Dr. Francine Cournos: On Loss, Foster Care, and Resilience
By
Al Desetta
By the time she was 11 years old, Francine Cournos was an orphan. Her father died when she was 3, and her mother passed away from breast cancer eight years later. Although her aunts and uncles had the capacity to take her into their homes, they did not, one uncle telling her they didn’t have enough beds. “For Uncle Milton, it was a question of furniture,” Cournos wrote in her acclaimed memoir City of One. “He, just like our other aunts and uncles, would go to his grave without ever acknowledging—I think not even to himself—that he had abandoned us.”
Originally from the Bronx, Cournos went into a foster home on Long Island, where she spent the years 1958-1964. In City of One, Cournos recounts her difficult journey to forge a healthy identity after her profound sense of loss and abandonment. Displaying great fortitude and resilience, she went on to become a psychiatrist and is currently Professor of Clinical Psychiatry at Columbia University, where she teaches, conducts research, and runs a mental health program.
I spoke with Dr. Cournos about her experiences as a foster child, the psychological impacts of childhood trauma, and how foster care could better meet the needs of youth. During the interview, I drew on my experience as former editor of Represent, a national magazine written by foster youth, and having grown up with a mentally ill sibling.
Al Desetta: I know from reading your memoir, City of One, that your biological family wasn’t really there for you—in particular, your aunts and uncles. Do you think more could have been done while you were in care, to create a better connection between you and your relatives? Or was that something that was beyond repair?
Francine Cournos: My family seemed to have the capacity to take us in, and chose not to. This made me very angry with them and I really didn’t have much desire to see them. So, I don’t think I would have been receptive. You know how it is with foster kids. There are a lot of things that adults think might be good for them, but they reject them. So as far as I was concerned, what little visitation I had with [my family] was unpleasant and I didn’t like it. In fact, what little contact I had I felt was mandatory and I would just as soon have skipped it. It wasn’t mandatory in that I could have refused, but I was expected to do it. And I went, and I was there without being there.
My brother was another matter. I didn’t have the most wonderful relationship with my brother, but it was very strange, growing up with someone, and then I saw him, I think only once, the entire time I was in foster care. So I think that might be in a different category. I think it’s tough on siblings who get separated and then never get to see one another.
Al Desetta: That’s very interesting when you say that what adults think is good for a child, the child very often rejects. Adults assume the child wants X or Y, but that’s not always the case. Were there other instances, while you were in care, when adults assumed things that weren’t true in terms of what you wanted?
Francine Cournos: I think one of things that I felt, that I think a lot of other foster kids feel, is that no one really understands your subjective state of mind, so that a lot of things are done to you. Nor do I think that I or most foster kids are very good at communicating our states of mind. It’s not as if I was busy saying, ‘I don’t like this or I don’t like that.’ I was pretty withdrawn. It’s a feeling that things are being done to you, that other people think are important to do as part of a system, but that aren’t making very much sense, or that you don’t really want, or you don’t see why you have to have them, or you interpret them in the wrong way. I don’t think the kids are necessarily much in sync with what others are trying to do for them or trying to get them to do. I would guess that’s a pretty common experience.
Al Desetta: I think it is. I did hear that often from the young people in care I worked with. As you said, a young person’s inability to articulate his or her emotional state is a very profound part of it.
Francine Cournos: It doesn’t make for a very good situation. You don’t have the words to explain your situation, you don’t trust adults anyway, you don’t think that telling them would do a lot of good, and so you frequently act in a passive or passive-aggressive way, or even in an aggressive way. As a child, you don’t have the same vocabulary as an adult. It’s very hard to say what you really feel about something.
Al Desetta: This is an issue I relate to a lot personally, having grown up with a mentally ill sibling. You don’t really have the language to describe what is going on in your life. And a lot of the kids don’t want to go to therapy, for various reasons. They feel judged in therapy and some of the therapists aren’t very good. What do you think could be done to help them deal with their feelings?
