strong need for attachment and a powerful fear of rejection. He or she will invariably attempt to sabotage the treatment. Adoption-sensitive, analytically trained therapists are best equipped to deal with this resistance.

  My review of extensive treatment notes and reports on the twenty adoptees who killed suggests that their treatment was not adoption-sensitive, and did not focus on these issues. Almost all of them, as teenagers or young adults, had attempted to search for their birth mothers, but were blocked (by a closed adoption system) in this quest. Ironically many did have reunions in prison, as defense attorneys or investigators were able to find information on birth families in almost every case. In my opinion, had they been raised with openness and honesty; had their treatment been with therapists who were sensitive to adoption issues; and if they had been able to find their birth mothers prior to the events (the Son of Sam case notwithstanding), the killings would never have occurred.

  This is not to say that reunions are always wonderful. Usually they do not result in long-term, close relationships. Reunion with the birth mother does, however, bring the adoptee back to the primal trauma. Revisiting this trauma, filling in the gaps and testing reality, no matter how unpleasant or painful, is often a major step in the healing process. In every case of the adoptees who killed, split fantasies of all-good or all-bad parent figures, dissociated adoptee rage, and the acting-out of an unconscious compulsion to repeat, was at the heart of the deed.

  In Beyond the Pleasure Principle, Freud (1920) describes cases where patients display an unconscious need to recreate and repeat the primal traumas of their childhood, in successive relationships. He states, "There really does exist in the mind a compulsion to repeat which overrides the pleasure principle ... and this compulsion to repeat is part of the death instinct" (p. 24). Nowhere, in my opinion, is the connection between traumatic loss, pathologic grieving, the death instinct and repetition compulsion more dramatic than in cases of adoptees who kill.

  For example, in 1989 1 examined then 45-year-old Steve Catlin, accused of killing his fourth and fifth wives, as well as his adoptive mother, with paraquat poison. Steve's third wife, Edith Ballew, raised suspicion about the deaths. The bodies were exhumed, traces of poison were found. I was called in to see if adoption issues could explain Steve's motivation and mitigate against the death penalty. When I evaluated him in prison in Bakersfield, California, I asked how he felt about being adopted. Steve, a macho kind of guy, started crying and said, "I can't believe you're asking me that. No one ever asked me how I felt about adoption before." When questioned what he had been told about his birth parents, Steve said that his biologic father was a Royal Air Force pilot during World War II who met his mother while training in the United States. He fell in love with her, went back to war, and was killed in the Battle of Britain. His birth mother, so he was told, upon learning of her lover's death, committed suicide by