|
Birthmother
Research Project
J. Kelly M.A.
Chapter
IV. Results
DESCRIPTIVE STATISTICS
Survey Respondents. All 79 survey respondents
participating in this study had relinquished their infants
to adoption during the years 1965 and 1972. The mean
age of the birthmothers was 50; ages ranged from 43
to 57 years of age. Their mean age at the time of giving
birth was 19; ages ranged from 14 to 25. Responses were
received from a total of 32 states within the United
States.
Of the 77 responses received concerning whether the
adoption was open or closed, 95% were closed adoptions.
67% of the birthmothers had been reunited with their
child. 89% of these women were still in contact with
the child. 28% of the respondents were single, divorced,
separated, or widowed; 72% were married or living with
someone. Of the 79 respondents, 27% did not have other
children.
42% of the birthmothers had received psychotherapy
because of the relinquishment; 67% of whom responded
that psychotherapy had helped. 86% of the birthmothers
had participated in birthmother support groups, of which
91% reported that it was helpful.
Post-Survey Discussion Group Profile. The post-survey
discussion group was comprised of three birthmothers:
Chris, Jarrett, and Terry. Their mean age was 50 years
old. The mean age at the time of the birth was 18. One
member was married with two kept children; one was divorced
with one kept child; and one was living with someone
and did not have other children. All had been involved
in closed adoptions. All had been reunited with their
children. Chris and Jarrett had both been reunited with
their children for several years. Terry had only recently
made contact and was preparing to meet with her son.
One member of the group had been found by her child;
the other two members had searched and found. Each of
the birthmothers was currently in contact with her child.
All three of the participants had received psychotherapy
because of the relinquishment and had also participated
in birthmother support groups. All participants were
enthusiastic to participate in this study. For one birthmother,
this was her first time meeting other birthmothers face-to-face.
SURVEY RESULTS
Relinquishment and Traumatic Stress Symptoms. The
birthmothers in this study overwhelmingly described
their experience of relinquishment as traumatic. Responding
to the statement "Relinquishing my child was a traumatic
experience," 89% answered that this statement was "Extremely
true;" 96% of the respondents answered either "Extremely
true" or "Very true." The three positive responses combined
("extremely/very/somewhat true") accounted for 99% of
the responses.
The mean scores for traumatic stress symptoms of intrusion,
avoidance, and hypervigilance experienced since the
relinquishment were 25.5, 25.8, and 18.3, respectively.
For the assessment of posttraumatic stress disorder,
Horowitz, Wilner, and Alverez (1979, cited in Fullerton
& Ursano, 1997) assigned the following IES intrusion
and avoidance clinical thresholds: less than 8.5 (low),
8.6-19.0 (medium), and greater than 19.0 (high). In
this study, the total mean score for intrusion and avoidance
was 25.7, and for the three subscales, 23.2. Since the
instructions to the Impact of Event Scale questions
were modified to measure the occurrence of symptoms
since the relinquishment, rather than in the last seven
days, the current study may not be valid for the clinical
assessment of posttraumatic stress disorder. However,
the birthmothers' responses indicated that the majority
of the birthmothers reported experiencing one or more
traumatic stress symptoms often. During the time period
since the relinquishment, 87% experienced at least one
or more symptoms of intrusion; 84% experienced at least
one or more symptoms of avoidance; and 61% experienced
one or more symptoms of hypervigilance.
Unresolved Grief, Depression, Guilt, Remorse and
Shame. As found in previous studies (de Simone,
1996; Gediman & Brown, 1991; Lauderdale & Boyle,
1994), unresolved grief was common among the survey
respondents. 95% of the respondents selected the "most
frequent" or "most severe" response to one or more items
measuring unresolved grief. In response to items concerning
depression, 51% of the respondents reported experiencing
severe depression since the relinquishment, with
97% reporting some degree of depression (mild,
moderate, or severe). Over half of the
birthmothers reported experiencing depression often
since the relinquishment. 63% have had thoughts about
killing themselves. 89% of the birthmothers reported
experiencing feelings of guilt: sometimes (33%)
and often (56%). Feelings of remorse were reported
sometimes (34%) and often (58%), totalling
92% of the survey responses. The survey respondents
reported experiencing shame sometimes (32%) or
often (41%), totalling 72%, since the relinquishment.
