Effects of Adoption on Mental Health of the Mother: What Professionals Knew and Didn't Tell Us.

1968. - GRIEF OF NATURAL MOTHER.

Sister Mary Borromeo. RSM. BA. Dip.Soc.Wk.

Adoption: From the Point of View of the Natural Parents.

Borromeo based this article on many years of work with unmarried mothers. Its purpose was to draw attention to the grief reaction which the natural mother experiences after the adoption of her child which both she and her family are ill prepared for.

She compares the separation of adoption to the separation of a child through death. The loss is as irrevocable in terms of relationship.

Borromeo notes that the surrendering mother knows that acceptance back into her family circle is dependent on her ability to "put it all behind her", and so she is under double pressure to do this and suppress her grief. In cases where this is done it is not unusual to find a severe breakdown in self control occurring somewhere around the childs first birthday.

1976.

ANNIVERSARY REACTIONS.

Cavenar.J,: Spaulding.J.G: Hammet.E.: 1976.

Anniversary reactions are among the most interesting phenomena seen in clinical practice. These reactions are time specific psychological or physiological events which occur or reoccur in response to traumatic events in the individuals past, or in the past of a person with whom the individual is closely identified. The individual attempts to relive or re-experience the traumatic event again in a repetitious way, in anticipation of being able to master the trauma which was not mastered previously.

Freud was the first to recognize anniversary reactions in 1885. Pollock. (1971) describes the anniversary reaction as a response of the mind which is triggered by the anniversary of a personal loss or disappointment. Various case histories are described, indicating that a variety of physical and psychological problems may occur as anniversary responses.

Depressive disorders, ranging from very mild depression to psychotic level disorders, may occur on an anniversary basis. Heart attacks, pleurisy and pneumonia, suicides, and phobic fear are also attributed to anniversary reactions. Pollock (1971) has written extensively on the subject. He believes that these reactions are due to incomplete or abnormal mourning over a personal loss or disappointment.

Hilgard (1953) has written extensively on anniversary reactions. She reports that depression or psychotic reactions may be precipitated as anniversary reactions to childhood sibling deaths.

Various disease processes have been described as somatic equivalents or expressions of anniversary reactions. Weiss et.al. (1957) have described hypertensive crises, irritable bowel syndromes, and coronary occlusion as anniversary responses. Rheumatoid arthritis, migraine headache and dermatologic conditions have also been described as anniversary reactions.

Anniversary reactions are much more common in medical practice than is generally recognized. This is true with physical complaints and illnesses as well as psychiatric or emotional problems.

1977.

GRIEF OF NATURAL MOTHERS.

Cliff Picton. Lecturer in Social Work, Monash University.

The following material is drawn from an unsolicited group of fifty one letters received by the Conference office, Sydney, prior to the First Australian Conference on Adoption. Feb.1976. One of the letters came from a hypnotherapist who wrote "many of my patients are women distressed by not knowing what became of their children who they gave up for adoption, and adults who were adopted as babies and desperately wish to know something of their biological parents".

The range of feelings described in the letters runs the gamut from curiosity thirteen years after, to "complete and continuing agony and a sense of loss". Several talk of repeated crying and one woman said she was in tears as she wrote the letter. One woman who relinquished her child twenty years ago said, " I have never gotten over it, it still upsets me". Another, thirteen years later, says she still looks for the "lost" child and feels deep depression on the childs birthday. In addition to years of grief and remorse, she now experiences the fear that retrospective legislation could result in the break down of her marriage.

In the main there was strong identification with the child with references to "my child" and "loving". Six talk of seeing the child and wanting a meeting, ranging from "I believe he has a right to know me, to "I will find you one day fair means or foul". One letter contained disturbing details of desperation and unhappiness and contained the speculation that "the child will wonder who she is".

Picton goes on to speculate that most of these women have been left with unanswered questions and raw feelings and quote, "one is left wondering about the quality of service given to these women".

1978.

ATTACHMENT BONDS.

Martin Reite.MD. Conny Seiler. and Robert Short. MS.

In a paper illustrating attachment bonds between mother and child they point out that: attachment bonds are central to the development of many higher organisms. In higher primates they are crucial for the maintenance of family and social structure. The relationship of the individual to such structures and their disruption may be closely linked to the development of serious psychopathology.

Separations and losses have been implicated in the etiology of affective disorders and maternal loss has serious psycho-physiological consequences in human infants and children.

A monkey-mother and infant were used for studying the behaviourial and psychological consequences of maternal loss and the attendant disruption of the most important attachment bond. They made observations through implant systems that permitted psychological monitoring of the unrestrained infant living in its social group.

The period of behavioural agitation immediately following separation from the mother was accompanied by increases of heart rate and body temperature. Sleep patterns on the first night of separation were characterisd by increased sleep latency, more frequent arousals, less total sleep, increased REM latency, and decreased REM sleep. Most often both heart rate and body temperature showed pronounced decreases the first night of separation.

