(Continued from Part 2)
Submission by Dr. G. A. Rickarby, MB, BS, FRANZCP,
Member of the Faculty of Child Psychiatry,
RANZCP, MANZAP, Consultant Psychiatrist
Written response to questions submitted by The Inquiry to Dr Rickarby on 28/8/98.
When I first heard of the distress and illness in the lives of women who had lost a child to adoption, I thought the problems were unusual. Throughout the decades following I found I continually underestimated the severity of their distress and the widespread gravity of their disrupted and blighted lives. There are tens of thousands so damaged, and I consider the cruel and unnatural treatment of these women by their fellows to be of such extent and seriousness that it has only been surpassed by the treatment received by our indigenous people.
I would also say that while practices associated with drugging, threats of police and physical separation catch the attention and imagination, that the great bulk of damage was due to the `mind-bending’ techniques by those in power that shaped the mother’s view of herself, her entitlements and ability to fight for her own and her child’s obvious rights.
1. What is your current occupation and experience?
My Current Occupation is twofold. I am a Consultant Psychiatrist in Private Practice at Lake Macquarie, and I am a Part-time Psychiatrist Member of The Mental Health Tribunal which is under the administration of the NSW Department of Health.
I am involved in the latter on Tuesdays and Wednesdays mostly. In my private practice I confine my paediatric psychiatry to autistic disorders and assessment and consultation for children who are potentially taking action in Court as a result of abuse, assault or bereavement.
I also practice as a psychotherapist. It is in this context that I see mothers who have lost a child to adoption, although I have done assessments in preparation for litigation for these women also; three of which have been completed. (One was for action in another State).
2. What was the experience in counselling mothers who have experienced distress as a result of past adoption practices?
This began in general practice in Victoria where I had counselled five women and one man in the early to mid sixties.
In psychiatry practice in Victoria, London and at Rydalmere Hospital NSW, including the Fairfield community, between 1968 and 1976, I saw women who had previously lost a baby to adoption, and I realised in the mid-seventies that I had probably missed this information about many of them, as I was mostly only to obtain this information as I inquired about it. Many of these were out-patients and not In-patients, and commonly they had Pathological Grief which decompensated into Major Depression, or their life and family relationships were disturbed by their long term grief.
When I returned to Child Psychiatry in1976, while most of my work was with adoptees and adoptive families, I saw a steady number of original mothers whose distress was affecting their families. Much of this was due to the spreading effects of their depression, or post-traumatic phenomena related to their fear of losing another child.
A child Psychiatrist covering a wide area consults with numerous other professionals with problems and management dilemmas. Covering the Inner Western Suburbs of Sydney, The Hunter Region, Orange and the Far West, I was frequently consulting with other professionals who carried these cases without ever seeing the patient.
This led to me consulting with the Association of Relinquishing Mothers (A.R.M.S.), Offering supportive opinion, and some consultation: also assisting with submissions. This continued until this was stopped by a Gosford C.E.C..
On my retirement in 1989, I was able to see original mothers at my practice, however because of my other duties I was unable to see a large number; however, many write to me or telephone me from other states (except Northern Territory) and I was able to meet many at The Sixth Australian Conference on Adoption at Brisbane in 1997.
Particularly in legal cases, but also in others, I have studied in detail Photostats of their records from hospitals including the conduct of their labours and medication given to them. I have read at least a dozen of these, and have copies of at least five. I also know women from other contexts who are original mothers. In all I have seen some hundreds of original mothers over thirty-five years, and have consulted about or been contacted by as many more.
Unfortunately I have had to refuse to see many in the last two or three years for reasons of time and health. I have eight in long term psychotherapy, two of them on a weekly basis.
Unfortunately, some of the more severely affected do not readily come forward, because this requires some core mental health and strong motivation.
3. What was the psychological state of a woman considering the option of adoption, particularly in the period 0-7 days after giving birth?
Without drugs, this is an extraordinary crisis time in a woman’s life. Frequently it is a time of multiple crisis with concomitant factors such as Caesarean Section, breast and bladder distress, and worry about babies condition. It is a time of crises in relationships: the woman’s mother and male partner being essential people to meet her needs has been shown vividly in outcome research. It is a time of rapid change in the body with profound hormonal charges as the body switches from support of the placental circulation to lactation. These changes are associated with emotional liability and vulnerability. The community as a whole is and has been aware of the acute sensitivity of this time in a woman’s development.
