In this piece,
initially delivered as a 1983 lecture in the American Psychiatric
Association’s Distinguished Psychiatrists Series, Viola
Bernard repeated a theme she had discussed often during her
career. To work in the adoption field was to work in social psychiatry,
practiced in such a way as to bridge the gap between individual
needs, social institutions, and policies designed to influence the
lives of entire populations. Her term for this ambitious understanding
of mental health was “ecological.”
Adoption contains almost all the elements of social
psychiatry as I conceive it. It is a socially devised, rather then
biological, way of forming families. It involves courts, lawyers,
and—at least with agency adoptions—the child-welfare
field, along with consultants in medicine, clinical psychology,
child development, genetics, and psychiatry, both adult and child.
The central social reality of adoption is its power to prevent
misery and maldevelopment of children who lack families of their
own. It provides services for the interlocking needs of the so-called
adoption triangle—birth parents, adoptive parents, and adoptees.
Adoption has enabled infertile couples to experience parenthood
and family life; it has allowed birth parents who are unable or
unwilling to function as parents to get on with their own lives,
which for teenagers may mean schooling and employment as well as
future parenthood under better circumstances. But the children’s
needs are regarded as primary. Major strides have been made in expanding
the range of adoptable children to include older children and those
with various kinds of problems and/or disabilities. Practices that
discriminated against black and older minority children have undergone
extensive reform, and government subsidies now make adoption possible
for many children by parents who could not otherwise afford it.
Adoption today also illustrates how the lack of an ecological perspective
can turn reforms of the past into new sources of psychological harm.
More than simply a case of the pendulum swinging too far, this problem
is often a result of the failure to grasp the ramifications of a
psychosocial policy, or indeed, to fully understand it in the first
A case in point is the issue of permanency of a home of their own
for children. Many of us in child welfare and child psychiatry sought
to improve foster-care practices and to change policies and laws
that condemned children—some for most of their childhood years
and without periodic review—to a succession of foster homes.
Many of these children could and should have been freed for permanent
adoption, since their own parents had vanished or couldn’t
care for them properly. Today, “permanency” is the child-welfare
bureaucracy’s watchword, and foster care the villain. So now,
through the power of agency reimbursement policies, many children
are being returned from foster care to unsuitable parents, in the
name of permanency; others are being pushed into adoptions—often
without suitable psychological preparation, and whether or not such
placements are clinically indicated—because adoption offers
permanency. Unquestionably, the permanency of adoption
give it such potency for emotional health. But if the adoption is
ill-advised on the basis of differential diagnosis, or a child’s
readiness, for instance, its very permanence can lock a child, with
finality, into a pathogenic situation. What is missing is the essential
individualizing that would recognize that good foster care can be
the placement of choice for some children. . . .
I view such instances, and unhappily there are many, as misapplications
of psychiatry and psychoanalysis to social problems. . . .