Discussing the Primal Wound Theory and Surrogacy
The primal wound is a controversial theory that states all adopted children are irrevocable and permanently damaged as a result of their adoption, and they are saddled with a lifetime of psychological trauma, regardless of the love and support provided by their adoptive parents. In this article, I want to briefly discuss the primal wound theory, and then I want to see if there is any evidence to suggest that it may be extrapolated to children born via surrogacy. As a physician, I will focus on the published literature regarding the psychological and social health of children born via surrogacy, as I believe evidence-based medicine for physical and mental health is the basis for how we develop true understanding.
Before a few weeks ago, I had no idea what the primal wound theory was. I have grown up and am close friends with people who have been adopted, and the idea has never been discussed. As part of a social media group for men having babies, the question was posed to the group: Does the primal wound theory apply to surrogacy? This led me to investigate what the theory is, and to see what scientific evidence would support or refute its application to surrogacy.
The theory was developed by psychologist Nancy Verrier and published in a 1993 book of the same name (1). While I admit that I have not read the entire book, there are articles that summarize the theory and are available online which I have read (2). Here is my summary of the main ideas that are conveyed by the primal wound theory:
Theory that all adopted children have some behavioral and psychological trauma stem from the fact that in the U.S. they are overrepresented in special schools, juvenile halls, and residential treatment centers, comprising about 30 to 40 percent of these institutions while only being about 2 to 3 percent of the total population.
Children are psychologically ‘one’ with their mothers, through the genetic and biological connection they share in utero, exemplified by the following quotation from the article:
‘He had a 40-week experience with a person with whom he probably bonded in utero, a person to whom he is biologically, genetically, historically and perhaps even more importantly, psychologically, emotionally, and spiritually connected.’
Adoption is the ultimate rejection, which children pre-consciously feel and then consciously act out on, through a constant fear of rejection, generalized anxiety, and overall dysfunctional relationship formation. This is described in the article with the following:
‘During the nine months in utero, is a profound connection, and it is my hypothesis that the severing of that connection between the child and biological mother causes a primal or narcissistic wound which often manifests in a sense of loss (depression), basic mistrust (anxiety), emotional and/or behavioral problems and difficulties in relationships with significant others. I further believe that the awareness, whether conscious or unconscious, that the original separation was the result of relinquishment affects the adoptee’s sense of self, self-esteem, and self-worth.’
It is not my intention to discuss whether the primal wound theory is accurate for adoption, as it is written, but rather to see if there is any connection to children born via surrogacy. However, before I get to that, I would like to point out that I have a few comments regarding the theory for adoption. There are so many confounding factors regarding how children are raised, especially in the case of adoption with regard to how they came to be adopted that could impact the child’s development more than a psychological ‘one-ness’ with the birth mother. These include:
The medical and psychological state of the birth mother before and during her pregnancy
The psychological state of the adoptive parents, and the trauma they perhaps had to go through before pursuing adoption.
The impact on children who are adopted and found out at different times in their life, most likely too late when it was kept a secret from them.
The social interactions for adoptive children who are around mostly biological children, either in their own nuclear families or just at school.
I truly believe that these factors could weigh much more heavily than a subconscious ‘bond’ formed in utero. Also, I do know from friends that there is definitely psychological work for adopted people to do with regard to the rejection they can feel. However, the assumption that this is a permanent and universal detriment to all adopted people feels too expansive, and, perhaps, is biased by the author’s own experience having a ‘normal’ biological daughter and a ‘troubled’ adopted one.
Before I transition to the theory and surrogacy, I want to emphasize that I believe adoption is an amazing thing. I believe it provides homes to children, and it is far superior to the instability or true rejection and loneliness that children can feel without having a family to belong to. I think adoption should be celebrated.
In terms of surrogacy, there are a few elements that immediately stand out as not applicable with regard to the primal wound theory:
There is no rejection present in surrogacy. The egg donor and gestational carrier (GC) are not ‘giving’ an unwanted child away. Instead, they are contributing to the beautiful creation of a family.
In gestational surrogacy, the egg donor and GC are not the same, and the primal wound theory does mix the genetic, biologic, and hormonal aspects of ‘motherhood’ into the components of the relationship.
Many egg donors and GCs maintain relationships with the parents and children after their birth. Again, there is no rejection or lost relationship, and, in fact, there are lovely stories like a GC in Canada who recently met up with families from Sweden, France, and Canada she helped create. This group is delightfully nicknamed ‘The Grady Bunch’ after the GC’s surname (3).
In order to further validate that the primal wound theory does not apply to surrogacy, I have reviewed scientific publications that follow and analyze the psychologic and social health of children who have been born through assisted reproductive technology (ART). There are three articles that I wanted to summarize, two with heterosexual couples and one with gay fathers. These findings from a growing body of research on non-traditional families, which suggest that family processes such as warmth, communication, and conflict are better predictors of children’s adjustment than is family structure and formation.
