Psychiatrist
Viola Bernard, born in 1907,
was a charter member of the American psychoanalytic
movement. A lifelong friend of Justine
Wise Polier, Bernard shared the vision of therapeutic justice
that was common among unusually well educated women early in the
twentieth century. Bernard served for forty years as Chief Psychiatric
Consultant to Louise Wise Services, an adoption and child welfare
agency in New York.
Adoption, as an ingenious psychosocial invention can offer one
of the finest and happiest adaptive solutions to the desperately
frustrated needs of parentless children, childless parents, and
those who cannot be parents to the children they have borne. Such
are the human intricacies of this process of family formation on
the basis of nurture rather than nature that sometimes participants
fail rather than fulfill each other and themselves. Adoption agencies
represent the community's stake in providing skilled professional
services toward implementing and safeguarding this remarkable human
experience. Ways and means of carrying out such services logically
evolve in relation to the growth of understanding of the clients
served. As psychoanalytic concepts have enlarged and deepened general
understanding of human nature, they naturally are of special significance
to a field so closely concerned with areas specifically related
to major psychoanalytic contributions, such as child development,
psychosexual conflicts, dynamics of family relationships and the
role of unconscious motivation and emotions in behavior and symptom
formation. . . .
Diagnostic, prophylactic and therapeutic responsibilities of the
agency come into play during this period of temporary care between
surrender and adoptive placement. Of the infants, some are newborns,
straight from the hospital; others are a few weeks or a few months
older, some of whom have experienced a traumatizing succession of
being shifted about between different places and people, or other
forms of stress, before coming to the agency. The care they receive
represents a vital contribution to their future psychological development,
according to psychoanalytic assumptions and corroborating research.
It simultaneously provides an opportunity for continuous clinical
observation of each baby's behavior as the principal diagnostic
method, to be supplemented by psychological and pediatric examinations
and, in some selected instances, by psychiatric examination as well.
Because of the importance to infant development of warm, relaxed
human contact and adequate stimulation, temporary foster care seems
far preferable to group care. Considerable attention should be given
to selecting and working with the foster mothers, and it follows,
from what has already been said, that the criteria of their selection
should be heavily weighted in the direction of personal attributes
that can fulfill “the rights of infants” by affectionate
flexible mothering. Experience by the worker with the maturational
sequences of infancy and her insight into the behavioral language
of infancy helps her differentiate normal individual reactions from
signals of disturbance calling for remedial action. Such action
might take the form of helping the foster mother change some of
her ways of handling the baby or even changing foster mothers. Fluctuations
and aberrations in feeding behavior, for instance, are recognized
as delicate barometers of the infant’s condition. Anna Freud
has recently added to the sizable psychoanalytic literature around
this topic by a theoretical contribution in which she differentiates
three main ways in which the function of eating is open to disturbance:
organic feeding disturbances, nonorganic disturbances of the instinctive
process itself, and neurotic feeding disturbances.
There is a promising trend in psychoanalytic studies of child development
toward combining more data from direct observation of infants and
children with the information gained from analytic therapy of adults
by reconstructions of their childhood in the context of their full
life history. Direct observations have obvious methodological advantages
for studying the preverbal period of the first year of life and
from such investigations by Ribble, Fries, Spitz, Anna Freud, and
others, adoption agencies may hope to gain much needed data of specific
relevance in meeting their responsibilities and growth-promoting
opportunities around temporary preadoptive foster home care and
permanent adoptive placement. Thus, Fries, investigating factors
in psychic development in a group of children she studied from birth
to adolescence, offers supporting evidence—elaborated in detail—for
the interacting influential roles of constitution, habit training
and parental emotional stability on the personality outcome of her
original infant group. In his researches into “Psychogenic
Diseases in Infancy,” Spitz seeks to classify certain damaging
consequences to infants during their first year according to causally
insufficient or emotionally unhealthy forms of mothering. Correspondences
between the types of disturbances and types of mothering are differentiated
as to course and outcome in relation to chronological phases of
ego development within the first year of life. In the light of these
and many other studies, adoption for parentless infants by “good”
parents seems even more than ever the most logical preventive therapy
for what can be most devastating psychogenic illnesses, i.e. maternal
deprivation and “mal-mothering” of infancy. . . .
