Medical and Social Models of Orphanhood: Resilience of Adopted Children and Adoptive Families

Alexander V. Makhnach - The Routledge International Handbook of Psychosocial Resilience

This article studies different medical and psychological models of orphanhood and the effects these models have on the resiliency of orphanhood.

According to the article, there are three-types of orphanhood discourses:

The discourse of social danger; the discourse of social justification; and the discourse of social integration.  The first two are considered are considered medical models, while the last one is considered a social model.   According to this article the medical model dominates the world of science, where focus is on diagnosis and treatment instead of prevention.  The medical model is highly influential, but the article states that this model can distort reality, as it focuses mostly on data and observations.  This article points out that the medical model boosts a person’s negative self-perception.

The discourse of social danger is someone who is excluded from society as a potential criminal element.  This is the discourse generally seen in mental institutions, prisons, or orphanages.  The discourse of social self-justification is about finding culprits, generally the “troubled” family is seen as guilty.    Social integration considers the child as a dynamic developing personality that has its problems solved through the cooperation of social institutions, public organizations, etc. 

Through social models, a person has more personal control over outcomes.  Live a fuller life, be more resilient.  Social activity leads to social change through this or that group.  This model is aimed toward living a healthy lifestyle.  The article points to a study by M. Bleuer that observed 184 children with schizophrenic parents.  The study reviewed the resilience of family members and found that most children were able to lead a “normal” life, and that only 10% of children were diagnosed as schizophrenic.  Bleuer dissuades participants from following expected script, and in doing so, the children were able to deviate from negative patterns and expectations.

The article proposes that children in orphanages have lives based on a medical model. The article noted a study out of a Russian orphanage wherein the medical model caused orphans to depend on the orphanage more and more as time passed.  This model focused on illness and boosted labeling.  The orphans tended to identify with those in the orphanage and these identities tended to duplicate orphanage life when they no longer lived in the orphanages.  This often meant becoming part of a criminal element or victimization pattern.

Under the social model, teenage orphans with emotional and behavioral problems have their inner locus of control associated with social adaptation and resilience but only in case of their positive attitudes toward oneself and others.    Only in this case can they feel at ease and confidence and can admit responsibility for what is going on.  They long for achievements and dominance.

Losing relations with habitual environment and establishing relations with others shows the potential resilience.  However, the orphanage system does not encourage independent attitudes.  Research showed the successful family placement depends on the individual resilience of adoptive parents.  Therefore, it is important to make sure families have appropriate support to encourage social models.