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Singing the post-adoption blues By Limor Gal / Illustration by Ruth Gvili "The first time I stayed alone with her, after a month when there had been people in the house all the time, I suddenly understood that this was not a doll that you put on the shelf and then go to sleep. It's a little girl, she's mine, and I have to take care of her. Suddenly I understood that it was a lifetime responsibility, and I wasn't prepared for it. These were the first signs of the shock and the depression that followed." This description by a new mother about her first days alone with her infant daughter does not sound surprising. The depression some women encounter after birth, as a result of pressure, regret and anxiety, is no longer a secret. But this mother did not give birth to the infant - she adopted her when she was a month old. Although she wanted the child very much, and invested resources and much effort to get her, during the initial period she experienced feelings reminiscent of postpartum depression. Advertisement It started in Brazil about 20 years ago. "They showed her to me completely wrapped up, so that I wouldn't see how dark she was," she says. "But that made no difference to me, I fell in love with her immediately. I simply went crazy with excitement. The euphoria lasted for a month, and then ended. Adoption is something you plan, but still I wasn't prepared. I didn't know what was happening to me. After the adoption I divorced my husband, and as a single parent even the basic difficulties were greater. I found myself sitting depressed, listless, fearful, anxious and with a huge lump in my chest. The tears flowed and I thought to myself, what did I need this for? What was I lacking before? Today, when I know dozens of adoptive mothers, I know that many of them ask themselves this question. This is a stage for which you have to be prepared, but there's little awareness of it." "Post-adoption depression" is not an official, scientifically recognized phenomenon per se, but in the United States it has in recent years become relatively common among women who adopt children, experience distress and define their situation that way. The term can be found on a large number of Internet sites, forums and blogs dealing with adoption. "The phenomenon is at a stage where postpartum depression was in the in the past," says child and youth psychiatrist Dr. Miri Keren, director of the department for infants at the Geha Psychiatric Hospital in Petah Tikva. "There is almost no research information about it; in effect it is not yet really defined, and there is little awareness of its existence." In one of the few studies conducted on the subject in Israel, it turned out that women who adopt may experience a period of depression at some point. The study was conducted about five years ago by Prof. Rachel Levy-Shiff of the department of psychology at Bar-Ilan University, and was published in the English-language periodical Child Development. Levy-Shiff followed the transition to parenthood of 100 adoptive couples, and compared it to the transition to parenthood for biological parents. The participants were interviewed before the adoption, during the pregnancy, about three months after the adoption or the birth, a year later and three years later, and were observed interacting with their children. According to the study, depression is common among about 5 percent of the adoptive mothers (as compared to about 15 percent of biological mothers), but none of them reached the level of psychotic depression that is liable to affect biological mothers. As opposed to biological fathers, who occasionally reported difficulties and depression, no depression was found among adoptive fathers. In Israeli adoption forums on Tapuz and Ynet, the phenomenon is occasionally discussed. "Imagine that you recently came back with your cute baby, everyone around you is euphoric, but you want to cry all the time and the baby makes you angry," wrote one Internet surfer. "You are in effect undergoing postpartum depression, but you have nobody to share it with." "After the festivities, when we returned home, I felt like a balloon with the air taken out of it," wrote another. "I was angry at myself. I didn't understand how, after everything we went through, everything was suddenly so hard for me." "It happened to me, too," one woman confessed on a Hebrew site. "During the first days I was swamped with visitors and afterward suddenly everything became quiet ... The little creature who had suddenly landed in my life and my bed slept one-hour-on, one-hour-off at night, I was exhausted physically and emotionally ... Everyone around me, of course, expects me to be in seventh heaven with my new motherhood. Nu, really!" One woman posted a message in order to consult about her sister-in-law. "Yesterday she blew up at my brother," said the writer, "and said that she doesn't love the child and doesn't want to take care of her, and that they shouldn't have adopted her." Psychiatrist Keren says it is possible that, like women who have given birth, adoptive mothers also experience hormonal changes related to the onset of depression, and that the unique situation of adoption may be responsible for this in some cases. Not all her colleagues agree with her. "The adoption process is fraught with difficulties, there's no question about that," says Dr. Yehuda Senecky of the Child Development and Rehabilitation