 Okay, Shoshanim, in a desperate attempt to cheer you up, I'm going to discuss today orphans, orphanages, abandoned and adopted children, and foster care. This should definitely cheer you up. Two service announcements to add to your gloom. I will be releasing a video about Psycho, the famous Alfred Hitchcock masterpiece on the way to Halloween next week. And you should ask yourself, is this a Halloween treat or is this a Halloween trick? Because you never know with me. And on a more serious note, there's a new playlist, welcome playlist, there's a new playlist on my YouTube channel, it's the covert borderline playlist. I think there's about seven videos there about this new diagnosis, covert borderline, which resonates with many, many, many people. Many people identify themselves in this diagnosis and say I've been misdiagnosed with borderline, I've been misdiagnosed with last season, I've been misdiagnosed with bipolar. Now that I'm exposed to the idea of a covert borderline, that's me, that's 100% me. So with so many people, so many people's lives, so many people's psychologies, so many people experiences resonating with this diagnosis, I think I may have hit a rich seam of psychogold. Okay, let's delve right in. My name is Sanbaknin, I'm the author of Malignance of Love, Narcissism Revisited. I'm a former visiting professor of psychology and currently on the faculty of CIAPS Commonwealth for International Advanced Professional Studies, Canada, United Kingdom and Nigeria. I received this YouTube comment which triggered me or provoked me or incentivized me, choose your favorite victim would phrase, to make this video. And it said, the comment, I'm interested in knowing if any studies have been done on the prevalence of narcissistic or personality-disordered mothers who adopt and the utilization of adopted children is supply. The answer is no, there are no such studies. Subsequently, continues the comment, the triangulation between biological children and adopted children. Also, the prevalence of NPD in adopted persons and its effects on personality development with already established trauma from the separation from family of origin, followed up by adoption by a personality-disordered mother, father and family. Regrettably, there are no studies and therefore I cannot relate directly to the questions raised by you. However, I can discuss more generally the issue of adoption and foster care and how they affect personality lifelong. So, the comment ends with the following paragraph. Are there any studies on this? A whole ton of PTSD involved via parental units and adopted child. If anyone has had any doubt about the importance of the mother, not the father, the mother or more precisely the maternal figure, the primary caregiver, it has nothing to do with genitalia. It has to do with who is the person who played the role of a mother in early childhood development between 0 and 36 months of age. So, this is what I call mother. It could be a male, but it's a mother figure. If anyone has had any doubt about the importance of a mother figure, in determining the rest of your life, your attachment style, your personality, your character, your repetition compulsions, your ability to distinguish external from internal objects, your personality disorders, other mental health issues, it's all determined by the mother and this is demonstrated super conclusively by the studies of orphans, for example. Orphans, children who have been orphaned, there's the famous English-Romanian orphan study. There have been even studies by Winnicott on children who have survived war. Studies of adoptees, children who are adopted, studies of children in foster care, in short, studies of motherless children demonstrate the importance of the mother. Indeed, when mistreated and abused and traumatized, children often inquire, am I adopted? And this is the topic of today's video. For decades now, for decades now, there's been a raging debate about the importance of mothers and motherhood, proper motherhood, good enough motherhood. In very early development, pre-verbal and before the ego is formed. And we have studies, for example, by Vanessa Peetz, by Selma Freiber in the 80s in the footsteps of Vanessa Peetz. And they describe defenses in infants, defenses such as avoidance, freezing, fighting and inappropriate affect. These are all defenses against trauma and abuse. These are not defense mechanisms because there are no defense mechanisms without an ego. And this is all a pre-ego state, but these are defenses, defensive behaviors. Now, before I go into the issue of adopted children, what adoption does, what foster care does to the personality, mental health issues, defenses and so on. I'm going to do a deep dive into these issues. Before we go there, I want to set up the theoretical background, the scenes so that we can then explore everything being informed by what others had to say. So, Donald Winnicott, for example, the famous pediatrician turned psychoanalyst later. Winnicott suggested that abused and traumatized children don't dare to hope for love. And adoption, adoption, being orphaned, definitely going through the foster care system is a form of abuse