Viola Bernard had an enduring interest in understanding the many causes of infertility. From the 1940s through the 1960s, she conducted a series of studies at Columbia University, some small and others large, in hopes of illuminating the relevance of psychological factors and pinpointing their relationship to the physiological and biochemical factors at play in reproductive medicine. Bernard was always especially interested in infertility cases with no apparent “physical” cause because these suggested the possibility that infertility might be largely or exclusively “psychogenic.” Such cases came to the attention of adoption agencies regularly, as this letter illustrates.

Dear Mrs. Brenner,

I am returning the F chart, as agreed, before your interview today. This is indeed an interesting record and I am glad you made it possible for us to have the doctor’s report about the sterility and the measures to overcome it. I think his report reinforces your impression that here is a case in which unconscious anxieties and conflicts may well have contributed to the ability to conceive. By the references both by client and physician to “unnatural methods,” I presume they might mean artificial insemination, although, of course, I cannot be sure. This may be brought out in your interview.

Two years of course is not a very long time as sterility problems go, particularly where the degree of marital compatibility is playing a role, as seems likely here. Some times, therefore, even without psychotherapy, a couple may be able to work things out better in their mutual adjustment that in turn relieves the emotional interference with pregnancy. In any event, Mrs. F. might be reassured by having this pointed out to temper her impatience and frustration at not getting immediate guarantee of a adoptive baby. I feel this is one of the cases where it would be undesirable to hurry a home study—in contrast to feeling that desirable in most cases—because the interval, if prolonged, may permit events to better determine their feeling about adoption. Thus I think here I would utilize the realistic limitations of time to project the picture of possibilities for her into the future.

The other two courses that are open to you, I suppose, are giving a final turndown now or suggesting psychiatric help. As I sense the case, which is always less vivid than your own firsthand impression, I would be hesitant in referring her to a psychiatrist, with all the threats involved. . . . I would also refrain, I think, from giving a complete refusal, but, instead, point out the short time of her marriage, as indicated above, with the time limitations of the agency and suggest, therefore, that she make her application now and then let you know in six months how matters stand.

Part of my thinking in this is tied up with our frequent observation of pregnancy not only after adoption but after the decision to adopt. If Mrs. F. is made to feel she has not decided to adopt because of our refusal, that factor—for whatever it is worth—would not be available to her in bringing about the natural pregnancy she thinks she wants. On the other hand, if she could relax a little, know that there need be nothing particularly wrong with her just because she has not had a baby in two years—and that in time she be considered for adoption and has done something about it by filling out the application,—it is possible that she will resolve this conflict—and we won’t have to decide—either by getting pregnant or by becoming aware that she doesn’t want to be. This does not mean, of course, that I advise our committing ourselves to promising a baby.

In your interview I think it might be wise to elicit more about the marital adjustment, the length of courtship, etc. . . . The material this elicits may make your course of action plainer and go counter to much of the above that I have written. . . .