Bulletin of the History of Medicine

Sandra Sufian's Familial Fitness: Disability, Adoption, and Family starts with a particularly harrowing example: In 2010, an adoptive mother from Tennessee put her seven-year-old child, adopted from a Russian orphanage several years earlier, [End Page 470] on a plane back to Russia. She pointed to his psychological problems, claiming that she had been duped by Russian authorities into thinking she was adopting a "healthy" and normal child. (She was later sentenced by a U.S. court to pay child support.) The case brought national and international media interest on the fraught practices of international adoption, in which the ideals of adopting parents meet with the realities of children growing up in difficult circumstances. This contrast between the ideal and actual child, Sufian shows, was part of a much longer history of adoption, in which children with disabilities were long perceived as unadoptable. While such attitudes had softened by the 1990s, many American parents still preferred to adopt supposedly "healthy" children from orphanages abroad over children with disabilities waiting for adoption in an also broken American welfare system.

Throughout the six chapters, Sufian analyzes the intertwined history of disability and family and familial and social participation. Perhaps the most important theme is risk: the risk of unknowingly adopting a disabled child because the disability was not apparent at the time of the adoption or because biological parents had not been forthcoming with medical information; the risk of a disabled child disturbing the normalcy of healthy families; but also the risk a child faced if left or placed within certain institutions, birth or adopted families. As Sufian points out, "during the twentieth century, adoption professionals saw risk as either possessed by the child or a threat to the child; that is, from being something a child embodied to something that affected the child but was located within society" (p. 9). To assess and mitigate these risks, social workers developed elaborate checklists and background checks that mirrored the larger social and scientific paradigms of the time. Thus, Sufian shows, early- twentieth-century background checks were influenced by the eugenic belief that physical disabilities, but also socially deviant behaviors—including single motherhood—were biologically embedded in certain families and social classes.

These eugenic fears play an important role in the first part of the book that spans the period from 1918 to 1955, a period in which adopting services aimed to create "perfect" families. Children with disabilities were routinely excluded from this vision of normalcy, even considered a danger to it. By the postwar period, however, Sufian writes, "experts and social workers began to question the prospect and value of sustaining perfectionism in adoption family formation" (p. 17), instead pointing out that there was also a risk of disability in biological children. In part two, spanning the period from 1955–1980, Sufian detects an increasing willingness to include disabled children in adopted families. This came with a shift in risk perception: the risk of disability was no longer seen as resting within the child, but it was the adopting family who had to take the risk and to overcome their biases to welcome a family member that was not an ideal child. Here, Sufian points to the more general theme of overcoming disability; an interesting connection that would have deserved more space.

By the late 1950s, social workers believed that children with disabilities were "entitled to loving, stable homes" (p. 19). Yet, as so often in the history of disability, even with a general willingness from social workers and potential adoptive [End Page 471] parents, the structural barriers to actually adopting disabled children remained high. And just as with biological families, they faced even more barriers when it came to adequate schooling and social participation. The book's final part covers the period from 1980 to 1997 and explores these very obstacles as well as the additional challenges brought on by the AIDS/HIV crisis, the war on drugs, and subsequent foster care crisis. The moral panic over the stereotype of the drug-using mother giving birth to "damaged" babies dominated public discourse—and once again, tied social deviance to disability. As these children and those born with HIV were seen as tainted, parents increasingly started to look for adoptive children abroad.

Sufian makes clear that she does not write from the perspectives of adopted children themselves. Instead, her book is based on the perspective of professionals working in the adoption system, and, to a lesser degree, the parents willing or unwilling to adopt disabled children. This makes for a sometimes dry, encyclopedic read; a more stringent summary of policy papers and guidelines would have given space for the sociocultural, political, and scientific context of adoption. This context is often more alluded to than set up fully, and actors only introduced sparsely or not at all. More thorough editing would have taken care of these issues; although, of course, the time and resources for such editing are ever harder to find in current academic systems.

As it is, the book requires the reader to have quite a bit of background knowledge to fully appreciate Sufian's very valuable insights. This leads to some missed opportunities, for example in closer exploring the intersection of disability with other minority identities, the pathologization of black family life, which has recently been explored Dorothy Roberts, or the tearing apart of native American families. All in all, however, Sufian's book is a very erudite, thoroughly researched history of adoption, disability, and family and is particularly valuable in thinking about the ongoing exclusion of disabled people from "normal" family life. In the epilogue, subtitled "A Usable Past" in dedication to disability historian Paul Longmore, Sufian argues for improving social services for maintaining biological family, but also for improving the resources and services for adopted children with disabilities. The books final words ask us to think about the connection between "social and familial citizenship" (p. 225), a prompt that goes beyond just the history of adoption. [End Page 472]