and trauma. It's a definitely series of traumatizing events. So he said, these kind of children don't dare to hope for love. And to protect themselves against disappointment, these children hate others ostentatiously, conspicuously, in your face. They desire to be hated in return. This is these children's way of testing the waters. Can my foster mother, can my adopting mother, can institutions, can they hate me without resorting to maltreatment and rejection? If I push the envelope, if I test them, if I misbehave egregiously, can they still not hate me? Or, at least if they do hate me, can they still not abuse me and not mistreat me? Much later, about 20 years later, Fairburn, Gantry, Seinfeld came up with the concept of the empty schizoid core, which is a major reaction to being orphaned, being adopted, going through the foster care system. I'll discuss it a bit later. Then there is Albert Ellis, the founder of REBT, the precursor of CBT. He says that experience causes no specific emotional reaction. The individual's belief system produces the reaction. So it's not what's happening to us. It's what we believe that is happening to us. And what we believe about how we should react to what's happening to us. In short, this is socially determined. And indeed, Harris-Tex-Allivan said, people are products of their environment. The most dominant voice in this field is Boris Cyrilnik. Boris Cyrilnik, C-Y-R-U-L-N-I-K. Cyrilnik said that trauma consists of the injury and the representation of the injury. Not the injury alone, but also how the injury is represented, how it is perceived by others and how it is perceived by the victim. Adult interpretations of events are the most damaging post-traumatic experience for children. This was very controversial because what Cyrilnik says, for example, is that the act of insist itself is not the main cause of the trauma. It's how adults in the environment react to the act of insist that causes the trauma to the child. This is extremely controversial. He says that labels can be more damaging and damning than the experience itself. Hedl, long before all these guys, Hedl said, consciousness of self depends on the presence of the other. Jean-Paul Sartre said that the perception of the world, including of other people, changes when another person enters the picture, another person appears. We absorb their concept of the other into our own. Jacques Lacan took it a bit further and said that the unconscious is the discourse of the other. The unconscious is the hive mind, the collectivity of all the voices of others. Charles Horton Cooley came up with the concept of looking-glass-self. He said that the way we view ourselves is based on how we imagine that other people view us. Heinz Koh would say that the child's needs should be met and when the child's needs, especially psychological needs, are not met, a fragmented self emerges, consisting of the narcissistic self and the grandiose self. Eric Byrne suggested that we all harbor within ourselves a lifelong child, adult and parental ego states. Fritz Perls, who was the co-founder of Gestalt Therapy together with his wife, said that a sense of reality is created through perception, the ways we view our experiences, not the events themselves. All this is very, very important when we try to understand adoption because the reactivity, the reactions to adoption, short-term and long-term, psychological and somatic, all these reactions are actually heavily conditioned on societal expectations, mores, signals, broadcasts, edicts and strictures. Society determines the trauma involved in being adopted or being orphaned or going through the foster care system. Of course, I'm not implying that there are no cases of real abuse and real trauma. They are more rare than we are led to believe, but they do exist. I'm talking about the amazing fact that many, many, one would even say the majority of people, adopted, actually end up with severe attachment problems and with post-traumatic conditions, the kind of CPTSD. Why is that? I think that it's because of the way society perceives adoption. And to understand why I think this way, I encourage you to watch the video. It's in the literature, the link is in the literature, in the description. The video titled, Why Childhood Abuse Victims Hate and Are Hated. Okay, now what are we talking about? Over the decades, in multiple studies, including the one I've mentioned of Romanian orphans who've been adopted in the United Kingdom, this study was a longitudinal study over 20 years. So over the years, over the decades, we have learned that adopted children develop a pattern of behaviors which are highly specific to them. It has even been suggested that it's a syndrome, the adopted children or adopted child syndrome, but this has been rejected by the DSM committee, for example. Still, there's something going on there. We know, for example, that adopted children are more prone to violent temper tantrums, sensory self-stimulation when they are stressed or even just excited in a state of excitation, oppositional behaviors, contrarian, defiant, consummations, hatred of authority, which is a bit psychopathic, aggression usually