Francine Cournos: It’s best to think that the therapists are actually the foster parents. It’s one thing if you have a specific mental illness that needs treatment. But having run of the mill distress about being in foster care, and behaving badly or being withdrawn, the most important thing is whether the foster child can make a connection to the foster parent, who they’re forced to be with all the time. The therapist you can refuse to go to. The foster parent you’re stuck with. And so I think helping the kids means helping the foster parent help the kids, not by creating an artificial situation where they’re supposed to go off and explain what they’re miserable about to some other party who is disconnected from everything else that is going on with them.
Al Desetta: Do you see specific ways that foster parents could be trained to do that?
Francine Cournos: I think some foster agencies are trying to do it. I think it’s very important, especially in the initial phase of a placement, to prepare the foster parents for who the kid really is, rather than sell the kid as this wonderful eight-year-old who seems very sweet, and who then gives the foster parent hell. I don’t think it’s good to oversell kids. I think it’s more realistic to offer help right at the outset, because a lot of foster care placements fall apart early on. So that as soon as a foster parent takes in a child, in that initial placement period when I think things can go right or wrong very quickly, there’s someone involved with the foster parent, helping the foster parent understand what the child is doing, making sense of it, and helping them formulate some response to it.
So, for example, in my own situation, which I wrote about, I think if my foster mother had known it was normal for me to be angry or to feel disloyal by calling her my mother, that might have helped her a lot. She needed a little grounding in what it’s like to take in a teenage kid.
Al Desetta: I thought you captured very well in City of One how you and your foster mother were talking past each other. She expected you to be close to her, and you wanted something else. She didn’t expect your reaction.
Francine Cournos: And then there are some foster parents who are very clever. I remember one foster parent telling me that in the beginning she was very confused and disappointed, because she wanted so much to love these kids and take them into her home. She felt she prepared such a wonderful place for them to come to, but they’d be furious when they got there. She said, “Eventually, what I came to understand, is that’s where the relationship begins. First they’re angry at me for everything they’ve lost, but once I got that, it was much easier for me.” The adult has a better chance than the kid to be grounded in what’s realistic to expect.
Al Desetta: And so that training for the foster parent could take the form of a social worker or a very experienced foster parent serving as a coach, who comes in and helps you deal with things?
Francine Cournos: Right. Or a peer group of foster parents, maybe with a facilitator talking about what foster kids could be like when they first arrive and strategies for dealing with it.
Al Desetta: Do you think agencies are doing that?
Francine Cournos: My guess is that there must be a huge range and some agencies must do it better than others. It’s also a resource issue. There are places that don’t have much in the way resources so nothing much occurs.
Al Desetta: It’s a labor intensive and money intensive way of working with foster parents.
Francine Cournos: It’s a question of whether you pay in the beginning or later on. If you invest in making the very first placement work well, then maybe you’re breaking what is going to be a very expensive cycle—the kid’s not working out in one place, then getting sent to another place, and by that point they’re even more discouraged, they act even worse. That’s not inexpensive either.
Al Desetta: No, not at all. But we tend not to look at it that way when we’re making budgetary decisions.
Francine Cournos: Investing in children has probably got to be the best investment. But kids don’t vote, they’re not a powerful bloc, and we are much more willing to pay down the road for kids who leave the system and don’t work and need welfare, or who commit a crime and wind up in jail, or who have children that they give up into foster care themselves. If you could look at all the costs that result from not being more proactive and preventive in your approach, it’s got to cost a lot more in the long run, and that comes out of someone else’s pocket, not the foster care agency’s pocket. I think to really look at this issue would require having a much more integrated view of what the costs are over the long haul of kids coming into the system, not just in the moment.
Al Desetta: You had mentioned peer groups for foster parents. What would have been your attitude toward peer groups of foster youth when you were in foster care? Do you think that would have been a valuable thing for you? Or was that something not on your radar at the time?
Francine Cournos: I was placed in a fancy neighborhood and there were no other foster children around. So it made me feel so much more peculiar. I never came across another foster child in the environment in which I was living. If I were to have gotten involved with other foster youth, I would probably have had to travel to the agency headquarters, which was in Manhattan, and I was living on Long Island. It’s always good, when you’re a kid, if you have peers who are in the same situation as you, but I don’t know if they would have felt like peers if I had to go to a totally different location to meet them.
