My personal connection with adoption began nearly 30 years ago. As my mentor Dr. Holm and I hurried to the hospital, he told me about the child he and his wife Joanie had recently adopted.

Rick loved being a father, even more, it seems to me, than he loved being a doctor. He couldn’t quite believe that he got to parent this amazing little person, that he was blessed not just with Joanie and his sons, but with this precious girl who was now their daughter. His besotted delight so moved me that I knew I wanted to adopt, too.

Over the next few years, I witnessed other families grow through adoption. I walked with women as they wrestled with unplanned pregnancies. I watched them grieve the children being raised by other mothers. I read blogs and books by adult adoptees who discussed their joys and their struggles.

Nearly 10 years after that conversation with Rick, my husband and I, too, became part of an adoptive family.

As an adoptive parent, I’ve often been told how “lucky” my children are. Of course this is flattering: every parent wants to believe they are doing that incredibly difficult job well. However, people aren’t usually complimenting us on our parenting. They are frequently responding to a feel good-narrative about the orphan who is now part of a family, with the expectation that we will all live happily every after.

The reality of adoption is much messier. No child comes to adoption except through loss. At a minimum, that child has lost a parent: to poverty, addiction, mental illness, incarceration, death, or some combination of factors. Even infants experience distress on separation from their biological mothers. Many children have lost more than one parent or caregiver. Some children are in open adoptions and able to maintain a connection with their biologic families, although that connection may be tenuous. More are not. I have never understood how a culture obsessed with genealogy can simultaneously discount the importance to an adopted person of knowing their own genetic heritage.

Around the time I graduated medical school, researchers published a groundbreaking study linking traumatic experiences in childhood to a myriad of significant health and social challenges in adulthood. Subsequent research has born this out. These traumas are common; estimates are that 2/3 of middle class people have experienced at least one. They include abuse and neglect, having a household member who experiences addiction, mental illness, or incarceration, witnessing domestic violence, and the loss of a parent.

Additional research has demonstrated the impact of factors outside the home, such as bullying and community violence. The more of these a person experiences, the higher the likelihood that they will suffer, for example, heart disease, suicide, lung disease, mental illness, and even cancer in adulthood.

Adoption, even adoption into a stable, loving, privileged family, doesn’t erase the trauma that preceded it. We can’t address those wounds if we won’t acknowledge them.

Dr. Debra Johnston is part of The Prairie Doc team of physicians and currently practices as a Family Medicine Doctor at Avera Medical Group in Brookings. Follow The Prairie Doc at www.prairiedoc.org , Facebook, Instagram, and Threads featuring On Call with the Prairie Doc, on SDPB, a medical Q&A show, two podcasts, and a radio program on SDPB, providing health information based on science, built on trust.