An infant monkey at fourteen weeks old was used in an experiment on separation from it's mother. It starts with the infant and its mother being removed from their group and separated at 2 pm. The infant was returned to the group. The infant immediately exhibited increased locomotor behaviour and vocalisation, characteristic of agitation reaction. Within seven minutes of its return it was adopted by a childless female adult.

Following lights out that night the infant was monitored. The separated infant spent all night sleeping in ventro-vental contact with the adoptive female. During the first night of separation the infants body temperature decreased 1.4 degrees below its pre-established normal baseline. The infant also suffered increased sleep latency, more frequent arousals, more time awake and the total of absence of REM sleep. Behavioural depression the morning following was manifested by decreases in activity and play behaviour and impaired motor coordination.

These observations demonstrate the physiological accompaniments of maternal separation in monkey infants at least in terms of body temperature decreases and sleep pattern changes. These occur even when the infant is adopted by another adult female who can provide the infant with body heat, physical contact and normal sleep enclosed posture.

They concluded that they can infer that these physiological changes are not due to the physical absence of the mother but are instead etiologically related, at least in part, to the perception of the loss of the mother on the part of the infant. They suggest that the monkey data will prove to be of significant value to our understanding with respect to man.

1978.

MOURNING A STILL BIRTH.

It has been noted in a paper delivered in 1978 that failure to mourn a stillbirth can cause profound disturbance to the mother. In the hospital bereaved mothers are usually isolated. This was meant to protect the mother from the anxiety of the awareness of live babies. On returning home she was usually confronted by a "conspiracy of silence". No acknowledgement of the tragedy can seriously affect the mental health of the mother and her family.

Bourne (1968) describes the stillbirth as a non event in which there is guilt and shame with no tangible person to mourn. A still born is a person who did not exist, a person with no name.

Memory facilitates the normal mourning process essential for recovery. With other bereavements there is much to remember, not so with stillbirth, there is no one to talk about and no one to talk to about it. The bereaved mothers may themselves avoid contact with people because of the unconscious feelings of guilt and shame associated with a sense of being a failure as a mother.

The effects of stillbirth on the mother can be easily be equated to a mother who has lost a child to adoption.

1978.

BIRTH PARENTS REVISITED AFTER ADOPTION.

Pannor. R. Baran.A. Sorosky.A. 1978.

The findings of a thousand letters received from the three parties in an Adoption Research Project revealed that many exiled mothers had not resolved their feelings for their relinquished child that they were told they could never see again. Many were found to have a lifelong unfulfilled need for further information and in some cases contact with the relinquished child.

Many report varying degrees of grief, the persistence of troubled feelings, and no viable alternative that would have made it possible to keep their child. Their findings reflect the fact that the exiled parents seem to be functioning on two levels. They are functioning well within the existing marriage or family, but they harbor deep unresolved feelings and sharp memories of the bearing and losing of the child.

Fifty percent of the exiled parents interviewed said they continued to have feelings of loss, pain, and mourning over their child. Some expressed the feeling that "I have never got over the feeling of loss, I still have feelings of guilt and pain when I think about it. Giving up my child was the saddest day of my life".

They summarised by saying that feelings of loss, pain and mourning continued many years after the relinquishment. An overwhelming majority experienced feelings of wanting their children to know they still cared for them.

1982.

RELINQUISHMENT AND IT'S MATERNAL COMPLICATIONS.

Rynearson.E.K.MD.

The twenty women in this study were drawn from a population of psychiatric out patients. The fact that a woman had relinquished a child was established during psychiatric assessment.

Twelve of the women had a DSM-111 diagnosis of dysthymic disorder, and eight had a diagnosis of generalised anxiety disorder, borderline personality or dependent personality disorder. No one with a psychotic or schizophrenic disorder was included in the study.

All women had lost a child between the ages of 15-19, all were unmarried and dependent on their families. When they entered the centres for unwed mothers they all agreed to relinquish their babies. In spite of this, 19 mothers developed a covert maternal identification with the fetus. This was manifested more in the second trimester with quickening.

During this time the subjects developed an intense private monologue with the fetus, including a rescue fantasy in which they and the new born infant would be "saved" from relinquishment.

All the women dreaded delivery. All remember labor as a time of loneliness and painful panic. All received general anaesthesia at time of delivery, which heightened the extirpative quality of their last contact with their baby. Eighteen of these were not allowed to see their babies after delivery. All reported the signing of the adoption papers as being traumatic, all felt a feeling of numbness and disassociation during the hospitalisation.

All the women left the hospital with the question of what happened to the baby. Use of general anaesthesia during the final stage of labor and post partum period inhibited the open expression of mourning and intensified the fantasied attachment to the lost child.