externalized, depression and anxiety. All these are much more common among adopted children than in the general population or even in clinical populations. Now, part of the problem is that many adoptions are cross-cultural. The child is born and sometimes grows up to a certain point in one culture and then exported or transported into another culture. And the cultural differences do account for some of the variants in narcissistic, psychopathic behaviors, but still it's an insufficient explanation because we find the same phenomena, the same clinical features in children who have been adopted at birth and they have time to be exposed to the culture of origin. All adopted children or vast majority of adopted children have a difficult time understanding emotions in others. They miss social cues, which is very reminiscent of autistic spectrum disorders. They develop learned behaviors. These learned behaviors are adaptive when you're alone, for example, when you have to fend off for yourself, when you're in an orphanage or in foster care, actually, but these behaviors are maladaptive, post-adoption when you're embedded in a loving, caring, nurturing family. So, children who have gone through multiple modalities, they were orphans, so they spent some time in an orphanage, then they spent some time in foster care and then they were adopted. And such children actually are indistinguishable from children with autistic spectrum disorder. So, low functioning autistic spectrum disorder. This is a very interesting kind of similarity. So, we have psychopathic elements, we have autistic elements and they persist throughout life into adulthood. That is the big discovery of the era study, the English-Romanian orphans study. Many children suffer from trauma as a result of experiences before the abandonment or experiences from the orphanage or foster care. Trauma could be the outcome of real abuse, including sexual abuse in many cases, or it could be the outcome of dislocation, disorientation, being abandoned and detached, separation in security, object inconsistency. And if this reminds you of the origins, the psychodynamic origins of narcissism, the etiology of narcissism, you're right. That's how narcissism starts. It starts with a problem with a mother. A child cannot attach to the mother because she's not a secure base. She's not safe, she's not stable, she's not there. She's a dead mother, to use Andrei Green's phrase. And so, children who are adopted actually have all the preconditions of prerequisites to develop narcissistic personality disorder or pathological narcissism because they are not given the opportunity to attach securely to a mother figure. And this exposure to a motherless environment, an absent mother environment, which is even much worse than a dead mother, in some ways, this predisposes adopted children or foster care children to develop narcissism later on in life. Many of them have disordered attachment, insecure attachment styles, poor attachment styles, and so on. And this difficulties in attachment makes it almost impossible for them to form long-term, healthy, stable, safe, productive, constructive adult relationships. But insecure attachment of this magnitude also impacts self-regulation. So many of them are dysregulated. They lack impulse control. They are reactant. I mentioned that they are defined in consumations. They defy authority. That's called reactants. They are reactant. And there, as I said, as I mentioned, are able to understand emotions and respond to emotions appropriately. In general, identity formation is disrupted. So these people have identity diffusion on a constant basis. They are stuck in an early adolescent phase in this sense. In extreme cases, they have identity disturbance. So if you put together emotional dysregulation and identity disturbance, it's a great, great encapsulation of borderline personality disorder. The feelings of abandonment related to adoption, to having been adopted, and all of them find out sooner or later that they've been adopted. These feelings of abandonment lead to a total disturbance in multiple areas of psychological functioning. And it becomes very reminiscent to cluster B, but nowadays we know that CPTSD masquerades as cluster B personality disorders. It's very difficult to tell apart someone who has complex trauma from someone who has borderline personality disorder, for example. So these children having grown up and become adults, they actually suffer from lifelong CPTSD. They never develop the feeling that they belong. They never fit in, not only with the adoptive families, but by extension with any group or collective or environment. They just don't fit in. They're the outcasts. They're the freaks. They're the weirdos. They keep wondering, what would my life have been like had I not been adopted? Now everything I'm saying is a generalization. Of course I'm going to get a torrent of comments by adopted people who would tell me that that's not true. They have secure attachment. They don't have any mental health issues. They don't feel that they don't fit in. They fit in perfectly. They have a great social life and so on. Yeah, of course. Everything I'm saying is on