Birthmother Syndrome. The survey responses for
items measuring components
of Jones' (1993) "birthmother syndrome" and Carlini's
(1992) "core issues of relinquishment" are presented
in Table 1. Only the "most frequent" or "most severe"
responses are included. The derivation of characteristics
is described in Appendix H.
TABLE 1
BIRTHMOTHER SYNDROME/CORE ISSUES
OF RELINQUISHMENT
CHARACTERISTIC
|
PERCENT
|
|
Unresolved grief
|
95% |
| Traumatic Stress:
Intrusive thoughts |
87% |
| Traumatic Stress:
Avoidance |
84% |
| Self-punishment |
71% |
| Low self-esteem |
62% |
| Traumatic Stress:
Hypervigilance |
61% |
| Living at extremes |
44% |
| Relationship problems |
44% |
| Hysterectomy |
41% |
| Problems forgiving
|
39% |
| Self-hatred |
37% |
| Difficulty giving
and receiving love |
32% |
| Arrested emotional
development |
32% |
| Being out of touch
with feelings |
30% |
| Dysfunctional sexual
problems |
20% |
| Dual Identities |
n/a |
| Unexplained secondary
infertility |
n/a |
| Co-dependency |
n/a |
POST-SURVEY
DISCUSSION GROUP
Statistics in Context. Table 2 contains all
items for which more than 50% of the respondents selected
an "extreme" response (i.e., "most frequent" or "most
severe" or "not at all" response). These items formed
the agenda for the group discussion.
TABLE 2
"Extreme/Not at all/Often/Severe"
- where greater than 50% responded
| Ques. |
Statement |
Percent |
Mean |
| C12 |
I received adequate
counseling at the time of the relinquishment. (Not at
all true) |
94% |
0.1 |
| C5 |
Relinquishing my child
was a traumatic experience. (Extremely true) |
89% |
4.7 |
| C8 |
I was either misled
or not informed of the effects that relinquishment would
have on me. (Extremely true) |
85% |
4.5 |
| B1 |
Any reminder brought
back feelings about it. (Often) |
73% |
4.4 |
| C1 |
Relinquishing my child
was a great relief. (Not at all true) |
73% |
0.7 |
| C6 |
I have no regrets
about relinquishing. (Not at all true) |
73% |
0.5 |
| E2 |
Since the relinquishment,
I experienced grieving for the loss of [my] child. (Often) |
71% |
4.3 |
| E3 |
Since the relinquishment,
I felt hurt. (Often) |
70% |
4.4 |
| C9 |
I don't feel particularly
guilty. (Not at all true) |
70% |
0.8 |
| E1 |
Since the relinquishment,
I experienced grieving for the loss of [my] child. (Severe) |
66% |
4.2 |
| B6 |
I thought about it
when I didn't mean to. (Often) |
66% |
4.2 |
| B12 |
I was aware that I
still had a lot of feelings about it, but I didn't deal
with them. (Often) |
65% |
4.0 |
| C2 |
I have forgotten details
surrounding the birth, such as date of birth, name ofhospital,
etc. (Not at all true) |
62% |
1.1 |
| B9 |
Pictures about it
popped into my mind. (Often) |
58% |
4.0 |
| E3 |
Since the relinquishment,
I felt remorse. (Often) |
58% |
4.0 |
| E3 |
Since the relinquishment,
I felt loneliness. (Often) |
57% |
3.8 |
| E3 |
Since the relinquishment,
I experienced guilt (Often) |
56% |
3.8 |
| B16 |
I had waves of strong
feelings about it. (Often) |
56% |
3.8 |
| B13 |
My feelings about
it were kind of numb. (Often) |
54% |
3.6 |
| E2 |
Since the relinquishment,
I experienced depression. (Often) |
53% |
3.9 |
| E2 |
Since the relinquishment,
I experienced low self-esteem. (Often) |
52% |
3.8 |
| E1 |
Since the relinquishment,
I experienced drug dependencies. (Not at All) |
51% |
1.3 |
| E1 |
Since the relinquishment,
I experienced depression. (Severe) |
51% |
3.7 |
| B22 |
I tried not to talk
about it. (Often) |
51% |
3.5 |
"With-an-Agenda Counseling." Most of the respondents
answered that they did not receive adequate counseling
at the time of relinquishment. In response to the statement
"I received adequate counseling at the time of the relinquishment,"
94% indicated that it was not at all true and the remaining
6% indicated that it was somewhat true. The group unanimously
agreed that any counseling provided was done so "with
an agenda." The following excerpts reflected the group's
experiences with relinquishment counseling.