Add to this the woman’s helplessness, separation from significant others, being subject to repeated coercive suggestion, indoctrination and humiliation, and then to have the baby she knows so well inside her, taken from her by team work that is frankly conspiratorial, she would be in no state to rationally oppose or resist what `respected’ and powerful older woman were wanting her to do. The notion of `informed consent’ under such circumstances is unfit. The features of informed consent: `capacity’, `volition’ and `information’ were at their lowest point.
Add to this, the use of the drugs as outlined in 4. Below, the mother’s state was one without will, confused and helpless: and this should have been obvious even to the omnipotent and ignorant. The intent of those who brought young women to this state and sought consent from them to give up their guardianship of their own child is one object of this inquiry. Considering the mothers were meant to be cared for by these people, their conduct can only be described as treachery.
Certainly The Act and its intentions were treated in such a manner that `contempt’ is too weak a term to express their attitude to it.
4. What was the impact of any of these drugs on a person’s capacity to make decisions regarding consent?
This is essentially a continuation of 3. above.
I am aware from the records I hold that a series of potent mind-altering drugs were given to many of these women. The worst abuses of drug administration I know of were at Crown Street.
The commonly used drugs:
- Pentobarbital Sodium
- Sodium Amytal
- Chloral Hydrate
- Valium (diazepam)
- Largactil (chlorpromazine)
The first four drugs were barbiturates. They are depressant hypnotic drugs with a general effect on the brain, causing sedation, clouding of consciousness, a stuporose state and forced unconsciousness in higher dosage.
The Sodium version of each was to render the drug soluble to enable injection with rapid onset of effect. They were well known to have been used elsewhere in the world in political circumstances for interrogation or other uses. I have also reviewed Chelmsford files and Dr. Harry Bailey used all four to achieve so called `Deep Sleep’ in that hospital.
Some of my patients also had them given antenatally – one patient extensively during weeks before the baby’s birth. They cross the placenta to the foetus and are known to be highly dangerous to the baby, causing respiratory depression and hypothermia in the new-born.
In the 1990s they are virtually obsolete, but still valued by a small minority of drug addicts.
Pentobarbitone and Sodium Pentobarbitone were routinely used on selected mothers during the first week after the baby’s birth in Crown Street.
Chloral Hydrate. This drug is a small inorganic molecule with an effect very similar to alcohol but is highly sedative and can induce unconsciousness. It is well known when mixed with alcohol: this combination is the legendary “Mickey Finn”.
Valium (diazepam). This benzodiazepine drug is an anxiolytic and muscle relaxant. It particularly works on the part of the brain subject to emotional modification of behaviours and has an effect breaking the connection between feeling and cognitive states. It was often given on the morning of expected consent taking.
Largactil (Chlorpromazine). This wide acting tranquillising drug had many effects including the potentiation of other drugs and general inhibition of emotional responses.
Stilboestrol. This synthetic oestrogen compound was injected intramuscularly and given orally to selected original mothers from 1965 until well into the seventies. The first injection was usually given in the Labour Ward or shortly thereafter and continued in vigorous doses throughout the first week. Its intent was to dry up milk.
Because of its association with causing cancer in later life and for other reasons it is obsolete. There was already serious doubts about its safety at the time it was being used.
Ethinyl Oestradiol, the naturally occurring hormone was available in the Sixties but was more expensive. The administration of this drug was given without any knowledge by the mother of what it was for or what it might do – there was never a hint of consent. It is prima facie evidence that conspiracy to abduct the baby was well underway many days before consent was sought.
I am able to advise you that the use of all of these drugs other than Stilboestrol: in the case of barbiturates, even forty-eight hours before consent taking: would compromise the capacity of any person to make decisions regarding consent.
5. What was the psychological impact of women being given advice to “start life afresh” and that “they would soon get over ” the loss of their baby and the experience of the loss?
The experience of the mothers who lost a child to adoption is so polarised towards the inability to continue with their life and to almost universal Pathological Grief that simplistic advice of this ilk is fatuous. Remembering such advice makes them angry, but worse, they have feelings of hopelessness that what they went through at the time and their present plight will not be recognised by society and that their life as broken by the loss will not be validated.
