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Understanding why adoptees are at higher risk for suicide

First PersonForefront First Person Personal stories about how suicide has affected our lives

Understanding why adoptees are at higher risk for suicide

By Maureen McCauley Evans, M.A.

Most people view adoption as a happy, even blessed, event. A child finds a new family: nothing but joy, right? Adoption can be happy, a blessing, joyful. For some adoptees, though, adoption is complex, and can be filled with as much loss as love.

According to the American Academy of Pediatrics, adoptees are four times more likely to attempt suicide than non-adoptees. It's here in Pediatrics. Even more startling is that the mean age of the 1000 participants was about 14. Out of the total group, which included adoptees and biological children, 56 had attempted suicide. Of those 56, 47 were adoptees.

Why are adoptees at such risk for suicide? Here are a few reasons.Maureen McCauley, MA, is an adoptive parent and has worked in the adoption field for many years.

Adoption is a trauma.

This is a hard idea to accept, perhaps, but let’s look at some facts. Much research acknowledges that separation from one's mother is trauma. Children separated from their mothers for whatever reasons, including for adoption, sometimes struggle with trust and attachment as a result of separation. Even children placed for adoption as infants can feel the impact of separation from their original mothers.

In the case where the separation is the result of neglect, abuse, or death, the trauma is intensified. Neglect and abuse are often the reasons children are placed for adoption. The American Academy of Pediatrics wrote a report called "Helping Foster and Adoptive Families Cope with Trauma." It’s a helpful guide, to be shared with pediatricians and other caregivers.

I’ve known many adoptive families where the parents love their children and the children love their parents—but still the children struggle with the fundamental losses connected with adoption. We are hardwired to need and depend on our mothers for survival. If there is an end to that basic relationship, children can suffer—even if they are infants, even if there is a new (loving, overjoyed) mother. So it's not only neglect or abuse that contribute to trauma, though please don't minimize those challenges.

Some adoptees struggle with the fact of having been placed for adoption and not kept by their original family. Some struggle with wanting to know who they are, and what their family stories are. Some are the only adoptee in their family, or the only person of color, and struggle with feelings of isolation and difference. In addition to being adopted, some adoptees have other differences—learning issues, gender identity, sexual preference, physical limitations—that are challenging within their families or within the larger community. Some adoptees struggle with “survivors’ guilt,” the mental condition that occurs when a person thinks they have done something wrong by surviving a traumatic event (abject poverty, abuse, war, famine, natural disaster), when others did not. Some adoptees feel guilty for wanting to know more about their origins. Some struggle with overcoming abuse that occurred prior to being adopted.

The grief and trauma may not emerge all at once, or at a particular time or age, or in an obvious way. Some adoptees may have minimal struggles. Some struggle for a lifetime. Being open to talking about the losses in adoption, as well as the joys, is vital.

Adoptees often don’t know their medical histories, which might include depression and other illnesses.

Many adoptees, adopted in the US or internationally, do not know their own medical histories. In the US, some seven states allow adopted persons to access their original birth certificates. A handful more allow partial or restricted access. This can mean that adoptees have extremely limited access to their medical histories, so that neither they nor their adoptive parents have a full picture of their genetic and/or inherited conditions. International adoptees often have no medical histories available to them as well.

Access to one's medical and mental health history—too often denied to adopted persons—could be a matter of life and death. Knowing about a history of depression or other mental illnesses in one's family could mean proactive treatment and interventions.

Increasing numbers of adoptees are locating birth/first families through Internet and other searches. Many are using DNA testing. While those can be positive developments to finding out if depression or other conditions are present, sometimes that information is unavailable or comes too late. As a community, we need to insist that adoptees have full and accurate information about their own histories.

Adoptees don’t want to upset their adoptive parents with concerns about depression or what could be seen as ingratitude.

Adoptees are often expected to be happy and grateful. That can be a heavy burden at times. They don’t want to seem ungrateful, though the issue of gratitude in adoption is complex. When adoptees experience depression, especially related to adoption, they can be reluctant to tell their adoptive parents. They can act out in many ways, and often all this occurs during the “normal” turbulence of adolescence. Some of the acting out can be the result of known or unknown trauma, or of unexpressed depression.

As an adoptive parent, I believe that adoption is all about gains and losses, joy and grief, a balance that shifts often throughout life. I also believe if we took a deep breath and viewed adoption as trauma—trauma that can be acknowledged and treated, trauma that some people may experience to a small or large degree—we would be better able to help adopted children heal and grow healthy, sooner than later.

Some adoptees heal just fine from the trauma of separation. Some struggle with trust issues throughout their lives, and have a hard time beginning or ending relationships. Some are challenged with depression, anxiety, and more. I want to stress this point: there is a spectrum of resilience among adopted people. The spectrum does not negate the need for awareness of suicide prevention. Adoptive families need to be aware of the potential difficulties, to be open to thoughtful communication, and to obtain effective, timely services.

I’ve focused here on adoptees, and I want to acknowledge first/birth parents in these struggles as well. Trauma and mental illness are often (not always) challenges for them, and they deserve attention and services as well. Recognizing that adoption is a trauma, understanding that trauma manifests differently in different people and over time, and allocating resources for treatment and support: that would be a positive step toward healing.

Maureen McCauley Evans is a writer, editor, and artist living in Seattle. She worked in the field of adoption for many years, including as executive director for the Joint Council on International Children’s Services and for two adoption agencies. She is the parent through adoption of four now young adults. She has presented dozens of adoption-related workshops in the US and Canada, blogs at LightOfDayStories.com, and is co-editor of an upcoming anthology by Ethiopian adoptees.

How has suicide affected you or your family? If you have a First Person story to tell, please send your essay to ffront@uw.edu. (Your essay should be limited to about 800 words.)