Institute at the Schneider Children's Medical Center in Petah Tikva, who accompanies many families in the adoption process. "But a study I conducted recently indicated that women do not experience depression after adoption at all." The research he refers to was conducted as part of the master's thesis of Hanoch Agassi in the Bar-Ilan psychology department, and in addition to Senecky, Prof. Alan Apter, director of the Department of Child and Adolescent Psychology at Schneider, also took part in it. The study examined several dozen women chosen at random from an adoption agency list. The women were interviewed before the adoption and two months afterward, with questionnaires typically used to examine personality traits and anxiety levels. The findings showed that after adoption women feel relief at the fact that the process had ended; in women who demonstrated symptoms of depression in the period preceding the adoption, these signs decreased significantly after completion of the process. "I can't criticize the study because I haven't seen it," says Dr. Keren. "From my experience, it definitely seems that the phenomenon exists. I really don't know how common and how acute it is." A huge investment A psychologist who works in the field says the number of subjects questioned during the study - several dozen - was too small to substantiate the findings, while the timing of the second interview, two months after the adoption, may have been too early for assessing the effects of the process, since negative feelings can arise later on. She also claims that women who adopt are even more afraid than biological mothers to admit to psychological problems, certainly such a short time after receiving the child. Adoption can cause a lot of pressure and thus can trigger depression, says Dr. Miki Bloch, a psychiatrist in charge of the adult psychiatric outpatient clinic at the Tel Aviv Sourasky Medical Center. "There are also depressive reactions to adoption, but I believe that these are difficulties in adapting," he explains. "From here it's a long way to creating a name for a new syndrome. In my opinion it's a little exaggerated. It's a little like talking about a house-moving syndrome, or a reserve duty call-up syndrome." Ostensibly, the adoption process should culminate in pure joy. People who want to adopt a child are required to invest a great deal of time, and financial and emotional resources, and to undergo rigorous suitability tests, interviews and interrogation. This great investment arouses anticipation among the adoptive parents and those around them, that the journey will end with the exciting fulfillment of the dream. In most cases, apparently, that really does happen. According to the study by Levy-Shiff, adoptive parents reported more positive feelings, happiness and satisfaction with parenthood than did biological parents. The longer the adoptive couples waited for adoption and the greater their sense of having been deprived of a child, the greater their satisfaction is after receiving one. Levy-Shiff: "When the strong desire to be parents is fulfilled after a long period of feeling deprived, the joy and the satisfaction are tremendous. Often adoptive parents take things in stride. They complain less about having to get up at night - everything is less taken for granted." But sometimes it turns out that not everything is rosy, at least not at first. In such cases the extreme gap between the high expectations and the difficult reality coupled with the unexpected feelings it arouses, add feelings of guilt and shame to this complex package. "You choose adoption, and you choose a child, so why be sad all of a sudden?" asks Dr. Galit Lazar, a family therapist from Izunim, a center for alternative medicine, who treats adoptive families, among others. "Presumably there are no hormones here that can be blamed, so how can you explain the depression? The regret? The anxiety? You received a child, you should be happy. There's no room for other emotions, and certainly not negative ones." The roots of these emotions apparently are found in the period before the final decision to adopt is made. As opposed to an ordinary pregnancy, which lasts nine months, a "pregnancy" of adoption begins in most cases after years of fertility treatment, which are often accompanied by a pregnancy that ends in a miscarriage and the loss of the fetus, and ultimately accepting the need to give up the dream of a biological child. "And thus," notes Lazar, "the basic starting point of the entire process comes from a situation of being an exception: Why does everyone succeed and only I fail?" The adoption process is not short, nor is it an easy experience to endure. The waiting list for adoption in Israel is long, and the candidates do not know when they will receive the hoped-for notification. Adopting a child from abroad, which many people choose to do, is a very expensive process that involves countries with a great deal of unfamiliar red tape. "During part of the process additional fears arise," says N., who adopted two children from abroad about two years ago. "You're stuck in a distant country where they speak a foreign language, you don't understand what's happening around you and you have no idea when it will end. You're in a situation of uncertainty, anxiety and pressure." Both in fertility treatments and in the adoption process there's a great deal of activity: tests, travel, transitions between panic and euphoria. When the