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.