It is a provocation that makes their depression more likely, their personality defences more rigid and their life more isolated, many of them believing they are the only ones who are grieving and who didn’t start life “afresh”.
One salient issue in this respect is the continued control of adoption resources centres, reunion organisations, and other public services for original mothers by `professionals’ who push views of this type, indeed the views that were current in the Sixties and Seventies, and are sometimes staffed by the same people who colluded in taking their babies.
In hearing the experiences of mothers and particularly in studying the literature of these agencies, there is a continuation of patronisation, invalidation and also a wide-ranging insensitivity to mothers’ grief and psychiatric morbidity due to adoption, and the distress and despair in their life situation.
Issues and practices carried on by them in 1998 which are untenable to mothers are:
- The inability of these `professionals’ to take any responsibility for the plight of the mothers, to show by any word, empathic gesture or sympathy that their actions as a group caused any distress or damage to mother, baby or adoptive family, or that they were doing anything illegal or unethical.
- Taking mothers into situations as part of a group without any assessment of their grief status, distress, personality or psychiatric disorders.
- In group situations, requiring mothers to conform to attitudes, transactions with others, and styles of thinking about adoption, without any sensitivity to the mothers’ position or to crises in their feelings brought up by the professionals, adoptees, and adoptive parents, let alone the aggravation of post-traumatic stress phenomena and depression as a result of these group contacts. These organisations have `a party line’ which is against the interests of original mothers becoming validated or healed.
- The use of suggestion to control them which is a thinly veiled repetition of what was done to them originally.
- Crass paternalism from woman to woman – and only the mothers notice. The less damaged laugh.
- An underlying ignorance about the damage these woman experience. It is not just that social-workers are not able to assess the psychiatric syndromes or are ignorant in this area, but that they are dabbling in an area of illness for which they are totally untrained. They ignore research about the nature of grief and the connection of Pathological Grief to breakdown in Mental Health which has been known for decades. Their unawareness of their own ignorance when dealing with the severely damaged is like taking lighted tapers into a gunpowder storage. Their use of groups when a distressed person requires extensive individual assessment and debriefing is destructive.
It is for these reasons that I called for these organisations to be disbanded or unfunded in my written submission. In my view they should be replaced by services organised by a committee of original mothers with advisers from The Dept. Of Health in both the fiscal and health management areas.
1. What is The Nature of Post Traumatic Stress Syndrome? (In DSMIV it is Post Traumatic Stress Disorder: and frequently abbreviated thus: PTSD)
A. There are a series of elements: A major trauma (death, threat of death, disaster, loss, horror); the compulsive intrusion of the trauma into both waking consciousness and dreams, with fixation of memory onto specific elements of the trauma; major avoidance of situations, circumstances or people associated with the original trauma; major dysfunction and disability as a result.
It is a central issue for mothers who have lost a child to adoption because it is related to some of the other diagnoses and damage I have listed in my written submission.
- If elements of the experience are overwhelming, untenable or unbearable, breakdown to Major Depression occurs.
- Or, If the trauma is totally overwhelming, dissociative defences, can occur leading to the far more serious Dissociative Disorder.
- The defensive mechanisms against the Disorder can leave the personality damaged by detachment, thick skinned defences, or those that are distrusting, withdrawn, agoraphobic, anxious or obsessive.
In the mother’s case it is to be noted that PTSD is hardly ever existing on its own but in association with Severe Pathological Grief in one form or another. Pathological Grief is a condition that is also overwhelming, untenable and unbearable, and itself causes breakdown into Major Depression and the other conditions listed above. Pathological Grief may cause more psychopathology in the long run because it may become worse in later years because of its renewal with the stage of development of the lost child or at changes in the life stages of the mother.
However PTSD may also take a chronic form in the mother’s life and this was particularly noted among those women who presented to Child Psychiatry Services.
There would be a hyperalertness to separation from a later child (among those eleven out of twenty who were to have another child) sometimes precipitated by a strong sense of the child being in danger, a Family Law crisis, a grandmother or even the mother of a school friend alienating the child’s affections, even minor illness.
Another form would be a fear and hyperalertness about hospitals described in my main written submission.
This could create a major crisis when another fear was about losing the child because of sickness or accident.
Reading the newspaper or seeing other media coverage about adoption issues or loss of children can easily set off post-traumatic images of the original loss and the circumstances.