child arrives everything presumably calms down. "The transition is very sharp," says Lazar. "There's no gradually progressing pregnancy. One day there's a child and that's that." In single-parent families, says one woman with experience, there are many more basic difficulties. "First of all, you're alone. In addition, you're usually relatively old. Your life is already fixed and you have your habits. It isn't easy to suddenly get used to life centered around diapers and bottles. I adopted a baby when I was 43. I already had a full life. Suddenly I couldn't sit in cafes, go out, have a good time. My life changed, and I really wasn't prepared for it in advance. I assume that there are women who feel only happiness during this period. It depressed me. At the time I was pretty much alone with these feelings. Now I know there are many women like me." 'How will I cope?' After giving birth to four children D., 45, discovered that for medical reasons she could not give birth any more and began local adoption proceedings. Eight years ago she adopted a two-year-old girl. "I come from the field of caregiving," she explains. "I did a pre-adoption workshop at the Child Welfare Services and I was sure that it was no big deal for me. But from the first day I was already in shock. We went to pick her up, and we returned home with a new child in the car. It's an upsetting experience, although I chose it. I arrived home and told myself, Oh God, what have I done? How did I dare to do such a thing? It's something gigantic, it's something huge. How will I cope? How will the family cope? "And in fact, life turned upside down. I went on maternity leave, and to my amazement, I sat in the house for hours crying. I didn't expect that and I didn't understand what was happening to me. After all, I wanted the child. The idea was mainly mine, although my husband supported me, so what was happening now? After my births I also suffered from depression at various levels, but I knew that that had been connected to hormones. With adoption there aren't supposed to be hormones." Today D. is convinced that the depression she experienced is related to social expectations that were not automatically fulfilled: "There's an idea that everything has to be ideal and wonderful, that you're supposed to love the child immediately. But that's not how it is. It takes time. Moreover, you get a strange child, and you're supposed to get to know him. The pressure is tremendous, even more than with a biological child. I kept thinking that if something went wrong they would take the child away from me. They would say I'm a bad mother." One of her sons, who was three at the time, pushed the child out of bed one day. In the hospital they found a fracture in her collarbone. "I was sure they would think that we beat the child," recalls D. "It's impossible to describe the pressure and anxiety I felt. It could happen with a biological child, too, but as an adoptive parent your parenthood is always being examined by everyone around you. When I bathed her she used to scream. It took about two weeks until she calmed down. For those two weeks I was under tremendous pressure. What did the neighbors think? I kept feeling as though I was being stared at by eyes that were examining how I treated this poor adopted child, whether I love her. As though I had to prove that I'm a good mother." Eva Arbel, a family therapist who specializes in treating adoptive families, explains that after adoption, many mothers feel that they are being closely scrutinized by society, international adoption agencies and the Child Welfare Services. "For most of them this is their first parenting experience," Arbel says, "and often they have doubts as to whether they're doing the right thing with the child. Many of them lose their self-confidence. The result? They are more pressured when caring for their children, and are liable to experience serious mood swings, to the point of blues and depression." Levy-Shiff says that there are mothers who are afraid to report depression immediately following the adoption, because they are undergoing a trial period of about half a year. Keren points out another problem: "The adopted children come after staying in various facilities, and some have difficulty forming the initial connection with the adoptive parents in a smooth and natural manner." According to Levy-Shiff's study, the older the adopted child, the more difficulties the mothers had bonding with him or her. On the other hand, the longer the wait for the child, the greater the satisfaction and the joy. "There are situations in which parents feel that they aren't falling in love with the child quickly and easily, and this arouses difficult emotions in them," says Arbel, who in about two months will be publishing her book: "Adoption: Journey to New Parenthood" (in Hebrew), which she wrote with Dr. Gary Diamond of the Department of Child Development and Rehabilitation at Schneider. "There are children who shrink from contact, there are children who reach out and hug, but don't really accept the adoptive parent. And the parents sense that. After all the tribulations involved in adopting a child, that is liable to be the last straw. Parents can sense that they have failed in the attempt to bring a biological child into the world, and now they have failed again in the attempt to be adoptive parents. This explanation is difficult and overwhelming, and it is not easy to accept. Often the parents try