the extreme end of the spectrum are at risk. While it is just a small percent who are prone to commit violent crimes, we should pay attention to this group for, as criminologists Jack Levin and James Alan Fox (1985), Ken Magid (1988), and Joel Norris (1989) point out, adoptees are overrepresented in the criminal justice system and adopted serial killers have become household names.

  Despite a wealth of clinical data and many replicated studies, with consensual validation among most mental health professionals in the adoption field indicating that adoptees are at greater psychological risk (Steed, 1989), them is still controversy about whether or not children of adoption are more vulnerable/at risk for emotional problems. Authors such as adoptive parent Elizabeth Bartholet (1993), adoptive father/sociologist William Feigelman (1986), adoptive mother Florence Klagsbrun (1986), and adoption agency lobbyist William Pierce (1990) all argue/maintain that adoptees are not any more prone to suffer from emotional/psychiatric problems than non-adopted individuals.

  Adoption per se does not necessarily give rise to psychopathology. It must, however, be considered a risk factor, perhaps a precipitating one, in some families that are dysfunctional in terms of core adoption issues and parent-child interactions. Fortunately, not one of the hundreds of adoptees treated in my practice has ever killed anyone (thank G-d), though they all presented issues of loss, identity, anger/rage, etc., similar in kind, if not degree, to the twenty forensic cases who did act out in homicidal violence. What differentiates the few who kill from the vast majority of adoptees who work-through their issues of loss, abandonment, and identity and go on to lead productive lives? Why in these extreme cases is there pathological mourning, and an ultimately Fatal Quest instead of the healing,transformation, and new beginning that is often seen so dramatically, especially in the psychoanalytic treatment of adoptees? What can be learned from these cases at the extreme end of a spectrum?

  For one thing, almost all of the twenty adopted killers whom I have seen had been in therapy (in childhood and adolescence), often with a number of different therapists, but the adoption issues were left virtually untouched in their treatment, and their therapists were not psychoanalytically oriented. Many therapists tend to minimize adoption as an issue in child and adolescent treatment. They often unwittingly enter into a folie a trois with the parents and adoption agency in which the adoptive family is viewed as being no different from birth families. Sociologist and adoptive father David Kirk (1964) believes this "denial of difference" as opposed to a realistic "acknowledgment of difference" is key to parenting emotionally healthy, adopted children. Therapists should also be aware that the transference of adopted children is quite special, and arises from the distorted parental images of many adoptees. The therapist may come to represent the birth parents and the patient may be intensely ambivalent, feeling both a