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 place.

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. . . .