to ignore the situation or to repress it, and channeling energy into that place is also liable to cause depression." "After all the efforts," N. explains, "you come home and discover the most terrible thing of all: Love is not always enough. A one-year-old baby is not a newborn - he has already undergone something, and he can't always contain all the love that the adoptive parents were waiting so long to shower him with. So it can happen that the child sees you and tries to run away. It's very hard." D. also testifies to a similar experience. "The feeling is as though you are trying to fill a glass, and the glass is never filled," she says. "I tried very hard, but it was difficult for the child to receive anything. I received a child in deep shock. She didn't talk, she didn't cry. I started to be afraid that I wouldn't be able to love her. I heard other mothers who described how they fell in love with the adopted child and heard angels singing. It didn't happen to me. Today I'm crazy about my daughter. She's amazing, smart, an athlete, terrific. But the beginning was hard. It was frightening." Competing messages In many cases adopted children require various treatments that involve substantial expense. "When this situation exists on the backdrop of untreated depression," says N., "the most tolerant and most balanced family looks at the ruins of its life and says, God, what's happened to us? I hear that a lot." N., who suffered from post-adoption depression, identified what was happening to her, went to a doctor and received medication. "I happened to understand what was happening to me," she explains. "Without any connection to the adoption, I'm a person who reads a lot and stays abreast of things. But awareness of the possibility of post-adoption depression is nonexistent. And that's a shame. One can avoid these difficult situations and they can be treated if they do occur - first of all for the children. These children need strong and kind parents." "I think that advance knowledge would have helped me a lot," wrote a participant in an Israeli adoption forum. "Mothers who give birth receive guidance from various sources while they are still pregnant, and for us it's more like falling into motherhood. Some women manage with that, but certainly not everyone." Another wrote: "In two adoptions I did not experience only positive emotions, and in spite of the waiting and the excitement not everything went smoothly. I think that what made the situation worse was the message conveyed by everyone that 'now everything is great,' juxtaposed with that same message from myself to myself ... It's important to talk about it, especially in order to pave the way to openness on the subject for the next group of women." Yet another woman revealed: "After all the waiting and all the effort I suddenly had my own child, and I definitely thought 'What did I need this for?' It was hard for me, he cried all the time and didn't eat, I was stuck with him alone ... You enter a cycle of self-accusation, of [thinking] how is it possible that I'm not happy after waiting so long for a child? Maybe there's something wrong with me. And then the child senses your feelings and his behavior becomes more extreme ... I'm sure that there are others who haven't 'come out of the closet' and don't admit that they experienced adoption depression, because the [outside] environment expects us to be happy." On the other hand, there are mothers who have adopted, did not experience difficulties and have trouble understanding them - to the point of denying their existence. "There is no post-adoption depression," a participant in the Tapuz forum declared unequivocally. "I had it only beforehand. It doesn't seem real to me, friends ... Just to look at these little ones ... How can you become depressed by such darling children?" Such responses do not encourage women who have difficulty acknowledging it, exposing it and asking for help. During the past three years the infant unit headed by Dr. Keren has been examining the effect of professional guidance on adoptive families, from the beginning of the process until one year after the adoption, to find out whether these parents need such assistance. Keren says she has come across adoptive mothers who suffered from various levels of depression. Sometimes the women reported it themselves, sometimes the therapists identified the problem. "There is not enough awareness of the possibility of suffering, on some level, from post-adoption depression," says Keren, "and that is one of the reasons why we believe that adoptive parents need professional guidance and preparation." Proper treatment of depression in the parents, she notes, is likely to reduce the number of adopted children whose development will be harmed because of difficulties in the initial bonding with the adoptive parents. Eva Arbel says it also has to be understood that adoption is not ordinary parenthood. "It's impossible to receive an adopted child and to carry on as though it was a natural birth," she observes. "It's not better or worse parenthood, but it's different, and it requires dealing with questions, thoughts and emotions that do not exist in natural parenthood."W Bookmark to del.icio.us   Scuba SMS Ultrasonic sound wave technology revolutionizes underwater communication. 'Hip-hop violinist' Israeli violinist participates in New York event, celebrating Israel's 60th anniversary.

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