Love at Goon Park

by Deborah Blum

  Bakwin, by that time, was blistering up the medical journals. He had supplemented the signs at Bellevue that said “Wash Your Hands Twice Before Entering This Ward” with new ones declaiming “Do not enter this nursery without picking up a baby.” In a paper published at the height of the war, in 1944, he described hospitalized babies in a way that sounded startlingly like the separated children in England. The medical ward infant was still and quiet; he didn’t eat; he didn’t gain weight; he didn’t smile or coo. Thin, pale, he was indeed the good baby, the easy-to-neglect baby. Even the breathing of these children was whisper-soft, Bakwin wrote, barely a sigh of sound. Some infants ran fevers that lasted for months. The simmering temperatures didn’t respond to drugs or anything the doctors did. And the fevers, mysteriously, vanished when the children went home. A doctor ahead of his time—by a good three decades—Bakwin won support he needed from his superiors at Bellevue to let mothers stay with their children if it was an extended illness. He liked to point out that with the mother around, fatal infections had dropped from 30–35 percent to less than 10 percent in 1938, and this was before the availability of drugs and antibiotics became widespread.

  “The mother, instead of being a hindrance, relieves the nurses of the care of one patient and she often helps out in the care of other babies.” But Bakwin and Bellevue were an odd-island-out in the sea of medicine. Standard hospital policy in the 1940s restricted parents to no more than a one-hour-long visit a week, no matter how many months the child had been there. Textbooks on the care of newborns still rang with the voice of Luther Holt and the dread fear of pathogens. Experts continued to recommend only the most essential handling of infants and a policy of excluding visitors. Even in the 1970s, a survey of wards for premature infants found that only 30 percent of hospitals allowed parents even to visit their babies. And less than half of those hospitals would allow a parent to touch her child.

  Bakwin argued that babies are emotional creatures, that they need emotional contact the way they need food. Of course, he put it in words becoming to the doctor he was: “It would appear that the physiologic components of the emotional process are essential for the physical well-being of the young infant.” But he wasn’t afraid to suggest that this could be a bigger problem than just what he saw in hospital wards. Orphanages and asylums also ran on the sterilization principle. And although children might stay days, weeks, occasionally months, in a medical ward, they might stay years in the foundling homes. Bakwin gave a simple example of the problem, centered on what might seem a trivial point: smiling. Somewhere between two and three months, he pointed out, most babies begin to smile back at their parents. “This is not the case in infants who have spent some time in institutions.” They didn’t return a smile. He and his nurses, if they had time, could coax a response, but there was nothing spontaneous about it and they often didn’t have time. What if the child stayed longer? What would happen to her then? Or him? If people couldn’t make you happy as a baby, could they ever?

  Another New York physician, William Goldfarb, was also becoming worried about the fate of children in homes. The foundling homes were like a magnified version of a hospital ward; the emphasis was on cleanliness, order, self-control, discipline. Since psychology had declared affection unnecessary—perhaps even detrimental—to healthy child development, no one was wasting much warmth on these children, who were unwanted anyway. In the homes, youngsters were fed, clothed, worked, praised, punished, or ignored, but policy did not direct that they be cuddled or treated with affection. Often homes discouraged children from even making close friendships with each other because such relationships were time-consuming and troublesome. Goldfarb worked with Jewish Family Services, which operated a string of foster homes around the city. The children he treated were like the bomb escapees—apathetic, passive, and, which he found most troubling, they seemed to be extending their isolation zone. The foundlings often appeared incapable of friendship or even of caring about others. “The abnormal impoverishment in human relationships created a vacuum where there should have been the strongest motivation to normal growth,” he wrote in 1943. At least children in their own homes—even if they had cruel or hostile parents—had some thread of a relationship that involved emotional interaction. The vacuum, Goldfarb insisted, was the worst thing you could inflict on the child, leaving a small boy or girl alone to rattle about in some empty bottle of a life. The younger they were thus isolated, the worse the effect. “A depriving institutional experience in infancy has an enduring harmful psychological effect on children,” he said, and he meant all dimensions.

  Two other New York–based researchers, David Levy and Loretta Bender, took up the cause as scientists in that urban community began sharing concerns. Like Bakwin, Loretta Bender worked at Bellevue; she headed the hospital’s newly created child psychiatric unit, and many of her clients came from foundling homes. They were “completely confused about human relationships,” she wrote; they were often lost in a fantasy world that might have served as a kind of shelter were the fantasies were not so ugly. The children spun their worlds hot with anger, cold with visions of death. If this was evidence of how foundling homes raised the youngsters, they were not producing anything that looked like normality.

  Levy’s interest began at another end of the spectrum. Starting in the late 1930s, he had decided to study those overprotective mothers so criticized by Watson. He wanted to compare extremes: thoroughly watched-over children versus motherless foundlings. He did find some very unhappy children held tight under domestic wings. Some were desperate for escape, some inhibited into near silence, some arrogant and exhibiting a sense of entitlement. The foundlings he met were often silent or desperate. But they were often unnerving, as well. Many of the orphans had learned starched and polite manners. Too often, Levy couldn’t move past that polished amiability. Neither, it appeared, could anyone else. The foundlings, especially long-time ones, were the well-behaved strangers at a party who have perfect manners and complete inner indifference to you. Those upright behaviors did sometimes get them adopted. But they inevitably chilled the affection out of such relationships. One hopeful mother, after a year of trying to coax some warmth out of her adopted child, returned the little boy. She said that she felt that she had been punished enough. “Is it possible that there results a deficiency disease of the emotional life, comparable to a deficiency of vital nutritional elements within the developing organism?” Levy wondered.

