The Orphanage Problem

Last November I went to Bucharest to shadow an American neuroscientist, Charles Nelson, whose team has studied the same group of 136 Romanian orphans for the past 14 years. My (loooong) story about this project came out this week in Aeon Magazine. Here’s a snippet:

In 1999, [Nelson] and several other American scientists launched the Bucharest Early Intervention Project, a now-famous study of Romanian children who were mostly ‘social orphans’, meaning that their biological parents had given them over to the state’s care. At the time, despite an international outcry over Romania’s orphan problem, many Romanian officials staunchly believed that the behavioural problems of institutionalised children were innate — the reason their parents had left them there, rather than the result of institutional life. And because of these inherent deficiencies, the children would fare better in orphanages than families.

The scientists pitched their study as a way to find out for sure. They enrolled 136 institutionalised children, placed half of them in foster care, and tracked the physical, psychological, and neurological development of both groups for many years. They found, predictably, that kids are much better off in foster care than in orphanages.

Perhaps the strangest part of this project was that the fundamental scientific question it posed — Are orphanages bad for kids? — had already been answered. Definitively. Studies going back many decades had shown that orphanages are awful.

Research with human subjects is normally considered unethical if it doesn’t tackle novel questions. In this case, though, Nelson’s project was ethically justified because Romanian officials had not paid any attention to those previous studies. Quite the opposite: They had a strong cultural belief that state-run orphanages would protect orphans far better than unstable and untrustworthy foster parents. So the study went ahead, and exactly how it did so is the crux of my story.

During my reporting, I had a hard time wrapping my head around the Romanian cultural preference for institutions. I chalked it up to the lasting shadow of Nicolae Ceaușescu, the Romanian dictator who, for decades before his assassination in 1989, had deliberately cultivated the population of institutionalized orphans to ensure loyalty to the state.

But this week I learned from fellow science writer Maia Szalavitz that the pro-orphanage idea still persists to a surprising degree.

In 2010, Szalavitz wrote a Forbes post outlining all the ways in which orphanages are damaging. In one part of the post, she describes a fascinating early study:

Research on the dangers of institutional care for young children dates back to the 1940s. For as long as they have existed, orphanages have always had alarmingly high death rates. From the early 20th century onwards, this was blamed on contagious disease–and so, attempts were made to keep orphanages sterile, to isolate children from each other by doing things like hanging sterilized sheets between their cribs.

But Austrian psychoanalyst and physician Rene Spitz proposed an alternate theory. He thought that infants in institutions suffered from lack of love–that they were missing important parental relationships, which in turn was hurting or even killing them.

To test his theory, he compared a group of infants raised in isolated hospital cribs with those raised in a prison by their own incarcerated mothers. If the germs from being locked up with lots of people were the problem, both groups of infants should have done equally poorly. In fact, the hospitalized kids should have done better, given the attempts made at imposing sterile conditions. If love mattered, however, the prisoners’ kids should prevail.

Love won: 37% of the infants kept in the bleak hospital ward died, but there were no deaths at all amongst the infants raised in the prison. The incarcerated babies grew more quickly, were larger and did better in every way Spitz could measure. The orphans who managed to survive the hospital, in contrast, were more likely to contract all types of illnesses. They were scrawny and showed obvious psychological, cognitive and behavioral problems.

Now here’s the surprising part. Szalavitz told me that she got tons of comments on that post from people who still believe that institutions are OK for infants. There were so many apologists, in fact, that she wrote a follow-up post a few days later calling them out. In that, she pointed to a story in the New York Times with a dreadful headline: Study Suggests Orphanages Are Not So Bad. The study in question, published in 2009, indeed found no differences in cognitive development or emotional well-being between kids in Africa and Asia who lived in orphanages versus family homes. But the study had one big caveat that was ignored in the Times article: The kids were all between the ages of 6 and 12. For children younger than that, orphanages are so bad.

Why is this idea so difficult to accept? Szalavitz says it’s not about cost, as foster care is far less expensive than keeping an orphanage open. She suspects it does come down to money, though, in that government and non-profit funding is more easily granted to institutions than individuals. That agrees with what I heard in Romania. Elizabeth Furtado, one of the researchers working on the Romanian orphans project, put it like this:

The last two years on the project have been somewhat defeating, Furtado says, because the adolescents’ behaviors are becoming more difficult to manage, and the foster-care parents are getting less and less support — financial, educational, emotional — from the government. ‘On the one hand, I know that we are doing a lot of good for a lot of these kids,’ she says. ‘But it makes me sad that legislation isn’t keeping up with enough of what we’re finding.’