All the women returned home, they all reported dreams concerning the loss of the baby with contrasting themes of traumatic separation and joyful reunion. All experienced curiosity when seeing a stranger with a baby as to whether this was the baby they lost. When there was "enough" physical resemblance they would follow the baby as if to visually retrieve it. Underlying fear, was a constantly acknowledged urge to get pregnant, an overdetermined need to undo the act of relinquishment.

All of the subjects continued to experience symptoms of mourning at the anniversary of the relinquishment and presented the co-existent themes of sadness regarding the loss, and joy in the conviction that the child was happy and well.

In summary the women's fantasies and behaviour related to the act of relinquishment may be viewed as compensatory, allowing a sustained internalized attachment and maternal identification in spite of its external interruption.

1982.

ANGER IN THE NATURAL MOTHER.

Kate Ingles. (1982), talks about the anger of the natural mother following the loss of her baby. Anger at her helplessness and the officialdom that represents the power to decide what happens to her baby, a power she is without. Anger at all those known and unknown persons who could not and would not rescue her. Anger at her prolific body, so at odds with her circumstances. Anger at her parents, anger at friends, anger at the "unfairness" that allows the man involved freedom from the experience she must endure and integrate.

Anger at the adoptive parents for all they have and all she needs. Anger at the world that elevates motherhood to sanctity but failed her as a mother. Anger at her discovery that "approved of and supported motherhood" is very rigidly defined and excludes her. Anger on behalf of her baby who she feels is defined as unwanted unless she is removed. Anger that must be suppressed and contained that could provide a list of causes and directions too immense and personally derived for us to take account of.

She may, if the common numbness described by such mothers does not lift for many years, only come to anger years after her lost baby is grown up and the specific persons involved are far distant or dead in her present life. She may begin her pregnancy in anger and resentment and continue for years with a randomly placed rage.

1983.

WEEKEND AUSTRALIAN. MARCH 5-6. 1983. MOTHERS SUFFER AFTER ADOPTION.

Danielle Robinson. Quote. "Research has found that the forgotten natural mothers of adopted children are suffering serious psychological problems up to forty years after being parted from their children".

The research financed by the Institute of Family Studies has found that many mothers never get over the trauma of giving up their babies.

The research also found that of at least 50% of the women studied, a deep sense of loss had never left them since the time of relinquishment of their babies. In many of these mothers their sense of loss only got worse with time and in some cases lasted forty years, Professor Winkler said.

Most women found it difficult to cope and some needed psychological help to come to terms with their sense of loss.

Professor Winkler and fellow researcher Ms. Margaret Van Kepple were struck by the enormity of the response the women gave to the study and were alarmed by the strong emotions expressed.

1983.

FEAR IN THE NATURAL MOTHER: AFTERMATH OF ADOPTION.

Eva Begleiter: 1983.

The range and extent of fear expressed by the natural mother as the aftermath of adoption can relate to:

1. Fear that the adoptee will never know of his adoptive status.

2. Fear that the adoptee has suffered negative feelings and had other problems related to his adoption.

3. Fear that the adoptee has hateful and angry feelings toward his natural parents. Natural mothers often question how they will cope with this if contact occurs, although one recently stated she would prefer to hear negative feelings voiced directly rather than never have the opportunity to meet the adoptee face to face.

4. Fear that the adoptee will believe his natural mother did not want him, and never know she did and still cares and continues to be concerned about his progress and welfare.

5. Fear that the adoptive parents have told the adoptee lies, "your mother is dead", or painted a very bleak picture of his natural parents.

6. Fears that the adoptee is dead or fears for his welfare should his parents die while he is still dependent.

7. Fears that the child relinquished for adoption was not placed and instead grew up in an institution.

8. Fears that the adoptee will not search, despite his desire, because of his adoptive parents opposition or because he feels they will be really hurt if he searched.

GRIEF IN THE NATURAL MOTHER: HUMAN RIGHTS COMMISSION PAPER. 1984.

Dr Kathy Mc Dermott: July 1984. Sec. 55. The bereavement experienced by the natural mother and her continuing concern about the fate of her child, can take many forms. Some mothers report posting unaddressed birthday cards to their children each year.

Another possibility is that the bereaved mother will attempt to "replace"the lost child, either by adopting or getting pregnant again as soon as possible. In either case, she is likely to realize too late the new baby is not a substitute for the lost one.

Mc Dermott quotes from (Shawyer) "The emotional havok wreaked on the natural mothers of adopted children is frightening and it reaches into every other relationship they have with subsequent children and partners" and the mother who repeats her pregnancy in order to recover her adopted child becomes evidence of "the kind of woman" who is unfit to raise a child.

1986.

PSYCHOLOGICAL DISABILITY IN exiled MOTHERS.