__________
JARRETT: "There was not really any emotional counseling.
. . .Don't make a mistake like one girl who decided
not to give up her baby. . . .They pushed this girl
off to the side and pointed at her as an example and
said this girl is going to ruin her child's life. If
she loved her child she would give him up. And don't
make the same mistake that this girl is making. It was
like don't even talk to her. She had to be shunned.
. . .Having the group experience helped a little bit.
You weren't the only pariah. We were a group of pariahs.
. . . In my counseling, the general attitude was get
on with your life. But you will get over this in a few
years. This will all recede behind you and you will
forget all about it. . . . Counseling was defined as
a completely different thing in those days. Counseling
was how to make you give up your child and not give
them a lot of trouble about it. And then go away."
__________
TERRY: "I was in someone's home. There was another
pregnant girl there. I had no counseling. . . I was
basically warehoused. When I did see a therapist much
much later, I had already gone through suicidal bouts,
hospitalization. . . I think that what you mentioned
earlier. . . society, the niche thing it was trying
to fit us all into. . . was pretty phenomenal. As women
we had certain things we were supposed to do. If we
were not that person, we were a misfit. As a woman,
we were a mistfit in society and as an artist certainly.
. . this creative person. . . what was done to me...
to try to fit me into a niche and try to take me away
from what I needed for my creativity. . . no adequate
counseling. I think it's only now that I'm getting adequate
counseling."
__________
CHRIS: "The psychologist that my mother sent me to,
I think I saw him maybe once a month. And he would just
sit there for 50 minutes telling me that there's no
such thing as maternal instinct. I bought into it. I
mean I was seventeen. 'Oh. Okay.' I had seen him before
I had gotten pregnant. . . so when I saw him after I
was pregnant, I was like 3 or 4 months along. The first
thing he said to me was, 'You know if you had told me
about this, I could have gotten an abortion for you
under the basis of it endangering your health'. . .
I couldn't believe that he said such a thing."
JARRETT: "And his comfort to you at the end of the
pregnancy was there's no such thing as maternal instinct?"
CHRIS: "Oh. It was constant. So I guess it was to combat
anything, and so, of course, that made me feel like
there was something really wrong with me."
__________
JARRETT: "The counseling I remember getting was, "If
you love your child, you will give this child to deserving
people as opposed to you. . . .
CHRIS: "With two parents too. . . to a father, to a
mother."
JARRETT: "To nice people."
TERRY: "A real home."
JARRETT: "As opposed to you miserable creatures. .
. That's the agenda thing."
CHRIS: "And then you get on with your life."
__________
The group's experiences concerning the adequacy of
relinquishment counseling was consistent with the survey
results. Their experiences suggested that the emotional
needs of the birthmothers were not met by the counseling
provided by psychologists or agency social workers.
Rather, when available, counseling was viewed as a means
to persuade birthmothers to relinquish their children
to adopting couples. Several underlying assumptions
were raised: (1) That the birthmother would keep her
child only if she did not love him/her and would consequently
ruin the child's life; (2) That relinquishing the child
was an act of love; (3) That birthmothers were of less
worth than the adopting couple; and (4) That after relinquishment,
the birthmother would forget the experience and be able
to resume a normal life. The group acknowledged "buying
into" these assumptions at the time of the relinquishment,
but now challenged their validity.
Traumatization. In response to the statement:
"Relinquishing my child was a traumatic experience,"
89% of the survey participants responded extremely
true. In total, 99% responded that the statement
was either extremely, very, or somewhat true. The group
identified the following factors as implicated in experiencing
relinquishment as traumatic:
- shame (bad girl, stigmatized if the father didn't
marry you) secrecy (denial by family, not telling family
members, being hidden away)
- loss
- whether we believed or were told we would see the
child again may have diminished the experience of trauma
- trauma: physical wrenching, tearing away, total shift
of reality - everything you thought was, no longer is,
being violated
- self and shell
- dissociated from experience
- emptiness
- abandoned by parents
Analysis of this question began with a discussion of
the factors that might have accounted for the single
"not at all true" response.