Al Desetta: That kind of peer support seems to work well in many group homes.
Francine Cournos: My brother went to a group home rather than a foster family, and he liked it. He probably liked going to a group home more than I liked going to a family. Because as a teenager it seems natural to be around other kids. I think it’s very different to get support from peers in the environment you’re actually living in, versus whether it’s helpful to get together with some unfamiliar teenagers who aren’t normally part of your life.
Al Desetta: The writer Eileen Simpson, who was married to the poet John Berryman and wrote a memoir called Poets in Their Youth, grew up in care. I heard her talk at a conference and she said she preferred living in a group home to a foster home because the camaraderie of the girls was very supportive. The policy in New York right now is to take teens out of group homes and get them in foster homes. And in Represent magazine, several teens have written about their problems with foster homes. Do you have any reaction to this new policy?
Francine Cournos: The problem with every policy is that it’s good for some kids and not for other kids. The truth is that some kids would be better off in group homes and other kids would be better off in a family. It’s very hard to be viewed as an individual when you are in care. It doesn’t really matter what policy you create, because whatever it is, some group of kids is going to be harmed by it.
So, for example, even with the Adoption and Safe Families Act, where you can’t stay in foster care for more than two years and then they have to adopt you, there are kids who are very attached and foster parents who are attached, too. But for whatever reason, the foster parents aren’t going to adopt, so the kids are uprooted and placed somewhere else, whereas the kid wanted to stay in the foster home. Is that a policy that was helpful for that kid? You have to be suspect about that. The smaller the system is, the more the kids can get some individual attention. The problem with every policy is that there is no perfect policy. I think there are different pros and cons about group homes and foster homes. When I was in foster care I liked going to camp, because when I got to camp no one had parents. I didn’t feel different from the other kids because they were separated from their parents too. Plenty of kids go to boarding schools or go away to camp. It’s not so abnormal, for kids who are adolescents, to be put together in a group. It can make you feel you’re really not so different, even if it is a group home. You’re surrounded by other kids who are in the same situation.
Al Desetta: I get nervous seeing that one-size-fits-all policy.
Francine Cournos: Yes. But if you look at what happens to kids when they leave group homes, it might be much harder to keep a connection. So although I didn’t have a wonderful connection with my foster mother, I did maintain a connection with her. And there were times in my adult life when she was helpful to me. I think that’s the impetus to get kids into families, because there is the realization that there is no age at which you age out and don’t need a family. You always need a family. And so there’s a hope to create an environment where these kids are still part of something, the way all kids stay part of something as they get older and get into young adulthood. It may be less about what the adolescent years are like—in fact, in adolescence, the kids may feel very rejecting—and more about what it means to be transitioned out of care and really be on your own, and not have anybody to go home to.
Al Desetta: Yes, I think that is ACS Commissioner Mattingly’s concern, that the transition out is better helped by a foster family than by a group home situation. What else do you think could or should be done to help them with aging out?
Francine Cournos: One of things that would help would be to try to reduce the stigma that’s connected with being in foster care. To try to think of these kids as if they were your kids. If you sent your child out at 21 and said, “Never come home and never ask for any money,” what would happen to your child? So if you envision that, and you imagine what would happen to your kid, and you think that maybe your child wouldn’t fare so well, then you have to apply the same things to foster kids. And you really have to think about providing supports until such time as kids can create an independent life for themselves, either through work or family or both. My foster mother, for example, let everybody stay for as long as they wanted to. I had one foster brother who was 30 when he left—he finally made it, he got married, he became more responsible, he held a job.
Al Desetta: After college I had to move back and live with my parents for a year until I saved some money. If I didn’t have that, I don’t know what I would have done.
Francine Cournos: Exactly. Kids move back all the time after college. Until a kid is established, they need a support system. It’s just not a realistic view that there’s a specific age at which a kid’s going to transition and become totally independent. And then there’s the cost issue. So what would the cost be of maintaining support to allow people to get to a place of real independence, not just an age that declares their independence, versus the cost of not doing it?
Al Desetta: I’ve often thought there should be a program for former foster youth, ages 21-25, that was a combination of job training, residential apartments, etc.