Condon. J.T. 1986. Existing evidence suggests that the experience of relinquishment renders a woman at high risk of psychological (and possibly physical) disability. Moreover very recent research indicates that actual disability or vulnerability may not diminish even decades after the event.

Condon defines how the relinqishment experience differs from perinatal bereavement in four crucial psychological aspects.

Firstly: although construed as "voluntary" most relinquishing mothers feel the relinquishment is their only option in the face of financial hardship, pressure from family, professionals and social stigma associated with illegitimacy.

Secondly: their child continues to exist and develop while remaining inaccessible to them, and one day may be reunited with them. The situation is analogous to that of relatives of servicemen "missing believed dead". The reunion fantasy renders it impossible to "say goodbye" with any sense of finality. Disabling chronic grief reactions were particularly common in the war in such relatives.

Thirdly: the lack of knowledge of the child permits the development of a variety of disturbing fantasies, such as the child being dead, or ill, unhappy or hating his or her relinquishing mother. The guilt of relinquishment is thereby augmented.

Fourthly: the women perceive their efforts to acquire knowledge about their child (which would give them something to let go of) as being blocked by an uncaring bureaucracy. Shawyer describes poignantly how "confidential files are tauntingly kept just out of reach, across official desks". Thus the anger that is associated with the original event is kept alive and refocused onto those who continue to come between mother and child.

On a study of twenty women who relinquished their baby, all but two of them reported strong feelings of affection for the infant, both during the late pregnancy and in the immediate post partum period. None reported negative feelings toward the child.

Feelings of sadness or depression at the time of relinquishment were rated on the average as intense and "the most intense ever experienced". Anger at the time of relinquishment was rated at the time as between "a great deal and intense". Only 33% reported a decrease over time, and over one half said their anger had increased. Guilt at the time was rated as "intense" with only 17% reporting a decrease over the intervening years.

Almost all the women reported they had received little or no help from family, friends or professionals. Over half of them had used alcohol or sedative medication to help them cope after relinquishment. Almost all reported that they dealt with their distress by withdrawing and bottling up their feelings. One third had subsequently sought professional help.

A most striking finding in the present study is that the majority of these women reported no diminution of their sadness, anger and guilt over the considerable number of years which had elapsed since their relinquishment. A significant number actually reported an intensification of these feelings especially anger.

Taken overall, the evidence suggests that over half of these women are suffering from severe and disabling grief reactions which are not resolved over the passage of time and which manifest predominantly as depression and psychosomatic illness.

A variety of factors operated to impede the grieving process in these women. Their loss was not acknowledged by family and professionals, who denied them the support necessary for the expression of their grief. Intense anger, shame and guilt complicated their mourning, which was further inhibited by the fantasy of eventual reunion with their child. Many were too young to have acquired the ego strength necessary to grieve in an unsupported environment.

Few had sufficient contact with the child at birth or received sufficient information to enable them to construct an image of what they had lost. Masterson (1976) has demonstrated that mourning cannot proceed without a clear mental picture of what has been lost.

The notion that maternal attachment can be avoided by a brisk removal of the infant at birth and the avoidance of subsequent contact between mother and child is strongly contradicted in recent research. Condon and others have demonstrated an intense attachment to the unborn child in most pregnant women.

There is a strong impression from data that over-protectiveness is part of the phenomenon of unresolved grief and serves both to assuage guilt and compensate for the severe blow dealt by relinquishment to the self esteem in the area of being a "good mother".

The relatively high instance of pregnancy during the year after relinquishment invites speculation that this represents a maladaptive coping strategy that involves a "replacement baby".

1986.

THE LIE.

Watson. K.W. : Birth Families: Living with the Decision. 1986. exiled parents who place children for adoption are expected to live a lie the rest of their lives. The adoption eliminates the public record of the childs birth, and the exiled parents are counselled by family, friends and social agencies to go on with their lives as if the pregnancy never occurred. This socially sanctioned denial not only interferes with the resolution of grief, but intensifies the parents' poor self-image by reinforcing the idea that what they have done is so heinous that it must be concealed forever.

1986.

THE PARENT AND FOETAL RELATIONSHIP, OF MALE AND FEMALE EXPECTANT PARENTS.

Condon. John.T. In a questionaire issued to 54 first time expectant couples. Three of the major findings were. (1) thoughts and feelings about the foetus are strikingly similar between pregnant women and expectant fathers: (2) the behavioural expression of this antenatal attachment is considerably attenuated in the men, most likely due to perceived conflicts with the sex role stereotype of masculinity: (3) Attitudes towards the foetus per se are not necessarily correlated (in either sex) with attitudes towards "being pregnant".

Greenburg and Morris. observed that a group of fathers , first presented with their neonates, exhibited "engrossment" which was virtually identical with that of their spouses. The authors concluded that the encounter with the infant "released an innate potential" for fathering.