JARRETT: "I'm trying to figure out why people would
answer not true. . . . I was told outright that I would
be able to find my son again when he was 18. . . . And
I know other people who were told the same thing. So
I looked at this . . . of course it was very traumatic.
Eighteen years is a long time, but at least there was
an end. So if somebody was told that, that certainly
would reduce the trauma. . . . "
__________
As facilitator, I presented the following question
to the group: "What does relinquishment trauma mean
to you?" Each of the members shared their perceptions
and experiences:
TERRY: "It's a total shift of reality. . . . Everything
you thought was, no longer is. . . .Women have been
hiding from themselves for so long. It's almost like
a shadow self. . . . There's the shell and the self.
. . . It's disassociative. You're disassociated from
yourself. You've disassociated from what you've experienced.
You had to do that in order to continue and in order
to be able to live, basically, to protect yourself.
So you're disassociated. . . . If you have good things
happen in your life, it's not really going to be good
enough because it's not happening to you. . . . But
there's always that certain sort of emptiness inside
and it's not only connected to the loss of the child.
. . . I think that even now there are still some women
that this is a taboo, dirty, you don't count... you're
not a full human being. You don't deserve the same consideration
as other people. . . . You're a bad girl. And I think
some of this still exists. A lot of people who are out
there dealing with women who are thinking about relinquishing
a child or adoptees are still products of that. You
know they bought into it. They are still products of
the same thing that traumatized us, of the same system,
the same society. And I think society has a lot of garbage
left over. . . . The relinquishment was one thing. I
was so in denial of that for so long. I didn't really
deal with it. But the shame. . . the shame and the secrecy
are the worst -- the worst thing."
__________
JARRETT: "For me the sense of being violated and the
sense of having been abandoned were probably the two
strongest components of trauma. . . . It's having the
child and then having the child ripped away. . . .When
I was 29, my sister, who was ten years younger than
I, was killed. . . And I felt, it was like I was the
mother. I felt that loss as a mother would feel it,
I think. I felt physical pain in my belly and I think
that a lot of that was losing [my son] coming back to
bite me. And I think that's when I started feeling the
absolute need to search. . . .I thought that the loss
of my son was the worst, much worse even than the shame."
__________
CHRIS: "You know I went through for many years thinking
that I'd totally done the right thing. . . . I used
to think I got through that experience so I could get
through anything. . . . . How could a therapist, especially
a woman who's ever had a child, think that to lose your
child would not [damage us]."
Betrayal and Misinformation. 97% of the survey
respondents indicated that the statement "I was either
misled or not informed of the effects that relinquishment
would have on me" was true. 85% of the respondents described
it as extremely true. The following issues were
identified by the group as contributing factors underlying
this response or consequences thereof:
- everyone wanted to separate us from the child
- was told this was what was best for the child
- how could a mother having had a child herself put
her daughter through this
- resulted in anger
- resulted in feeling lost
- was unaware of what was going on
- spent 3 months knitting baby clothes that never went
to the adoptive family
- waiver of confidentiality was sent to the agency,
but was not kept by the agency
- no permissions for anything
- no rights - didn't know rights
- didn't know child would be in foster care
- was told that when child reached 18 would have right
to search
- was told that child was going to a wonderful home
The experiences and perceptions of the group participants
concerning this question follow:
JARRETT: "Everyone around us, whether we were in a
home or not, wanted one thing - to separate us from
our child. So everything they told us was colored by
that. You will be fine. We will take your child. Your
child will be better off. You're not worthy. . . .
__________
TERRY: "Did they care? Who was going to tell us? Who
cared? They didn't care. . . . This is something that
you will live with forever. . .
__________
CHRIS: "It's just hard to comprehend. It's hard for
me. It's really mind-boggling. For our mothers who had
children who knew the attachment that is possible with
the child. . . . There's that other part of them that's
a mother. How could they have ever done such a thing
to their daughter. . . And it was always thinking about
what's best for my daughter. And what's best for me
too. . . . As a mother from a gut feeling, how could
they imagine someone taking their baby from them?. .
. I wonder if they could even have allowed themselves
to think of that. . . . If someone had told me that
this is probably what you are going to be feeling at
some point in your life. This stuff is going to resurface
and it may happen this way or that way. Just not knowing
what was going on. With denial. With everything. Just
feeling kind of lost. . . ."
