Mad, Bad, and Sad: A History of Women and the Mind Doctors

by Lisa Appignanesi

  Maternal deprivation was akin to a vitamin D deficiency, Bowlby argued with the zeal of a campaigner. If the second caused rickets, the first seriously damaged the ‘psychic tissue’ of the child, who could be scarred by separation for life. ‘This is a discovery comparable in magnitude to that of the role of vitamins in physical health, and of far-reaching significance for programmes of preventive mental hygiene.’

  Bowlby called for more interdisciplinary research on the disrupted emotional relationships of early childhood so that the ‘embryology of the personality’ could be established with authority. He also argued for changes that would ameliorate or prevent ill-effects, notably as he himself remembered in a 1986 article, ‘by supporting a child’s family to enable it to care for him or her, and if this was not possible, by arrangements such as adoption and fostering. For children in hospital, unrestricted visiting by parents was recommended.’

  The impact of the report on health and care institutions internationally was considerable. An abridged Penguin version appeared in 1953 as Child Care and the Growth of Love, running into many editions. Denise Riley notes that this is the ‘book above all responsible for defining the “Bowlbyism”’ of ‘keeping mothers in the home’. Followed as it was in 1958 by a pamphlet for the National Association for Mental Health (now MIND) called Can I Leave My Baby?, it consolidated the need for mothers to stay as close to their infants as possible, while fathers were removed to a quasi-symbolic realm where they provided money and morale. The reward for mothers who cared for the mental welfare of their child, Bowlby writes, is the feeling ‘that they really matter, that no one else will do’.

  Bowlby’s work seems utterly commonsensical until one remembers that all his findings moved backwards from a child who had a problem or pathology. Looking for separation or maternal deprivation, it was often enough found in the histories of problem children: the correlations with poverty and other kinds of deprivation were not carried out, though Bowlby was well aware of the economic factor and parents’ dependence on a ‘greater society for economic provision’.

  But economics and welfare were not the principal factors in what became known as ‘Bowlbyism’. Bowlby’s own gloss that any continuity of care would do didn’t stop the emphasis on the role of the mother, which became increasingly amplified in the handbooks and parenting guides of the postwar world. If the analyst’s work in the nascent welfare state was to be a second mother and make good what the natural mother had left undone, then in the public imagination, woman’s place, whether she was working or not, was with her babe at home. Only later would Bowlby himself and other theorists find psychological problems in children whose mothers were overattached and didn’t allow for sufficient separation.

  Despite his institutional links with psychoanalysis, in the 1950s Bowlby moved further and further away from any interest in the inner life of the child. Instead he turned to Konrad Lorenz’s ethology and the animal world, where he found a scientifically credible model for infant–mother attachment, as well as for observing ‘animals’ in their natural habitat, which echoed his own team’s observation of children. A psychobiology group began to meet at the Tavistock through the fifties. It included key figures from anthropology (Margaret Mead), ethology (Konrad Lorenz, Julian Huxley), and Erik Erikson, one of the doyens of American psychoanalysis. In Bowlby’s thinking, attachment now emerges as an instinct necessary for survival: its component behaviours such as sucking, crying, clinging, following, bind the child to the mother in the first twelve months of her life. Presented to the British Psychoanalytical Society, Bowlby’s work on this new ‘instinct’ of attachment caused a stir of opposition, but, ever-practical, Anna Freud pointed out to her colleagues that Bowlby was too valuable a person for psychoanalysis to lose.

  If attachment was animal-based, so now was separation. Bowlby had earlier postulated three stages of separation–protest, despair (related to mourning) and denial of grief and of the object/mother from which separation took place. Now he talked of separation anxiety being provoked when a situation activated both escape and attachment behaviour but no attachment figure was present. If the mother continued to be unavailable, grief and mourning would ensue. Children who had too many mother substitutes and suffered this mourning too often would not be capable of profound attachments in later life.

  Bowlby’s theories fed into psychological research studies and into mainstream American thinking in part through his collaborator Mary Ainsworth, who worked with him at the Tavistock. She questioned his use of animal observation as a model for children and went on to carry out infant observation studies in Uganda. These observations, published first in 1958, shored up Bowlby’s work: Ainsworth concluded that securely attached children were those with mothers who were sensitive to their cues and enjoyed breastfeeding. As a result the children cried little and were adventurous in their play, happy to explore while in the presence of their mothers. Children of mothers who were less sensitive to their child’s ‘signals’–that is, those who were insecurely attached–were prone to cry more and explore less.

  When Mary Ainsworth moved in 1955 to Baltimore to teach at Johns Hopkins and do clinical work and psychological diagnoses at the Sheppard and Enoch Pratt Hospital, the link with Bowlby was not only maintained but intensified. The architecture of attachment theory now took shape on both sides of the Atlantic. It quickly became part of the accepted lore of child-rearing: the bridge from the child with a problem whose difficulties were ‘psychoanalytically’ traced backwards to conflicts between desire and a reality which was first of all parental, to ‘psychological’ guidance on how to be a good parent and raise a healthy/normally attached child, now had firm structural underpinnings. This link to psychology grew ever more important in the United States, where batteries of tests for disorders, personality determinants and development were put into constant use in clinics, schools and prisons. In Britain and elsewhere, Bowlby’s ideas became received truth, shaping adoption regulation and troops of unquestioning teachers of social work.

