their deep loneliness. These kids are candidates for self-harm and suicide because they don’t allow others to see or help them with their pain. It is often a shock that to people in the community when the star of the football team or the lead in the band commits suicide, because he ‘seemed so happy’. Encouraging these kids to take risks and let others see who they truly are is essential to healthy development. Risks entail not being people pleasers, asserting themselves by speaking up about their needs and wants, and celebrating their uniqueness rather than their ability to conform are important steps to freedom and reducing isolation.
Unfortunately the origins of many adoptions stem from major family issues from previous generations; mental illness, alcoholism and drug addiction, abuse and neglect, or lack of proper parenting.Our kids often come loaded with organic issues from their parents, and/or being subjected to abuse. As adoptive parents, we are often under the misconception that these issues can be rectified by a healthy family environment and lots of love. Years into the adoption, we may find ourselves sitting in a specialist’s office being given advice on medication, brain scans, or various other therapies for our child – realizing we have inherited a lot more than a child merely needing a home. This is where I see a lot of parents get stuck, as they don’t want to accept their child is more affected than previously thought, that it might be a lifetime of care, that their sphere of parental influence might be more mental health management than parental shaping, or that the impact of their birth family far outweighs the influence of the adoptive family. Many parents choose to remain in denial because it feels like they’re giving up. This is exacerbated by their kid’s ability to look more functional than they really are, a defense mechanism developed in order to survive.
The other issue that complicates things is being abused or neglected, and often witnessing domestic violence in the birth home. The impact of these experiences is profound on our kids, and amplifies their distrust of others. Even if they don’t have a working memory of the incidents, they all too often have ‘body’ memory. Trauma remains locked in their bodies and they are hypersensitive and hypervigilant to their surroundings. This takes a major toll on their health, as they are always in a state of stress and anxiety.
Adopted children are often painfully aware of how different they feel than other children who haven’t shared their experiences. When you add in mental illness and/or abuse issues, kids feel a great deal of shame and even more marginalized. Most kids I see who are born to a birth mom who struggled with schizophrenia, bipolar disorder, personality disorders or other mental health diagnoses are very afraid of inheriting these issues. Many kids are indeed at risk, and adolescence is when organic issues often rear their ugly head. Similarly, kids who are born to addicted parents are at greater risk of experimenting with drugs and alcohol in their teenage years and prone to addiction.
I would be remiss in doing my job if I didn’t mention the ACE Study, a massive ongoing research project initially surveying over 17,000 participants who had varying numbers of adverse childhood experiences (www.acestudy.org). These include abuse, neglect, divorce, alcoholism and drug addiction, or witnessing domestic violence. The research findings demonstrate that the larger your ACE score, the greater chance of a breakdown in functionality and adoption of risk behaviors. The striking correlation between ACE scores and early death is an indication of how seriously we must pay attention to these adverse childhood experiences. Many children who come into our families through adoption have elevated ACE scores of 3 or more. When discussing suicide risk with ACE scores as our background, we see how impactful high ACE scores are on suicide attempts; kids with ACE scores of 4 or more are 20% more likely to attempt suicide than kids with Ace scores of zero.
There is great news however; research also shows how we can foster and nurture resilience in our kids by surrounding them with support and teaching them the skills to be able to deal with adversity in their lives. Resilient people are more likely to feel like they are capable of withstanding and overcoming obstacles. Some of the things we can do to help build resilience in our kids are helping them develop peer relationships and support, build on their personal interests and strengths and uniqueness, get them involved in volunteer opportunities in order to give of themselves and be part of the larger community, seek proper counseling that encourages healthy expression and understands adoption issues, be consistent and regulated, and don’t forget to take a break from parenting just to have fun with your kid, building a greater positive bond. Remember, even though adolescents seek individuality they actually need more support and involvement from parents than ever before. They need to know that you will not abandon them in their most chaotic time of their life.
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