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Orphanages and other forms of institutional care have been largely replaced by foster care and group homes in most Western countries. They are, however, still a prevalent form of care in the rest of the world. Their inhabitants are generally children that nobody wants. Because of inadequate funding for these institutions, the children receive little education and are affectively deprived. Nonetheless, studies demonstrate that their IQ, their capacity to attach to another person, and their sense of identity need not necessarily be affected (Hersov, 1980; Hodges and Tizard, 1989). Some 20% show signs of later positive psychosocial functioning (Rutter et al., 1990). These surprising findings are mainly based on people who were raised in considerably better conditions than are prevalent in most of the world. Furthermore, we have found no reports of the psychosocial adaptation of a middle-aged group of those who were in institutional care as children.The Social Context and Institutional Environment. The subjects in this study were born at a time when Quebec, a Canadian province, was primarily rural and poor. Abortion was illegal. Illegitimate children were "children of perfidy" and without legal status. Pregnant single women were ostracized, concealed by their families, and dispatched to Montreal or Quebec City to give birth to their babies. The babies were placed in crèches until the age of 6 when they were placed in orphanages. With few exceptions (Pelletier, 1950), these institutions were underfunded and poorly staffed. Individual attention was limited to crisis situations. At the age of 12 to 14, boys were placed on farms or in reform schools. They received little or no pay and were frequently abused. At the age of 14, girls worked as maids, often in similar conditions. All were ill prepared to deal with the exigencies of everyday life. In this study, we examined the psychological and physical effects on these children some 40 years later.Thiry-two people raised in an orphanage were recruited in alphabetical order from a list of 112 members of a self-help group. The interviewer obtained written informed consent before proceeding with the interview. One person withdrew after giving informed consent, because he was too upset to continue. Our final sample consisted of 25 men and 6 women, ranging in age from 45 to 68 (mean 55.4 ± 4.1). Twenty-one (75%) of the 28 who knew at what age they were placed in the orphanage were abandoned and placed at birth, and 7 were placed by the age of 3. The reasons for the placement of those who were not abandoned at birth were distributed almost equally among these: death of a parent, divorce/separation, family problems, and parents' personal problems. A majority (75%) left the institutions at age 14. There were no notable differences between men and women in these demographics.The comparison groups were chosen from the data bank of a health survey of a random sample of all Quebec residents conducted by the Provincial Government (Santé Québec, 1988). We chose all 85 residents of the greater Montreal area who had an annual family income of $0-$9999.00, and all 361 who had an income of $10,000.00-$30,000.00. A further inclusion criterion was that they had to be 45 to 65 years old. These residence, income, and age ranges were selected to coincide with those of the index group.For our index group, we used some of the measures that had already been pretested and used for the general population survey. They included the following:Psychological Well-Being.