average, population average, a cohort, a cohort average. It doesn't apply to each and every individual who has ever been adopted, but we're talking about statistics and this phenomenon that I'm describing is very, very common, common enough to generalize, so to speak. Many adoptees who were raised in closed adoptions develop a wish, an overwhelming wish to find the birth family, the mother, at the very least the mother, most commonly the mother. If adoption is such a great thing and they fit in and they feel great, why would they want to look for the birth mother? There's something is missing. There is some deficiency there. There's some lack, some lacuna. And many adoptees have negative views of adoption. They regard the very process of adoption as traumatic and some of them even advocate against adoption. They ask to ban, they demand to ban adoption as a practice. Adoption is about loss. It's early childhood loss. It's an inability to form an identity because of critical, a critical lack of very crucial and basic information. Who am I? Where do I come from? Who is my mother? What is her background? Even genetic if nothing else. So this in itself creates trauma. And there's a struggle with psychological disorders, behavioral challenges. This sense of not belonging has a pernicious poisonous effect on almost everything imaginable, every dimension of psychological functioning imaginable. And cultures and societies throughout the world, they don't help. They're not helpful because there are various myths associated with adoption. For example, you should be grateful that you've been adopted. You have been saved from a fate worse than death. You were taken out of the impersonal foster care system and into loving, caring, warm, embracing, holding and containing family. So all is well that ends well. On the other hand, there's the opposite myth that adoptive parents, parents who adopt cannot love the adopted children as much as they love their real children or would have loved their real children had they had them. But that's not true, of course. The bonding between adoptive parents and adoptees is often very strong and as strong as it is with real children. Actually, in such blended families, some children adopted, some children biological and real, there's often competition, triangulation and a lot of envy and jealousy. The real children complain that the adoptive children are consuming an unfair share of parental resources. It's usually the other way around, totally. But all these cultural and societal nonsense myths, they weigh heavily on the adopted child's mind. My mother can't love me because she's not my mother. I should be grateful, so why am I grieving? Something's wrong with me. I'm a bad person. I'm not grateful. Why am I mourning? What it is that I'm mourning? And this is what gave rise to the idea of an adopted child syndrome, which is very controversial and probably doesn't exist. But it's kind of an amalgamation of issues of bonding and issues of attachment coupled with problematic behaviors like the aforementioned defiance or violence and so on and so forth. Adoption is subject to stigma, subject to mythology, subject to misunderstandings, subject to a lot of hurt feelings on both sides, subject to an introduction to an environment that existed there before you, the adoptive family, and trying to fit in when by definition you can't fit in. So it's constant struggle, lifelong struggle, struggle to conform, to be accepted, to be loved unconditionally, not to be saved. And there is the kind of grief that is denied by society. Usually when someone is traumatized, there's a lot of sympathy, if not empathy. There's a lot of support and succor, at least from close family and friends. But when you're adopted, your grief is denied. Your mourning is criticized or ridiculed. You're not allowed to grieve and to mourn what could have been your original mother, your family, the abandonment, the dislocation. So many traumatic experiences. Adoptive families are real. And the vast majority of adoptive families love the adopted child, care for the adopted child, nurture the adopted child, embrace and raise the adopted child as best they can in total equality with the real children. Foster care is a different story because money is involved and the motivation is usually pecuniary or economic rather than emotional. So foster care is more like a hotel than a family. But adoptive families really want to adopt. Sometimes adoptive parents can't have children or don't have other children. Adopted children are chosen. They're usually selected even, like there are many options. The parents zoom in or hone in on to a specific child. And yet this is not how it's perceived. It's perceived as if the adopted child is a burden or not fully loved or requires an inordinate investment of effort on the part of the parents to be loved and accepted. Many adoptive parents are supportive and nurturing. There's a small minority who adopt children for narcissistic reasons, of course, but that applies to biological families as well. There are narcissistic parents everywhere, adoptive and non-adoptive. They bring children to the world or they adopt children