The present writer (Condon) has observed profound grief reactions in fathers bereaved by stillbirths, suggesting a significant antenatal attachment.

1987.

BIRTH PARENTS AND LOSS.

Van Kepple. M. Midford.S. Cicchini.M. 1987. In a paper presented at the National Association for Loss and Grief, Van Kepple, Midford and Cicchini state that perhaps the most obvious loss experience in adoption is the loss of the child relinquished by his/her natural parents. The significance of this loss, however has either been denied or grossly underestimated by society in general and by adoption practices in particular.

"It is our contention that their grief has been cruelly exacerbated by the long standing conspiracy of silence which surrounded adoption practise".

Many natural mothers have reported extended periods of depression, anxiety, feeling suicidal, as well as alcohol and drug use, and poor physical health immediately following the relinquishment. In many instances the mother didn't necessarily attribute these physical and emotional disturbances to the loss of their child, primarily because they had been led to believe they would not suffer and if they did, it would be short lived.

Research has demonstrated that in the long term relinquishing mothers are more susceptible to a variety of physical and emotional difficulties: they experience an on-going sense of loss, which for some fluctuates according to events such as anniversaries.

1987.

PRIMARY PROCESS THINKING IN PREGNANT WOMEN.

Condon J. 1987, in his paper on the Altered Cognitive Functioning in Pregnant Women, refers to Raphael-Leff (1980) who has provided one of the few detailed descriptions of analytic psychotherapy with pregnant women. She writes: the pregnant woman has immediate and direct access to her well of fantasies, her earlier modes of symbolic thinking. . . she is in touch with her unconscious, and at times feels most overwhelmed by the power of the irrational within her.

She suddenly finds herself different from others, and unable to communicate the "mad" content of her experiences, which she recognizes and is embarrassed by. Her dreams too, have become extremely vivid with often explicit symbolism and with little attempt to "censor" or disguise forbidden content.

1988.

PARENT AND INFANT ATTACHMENT IN THE EARLY POSTNATAL PERIOD.

Condon J. 1988, Says that inquiry into the early development of mother-to-infant bonding has been heavily dominated by the "critical period" theory or "bonding hypothesis" of Klaus and Kennel (1982). In its simplest form, the theory states that skin-to-skin contact between mother and infant during the first 24 hours after delivery is necessary for the normal development of maternal-infant bonding. Conversely, the absence of such contact during this "sensitive period" carries a significant risk of deficient bonding that may endure throughout early childhood and exert potentially detrimental effects on the childs development.

In Condons view, the critical period theory, with its strong overtones of animal behavioural psychology, provides a very limited perspective on the richness of a human mothers cognitive and emotional experiences during the early postpartum period and the complexity of the factors that determine these experiences.

Twenty five years ago, Gerald Caplan (1961) wrote:

You can predict this time lag ( between the mother seeing the neonate and experiencing attachment) by paying attention to her attitude to the foetus. In extreme cases there is no time lag at all: she continues to have the relationship with the baby which she had to the foetus, interrupted only by the mechanics of delivery ("Now he's outside. . . but he's the same person").

1988.

BIRTH FATHERS.

Winkler.R. Brown.D. Van Keppel.M. Blanchare.A.: 1988.

It has been conservatively estimated that one in fifty women in Western countries in 1988 will have placed a child for adoption since the beginning of the twentieth century. Approximately half of these women will have experienced much pain and suffering as a result of their decision to relinquish their child (Winkler & Van Keppel).

It is only in more recent years that natural-parents have "come out" and talked publicly about their private anguish. There is also a growing body of recent research data which has supported their claims that relinquishing a child is a profound loss experience, and this life event can have long term deleterious results.

While a considerable number of natural fathers are not aware of their role in the adoption process (because the natural mothers chose or were unable to disclose such information to the fathers of their children), those who were involved, also suffer. While fewer natural fathers seek professional services in an attempt to alleviate their suffering, those who do, appear to have similar experiences to the natural-mothers.

Too frequently, natural parents have stated that they felt pressured into relinquishing their child for adoption by adoption workers (and others). They felt that they were not given accurate or adequate information about their rights and the adoption process. Almost none expected the strong emotional reactions which they experienced and were not encouraged to actively mourn the loss of their child.

Many felt incidental to the adoption process and felt the major focus of attention was to the child and the adopting family.

The above difficulties have resulted in additional, more complicated psychological and social difficulties than might have otherwise been expected to result from the relinquishment process.
For example:

• A sense of powerlessness and betrayal that has permeated subsequent relationships, not only with the professionals but also with family and friends.

• Inability to mourn the loss of their child, because they had no memories of the actual child: there was often no saying goodbye, nor memories of seeing or touching the child which would have assisted the parents to shift the experience from the realm of fantasy into the realm of reality. Denial of the experience was promoted as an effective coping strategy.