The first study worldwide to examine parent-child relationships and the psychological adjustment of children in surrogacy and egg donation families was published in 2011 (4). Overall, the findings indicate that these families continue to function well in the early school years and are more similar than they are different. The study examined the impact of surrogacy on mother-child relationships and children’s psychological adjustment. Assessments of maternal positivity, maternal negativity, mother-child interaction, and child adjustment were administered to 32 surrogacy (21 [66%] by traditional surrogacy and 11 [34%] by gestational surrogacy), 32 egg donation, and 54 natural conception families with a 7-year-old child. The results showed that there were no differences in maternal negativity, maternal positivity, or child adjustment, although the surrogacy and egg donation families showed lower levels of mutuality (defined as the extent to which the mother and child engaged in positive dyadic interaction characterized by warmth, mutual responsiveness, and cooperation) than the natural conception families.
This finding of lower levels of mutuality was unexpected by the authors, as these same children born via egg donation and surrogacy were assessed in earlier years, and this metric was actually higher than for the natural conception families. The authors postulated that this finding was only present when the children were at age 7 due to the increased understanding of surrogacy and egg donation at this age. The authors also stated that the mothers’ unresolved feelings about their infertility may have a greater influence on mothers’ feelings and behavior toward their child following the child’s increased awareness of their origins. While this may have affected the results related to mutuality assessments conducted in the study, the authors emphasize that in no way were these families experiencing any difficulties, and they state that communication — early and confidently — about a child’s origins are the most beneficial path towards a healthy family relationship. Also, I would like to point out that if unresolved issues around infertility are influencing parent-child interactions around this age, this is not something that would be experienced by gay fathers.
The second study in heterosexual partners examined adolescents who were conceived through donor insemination (DI), egg donation (ED), surrogacy, or natural conception (NC), and it included data from 31 DI families, 28 ED families, 29 surrogacy families, and 57 NC families when the children were 13 to 14 years old (5). In 2015, this was the first longitudinal study to compare children conceived by different forms of reproductive donation at adolescence, the time at which identity issues become prominent and difficulties in parent-child relationships are likely to increase. The results showed that the families in this study were highly functioning in relation to parent psychological well-being, and the quality of adolescents’ relationships with their parents, irrespective of the specific method used in the child’s conception. Findings indicate that parents who used ART are not more likely to reject their child or have increased strain in parent-child relationships at adolescence. Furthermore, adolescents did not differ in their psychological adjustment. Whilst disclosure rates differed between groups, most of the adolescents who were aware of their conception showed a clear understanding of it regardless of whether they were told earlier in childhood or at adolescence, and the majority expressed a neutral or indifferent attitude. As an aside, I love how adolescents can be ‘indifferent’ to pretty much anything, even their own methods of conception.
Finally, the third and most recent study specifically analyzed the family dynamics of gay fathers (6). Similar to the background for heterosexual relationships and the avenues towards having children, previous research on same-sex couples starting families consistently showed that children raised by same-sex parents are functioning as well as children raised by different-sex parents. In 2019, this was the first study to examine the psychosocial behaviors of children conceived via surrogacy and raised by two gay fathers in the U.S. The study population included 68 families with children between the ages of 3 and 10. The scores from these families were compared to those from a normative sample of parents matched for parents’ occupations and children’s gender, age, and race/ethnicity. The results showed that the children conceived via surrogacy and raised by gay fathers received significantly lower scores on externalizing problems (aggression, rule-breaking) and internalizing problems (anxiety, depression) than a comparison sample. In essence, the children — especially daughters — being raised by gay fathers were doing better than those being raised by heterosexual couples of similar backgrounds. The authors comment that one possible reason for this is that male-male and female-female parents who have children in the context of a same-sex relationship do not get pregnant by accident. These children are always wanted, planned, and very intentional. By contrast, surveys of women in the general population indicate that 45% of pregnancies in the U.S. are unintended (this includes pregnancies that are terminated). However, the study also found that fathers who experienced more antigay prejudice had less positive parenting, couple relationships, and social support. These results concluded that children of gay fathers by surrogacy are functioning as well as or better than children in the general population, but that public policy should be targeted toward the reduction of prejudice against gay father families and helping them cope with stigma and discrimination.
In conclusion, I do not believe the primal wound theory has any applicability for children born via ART. The theory does not seem to apply to the genetic and biological logistics of egg donation and surrogacy, and the scientific literature does not suggest that these children, through adolescence, experience any psychological worsening compared to naturally conceived children. In fact, the science does suggest that communication, openness, and a lack of internalized and externalized stigma (around fertility and/or gayness) is more to blame for the relationship issues that could arise between children and their parents.
This is definitely an area where more research is needed, and I look forward to continuing to review additional publications. If you have any other articles or literature on the topic that you would like to share, please feel free to email them to babymoonfamily@gmail.com.
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