because they use the children as sources of narcissistic supply as extensions of themselves. That's designed to do with adoption, has to do with psychopathology of specific individuals who unfortunately become parents because parenting is not licensed and is not supervised and anyone and everyone can become a parent. But still, adoptees always feel somehow misplaced, abandoned, sometimes guilty even. When you're young, when you're a child, you tend to split the world. Money is all good, you're all bad. That you've been abandoned must have been your fault. You must have done something wrong. You deserved it. You're a bad object. You're unworthy. And this is compounded and complicated with post-adoption trauma or trauma in foster care, which is much more common than post-adoption trauma. So how you react to adoption as an adopted child depends on numerous factors. The parents' behavior, their personality, the child's makeup, including genetic makeup, personal history, personality traits of both parties, the environment, culture, society, messages of mass media and social media, the reactions of peers. When the fact of adoption is discovered, contact with biological mother later, conflicts which may arise between the biological mother, the adopting parents. It's not two cases alike. Sometimes children are adopted out of foster care. They go through foster care and one of the foster care families falls for them, loves them and wants to adopt them. Others remain in foster care for years until they are of age and just leave the system. Theodora Blanchfield has written an article titled What are the mental health effects of being adopted? And while I disagree with quite a few things that she says, she makes a few very cogent points. Again, it's in the literature in the description. She says that adoption is often forgotten when speaking about trauma leading to a form of disenfranchised grief, which is grief that is not typically acknowledged or validated by society. Adoptes are statistically known to be more at risk for mental health problems, she says, both due to the initial trauma and genetics. A meta-analysis, a review of studies about adoptees' mental health found higher levels of depression and anxiety than in non-adoptees with bipolar disorder and major depressive disorder, the two disorders most associated with adoption. Additionally, adoptees are more than four times more likely to attempt suicide, which is very reminiscent of borderline personality disorder. Research shows that children who have been adopted face higher levels of attachment insecurity than non-adoptees, and adoptees who enter their parents' lives later than at one year old have deeper attachment issues than those adopted at birth or soon after. Additionally, she's quoting someone, Johnson says, that some of the issues come from the messaging that adoptees receive, both societally and at home. If they are told your parent loved you so much she wanted you to have a better life, kids might conflate love with loss, like the mother of origin, biological mother loved me and so she abandoned me. So love is about abandonment, love is about loss. And Johnson says, it's not a great way for adoptive parents to explain it to kids. Literature shows that several mental health disorders are exponentially higher among adoptees than in the general population. They include depression, anxiety, bipolar, attention deficit, hyperactivity disorder, post-traumatic stress disorder, or CPTSD more precisely, and oppositional defined disorder. Now, this can be an accident because this characterizes even adopted children in happy families. It seems that the very act of adoption has a disruptive, destabilizing effect and genders dysfunction later in life. It is a recreation of the dead mother effect in the formation of narcissism. That's why mother is so critical. Disenfranchised grief is very, very important. When adoptees are allowed to grieve, when they're mourning and sadness, their sadness, their dysphoria, their depression, when they're legitimized, when they're accepted, when they're encouraged to verbalize what they feel, when everyone around them is comfortable with their grieving, the outcomes are much better. Johnson says that, and I'm quoting, this type of grief is common among adoptees because of the societal messaging suggesting you should be grateful or you were adopted into a good family. Because of this, adoptees often will downplay their loss and the loss of the birth mother or a parent is a major loss, even if it is for a good reason. Another aspect of adoptees psychology and you're beginning to see the similarities with lots of cluster B features, yes, most notably antisocial and narcissistic and borderline. So another feature is hypervigilance. Hypervigilance is an outcome of CPTSD. It's a feeling of being constantly on guard, some undefined danger. It's a close kin of anxiety. It's a problem of trust. These kind of children would find it very difficult to trust people in relationships and love. It's their first experience of love was having been discarded by the mother who should have loved them. Johnson says they wonder, who can I trust? Their major experiences