__________
JARRETT: "We had no rights. . . . [I was misled about]
the fact that I would be able to find him when he was
eighteen."
TERRY: "Actually, we did have rights. In some states
you had a certain period of time that you could say
you wanted your child back. I was never told that."
CHRIS: "I called the agency after I got home from the
hospital. And after I signed the papers, I don't remember
how soon it was, but it was soon. It was like a day
or two later, I called the agency. And I said I don't
want to do this. I want her back. And they said it was
too late. That she was in a foster home for a month.
. . .[What has come around to me] is the anger at the
agency, at the system that did this, at the society.
. . .And what are you going to do with that anger? It's
frustrating."
Intrusion. 95% of the respondents answered that
"Any reminder brought back feelings about it" sometimes/often
(22% sometimes, 73% often). The group participants had
mixed responses to this question. Their experiences
included denial, avoidance, and intrusion.
CHRIS: "I'd have to say no because I just stuffed it
down so far. Even with having other children if I was
reminded I wouldn't go there. I forgot her birthday.
I couldn't remember her birthday. If you haven't been
in that experience, someone could say how in the world
could you forget your daughter's birthday."
__________
JARRETT: "Mostly it made me flee from reminders."
__________
TERRY: "Every year [on his birthday] I was really down
with no one to share it with."
No Relief. Relinquishing my child was a great
relief.
Regrets. I have no regrets about relinquishing.
These two items were discussed simultaneously. For
each, 73% of the respondents answered that these statements
were not at all true. The group wanted to follow up
on the 27% that responded that relinquishment was a
great relief or that they had no regrets. They considered
whether denial was a factor. They suggested that if
the birthmothers saw that their child went to a good
home and felt that they were unable to provide it, then
there might be feelings of relief or no regrets. However,
for the group participants, these statements were not
at all true.
Grief. Since the relinquishment, I experienced
grieving for the loss of [my] child. 71% responded that
they grieved for the loss of their child often. The
group members raised the following associations to this
statement.
- never given permission to grieve
- not allowed to share
- felt like acid in your stomach
- isolated with pain
- howling with grief
- still grieve after reunion; lost years, not having
history
The experiences and feelings of the group members supporting
these associations follow:
JARRETT: "I think we grieve still even after reunion.
But the grieving thing, that really is true. And it's
partly because we were never given permission to grieve
back when it was time to. We were never given support
of any kind whatsoever. And our child was not dead.
Our child was out there somewhere. We couldn't even
be at peace with their being wherever we imagine dead
people being. . . .It's like acid in your stomach. I
spent weeks sitting in the middle of my queen size bed
howling -- like baying at the moon, howling with grief.
. . . But now that I've found my son I still grieve
. . . in the same way over different things. . . about
having lost all those years. . . about not knowing what
his favorite foods are. . . .like he's a guest. . .
. like not having him know those things about me. .
. about my guilt that I did this to him. . . about his
anger. . . grieving. . ."
__________
TERRY: "We weren't allowed to share. I certainly didn't
share. I only shared it with men I was with. . . . I
started to tell women friends about it very slowly.
There were people I knew for years who didn't know.
Suddenly as I got closer to searching, I started to
tell more people. There was no hope that you would be
able to share it with anybody. . . . You're isolated
with the pain."
Language. As facilitator, I asked the group
if they could identify how the use of language may have
influenced the relinquishment experience. Several themes
emerged:
- unwed mother, out-of-wedlock
- mother: natural mothers, birthmothers, first mothers
- relinquishment: voluntary, beaten
- gave up: "lost the war, lost the battle"; voluntary
- lost to adoption
The terms "unwed mother" or "out-of-wedlock" were viewed
as patriarchal and stigmatizing. The group also felt
uncomfortable with the terms used to differentiate birthmothers
from adoptive mothers. The language used to describe
the relinquishment, such as "relinquished, gave up,
surrendered," were imbued with a variety of meanings.
The term "lost to adoption" was identified as best describing
their experience.
On Shame. Shame was a predominant theme throughout
the discussion and surfaced as a major player in affecting
the relinquishment experience. The following comments
portray the underlying assumptions surrounding the group's
experience of shame and its effects:
CHRIS: "There is this stigma, you weren't even good
enough for him to marry. . . . Or you made such a bad
choice of fathers. . . . While I was pregnant living
in this house with my mother, she never talked about
my pregnancy... It was like there's a pumpkin in your
stomach or something. You'd better take care of that.