• Damaged self-esteem and a strong sense of worthlessness (complicated by shame and guilt) resulted from the way in which their needs and experiences were ignored by members of the adoption community.

1988.

GIVING UP THE BABY.

Gediman. Judith. 1963. In her article "Giving up the Baby" notes, "what I have learned, from researching the reunion phenomenon and the interviewing of the natural mothers, is that contrary to what these young mothers were advised by humiliated parents and adoption social workers, the fact that being a mother, did not disappear with the surrender of the child. Vast numbers of them were not able to put the experience behind them, "get on with it" and "get on with their lives."

The need to know what happened to their child seems almost universal and does not disappear. One natural-mother after another talks about the pain of going through life wondering whether the child is alive or dead: Is he well? Is he happy? What kind of life has he had? Where is he. Not knowing is compared to having a loved one missing in action.

So natural mothers find themselves looking involuntarily at every boy or girl they pass on the street and feeling a part of themselves is missing.

In addition to the impact on their feelings about themselves and their lost children, natural mothers report still other kinds of consequences resulting from long ago adoptions. Some reveal that the psychic strain of living with such a secret over the years has taken a profound toll, consuming energies which might have otherwise have been put to more constructive educational, career oriented or other pursuits.

Adoptions have also influenced subsequent childbearing. Some mothers, for example, became pregnant shortly after the relinquishment. The reverse effect also exists, with secondary infertility found to be higher among women who have surrendered a child to adoption than among other populations.

1990.

BIRTH MOTHER SPEAKS.

Sue Wells, a natural mother says in her article: "What has happened to my child? Is she well and happy?" These are questions that plague all natural mothers who, like me lost their children to strangers through adoption. Some mothers will never know. Some dare not dwell on the subject. Some have sought psychiatric help to cope with the anxiety of not knowing, or succumbed to physical stress. Some are still searching and hoping for a reunion. I am lucky I have found my daughter. We have found each other.

She continues: Everyone automatically assumed that babies born out of marriage in the 60s and the early seventies should be adopted; Our parents assumed it, the medical profession and the adoption workers not only assumed it but strongly advocated it. It was as if we did not exist. Many of us were offered no support, no counselling, no information.

We were told to "go away and forget" and that we could make a fresh start, as if nothing ever happened. But what they forgot to tell us was that we would never forget the child we bore and gave birth to, in spite of the various ways we may have tried. They also forgot to tell us it would affect us the rest of our lives.

The loss of our children does not fade with time and is exacerbated by a lack of information about them.

THE ABSENT CHILD.

Maureen Connelly says: What makes a mother? Is it the child birth? Is it the bearing and nourishing and sustaining him for the first nine months of his life? Is it the raising of him, spending his growing years with him? When do women become mothers? Does some thing magical happen during or after childbirth?

Is this the forging, the test by fire, or do mothers become themselves under the gentle pedagogy of the tiny teachers who make them feel too much too soon? Are we the mothers when we begin to care, to wonder, when we realise we are moved by a child we can't even see? When does motherhood begin, when does it end - or does it have beginning and end? Is it time bound?

Grumet; (1983, p47) Why did I want to look at my child when I knew it was a look of impossible opportunity? We had a momentary meeting, a cheat, really, because no relation could come of it, and yet there was something. The look that said, "your mine forever", wistfully from mother to baby but, more significantly from baby to mother, and I was absolutely correct. I am his forever.

Connolly asks: What is it like to live with an absent child? Perhaps more than anything it is one-sided. The bond and the bonding are felt by one person.

The short time that a mother and baby have with each other is nonetheless long enough and strong enough to forge a togetherness that cannot be forgotten, regretted, or denied, a togetherness that is remembered, relived, and lived with excruciating fondness and tenderness. She is his mother, an unalterable, irrefutable, recurring, unending awareness, wondering, missing. How strange that one can miss utterly someone one has known so briefly. It was and is the quality of the knowing that makes the missing and the absence so intense.

It is the "not knowing" which is the most painful at times. All the authorities will tell you: It's better not to know; but then how do they know?

1991.

IMPACT OF GRIEF TO BIRTHMOTHERS.

Lavonne. H. Shiffler. 1991.

Shiffler quotes Butterfield and Scaturo (1989), therapists who specialize in child bearing loss and who recognize a pattern of stages in natural mothers grieving process: denial, shock, disbelief, and numbing: guilt: anger: yearning: longing and searching: depression, disorganization, despair and integration. They (Butterfield) emphasize that this is an ongoing nonlinear process.

Butterfield continues, a natural mother does not just grieve for a few months and it's over. She may not feel her grief initially, but will find it surfacing later in her life cycle (i.e. at a reunion or the birth of a grandchild). She may not start grieving until as many as forty years later, in a support group, where she is free to talk, to open the closet and take out the grief piece by piece.