with love have included loss. So they wonder who is going to stick around and who is going to disappear. And all this makes it extremely difficult to form a core identity or a sense of self. We all figure out, we all figure out at some stage who we are, our place in the world. We develop a theory, a working model of the world, ourselves, others, theory of mind regarding others. So adoptees find this extremely difficult to do because they don't know who they are. They lack critical information and they don't know who they belong to. There's an issue of belonging, serial belonging. Serial belonging and an ex nihilo effect, like the adoptee just materialized out of nothing and nowhere. Untethered, floating, adrift, unconnected. There's no mother there. If you don't even know anything about the people responsible for your genetics, says Blanchard, it can be hard to know who you are. Adoptees, particularly in transracial adoptions, they feel stuck between two worlds. They feel like they don't quite belong in the family, raising them, nor do they belong in their family of origin. Johnson says that younger kids between ages three and five have a very literal understanding of adoption. They perceive adoption as someone gave me a way, someone gave me a way to this family. As these kids grow older, they're beginning to feel bad about this. They're beginning to question the narrative, they begin to associate or socialize with peers and they witness the families of these peers. They begin to realize the differences between an adoptee family, never mind how loving and caring, and a real family with a real money and a real daddy and biological children who are genetically related. And so they begin to make comparisons and they want to revisit their past. They want to find this connectivity. They don't become tearful or sad. They're not adults. They act out. They misbehave. They become delinquent. It's their way of signaling distress and attracting attention and this escalates all the time. Adoptees commit suicide. As I said, at a rate that is four times higher than the general population and the figure is even higher among teens. So it's not only the early trauma, the attachment issues, the history of institutional care, such an orphanage or foster care, but it's also this ongoing quest, ongoing frustrated quest to find yourself, the inability to look back. And so they don't know anything about themselves. For example, do they come from a family with susceptibility to mental illness, cancer, substance abuse, suicide, they don't know anything. They can't answer these questions. Now, there's been a study by Fahy and Anthony and others titled Early Adversity predicts adoptees and during emotional and behavioural problems in childhood. It's published in the European Child and Adolescent Psychiatry Journal. And again, you can find all the links to the literature in the description. And I would like to read to you extensive excerpts from this excellent study. They say, children adopted from the public care system are likely to experience a cluster of interrelated risk factors that may place them on a trajectory of mental health problems that persist across the life course. However, the specific effects of putative risk factors on children's mental health post-placement are not well understood. So they conducted this study, they correlated it with what we call adverse childhood experiences, ACEs, and they say, contrary to expectations, more pre-placement moves in time in care predicted fewer problems over time. Because probably there's habituation. That's my interpretation. The children get used to being handed over from one institution to another from one foster care family to another, from one adoptive family to another. Habituation numbs the emotional reaction, takes the edge of the feelings of dislocation and disorientation and identity problems and so on. That's my interpretation, but that's a fact. The more pre-placement moves in time in care, predicted fewer problems over time. But exploratory analysis continued the authors. Exploratory analysis of interactive effects revealed this was only the case in rare circumstances. We identify pre- and post-removal factors that may incur benefits or have a deleterious impact on adoptee's outcomes in post-adoptive family life. Our findings provide knowledge, etc. I would like to continue to read to you from this again excellent study. An accumulation of early risk factors heralds numerous negative developmental outcomes including emotional, internalizing, anxious, withdrawn, depressed and behavioral, externalizing, disinhibition and aggression problems. For adopted children, early risk factors may include birth family history, birth mother, birth father, medical, psychological problems, parental risk factors, for example maternal drug and alcohol misuse, stress, poor parental prenatal care and birth complications, postnatal adversity, abuse, neglect and instability which may occur at crucial stages in development and place the adoptee's at higher risk for enduring developmental problems we don't know in the majority of cases. That's the black hole of information that makes it extremely difficult to