Being alone in a vulnerable situation (even a supermarket) can produce a return of overwhelming helplessness of the original experience in the maternity hospital. Anniversaries of admission and birth, can cause intrusion of painful and traumatic images. Frightening dreams of a post-traumatic nature can occur decades later, sometimes precipitated by an event such as described, but often occurring during a fever or brought back by a drug effect from preparations bought over the pharmacy counter.
B. The other disorders described in my main written submission all occur, some of them much more commonly than PTSD. Many women have gross disorders without having any PTSD. In order of frequency:
- Pathological Grief.
- Personality damage of the four types discussed in my written submission.
- Major Depression.
- Post-Traumatic stress disorder.
- Dissociative Disorder.
- Panic Disorder.
C. How common are Post Traumatic Stress Syndrome and other disorders as a result of past adoption practices?
Research is needed on these topics.
Among the group that go to peer support groups, Pathological Grief, and recurrent Major Depression are almost universal, Dissociative Disorder and PTSD also occur.
Of the more severe group who do not come forward but are sometimes `found’, there are a mixture of three or four diagnoses with major personal failure.
Of the group who use Child Psychiatric Services, PTSD is most common.
Of the group who have difficulty accepting contact with adoptee’s, personality damage associated with shame, guilt and secrecy is most common, and there is evidence from the networks of mothers that this group is very common, but many accept help to have reunion. From this source also is the indication that the group with major defences damaging to personality (often associated with Dysthymia) is also common.
2. What are the measures that might assist people experiencing distress as a result of past adoption practices?
Many of these mothers are `just hanging on’. they see the Inquiry as the one chance that their position, their circumstances and their broken lives and feelings can be understood by the community at large and particularly by their children. There is a strong feeling that if this is not achieved in this Inquiry there will be no other opportunity. They also require their powerlessness and their sense of betrayal by other women understood.
In many instances The Inquiries’ findings per se will assist them significantly.
Some mothers want justice. The identification of illegal unethical and damaging practices will serve much of this. The identification of those responsible for flaunting The Act from a leadership position will also serve this and be a guideline for Civil action in unequivocal instances.
However, with one class of exception, I do not think criminal proceedings or other recriminating action is necessary or desirable provided the other issues above are addressed, as I think there will be a widespread beneficial change in the whole group when many of the facts and their implications are public. The class of exception: a large number of mothers are aware of histories of people who took part in taking their babies who themselves benefited by receiving a baby to adopt. This question needs to be looked at carefully because the mothers specifically need answers in this matter. If there are found to be those who took a leadership position in the illegal taking of babies, with damage to the mother, and also benefited themselves by receiving a baby or babies from this system to adopt, it will be important for the mothers to see such a person prosecuted criminally as the law provides.
In my main written submission I consider the nature of public education about The Inquiry’s findings; I go on to consider the needs of mothers for individual counselling or therapy. I consider the type of counselling to assist with reunion to be of a specialised quality and sometimes of a different nature than remedial counselling, although in some instances much remedial work is needed before reunion is tenable.
I would emphasise the requirement for all counsellors to be approved by a committee largely consisting of original mothers. Wherever an original mother could train for this role or train others; it would by highly desirable.
Within the Department of Community Services much incompetence has arisen from the Department’s policy of demanding officers carry out generalist duties; whenever they have picked the trained and sensitive for these duties their service has improved; however, consent takers of the sixties and seventies often ignored the Act, the lack of capability of giving consent, distress, or even blatant expressions in the negative, let alone ambivalence about decisions. Because most of the remedial issues are Health issues and outside the Department of Community Services range of expertise, it would be better administered by the Dept. Of Health with some input from Psychiatry.
In general, people with qualifications in clinical psychology or psychiatric nursing should also be considered when staff working in adoption are being recruited.
Please see my main written submission for further issues.
Because of the reasons given at the beginning of 7, I consider that an apology from Government Departments of today would be a drop in the bucket and on its own would have a negative effect. It would be seen as blatant tokenism. I would not advise it.
However from those who conducted Adoption Agencies and institutions for the pregnant single woman I think a comprehensive, humble and sensitive apology, particularly from the two religious organisations most commonly identified for their inhumane treatment of thousands of young women would have a significant beneficial effect.
Copyright Origins Canada Inc. 2010