  Bowlby’s famous trilogy on attachment and loss, beginning with Attachment (1969), then Separation (1973), and finally Loss, Grief and Mourning (1980), gave his concepts such currency that the patterns of intimate attachment he traced even re-emerged in the analytic setting as patterns re-enacted in the transference. Their positioning as contemporary science–rather than old-fashioned Freudianism–abetted Bowlby’s ‘expert value’. To the ‘signals’ of animal behaviour Bowlby then added the language of cybernetics and information systems, of cognitive working models and evolution: attachment behaviour was seen as an ‘evolutionary’ function which protects the infant from danger. If the mother or ‘attachment figure’ acknowledged the infant’s needs for comfort and protection, while also respecting his needs for independent exploration of the environment, he or she would develop an internal working model of the self as valued and reliable. The alternative was an unworthy and incompetent self.

  Winnicott had positioned the mother–child relationship within an artistic/creative nexus, with the good-enough mother acting as a ‘holding’ environment, putting all the infant’s component parts together, enabling imaginative play and a ‘potential space’ which is a transition towards building authentic relationships with the world and enjoying its cultural goods. Bowlby positioned the mother–child within a world of empirical observation–of animal behaviour married to cybernetics. Whatever the theory, whether the child analysts found it deep in the inner life or in animal models, for the mother in her relation to the child it all meant an examined relationship with new internal as well as external tests to confront, which sometimes came in the form of welfare services. Mothering had not only become visibly important. It was also problematic and potentially now a double burden for the woman–something that the experts seemed to think they knew how to do better.

  Winnicott, perhaps revealing his own ambivalence about ‘mother’, wrote a telling postscript to the popular set of talks he did for the BBC, published und
er the title The Child and the Family, in 1957. Because of their importance for the child, he noted, women are feared. Men, especially, are terrified of them, hate Woman because she represents their utter dependence, their absolute helplessness as babes. They owe her an infinite debt. Not that they remember it, or even necessarily know it. It is for this reason, Winnicott urges, that we ought all to recognize the ‘mother’s contribution to society’:

  The result will be a lessening in ourselves of a fear. If our society delays making full acknowledgement of this dependence, which is a historical fact in the initial stage of development of every individual, there must remain a block both to progress and to regression, a block that is based on fear. If there is no true recognition of the mother’s part, then there must remain a vague fear of dependence. This fear will sometimes take the form of a fear of WOMAN, or fear of a woman, and at other times will take less easily recognized forms, always including the fear of domination.

  In every dictator there is a man who is trying to control the woman whose domination he unconsciously fears, all the while demanding total subjection and love. We can make a plausible guess that Winnicott also feared there might be a dictator in many men, or his shadow, in many a mind doctor.

  Perhaps the very immensity of society’s debt to women, combined with male fear, played into the ways in which postwar American psy professionals enshrined the mother as all-responsible and therefore, soon enough, a prime object for hate. The attachment–separation nexus manifested itself in a more intense register in the United States, where there was no cushioning provided by a welfare state. It helped to create the monster that was Mom. Childhood had been made interesting by the psychoanalysts, motherhood imbued with a new and exacting responsibility: together this fixed women into a single identity. Mom became both less and more than human.

  11

  SHRINK FOR LIFE

  Hitchcock’s film Spellbound of 1946 captures something of the triumphant cultural position psychoanalysis, and the psychiatry it became increasingly identified with in postwar America, came to occupy. Set within a psychiatric clinic, the film has novice shrink Ingrid Bergman restoring the new head of the clinic, Gregory Peck, to health through love and therapy. Peck is a walking exposition of the power of the unconscious: he isn’t who he purports to be, though he’s not sure he knows it. The merest glimpse of parallel lines terrorizes him and induces blackouts.

  Bergman guides him back to the traumatic origin of his amnesia and out again into cure with a little help from an all-wise, European-accented psychiatrist, who is Bergman’s training analyst. Meanwhile, through the forensic method of detection, evil is unmasked. Analysis emerges as a near-magical therapy, working through dream analysis and insight, to restore memory by its re-enactment: this cathartic cure, the kind so many soldiers had undergone in the war, brings back to life and full consciousness an individual of heroic dimensions. As a side-effect of the treatment, Bergman’s woman doctor is unfrozen from ambitious professionalism and herself cured by love and marriage.

  Spellbound was the first film to have a paid psychiatric consultant standing in the wings, Hollywood’s own May Romm, a feisty Jewish Momma, who serviced the film industry. She helped with the opening card, which talks of psychoanalysis’s ability to overcome ‘the evils of unreason’. Since the unreason included some murderous shrinks, the film ended up unleashing not a little unreason in an envious and ever critical analytic profession, which in America was solidly married to that bastion of traditional professionalism: medicine.

