Dear Adoptee X:

What do appendicitis and adoption have in common?

Christian Casto
5 min readAug 18, 2022
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There’s something that’s been weighing on my heart, and I want to try and share it with you. I’m no psychologist or doctor — I’m just like you. A kid who suffered through anger, confusion, and desperation to understand how or why I was given away, to be raised by parents that weren’t mine. It’s hard to explain. So first I’ll tell you a useful story about our most useless organ: the appendix!

Hundreds of years ago — the olden days before hospitals and appendectomies — sailors had terrible diets and drank too much, and they would get appendicitis on their long-haul journeys across the Atlantic Ocean. I don’t know if you’ve had appendicitis, but it’s super painful, and after awhile the appendix ruptures. Back then, these sailors would usually die a horrible painful death from it. But then, this doctor (read: a sailor who was good at drinking and sawing off limbs at the same time) found a way to help his crewmates survive the ruptured appendicitis without antibiotics or any kind of surgery.

He realized if he laid the person down on their right side (the appendix side), and slightly tilted their torso up, all of the pus that was coming out of the ruptured appendix would wall-off in the lower part of the right abdomen and form this tough, fibrous capsule around the appendix. In medicine this capsule is called an abscess. It’s when your immune system forms a barrier around an infection to wall it off in one spot, so it doesn’t spread and infect the rest of your body. This capsule prevented the ruptured appendix from causing sepsis (when toxic bacteria gets into your blood and infects your whole body), which is the super dangerous thing that actually kills you.

So this doctor figured out how to help the sick sailors’ bodies form an abscess, and they would live. They wouldn’t be perfectly healthy, but they would survive; the sailor would be in pain and be very unwell, but they could still work on the ship and they wouldn’t be dead. When the ship got back to land, they could treat the abscess by opening it up and releasing all of the bacteria and toxic stuff that built up inside the capsule. At first, the sailor would get really sick. Way worse than the original pain of appendicitis, but with medicine and real doctors, they could monitor the sailor as things got worse before they eventually got better.

Isn’t that wild? How our bodies come up with these crazy ways to keep us alive? Well hold on, it gets even wilder.

Abscesses are a physical survival mechanism our bodies use when we experience some kind of bodily trauma. And psychologically, our brains do the exact same thing when we experience emotional trauma.

Say, for example, being adopted.

Many people don’t understand that being placed for adoption is undeniably traumatic, and that often includes our adoptive parents and ourselves as the adoptees. This traumatic event is rooted deep within us as an implicit life truth— especially when we’re adopted as babies — before we develop language or cognitive understanding. People who grow up with their birth parents simply cannot comprehend what the experience is like for us, & we know that only other adoptees really get it. That’s why we hide our emotions, and feelings, and voices away in an effort to protect ourselves. All of the darkness, ugliness, sadness, and grief we feel is walled-off in an emotional abscess in our unconscious. We’re like the sailor with appendicitis, except adoption is the traumatic event that hurts us, and our emotional abscess can’t be seen like a big bulging physical one in our lower right abdomen.

But the abscess is still there.

Instead of a bunch of pus that builds up in our abdomen, we have an invisible build up of shame. Shame is the worst, because even though we can’t see it, we can feel how toxic and gross and heavy it is. All the time. Even though adoption didn’t kill us, we’re just like the sailor because we too live with this unhealthiness walled-off deep inside us. Shame underlies our internal dialogue and shifts the lense through which we see ourselves and the world around us.

Shane is like a river — swifting below the surface of our lives — guiding our actions and watering our words.

The banks are sown with seeds of longing, desperation to be kept, and self-denigration. They sprout and are fed by the river — growing like weeds, wild and out of control — until we can’t see the good things that were growing there before the weeds

Like confidence, or courage, or compassion for ourselves.

When adoptive parents consider the journey of parenting someone else’s child, the most vital step they can take is to be very, very clear about who they are and why they are adopting. Are they adopting for themselves, or for the child? Who is really benefiting from this unilateral decision? Do they understand the irrevocable nature of their choice?

Because although adoption can be an altruistic act of grace and kindness, it is also an act of theft that causes insurmountable pain. Is this a gift of family for a child? Or is this an attempt to complete the adoptive parent? Can they see the role of parent through the eyes of their adopted child? Or are they filling a void in themselves, hoping to be relieved through the life of another?

Has the parent really done everything possible to reunite this child with biological family, and bring healing to the birthparent-child relationship?

Or did adoptive mom send back birthday presents and withhold letters sent by biological mom, because your adoptive mom’s ego was too fragile to let your biological mom call you “son.”

Nothing about adoption is simple; the complexity and nuance is as rich and diverse as each of us adoptees are as people. It’s a bit of a paradox really:

Adoption is grace.

Adoption is theft.

Adoption is beautiful.

Adoption is heartbreaking.

Life as an adoptee is simultaneously a gift, and a source of pain. And while it is wonderful to celebrate the completion of families through the adoption process, let’s ensure that we don’t overlook the trauma suffered by the children at the epicenter of it all.

Because we’ll feel much better after lancing our abscess, and let our hurt start to heal.

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