Francine Cournos: And school support. A set of things that really got kids settled.
Al Desetta: It would seem not that hard to do. You have these agencies that are losing beds now because of the decline in the foster care population. They’re going out of business. Why not turn some of these agencies into places that are like post-care or post-discharge centers?
Francine Cournos: Which nobody, I think, is funding. In working with kids, it’s also working on who are their supports, who are their mentors, are there any people left in their family? Right now, the way we raise most kids, they’re often somewhat dependent until they’re in their late 20s.
Al Desetta: There were 49,000 youth in foster care in 1992 and now there are 18,000. I know there was a crack epidemic and the murder rate was really high and AIDS was creating a lot orphans, but was enough done to keep 49,000 youth out of foster care? Now the whole emphasis is on preventive services and trying to get people adopted and trying to prevent families from disintegrating, to keep kids from going into foster care. It’s interesting to me how what was being practiced in 1992 is not being practiced in 2005. Do you have any feelings about what should be done to prevent more kids from going into care?
Francine Cournos: Obviously there are cases that make a splash in the news, where biological families kill their kids, and people scream why didn’t they remove these kids. And there’s certainly instances where children are in so much danger and so neglected that they really need to be removed. But I do think that prevention is a much better strategy because one of things that often perplexes social workers who work in the system is, how can kids stay so attached to such an abusive parent? They go from one foster parent to another and never make a connection, and they want to go back to the original parent. We’re all programmed as mammals to attach to people who care for us, and when you disrupt that attachment, there is a very high cost for it, and it’s very hard to form new ones as a child. Now, there are exceptions to that rule, because, again, you can’t make one generalization that works for everyone. But many kids feel very attached to the parents they’re living with, and if there’s any way to make it work by providing enough services, so that things calm down in the family and the kid gets to stay, it works a lot better. If these kids are removed, the assumption that they don’t love their parents is frequently false. A lot of these kids love their parents, even if their parents haven’t been much good from an objective perspective.
Al Desetta: A lot of the youth in care I worked with had been abused by their parents, but that attachment to the parents continued to endure. That raises a very interesting issue of fantasy, in the sense—and City of One captures it very well—that the ideal parent is always there within the child, even though the evidence may not be there. And sometimes that comes full circle. I knew kids who had abusive parents, their parents did terrible things to them, but now the parents got their acts together and they have some sort of relationship. But there were also kids who held onto a fantasy of the parent that was positive, in the face of evidence to the contrary, and it was damaging for them to hold onto it. But psychologically they couldn’t let go.
Francine Cournos: Even though people’s psychological adaptations don’t look like they’re very successful, from the perspective of the person who has it, the alternatives seem worse. It’s the best possible solution you can come up with to feel that you’re somehow going to survive. And you’re holding on to that view, because if you had an alternative view, it would have a worse impact. So from that perspective, it’s adaptive.
Al Desetta: Yes, it makes sense. I go to a Zen monastery near me and one of the teachers gave a talk and he said human beings have thoughts and fantasies and behaviors for a reason, that they serve a purpose. He was making the point that they can also outlive their purposes.
Francine Cournos: And that’s what keeps psychiatrists in business. People make good adjustments for the situations they’re in, then they get into adult life and all kinds of other possibilities are open to them, and they don’t know how to take advantage of it.
Al Desetta: Your book was very good in showing the persistence into adulthood of these kinds of psychological issues. A lot of the emotions you described I just related to very much. The contradictions—the ability to concentrate and do well in school, yet at the same time not having “a sense of internal structure” that would hold up in times of separation or stress. That was a wonderful line, because I felt that applied to my own life, and I’ve seen it in the foster youth I’ve worked with.
Francine Cournos: In your own situation, you mentioned that you had a schizophrenic sister. How did your parents handle it?
Al Desetta: As well as they could. It was overwhelming. My sister suffered from severe mental illness and was acting out, often quite destructively, throughout her childhood. My parents tried, when she was about 7 or 8 years old, to put her into a residential facility where she would just come home on the weekends. They understood that she shouldn’t have been living at home. But that place went out of business after about a month. And so, it’s really a story of a lack of facilities. The choices my mother and father had were to put her in Willowbrook or someplace inhumane like that, or to keep her at home. So they chose to keep her at home. But she shouldn’t have lived at home—at least not all the time. That was the Catch-22 they were in. If she was growing up now, there might have been a better sleep-away facility for her.
