Adopting As a Child Psychiatrist: Lessons Learned

Over 100,000 children are adopted each year in the United States.

Over 100,000 children are adopted each year in the United States.

As a child and adolescent psychiatrist, I see children ages 2-18, adults with developmental disabilities, and specialize in the areas of trauma, neurodiversity, foster care and adoption. Finally, I am also an adoptive mother and used to be a foster mother. As an “expert” on adoption, trauma, and developmental disabilities, what advice do I have for adoptive or pre-adoptive parents? Listen to adoptees. As an adoptive mom to special needs children has prepared me in multiple ways. My medical training as a child psychiatrist has no doubt helped me in this journey. My own experiences as the daughter of an adoptee and as someone who is neurodiverse herself have helped me in this journey. However, the best thing I have ever done was listen. Through listening to adoptees and former foster youth, I come away with four significant opinions of adoption.

  1. Adoption, the majority of the time, is unnecessary.

  2. Even when it is essential, adoption always begins with trauma.

  3. Adoptive and foster parents are not equipped to be trauma-informed parents.

  4. Our children are not given adequate tools to navigate their feelings.

On this journey, I have come to understand the systemic issues that lead to a lot of needless adoptions (not exactly what people want to hear, but true). The fact is, that trauma begets trauma and that most foster care related adoptions are due to neglect (not abuse) and infant adoptions are due to lack of resources (not lack of wanting to be a parent). There are, of course, some cases where physical or sexual abuse leads to necessary removal or parents do not want to parent (regardless of resources or societal interventions), but those cases are a much smaller number than we are led to believe. Therefore, many adoptions are a result of a fundamental failure of society to take care of its’ people in treating their mental health and providing support. Becoming an adoptive and foster parent has opened my eyes to just how pervasive our systemic failures genuinely are. We know how to fix this. We have the research. We, as a society, must be willing to invest in children and families. However, this is a point that we, as a society, have not yet reached.

Adoption always begins with loss or trauma, oftentimes both. As adoptive parents, it is our childrens’ best interests to acknowledge this and hold space for this fact, even in infant adoptions. There is the loss of a mother they bonded to for nine months and even more so the loss of a family they are now legally no longer a part of. When we understand this fact, we will be able to serve our children so much better. We are not offended by the thought of open adoptions or the notion that the children will want to explore that loss, which can happen in multiple ways.

The amount of training that I had as a foster parent for trauma-informed parenting is laughable. The training I had was not necessarily useless; it was just extremely superficial. Foster and adoptive parents need to be taught the importance of the first family, the importance of being honest and open with your kids, the benefits of open adoptions and finally, how to parent in a trauma-informed manner. I learned some trauma-informed practices as a child psychiatrist, but even that was inadequate. A lot of this I have discovered myself through research and again listening to adoptees. Connected parenting and trauma-informed parenting is sorely lacking and is beneficial for all children, but especially for adopted children.

Our children are not given adequate tools to navigate their feelings about having two families, of being adopted and of transracial adoptions. They certainly are not taught how to manage their feelings around any history of trauma. Many therapists and psychiatrists are not trauma-informed or do not understand the nuances of adoptions. Lots of things are explained away as attachment issues that are trauma and need to be treated as such. A lot of adoptive parents are not aware or able to separate their feelings about adoption and allow themselves to be a safe space for their children.

We need to approach adoption with the understanding that: we need to do a better job of keeping families together, we need to listen to adult adoptees without defensiveness, we need to understand trauma and we need to allow our children the space to grieve what they have lost and work through their complicated feelings. When we utilize that approach, we can make the best of what is a less than ideal situation. If you are interested in becoming an adoptive parent, my recommendation is to join groups that are adoptee-centered. Follow adoptee activist. Listen, learn, honestly evaluate your reasoning and invest in learning about trauma. This list forms the building blocks to becoming a suitable adoptive parent.

Psychiatrist Shares Her First Day in Prison

Psychiatrist Shares Her First Day in Prison

“Ma’am, we can’t let you in!” These words rang like a loud tocsin as I was told that I had worn a forbidden color, a chambray blue denim ensemble. On my first day at work at the correctional facility, I quickly learned that orange and neon green were also among the many prohibited colors of clothing. Contraband included personal cell phones, earbuds, smart watches, an extra pair of shoes and anything made of glass and personal decorations for my cubicle. While I always knew that practicing psychiatry was never going to be boring, this took the novelty to an unexpected level.

Humanity in Medicine: Relic or Right?

It was about two weeks ago, February 12, 2019 to be exact, when Neurology (the official journal of the American Academy of Neurology) published an article that caused what some would call a stir. This also happened to be the week that Valentine's Day fell on. Like so many other holidays usurped by corporations, Valentine's Day is often forcibly thrust upon us, even in academic circles. So it is unsurprising that many among us may have expected our inboxes and notifications to be filled with lighthearted content to this end, for example an editorial filled to the brim with cardiology puns. Or maybe an article about the chemical and neurologic changes that occur when a person falls in love. Predictable and light-hearted, but appropriate. What none of us were expecting, save for the individuals who wrote, edited and published the piece, was the dizzying reminder of the racist history, misogynistic  leanings, and toxic superficiality, that still plagues many of our “trusted” institutions.