  Of course, this was a worry mostly still buried in academia, a matter of research journals and scientific debates. The lonely-child syndrome that Bakwin described so eloquently had a name: “hospitalism.” But what did that mean? Most people had never seen a child suffering from hospitalism, or watched a baby spiral down in his weeks on the ward. Bakwin could write of the despairing sigh of a child’s breath. He could draw a heart-wrenching portrait of the way a lonely baby would begin to wither, until he began to look like an old man. And Bakwin did do that, all of that, with determined eloquence. But his words, however frustrated and angry, were still words in a medical journal. They were read and debated by a select few. It seemed that to change the picture, some advocate of the lost child would need to think about a far wider audience.

  Scientists like to work within their own community, communicate in their own jargon, publish in their own journals. But to be a crusader, one must sometimes push beyond the academic envelope. John Watson had understood that perfectly—and used it to remarkable effect. Researchers working with orphaned children were reaching that same awareness. They would need the power of public opinion to change the system. They would need to make people see the problem, literally. The power of the filmed image suddenly beckoned as a way to break through the refusal to find out what children needed. In particular, a Viennese psychiatrist named René Spitz and a Scottish medical researcher named James Robertson both came to that conclusion. Spitz and Robertson, on different continents and for different reasons, decided that words were never going to win
this fight. Each one decided to find a movie camera. Each would attempt to show people exactly what was being done to children.

  Spitz was a Vienna-born Jew who fled from Austria to France, and then from France to New York, as Hitler’s armies spread across Europe. He had worked with Katharine Wolf in Austria on the issue of sterile children’s wards. In New York, he settled down with a passion to join forces with the likes of Harry Bakwin and William Goldfarb. In 1945, he was the author of yet another research paper, “Hospitalism: An Inquiry Into the Genesis of Psychiatric Conditions in Early Childhood.” If one reads beyond the scientific terminology, his paper tells the compelling story of four months that Spitz spent comparing two sets of children. None of the children was blessed in his circumstances. One group consisted of infants and toddlers left by their parents at a foundling home. The others attended a nursery school attached to a prison for women.

  Spitz’s description of the foundling home would have a familiar feel to anyone following Bakwin’s work. The place was gloriously clean. Each child was kept in a crib walled off with hung sheets—or what Spitz tended to call “solitary confinement.” The home observed the common practice of “don’t touch” the child. Masked and gloved attendants bustled around, arranging meals and delivering medicine. Still, the only object the children saw for any length of time was the ceiling. In spite of “impeccable” guards against infection, the children constantly tumbled into illness. The home housed eighty-eight children, all less than three years old, when Spitz arrived. By the time he left, twenty-three were dead, killed by relentless infections.

  The nursery, by contrast, was a chaotic, noisy play place, a big room scattered with toys. Children constantly tumbled over each other. The prison nursery allowed mothers to stay and play with their children. Perhaps because it was such a break from cell life, the mothers did as much as possible. Or perhaps they just wanted to be in a place where they found plenty of hugging and comfort. None of the children there died during Spitz’s study. That didn’t mean that you could blame all the deaths on loneliness. But, Spitz insisted, it should be considered as a legitimate peril, a recognized threat to health.

  The “foundling home does not give the child a mother, or even a substitute mother,” Spitz wrote. There was one staff attendant for every eight children, or what he called “only an eighth of a nurse.” The problem with solitary confinement, he argued, is not that it’s boring or static or lacks opportunities for cognitive stimulation, although all of that is true, and none of that is good. The more serious problem for the children was that there was no one to love them. Or like them. Or just smile and give them a careless hug. And it was this, Spitz said—isolation from human touch and affection—that was destroying the children’s ability to fight infection. At the center of Spitz’s argument is a simple statement: For a child, love is necessary for survival. His first choice to provide that was the mother. He wouldn’t turn away others, though—an affectionate caretaker, a person actually interested in the child, someone more than one-eighth of a nurse. Any and all of those people were, he thought, a medical necessity: “We believe they [the children] suffer because their perceptual world is emptied of human partners,” he said flatly. What is life without a partner? Can there be a home without someone who welcomes you there?

  Spitz found that his paper received, well, mild interest, moderate attention. It added to the ongoing argument—the one that was going nowhere.