Another interesting aspect of your book is when you say traumatic childhood events are undoubtedly difficult, but it’s also the explanations you get for those events from other people, or the explanations that families develop, that are just as difficult. Or the lack of explanation. You wrote that neglect can be worse than abuse, and that the abandonment by your relatives was almost as bad losing your parents.
Francine Cournos: No, the abandonment was worse, actually.
Al Desetta: Worse. Well, I often felt abandoned in my own family. It’s a common thing where the kid who is basically okay is left to fend for himself. I related to the foster kids I worked with, not because I was in foster care, but because I understood a lot of their issues. I understood the anger. I understood the inability to articulate your situation. And much of the time my parents seemed more like distant relatives, rather than parents.
Francine Cournos: Because they spent a lot of time managing your sister, more or less assuming you were the well one and could take care of yourself?
Al Desetta: Yeah, in a nutshell. When I was editing Represent, especially in the early years, a lot of former foster youth were coming out of the closet and calling me up. So one day this guy called me up, an adult in his 50s who went into foster care as an infant because his mother became pregnant as an unmarried teenager and couldn’t afford to keep him. He spent the first 17 years of his life in five different foster homes, and he had a very difficult time. And he wrote about his experiences for the magazine, how he developed the habit of biting his knuckles, until they were all red and bloody. And his social workers would visit him regularly to talk to him about how things were going, and none of them ever mentioned the fact that he bit his knuckles or tried to do something about it. And this went on for years. He couldn’t hide his bitten knuckles, they were right out in the open, but the social workers never said a word about them. And as I was reading this story he submitted, I was just floored, because I used to have that same habit. From around 7th grade through maybe 9th, 10th grade—it had to be at least three or four years—I developed the same habit of biting my knuckles. And they were totally red, totally chewed up. I used to walk around with my hands in fists so people wouldn’t see them. It was a reaction to my family situation. But my parents never said a word about it. And, like the social workers, they had to notice. And here was this man writing about the exact same thing I experienced.
Francine Cournos: It was obvious you weren’t doing so well.
Al Desetta: It was a kind of neglect, as much in my life as it was in his. And telling yourself that your parents have too much on their plates doesn’t make neglect any easier to take or lessen the consequences. Not necessarily permanent consequences, but consequences nonetheless. You wrote in City of One of having suffered from the symptoms of Post Traumatic Stress Disorder (PTSD) for years after your childhood experiences. You even said in your book that you wondered, at times, whether you were mentally healthy for years after your childhood experiences. I felt that same kind of stress and emotional turmoil for a long time after leaving home. And that kind of emotional state was certainly true of the foster youth I worked with. I was amazed that so many of them were together to the extent that they were.
Francine Cournos: One way to look at that issue is that the well-being of a child is regulated by their parents. Of course, much more extremely when they’re very little, but that’s also true over time. There’s this experiment called the “Still Face Experiment,” where they asked the mother, who usually smiles and makes faces and imitates the baby, just to keep still and not make any expression back. And the baby completely disintegrates over it. You always see adults—even if it’s not your own—making faces at a baby. And think about what would happen if we didn’t make those faces. A baby’s sense of well-being is regulated by contact with an adult—moment by moment contact. And I think that’s true throughout childhood. Once you feel cut off from being connected to a parental person, then you’re really not well off in life, you’re in a fog, you’re disconnected. You need that central relationship.
Al Desetta: I read an article that said there are two needs that have to be fulfilled while a child is growing up, for that child to be emotionally healthy. First, the child has to recognized for who he or she is, and second, there can’t be a denial of reality in the home. Because otherwise, you never have an accurate mirror for who you are. You’re always searching around for it and the sand is always shifting under you because you don’t have a basic core sense of who you are. And that’s what your book captures—how childhood trauma can impact a basic core sense of self . So when we talk about foster care policy, I always feel daunted, because there’s a huge psychological task that the young people face.
