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
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
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. . . .