  Fleeing the Nazis and war, a substantial number of analysts had arrived in America. Amongst them were Heinz Hartmann, Frieda Fromm-Reichmann, Franz Alexander and Karen Horney: though all different in their orientations, they helped cement the American trend towards an ego psychology focused on the personality and its reorganization towards a new and happily normal maturity. This entailed an adjustment to reality and the leading of a responsible life. It was a form of psychoanalysis which lent itself to psychotherapy, with its less frequent sessions, and to that eventual ‘scientific’ demand for statistical results that could prove the therapy efficacious, even, in the event, for insurance companies.

  Through the fifties, American psychiatry grew increasingly conservative, shoring up a vision of ‘therapy as a tough, painful exercise that resulted as a rule in marital happiness, personal equilibrium and vocational success’. Freud, who had shown, if nothing else, how the individual mind was always peopled by others and how humans had a propensity to unhappiness, might have marvelled at the ease with which his work was adapted for the church of the self and its happiness. But then, whatever Freud’s popularity, many analysts considered his writings old hat. Unlike him, they pathologized homosexuality as a mental disorder and severely narrowed the range of sexual and human possibility that the profession’s pioneering founder had opened up. Some have said that it was the move away from ‘lay analysis’ and into paramedical standardization, with its bogey of science, which helped to foster this conservatism. The mind now had ‘cures’ as effective as those for the body.

  In Britain and France psychoanalysts did not need medical training to practise. In America, they needed both a medical degree and an internship in psychiatry. Psychoanalysis was thus integrated into the specialization of psychiatry which swung, roughly between 1940 and 1975, towards mental rather than biological modes of explanation. The link with medicine gave psychoanalysis in America both a more conservative cast and more social power. Although it did its best to keep out some of the most talented of the European analytic refugees, who lacked medical degrees, the field burgeoned and became an inescapable cultural force.

  Psychoanalysis had played an important role in the Second World War effort. So had the new, growing field of clinical psychology, propelled by Carl Rogers’s influential Counselling and Psychotherapy (1942). Psychoanalytically informed doctors, given basic principles by William Menninger, head of the US Army’s neuropsychiatry division, had diagnosed soldiers fit or unfit for duty, rejecting one million from the ranks. Their success with war neuroses, from which some 860,000 soldiers had suffered, had heightened the reputation of the talking and particularly the cathartic cure, while glorifying the men’s fate.

  True-life stories, in which soldiers broke down under the strain of battle, were puffed in the press. Their therapy was popularized in any number of films in which the soldier’s ability to remember or relive the moments which had resulted in his blindness or paralysis precipitated a cure. Time Magazine informed its readers in its issue of 29 May 1944 that these soldiers were heroic ‘high strung, nervous people…who cannot face certain difficulties without developing bothersome symptoms such as headaches, tiredness, weakness, tremors, fears, insomnia, depression, obsessions, feelings of guilt’. The doctors who brought them round with a cathartic talking treatment were equally heroic in their flashes of insight, their understanding and their charismatic ability to enable cure.

  Freud, inventor of analysis both terminable and interminable, and ever a sceptic about cures for the human condition, might have chuckled at what America had now made of him–and would make of him again, when the backlash came.

  War had also heightened a sense of the value of psychosomatic medicine: it became clear from soldiers’ experience that stress, fear, anxiety and the emotions in general could produce any number of physical ailments. In the USA, a new postwar cohort of medics took up psychiatry. Their numbers swelled more than sixfold between 1948 and 1976 to 27,000, thanks in part to the new National Institute of Mental Health, which encouraged and subsidized research into such areas as suicide and delinquency. Increasingly taught by those who had a psychoanalytic training, themselves analysed, the new recruits worked in clinics, as consultants and in private practice, but also took on key university posts in psychiatry and spread the psychodynamic word. Only a small number of these analytically oriented psychiatrists serviced the large state mental hospitals–some 16 per cent in 1958–which had grown into the unwieldy
‘snake-pits’ where the poor and incurables were predominant. This state asylum population of some 750,000 was treated by the older biological psychiatrists, whose function was largely custodial. In Anatole Litvak’s 1948 film The Snake Pit, a new-style analytic psychiatrist stands up to the older doctor and effectively works with a patient’s anger, rather than punishing with confinement.

  In the years around his 1956 centenary, Freud became an American cultural hero. There may have been only 942 practitioners who were members of psychoanalytic societies in America (or, as Time Magazine stated, 619 hardcore Freudians), but their impact and Freud’s were swelled by the rise in the number of psychologists, psychiatrists, therapists and social workers who practised versions of the talking cure. In its Freud centenary issue (23 April 1956) Time Magazine claimed that millions had not only been taught a new way of thinking about themselves by Freud, but were affected by the penetration of Freudian theory into social work, the probation service and the courts. President Eisenhower sent Freud birthday congratulations. Ernest Jones’s monumental three-volume biography, which began to appear in 1953, abetted the process. It turned Freud into an icon: a daring, perspicacious, if all-too-human scientist, who had launched a great revolutionary adventure. Though the work is now seen as idealizing, Time then noted that Jones belonged to the warts-and-all school of biography, given his intimate charting of Freud’s own neuroses and foibles.