IMPACT ON SEXUALITY.

There is a heart breaking trauma in an adolescent who becomes pregnant in her early sexual experience. She may go through a post traumatic stress reaction in her later relationships, associating sex with loss, shame and loss of control. Why should she ever want to have sex again? (Kaplan, 1989)

Many natural mothers who marry find their earlier birth experience affects the marital interaction (71%), with problems in committment, allegiance and jealousy heightened. natural parents who are married to each other have a high risk of marital unhappiness and fragmentation in their relationship, but stay together because their shared bereavement is a stronger bond than commonality of spirit or interests (Deykin et al.1984).

IMPACT ON SPIRITUALITY.

The relinquishment experience in its cultural-religious milieu has had a profound spiritual impact on natural mothers. Nave (1989) found that many natural mothers had gone to their churches for advice and support during pregnancy and were counselled in a manner they now regard as anti-ethical to Christianity, shame based rather than love based. The results were feelings of demoralization, lowered self esteem and estrangement from the church.

One woman reported "The attitudes and actions of individuals and institutions representing the church are what caused me to leave and stay away for many years". Another said "Adoption and the church are very much intertwined. . . . they explained what adoption was and how, if I really loved my baby. I wouldn't think of keeping him".

Part of the rage they feel is no one warned them of the severity of the depression that follows relinquishment. Some were deceived by social workers who promised them the baby would be placed with parents of a particular denomination: the truth was found out later after reunion.

A committed Christian natural mother may compensate after relinquishment by becoming super-spiritual, devoting her self to church work, being judgemental of herself and others and avowing a strong belief in the power of prayer. Yet inside, she may have grave doubts and feel spiritually frozen, because her primary request to God, to know the whereabouts and welfare of her child (as mothers in biblical accounts of adoption were privilaged to do) has never been answered.

If the day comes when she has been reunited with her child, it is a miracle of the highest order. It may have the power of her original encounter with God, like being born again. She may report the restoration of feelings of closeness to God which may result in the development of a genuine compassion for other people as human beings. She may feel that the real self she acquired in her original salvation experience was lost at relinquishment and restored at reunion with her child, but only natural mothers understand or care.

1993.

POST TRAUMATIC STRESS IN BIRTHMOTHERS.

Sue Wells, giving extracts in her presentation to a conference in Amsterdam based on her research into post traumatic stress (PSTD) which is defined as the development of symptoms following a psychologically distressing event that is outside of the usual human experience. Serious attention is now being given to the trauma attached to the separation and loss of the mother and child through adoption, and the profound and long term effects this can have on both of them.

A survey conducted on 300 natural mothers suggested that the loss of their children constitutes a trauma which may be life long. Almost half of them say it had affected their physical health, and almost all say it affected their mental health. This in turn has affected their interpersonal relationships with family, partners and the parenting of subsequent children.

Symptoms of Post Traumatic Stress Disorder: Many natural mothers say they split themselves off from their trauma as a coping mechanism. This avoidance as a strategy is one of the key symptoms of PTSD which Allison says may be caused by the trauma being internalised to avoid immediate pain. Many say they escaped into drugs and alcohol or precocious sexual activity, especially in the year or so after relinquishment. Most say they felt numb, shocked, empty, sad and many said they felt the same way many years later.

The distress associated with the loss may cause Psychogenic Amnesia which many mothers have verified by saying they are unable to recall important events associated with the birth or adoption.

Strategies for reducing distress means that exposure or events associated with the trauma, e.g. anniversaries, childs birthday, Christmas, family gatherings etc, are experienced by all the natural mothers in the sample as painful or causing "intense psychological distress".

Psychic numbing, where the natural mother feels detached or estranged from others who have not been through the same experience is also substantiated early on. The burden of secrecy can perpetuate this.

Difficulty in forgiving their own parents whom many saw as instrumental in the loss of their babies has affected their subsequent family relationships.

Lack of a positive image of their future is another symptom described by Allison where guilt feeling about what they had to do in order to survive is very much an issue with many of the natural mothers.

Recurrent dreams or nightmares where the trauma is relived is characteristic of some mothers experience, especially early after the relinquishment.

Elsewhere it is stated that symptoms of depression and anxiety are commonly associated with PTSD.

1994.

THE HOSPITAL EXPERIENCE. "I REALLY AM A MOTHER".

Lauderdale.J.: Boyle. J.: 1994.

Many of the natural mothers recalled that the other hospitalized mothers were showered with flowers and candy, while video cameras recorded the happy event. The experience of the relinquishing mothers, particularly those in a closed adoption group, was far less of a celebration. While they valued the occasional physician and nurse who treated them like real mothers, they could recall very few of these situations.

