Florence Clothier, a graduate of Johns Hopkins Medical School, worked as a psychiatrist at the New England Home for Little Wanderers from 1932 to 1957. She was an active member of the Boston Psychoanalytic Society, where she knew Helene Deutsch and Erik Erikson, among other notable Freudians. In addition to her work on adoption, she was an active advocate of birth control. Clothier directed the Planned Parenthood League of Massachusetts from 1939 to 1956. In this excerpt, she anticipated themes of attachment and loss that became commonplace in later years.

The child who does not grow up with his own biological parents, who does not even know them or anyone of his own blood, is an individual who has lost the thread of family continuity. A deep identification with our forebears, as experienced originally in the mother-child relationship, gives us our most fundamental security. The child’s repeated discoveries that the mother from whom he has been biologically separated will continue to warm him, nourish him, and protect him pours into the very structure of his personality a stability and a reassurance that he is safe, even in this new, alien world.

Every adopted child, at some point in his development, has been deprived of this primitive relationship with his mother. This trauma and the severing of the individual from his racial antecedents lie at the core of what is peculiar to the psychology of the adopted child. The adopted child presents all the complications in social and emotional development seen in the own child. But the ego of the adopted child, in addition to all the normal demands made upon it, is called upon to compensate for the wound left by the loss of the biological mother. Later on this appears as an unknown void, separating the adopted child from his fellows whose blood ties bind them to the past as well as to the future.

Environment, or experience, influences the personality in very different ways, depending upon the age and maturity the individual. Those experiences and emotional relationships which exist in earliest childhood have effects that are incorporated into the very structure of the personality. Experiences and relationships after the Oedipal development may mold or modify the presenting or external personality but their effects are as a general rule not incorporated or built into the personality. It may be said the external environment functions in two capacities. In the earliest years, it combines with constitutional factors to determine personality. Later on, through the influence of education, environment and experience modify persona1ity manifestation, even to the extent of creating the person we think we know. Though analogies are unsatisfactory, we might say that, in the construction of the personality, constitution provides the basic metal, infantile emotional relationships and experiences add alloys and temper the metal, and childhood education and environment provide the superstructure, facade, and the paint.

The implications of this for the psychology of the adopted child are of the utmost significance. The child who is placed with adoptive parents at or soon after birth misses the mutual and deeply satisfying mother-child relationship, the roots of which lie in that deep area of the personality where the physiological and the psychological are merged. Both for the child and for the natural mother, that period is part of the biological sequence, and it is to be doubted whether the relationship of the child to its post-partem mother, in subtler effects, can be replced by even the best of substitute mothers. But those subtle effects lie so deeply buried in the personality that, in the light of our present knowledge, we cannot evaluate them. . . .

Although the adopted infant obviously cannot experience fully with his substitute mother the satisfactions of the nursing period, he will experience with her his first and supremely important socializing relationship. The process of receiving food or sucking is for the infant at first an intensely personal experience, but through it the child establishes his earliest meaningful rapport with another individual. If his first social relationship is satisfying and free from tension, his later social relationships will be easier for him. If his feeding experiences in infancy consist of one battle after another, he is apt to go battling through life, tense, suspicious, and anxious over social relationships.

The child who, before being placed for adoption, has lived in an institution or a foster home has been profoundly influenced by his feeding experiences. Babies cared for in institutions are usually fed by a number of different nurses or attendants who are more interested in getting correct amounts of formula into their charges at specified times than they are in the infants themselves. Some institution babies are even left alone in their cribs to suck from a bottle propped on a pillow. These children lose their earliest and most important opportunity to establish an object relationship through which they can progress from the stage of primitive narcissism to that of socialized human beings. . . .

The following case is one that shows very clearly the traumatic effect of an ill-advised adoption on a boy whose social and emotional development was tied up with a previous foster-home placement.

Dan is a nine-and-a-half-year-old boy, who was adopted at the age of three years. He was referred to a children’s study home because of running away, bunking out, and a devastatingly negative, hostile reaction to his adoptive mother. Dan ran away only when his adoptive mother was at home. He never ran very far, but rather than come home, he would endure untold hardships and discomforts. On one occasion, in the dead of winter, he stayed out for several nights, and when the police found him, his legs were both badly frozen. . . .

Dan’s immediate life situation in no way explained his behavior. The home was a good one and offered all the satisfactions that a boy would need. The adoptive father was an exceptionally fine person, and the adoptive mother, although tense and neurotic, was kindly and well-intentioned.. The adoptive brother [another child of Dan’s age, but adopted in infancy] was making an adequate adjustment and was devoted to Dan. For the key to Dan’s behavior, we have to go back to the story of his adoption and his life prior to that fateful event.

When we review Dan’s history, we gain some understanding of the problem he presented. He was an illegitimate baby who, at the age of three weeks, was placed by his mother to board. He remained in this foster home for three years, until his adoption took place. In the foster home, he was the baby of the family. There were two children very much older than “Sonny,” as Dan was called. The foster mother had lost several other children in infancy, and she accepted Sonny completely as her own baby. He was the adored baby of the entire family, even of the neighborhood. For three years he lived in that home and held the center of the stage. The foster mother was a warm, motherly, affectionate person, and it is said that when they parted with Sonny, both the foster mother and the father felt the loss as if it had been the death of their own child.

While living in the foster home, Sonny was visited periodically by his own mother, whom he spoke of as “Mummie Kay.” She, too, was “a good mother” to him and brought him frequent gifts. During these three years, Sonny was apparently an outgoing, happy child, developing normally.

When arrangements for the adoption were made, the foster parents were loath to lose their baby, but felt that in the adoptive home he would have far greater educational opportunities than they could hope to give him. They did not wish to upset him by telling him that he was to leave home, so he was told one day that after his nap he was to go for a drive with a friend of “Mummie Kay’s.” Sonny complained that he did not want to go, but would prefer to stay at home with “Mummie” (his foster mother). However, after his nap, when the big automobile drew up at the house, Sonny climbed in full of enthusiasm for a ride in the car with the nice new lady. He was driven away and has had no contact since with either of his foster parents or with “Mummie Kay.” One can imagine what a horribly traumatic situation this must have been for a three-year-old child whose entire world revolved around his love objects.

When Dan arrived in his new home, he showed a typical childish absence of a mourning reaction. It is likely that Dan’s sorrow at the security he had lost was so great that his immature ego could not face it and his sorrow was, therefore, entirely suppressed or denied. Dan repressed all memories of his first foster home. In his unexplained outbursts of crying, he is now giving evidence of a deferred mourning reaction. He cries, but he does not know why or for what he cries. It may also be that in his symptom of running away and hiding, he is repeating, in a distorted form, the traumatic situation to which he was subjected at the age of three. He comes back from his expeditions in such a condition that he has to be put to bed and lovingly cared for and nursed. . . .