The social worker’s task may be seen as helping the preadoptive
child survive an undue succession of prematurely ruptured attachments
to parental figures with minimal hardship and psychological damage
while repairing, conserving and fostering his capacity for healthy
attachment to new parents. Appropriate reassurance based on understanding
the child’s language, behavioral and symptomatic as well as
verbal, entails repetition, consistency and honesty by the worker.
Enlisting and permitting maximum participation by the child in the
adoptive planning and placement is generally recognized as a most
desirable reassurance against his anxiety-laden sense of helplessness
as a passive pawn at the mercy of all-powerful unpredictable grownups.
Sensitive timing of the various stages of adoption attuned to the
particular child's inner pace is a vital ingredient of reassurance;
destructive anxiety can mount when certain stops of the process
are too prolonged, such as between a child’s relating to prospective
parents and his actual placement with them; by the same token, however,
panic may stem from feeling rushed and stampeded so that a more
graduated spacing and slowing down is the most effective reassurance.
Another general principle along this line with preadoptive children
consists of consolidating each step along the way of new environments
and new relationships by converting a previous unknown into a positively
experienced known which can then furnish continuity as the next
unfamiliar element is introduced.
Psychodynamic insight and concepts of personality development underly
[sic] these principles and procedures for direct work with children
for adoption so that theoretical substantiation in general may be
found abundantly in the literature. It may be of some interest to
single out, however, one ingredient of personality recently discussed
by Erikson because of its particular applicability to our topic.
Erikson regards the inner institution of “ego identity”
as crucial to healthy personality and defines it as “a sense
of identity, continuity, and distinctiveness. . . .
a sense of who one is, of knowing where one belongs, of knowing
what one wants to do. . .a sense accrued throughout the
stages of childhood that there is continuity and sameness and meaning
to one’s life history.” Ego identity, as something both
conscious and unconscious, is normally established at the end of
adolescence, according to Erikson, and sufferers from impaired or
insufficient ego identity cannot “integrate all the various
steps of their previous ego development, nor achieve a sense of
belonging from their status in their society.” By contrast,
healthy ego identity entails “feeling that his past life has
a meaning in terms of his future but also from the feeling that
the future has a meaning in terms of his past.” It is obvious
that the typical life history of a child adopted later than infancy,
with its lack of continuity between successive, unrelated experiences
and relationships—natural parents, institutions, foster homes
and adoptive homes—is especially inconducive to healthy establishment
of ego identity in Erikson’s sense. Such a series of changing
worlds for the young child opposes his accrual of feeling identical
with himself. Correspondingly, however, this specific impairment
may be greatly minimized and corrected by the case worker’s
therapeutic opportunities as discussed above, particularly as to
continuity, meaningful relatedness to past and future, and the restoration
of trust. . . .
Perhaps some readers have become impatient by now with what may
appear to them as needless exaggeration of the psychological complexity
of adoption and the precautions advocated. This attitude may be
bolstered by knowing of some apparently happy adoptions accomplished
much more simply, either through independent adoption or social
agencies with minimal case work. The personal qualifications for
adoptive parents and for case workers may seem perfectionistic and
the intensive psychological work with unmarried mothers and preadoptive
children a lot of fancy nonsense. By way of reply, psychoanalysis
provides a microscope whereby otherwise invisible psychic structures
and processes come into view. A description of pond water in accordance
with structures and movement observed in a drop under the microscope
can sound unbelievable to one accustomed to water, but not to microscopes.
Although hit-and-miss methods of adoptive placements sometimes do
turn out well, reliance on knowledge rather than luck promises better
control over the outcomes by adding to the successes and reducing
the failures.
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