One mother poignantly described how she sneaked out of her hospital room late one night and made her way down to the nursery.

"I was scared to death that they would catch me. I just stood there at the nursery window with tears rolling down my face, looking at all the babies trying to see which one of them was mine. I thought I would die when a nurse opened the door and asked me what I wanted. I just cried and cried and told her my baby was in the nursery and was being placed for adoption. She said to come in, that wonderful woman took me into the nursery and let me sit in a rocking chair and hold my baby. I just sat there crying and rocking."

Common advice from the family, nurses, physicians, and social workers included "pretend the adoption is a miscarriage", or "Oh, you'll get over it". "Why you'll forget it after you have another baby."

The hospital experience culminated with the natural mother signing the adoption papers. This experience was described as "numbing" and "amnesic". Many described feelings of "checking out" and "leaving my body", or not even remember signing anything.

1996. UNCHARTED TERRITORY.

Logan. J, 1996, reports on the findings of a study conducted by the Mental Health Foundation which examined the experiences and needs of natural mothers who relinquished children for adoption.

Adoption is a violent act, a political act of aggression towards a woman who has supposedly offended the sexual mores by committing the unforgivable act of not supressing her sexuality, and therefore not keeping it for trading purposes through traditional marriage. . . the crime is a grave one, for she threatens the very fabric of our society. The penalty is severe. She is stripped of her child by a variety of subtle and not so subtle manoeuvres and then brutally abandoned. How many are set free? How many exiled mothers remain trapped inside an emotional nightmare with unresolved death as a lonely companion? (Shawyer.1979).

Historically, exiled parents have been the most neglected party in the adoption triangle: both in the literature and in the practice they have been afforded little attention compared with the adopted people and the adoptive parents.

Shawyer's analysis showed that natural mothers are deemed to have wronged, need to be punished and are therefore not worthy of attention. A study by Baran et al. (1977) revealed bias and ambiguity in the attitudes of mental health professionals towards women who relinquished their children.

On interviewing mental health staff they were told that these women had sinned, suffered and deserved to be left alone. While Baran's research was conducted some time ago, the findings in this study indicate little positive change.

Perhaps the most important findings of this study and one that has not been reported elsewhere, is the way in which the medical profession responds to natural mothers. Research has shown that relatively few women who suffer depression are referred by their GPs for specialist psychiatric help. Yet this study has demonstrated that a significant proportion of natural mothers (32%) were referred to specialist services. The referral rate of relinquishing women therefore is considerably higher than that of women in the general population who suffer depression.

This raises some interesting questions: given the pivotal role of GPs in defining the boundaries of mental illness, are natural mothers more seriously mentally ill than other women that suffer depression? Is this therefore an indication of the impact of relinquishment or an indication of the way they are perceived by the medical profession?

1990s.

MULTIPLE PERSONALITY & DISSOCIATION.

Dissociation is a mental process which produces a lack of connection in a persons thoughts, memories, feelings, actions, or sense of identity. During the period of time when a person is dissociating, certain information is not associated with other information as it normally would be.

For example, during a traumatic experience, a person may dissociate the memory of the place and the circumstances of the trauma from his ongoing memory, resulting in a temporary mental escape from fear and pain of the trauma and in some cases, a memory gap surrounding the experience. Because this process can produce changes in memory, people who frequently dissociate often find their senses of personal history and identity are affected.

Most clinicians believe that dissociation exists on a continuum of severity. At one end are mild dissociative experiences common to most people such as daydreaming, highway hypnosis, or "getting lost" in a movie or book all of which involves "losing touch" with conscious awareness of ones immediate surroundings.

At the other extreme, is complex chronic dissociation, in such cases of MPD and DD, which may result in serious impairment or inability to function.

The symptoms of MPD/DD; may include the following, depression, mood swings, suicidal tendencies, sleep disorders (insomnia, night terrors, and sleep walking) panic attacks and phobias (flashbacks, reactions to stimuli or triggers), alcohol, and drug abuse, compulsions and rituals, psychotic-like symptoms (including auditory and visual hallucinations) and eating disorders.

In addition, individuals with MPD/DD can experience headaches, amnesias, timeloss, trances, and "out of body experiences" Some people with MPD/DD have a tendency toward self-persecution, self sabotage and even violence (both self inflicted and outwardly directed).

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1999

Journal of Obstetric, Gynecological and Neonatal Nursing, 1999 Jul-Aug. pp.395-400.

"A grief reaction unique to the relinquishing mother was identified. Although this reaction consists of features characteristic of the normal grief reaction, these features persist and often lead to chronic, unresolved grief. CONCLUSIONS: The relinquishing mother is at risk for long-term physical, psychologic, and social repercussions. Although interventions have been proposed, little is known about their effectiveness in preventing or alleviating these repercussions."