Francine Cournos: My guess is that one of the reasons why these kids reject therapy is that therapy is associated with society declaring that something is wrong with you. And you already feel very defective. So the last thing you need is further evidence that you have something wrong with you. And kids, of course, think that every bad thing that happens to them is somehow something they had control over. If they had been better kids, their mothers wouldn’t have acted this way, they wouldn’t have ended up in foster homes. So you don’t need something else to make you feel worse about who you are. Therapy seems very threatening from that perspective. It works better after you feel a little more secure about having some positive feelings about yourself, having some direction you’re going in, having certain skills. It might be that they need therapy, but probably what they need more are some skills to cope and to manage and to become something.
Al Desetta: You have to develop a self before you can analyze it?
Francine Cournos: You have to feel that you are a little bit in control of yourself. There are probably some kids who really need treatment who should go. But I really think it would be more effective to get foster parents to respond in more successful ways to kids, because it’s that relationship that’s going to have a healing effect.
I think there probably needs to be more therapeutic foster care. Usually you have to fail regular foster care before you get into therapeutic foster care. That’s a group of people who are getting paid better, but they’re also better trained and a little more sophisticated. And there are probably plenty of kids who need that.
Al Desetta: I would say that almost all the youth I worked with need it at some level.
Francine Cournos: So you could say that as the system gets smaller and there are fewer kids in foster care, maybe you can make the actual foster care that exists better. You raise the threshold of who goes in, but once you’ve done that, if you train parents much better, if you had a larger group of therapeutic foster parents, you’d provide more intensive services for that group that really couldn’t avoid foster care.
Al Desetta: And that’s probably what they’re trying to do, with that smaller system, because certainly when there were 49,000 in it, people were getting lost in the cracks.
Francine Cournos: I once went to a foster parent recognition day in Delaware, and there are only 900 foster children in all of Delaware, which I thought was amazing. So they knew all the kids, they knew the foster parents, because it was such a little system. And the other thing that was interesting was that the foster parents more or less knew their strengths and weaknesses. They took in certain age kids, certain gender kids, that they felt were the ones they really knew how to manage. When there’s 49,000 kids, maybe you can’t think of a match. But as the system gets smaller, it may be possible to really think through which foster parent has what kinds of skills for which kind of kid.
Al Desetta: It would not be one size fits all. Maximum attention on preserving the family, or finding family connections, but for those who have to go into the system, really tailor it to each individual.
Francine Cournos: I gather your sister was in some kind of care, of some kind?
Al Desetta: In 1959 or 1960 she was one of eight children who started the first school for those kinds of kids on Long Island. And eventually it developed into the Nassau Center for Emotionally Disturbed Children, well-staffed with psychiatrists and social workers. So my sister would go to that during the day, but she lived at home until she was 21, after I left for college. Now she lives full time in upstate New York in a facility. The problems were those of stigma and our inability to deal with the emotional issues.
Francine Cournos: So let’s say that as part of this school, there were some people who worked at the school who sat down with the parents and supported them through the common issues. What’s it like to have a sick child? What’s the impact on the healthy child? There’s a lot of work that could be done that isn’t even all that intensive or expensive. They could just outline some of the common issues.
Al Desetta: Very simple stuff in a way.
Francine Cournos: Very simple stuff.
Al Desetta: When I look back at what my parents faced with really no support, I’m amazed. There was more attention given in the public realm on how to care for a dog rather than how to live with a mentally retarded/schizophrenic person.
Francine Cournos: Right. And if that had been available to your parents, then maybe they also would have been able to talk to you about it. Some very simple, non-expensive measures have to do with getting some perspective on the situation. And letting people know what are the common issues they’re going to wind up struggling with, and what are some of the ways people cope with them.
Al Desetta: And that can certainly be applied to foster care.
Francine Cournos: All that stuff could go a really long way. We now know that if a family has an ill sibling, the healthy sibling frequently suffers quite a bit. And there’s much that can be said about that situation. There’s a lot of room for doing some prevention that helps the other siblings and that helps the parents. And I’m sure good programs do that work. So really, I’d endorse things like that—being realistic, looking at the common themes of what happens, and not letting people blunder through it on their own.
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