The Most Important Questions To Ask About Psychotherapy

The Most Important Questions To Ask About Psychotherapy

Most physicians work in settings where psychotherapy is outsourced to other caregivers, leaving them to wonder exactly what transpires during therapy time.

In this post, I will share some thoughts about the role of psychotherapy in modern clinical practice and some questions that we should consider when third-party therapy is part of the picture.

Drowning in Shallow Waters: A Star is Born Shines a Light on Co-Dependency and Substance Abuse

Due to its pervasiveness, the leaching landscape of substance abuse provides fertile ground to cultivate the dangerous seeds of co-dependency.  As professionals who chose to dive headfirst into all makes of dysfunction, psychiatrists and other mental health professionals likely encounter this behavioral and emotional phenomenon often. It may present itself as the overly avoidant patient who’s loved ones enable their misanthropic tendencies. Or perhaps you have enough self-awareness to recognize the patterns of co-dependency in your own life? Unfortunately, if we look at one particular subset of the population, it is obvious that the number of people who find themselves in such a dyad, far surpasses the number of mental health professionals there will ever be at one time.  According to the WHO, some 31 million people suffer from some form of substance abuse. Of that 31 million, it is estimated that about 4 million of them suffer from alcohol use disorder. 

Resident Corner: A Day In the Life

Resident Corner: A Day In the Life

As a third-year psychiatry resident in at SUNY Downstate, a university hospital in East Flatbush, Brooklyn, most of my training time is spent working at Kings County Hospital (KCH), a large community hospital across the street from Downstate, serving one of the poorest neighborhoods in this rapidly gentrifying borough of New York City. I am confident that all of you must have either read or heard of “physician burnout.” Maslach and Jackson define it as “a syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment that can occur among individuals who work with people in some capacity.” In health care settings, resident clinicians are known to be its most frequently affected victims and literature suggests highest prevalence in the surgical specialties. Although psychiatry is considered by many an “easy and relaxed” specialty, psychiatric trainees and other mental health staff are not immune to burnout. The assumption that mental health professionals can utilize their skills to handle and ‘cope’ with their problems is as wrong as thinking that oncologists have a lower risk of cancer.

The One Medication Every Psychiatrist Needs to Know About

The One Medication Every Psychiatrist Needs to Know About

Getting to know metformin is one way child and adolescent psychiatrists can be more prepared to address metabolic side effects of atypical antipsychotic medications.  

Metformin (Trade names: Glucophage, Glucophage XR, Glumetza, Fortamet, Riomet)

Metformin is first-line treatment for overweight patients with Type II diabetes and is FDA approved for diabetic children age 10 and older. Metformin improves sensitivity to insulin and limits the production of glucose in the liver. Typical pediatric dosing of metformin starts at 500 mg per day for the first week with increases to a maximum dose of 1000 mg twice a day. Modest weight loss can occur in overweight youth at risk for diabetes (Park MH et al Diabetes Care 2009;32:1743-1745). Typical side effects of metformin include nausea, vomiting, gas, bloating, diarrhea, and loss of appetite.  

One Psychiatrist’s Take on Managing Tardive Dyskinesia

One Psychiatrist’s Take on Managing Tardive Dyskinesia

I routinely order ECGs, check weights, and draw labs to assess metabolic status for my patients taking second generation antipsychotics (SGAs). Before 2017, I didn’t rigorously screen for tardive dyskinesia (TD). Effectively this meant I didn’t care about it. In my private practice, I hadn’t noticed anyone with obvious TD symptoms, and no one had complained of involuntary movements, so I assumed that TD was a “solved problem”.

The Sleep Disorder You Might Be Missing

The Sleep Disorder You Might Be Missing

Every living creature, from deep sea fishes to microscopic single-celled terrestrial organisms, has an innate biological clock. For us surface dwellers, our rhythms undulate to the beat of the earth’s dark and light cycles. Light is the most powerful zeitgeber, or time giver, that regulates the internal clock. In this era of breaking news and binge watching, we are bombarded with constant exposure to artificial light, resulting in disruption of our natural body rhythms. Disturbances in the circadian rhythm can result in metabolic diseases, obesity, cancer, and mental health disorders. Despite the growing appreciation of chronobiology, circadian disorders are frequently missed in clinical practice.

Using Mindfulness to Heal Ourselves

Using Mindfulness to Heal Ourselves

We spend so much of our lives planning for the future or replaying the past that we miss the only moment we ever have, the present moment. It’s never the past or the future, those are just thoughts in our head; it’s only ever right now. The present moment is the only moment we can ever truly experience real joy or connect deeply with others.