It was like totally nothing about how it was like when
she was pregnant. . . . We're just going to keep going
on like nothing happened. You'll go into the hospital
and then it'll be over with."
__________
[Jarrett was the only group member who
had held her baby after he was born. Terry was not permitted
to hold her baby and recalled begging the nurses to
permit her to see him through the nursery window. Chris
neither held nor saw her daughter.]
__________
CHRIS: "I asked the doctor if I could see her and he
said yes. . . He said he'd tell the nurses. . . And
I was like this very wimpy kid and I asked the nurses
and they said 'Oh, in a little while.' And they just
kept putting me off and putting me off. . . . As soon
as I got pregnant and I had like brought this shame
on the house, they could do anything to me. Because
this was the punishment... So don't rock the boat, Chris.
. . .They didn't say that. . . But that was the message
I got. . . .Even if I had had rights which I probably
did at 18 when I had her, but I don't even think it
crossed my mind. . . . We had a commodity. . . . I think
the commodity was a very big thing. I don't think it
started out that way, but I think that's what it turned
into."
__________
JARRETT: "I definitely had the feeling that I had brought
all this horrible shame on my parents and at this point
they were going to take over. I'd done quite enough
. . . and I should just get out of the way. . . . [There
was] denial of the pregnancy. Denial of the relinquishment.
Denial of all the emotional stuff. . . . I remember
as a sophomore or junior in high school, the minister
asked me if I would come visit a girl who was living
with him because she was friendless from out of town.
And she turned out to be a pregnant girl who was stashed
at his house and locked upstairs and she lived in his
bedroom upstairs. She had no social life. She wasn't
allowed to go out. . . .
I felt so sorry for this creature. If it's bad enough
to get locked up over it, it's pretty shameful."
__________
TERRY: "[The focus was on] "Why did you allow this
to happen to you? . . .Instead of trying to explore
what we were feeling about ourselves. . . .I think we
had models of other women who had come before and been
shameful. I mean in my town there were the bad girls
and there were the good girls. And the bad girls, a
lot of them ended up pregnant out-of-wedlock and they
were sluts. So of course I was a slut, or I would have
been if I had been in that town. So my parents just
simply hid me away somewhere. So I think that they were
trying to protect me. They were also trying to protect
themselves. But they were trying to protect me in the
only way that they knew how. . . You couldn't talk about
it. My sister didn't know. My two brothers didn't know.
No one in the family knew except my mother and my father.
And I only told [my family] last year, at Thanksgiving
dinner. . . . So shame has been such a driving force
in my life."
__________
The group was presented with the survey finding that
41% of the participants had received a hysterectomy
and were asked how they interpreted that.
CHRIS: "I never had any problem. I went in for my checkup
and then about four months later, this was right at
the time of the reunion. About six months into the reunion,
then I started to develop all the symptoms of fibroids.
And because they grew so quickly and because they were
so large they said we'd just better take this out. Because
it just was too quick and then my therapist said think
about this. Think about this timing because you don't
have a history of this in your family. And talk about
the mind and body connection and that that's where it
decided to plant itself."
__________
JARRETT: "It comes back to that physical feeling that
I had at the death of my sister. In my belly. In my
womb. It was being like torn away, that tearing away."
__________
In this section I have presented the summarized data
from the survey and have drawn from the interpretations,
perceptions, and insights provided by the discussion
group for greater depth. I have attempted to present
the relinquishment experience as an intricate tapestry
woven together by the threads of data emanating from
the survey responses. In the next section, the implications
of these results are discussed and considerations for
social action, clinical counseling and future research
are presented.
Copyright © 1999-2005 Judy
Kelly, M.A., C.P.A.C.,
All Rights Reserved. Reprinted with permission of the
author
Note: The words "birthmother" or "birthparent"
are derogatory terms utilized by adoption "counselors"
and "facilitators" in order to diminish a mother
into playing a solely reproductive role in her child's life.
The terms "birthmother" and "birthparents"
are used on this site as a consession to search-engine requirements
for a North American audience. The terms "mother",
"single mother", "natural mother," and
"exiled mother" are acknowledged to be accurate,
respectful, and nonderogatory terms. See " by Diane Turski for more
information.
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