even treat, to even provide therapy for adoptees. There's a lot of critical information is missing. Studies investigating the mental health of primarily US adoptees demonstrate that adopted children are at a greater risk for emotional and behavioral problems than non-adopted children and that there is an overrepresentation of adoptees in mental health settings. Most adopted children in the UK are taken into care due to maltreatment within the birth family and they are likely to have experienced adverse childhood experiences, ACEs such as abuse, neglect and household dysfunction. They are more likely to experience this than the general population. Recent work continued the authors of this study. Recent work revealed that over two-fifth, 40% of children adopted in a one-year period experienced four or more ACEs with such exposure linked to an increase in vulnerability for health risks across the life course such as delinquency in adolescents and poor psychological health, alcoholism, drug abuse and suicide attempts in adulthood. In the UK, most children spend time in temporary kinship care or with foster carriers prior to adoption. Although this arrangement seizes the immediate risk of harm to the child during this transition all adopted children experienced a loss of their birth parents and potentially extended family, friends, possessions owned in community. Early adversity and loss may be also compounded by placement instability following the child's removal. Repeated separations at unstable and unpredictable living arrangements also impact a child's well-being. Evidence suggests placement instability influences a child's behavioral problems irrespective of their pre-existing attributes or problems following their removal. Adopted children's pre-placement adversity is often estimated using age at adoption as a proxy for pre-placement risk. Children who are older at the time of adoption are more likely to experience psychological and behavioral problems with children placed in their adoptive homes over the age of four being the most trouble. Older children placed for adoption are likely to have entered care at an older age to have accumulated more pre-placement risk factors including ACEs and are at greater risk for their adoptive placement breaking down termed a disruption. Although aged placement has been used to predict children's outcomes in recent work age at adoption is a sole indicator of pre-adoptive adversity is more problematic. Not only are associations with children's outcomes inconsistent but implicit in the use of age at adoption is the assumption of a linear relationship between time before placement and the magnitude of pre-placement adversity. As such, the influence of age at adoptive placement on children's psychological and behavioral outcomes must be examined in combination with other pre-placement risk factors. Children adopted from care are more likely to experience enduring mental health problems that persist in the years following their adoptive placement. Determining the risk factors for adoptees enduring mental health problems is vital to inform early interventionists to improve children's outcomes and for the prevention of adoptive family crisis and breakdown. Let me translate all this to spoken English. In the UK, because the study focuses on the UK although it does include an overview of studies in the United States I'm not quite sure there should be major differences. I'm not quite sure. Although the care system in the UK is different to the Child Protection Services in the US are very different and the procedures and methodologies are very different still I think the psychology should be the same but that is speculation. There's no data on this. Now, the study says that adopted children in the UK do experience enduring life-long mental health and behavioral problems and there is no improvement in mental health four years after they've been adopted. The adoptive parents' love and care and nurturance and holding doesn't help. It's insufficient. The mental health problems persist and actually get aggravated regardless of how good and wonderful and amazing the adoptive parents are. This is the impact of the family of origin and at an early age, prior to age 4 it's the mother. It's the mother. It's the mother, period. That's not only me. The greatest names in psychology keep insisting on this. Kept insisting on this. Now, the children's emotional and behavioral problems did increase. These problems have been correlated with a number of adverse childhood experiences they've had. Abuse, neglect, unstable living arrangements and so on. There's about 10, a list of 10 and if you have four or more you're prone to develop mental illness or some kind of mental health problem. So, the researchers in the study looked at the children's experiences before they were adopted. They wanted to find out if the children were maltreated. The numbers of number of times the children were moved from one home to another. How long they spent in each home, in care. And then they looked at the data on the children's psychological health after the adoption. And what they found is that adoption itself was not linked to an