  Spitz prepared to fight harder. He had filmed the children as they came into the foundling home and had allowed the camera to continue observing as the weeks passed. Simmering with his own outrage, Spitz turned his grainy little black-and-white film into a 1947 psychology classic, a cheap little silent movie, its title cards crammed with furiously compassionate words. He called the film simply, Grief: A Peril in Infancy. It starts with a fat baby named Jane, giggling at the experimenter, beaming at the people around her, reaching to be held. A week later, Jane sits in her crib, peering constantly around, searching for her mother. She is unsmiling and, when Spitz picks her up, she breaks into uncontrollable sobs; her eyes are pools of tears. There’s the next little girl, “unusually precocious” says the title card, seven months old, happily stroking Spitz’s face, shaking hands with him. A few weeks later, she’s pale, unsmiling, dark circles curve under her eyes. She won’t look up at Spitz now. He gently raises her from the crib. And then she clings to him so desperately that he has to pry her off when he leaves. She’s still sobbing when the camera turns to another baby, lying flat, staring into the air, pressing a fist against his face; and another, curled up, trembling, gnawing on her fingers. The title card this time is short and indeed to the heart of the problem: “The cure: Give Mother Back to Baby.”

  Spitz took his film from medical society meeting to medical society meeting in New York. In his eloquent book on the importance of early relationships, Becoming Attached, psychologist Robert Karen writes that one prominent analyst marched up to Spitz with tears in his eyes, saying, “How could you do this to us?” The film did indeed cause the debate over mother-child relationships to steam. Could Spitz be right? Could some fifty years of psychiatry be so wrong? Even eight years after Grief was produced, the quarrel still simmered. Critics shredded the film all over again as emotionally overwrought and nonscientific. Even in the late 1960s, researchers were arguing over whether he was right. But it was almost impossible, as Spitz had known, to argue those weeping children away.

  Another film was circulating by this time, James Robertson’s documentary of children in medical care. It was a cheap little film, too. Robertson estimated that it cost $80 to produce. His was a different story from Spitz’s—and the same. Robertson wanted to tackle children in hospital wards and what it cost them to feel abandoned by their parents. This was still, of course, during the time of brief weekly visits. He called his film A Two-Year-Old Goes to the Hospital.

  For a child at that time, hospitalization was, essentially, isolation from home and family and friends and everything that might have given a sick child security and support. Robertson’s film followed a poised little toddler named Laura. He said once that she was so naturally composed that he worried that her very temperament would render his case meaningless. And Laura did indeed go easily into her hospital bed. But by the next week, she was begging her parents to take her home; and the next, pleading with them to stay; and by the next, hardly responding to them at all, just her lips trembling as they left her behind. At the end of the film, she was like a frozen child, silent and unresponsive. Months later, Laura, back home and secure again, saw Robertson’s film, turned to her mother, and said angrily, “Why did you leave me like that?”

  Robertson showed his film to an audience of three hundred medical workers in England. The initial reaction was concentrated fury. The hospital staffers felt personally attacked. Many demanded that the film be banned. “I was immediately assailed for lack of integrity,” Robertson recalled. “I had produced an untrue record. I had slandered the professions.” In 1953, Robertson became a World Health Organization consultant and brought his film to the United States for a six-week tour. Here, again, he ran into a solid wall of defensiveness, as if the ghosts of John Watson and Luther Holt were rising up in revolt. Robertson was assured that the problems he had documented were British ones: “American children were less cosseted and better able to withstand separations.” And his simple solution—let parents stay with their children—was rejected as wrong-headed.

  Robertson, though, had an unusual ally who liked the film and the message behind it. Edward John Mostyn Bowlby, born in 1907, was the son of a baronet. His father had been surgeon to the royal family. The son had been raised in time-honored upper-class style—a nanny until he was eight and then off to boarding school. It hadn’t been a happy experience. John Bowlby later told his wife that he wouldn’t send a dog to boarding school. Bowlby’s father had wanted his son to follow him as a physician. He obediently entered medical school at Cambridge, but finally reb
elled against doing as he was bid. Bowlby dropped out of the university and spent two years working in schools for troubled children. That time, and the almost heroic struggles of children seeking some kind of balance, decided Bowlby on a career in psychiatry. In 1929, he entered medical school at University College Hospital to train as an analyst. In time, he would indeed become a smart and thoughtful psychoanalyst. He figures in this story, though, because he would also become more—a brilliant theoretician, a world-class crusader.

  Psychoanalysis belonged to one man at the time, and that was Sigmund Freud. When Bowlby began training as a psychiatrist, Freud was seventy-three years old, living in an affluent section of Vienna. Within the next decade, the Nazis would confiscate Freud’s home, his money, his publishing house, and his library, and kill all his sisters in the gas chambers. He, his wife, and his children escaped to England in 1938, but Freud never recovered. He died of cancer within a year of arrival on safe soil. Yet even in the last ragged years of his life, Freud cast a long and powerful shadow. He still does, of course, more than sixty years after his death. In Bowlby’s time, it was a living shadow, as if some smoky image of Freud were still standing by, frowning at one’s mistakes and one’s doubts about his theories. His daughter, Anna Freud, helped keep his influence alive. She became one of the dominant psychoanalysts in post–World War II Britain. But Freud’s ideas stood on their own power. They were potent enough, provocative enough to continue challenging the field indefinitely. The years since Freud died have stayed full of his ideas—of the subconscious mind, of sexual repression, of the power of a fantasy life. The smoky figure has faded, but not away, ever, entirely.