improvement in mental health. Was not. Adoptive parents and social workers must obtain biographical information about the child's life before the adoption. This is the critical phase. After age 4 or 6, it's too late. No amount of love can compensate. The destruction is there for life. That's what I keep saying when I describe the formation of Nazis. That's why the mother engenders Nazis. Not the father. U.S. studies found that adopted children are at a greater risk of experiencing emotional and behavioural problems than non-adopted children. Started there. This realization, this insight. And so, in the United Kingdom children who are taken into care are children who are taken into care are children who have been identified as abused children. Maltreated children. Traumatized children. Of course, these kind of children are more likely to have experienced adversity at an early stage of life. So what I'm trying to say is that the UK care system is a kind of filter. The children who end up in care in the United Kingdom are to start with children who have been exposed to abuse and trauma and therefore much more likely to develop mental health issues. So maybe the mental health issues have nothing to do with the adoption. They have to do with everything that has happened up to the adoption and prior to the adoption. But we don't know. There's a black hole, a lacuna. There's no information. The adoptee itself doesn't know. So children who are older by the time of adoption are more likely to experience psychological and behavioural problems which just goes to prove the point that your past with your mother of origin, with your biological mother is far more important than anything that happens to you later in life, including cataclysmic, dramatic events like adoption. Children over 4 are more troubled than children under 4. Under age 4. So the first few years are critical. There are multiple risk factors involved in the first few years that they all converge in the mother figure. She is in charge of traumatising the child or raising a healthy happy child in a way what she does determines her children's lives later. And so the only mitigating factor in all this was actually constant change when children were handed from one home to another. Children who had more home moves and time in care before adoption had fewer behavioural problems and I suggested that it has to do with habituation getting used to this, but this is not mental health it's a numbing response it's reduced effect display these children simply don't externalise what's happening inside them they act in not out that's all internally they're in tumult, they're in chaos they're falling apart they develop anxiety and depression and worse so you could compare it to the distinction between shy or quiet borderline and classical borderline where the shy and quiet borderline, she's not a diagnosis it's just a pattern of behaviour, but the shy and quiet borderline in most of the cases would not act out she would act in, she would have internal disruptive processes same with adoptees we need to know more if we are to help adopted children with troubles and problems in adulthood we need to find out the history of these children and so this should inform public policy every adoptee should have full access to all the information that preceded the adoption it's crucial to the mental health of the adoptee and to any therapist's ability to help the adoptee and all the systems the legal system, the care system they should realign they should transform themselves and put emphasis on full disclosure even I would say full disclosure at an early age earlier than age of majority this is the picture with adopted children it's not a nice one adoptionist is the list of two wrongs it's a bad solution but it's not as bad as remaining in foster care for the rest of your life or for the rest of your childhood or adolescence it's not as bad as being abandoned on the streets and engaging in prostitution drug abuse children whose family of origin is disruptive, dysfunctional broken apart whose mothers are absent or dead in the metaphorical sense or really dead these kind of children their options are limited they have a menu of traumas they can choose one trauma another but it's going to be traumatic it's going to be painful it's going to destroy the ability to attach and to love to function later in adulthood not for everyone there are always exceptions and with a lot of love and care and investment even in some cases adoptive parents can somehow maintain the mental health of the adoptee but unfortunately that's not the average case we need to reform and to revolutionize the idea of adoption to render it an alliance between the adoptive parents and the original parents an alliance a collaboration for the child's own sake today when a child is adopted he or she is cut off from the past from biological parents from his own personal history this is wrong this is what caused the trauma in adoptees throughout history we need to stop this we need to engage in open adoption with parents biological parents of origin hand over the child to another couple with that couple for the benefit and well-being of the child