Abstract
Eleanor Galenson became famous in the psychoanalytic world for the research nursery she established at the Albert Einstein College of Medicine, modeled on the work of Margaret Mahler at the Masters Children’s Center. The Albert Einstein program observed mothers with their infants between the ages of one and three while therapists and assistants worked with them to address problems of separation/individuation, gender identity, expressive language, and other concerns. The Albert Einstein nursery, and the papers that Galenson wrote from 1971 to 1995 about her observations and conclusions, are the subject of Play, Gender, Therapy: Selected Papers of Eleanor Galenson, edited by Nellie Thompson.
Interactions between mothers, children, and therapists were recorded and reported meticulously and in great detail. Through close observations of these infants, she and Herman Roiphe validated their hypothesis that children notice genital difference at fifteen to twenty-four months, much earlier than the three to five years postulated by Freud. This was ground-breaking at the time Galenson’s papers were written.
The book is divided into three sections: (1) Symbolization, Thought, and Language, (2) Infantile Origins of Sexual Identity, and (3) The Tripartite Model. The first has commentaries by Patricia Nachman and Phyllis Greenacre, the second by Lucy LaFarge, Albert Solnit, Elizabeth Lloyd Mayer, and Jerome Oremland. These commentaries, along with the introduction by Thompson, a prologue by LaFarge, and an interview with Galenson by Milton Senn, provide a helpful theoretical and historical context for the papers.
In her introduction, Thompson, an historian, analyst, and the book’s editor, writes that her aim in assembling this selection was to highlight Galenson’s “approach to the study of the early years of life and, in particular, her contributions to understanding the developmental significance of the very young child’s discovery of sexual difference, and the ways in which each child expresses this through play, symbolisation, and language” (p. xv).
The nursery at Albert Einstein was primarily a site for Galenson’s research on the origins of sexuality and gender identity in very young children. However, the real brilliance of her work comes across in her role as psychotherapist. She made her reputation in the 1940s as a child therapist who was able to cure children of enuresis, behavioral problems in school, and learning difficulties. Schools began referring children to her, and soon she was so swamped with referrals that she “dreaded another phone call” (p. xxix).
The children’s presenting problems at the Einstein nursery included sleep and eating disturbances, lack of impulse control, excessive fearfulness, delayed speech, and difficulty forming social relationships with peers. The therapists saw all the children in conjoint treatment with their parents, usually the mothers. Providing treatment for both mother and child, combined with close observation of the children, proved very effective. One may surmise that the mothers became better able to work effectively with their children’s symptoms when their own anxieties and depression were addressed.
For example, Janet, a twenty-one-month-old child brought to the center by her mother, had “never been heard to utter a word” (p. 167) and communicated only through gestures. Janet was highly intelligent, nonpsychotic, and had normal hearing. From observing mother and daughter together, the therapist concluded that Janet’s refusal to speak was caused by disturbances in the mother-child relationship.
Janet’s mother, Martha, had been ambivalent about having a baby and was unhappy in her marriage. She immediately went back to work after Janet was born and relegated childcare to a nanny. As therapy helped Martha became more aware of her ambivalence toward both her child and her husband, Janet began to express her anger toward her mother more openly and began to speak. Many examples of the conjoint treatment are provided in this volume, and the effectiveness of the approach appears impressive.
At the Einstein Center, Galenson and Roiphe closely observed infants’ reactions to genital difference at fifteen to twenty-four months. The descriptions of the behavior of these children, mostly girls, are utterly convincing and some of the best parts of this collection: At fifteen months [Suzy] began to show definite and pervasive curiosity about the genitals of other children. As soon as any child was taken to the changing table at the nursery, Suzy would come over and watch intently as the diaper was being changed. No matter what she was doing, she never missed an opportunity to witness the whole procedure [p. 96]. [Ruth’s] occasional fleeting gesture toward the genital area during changing in the preceding month or so was now, at seventeen and a half months, replaced by the intentional genital handling during every changing as she inserted two fingers between her labia. She crouched down and peered up between her widespread legs; undressed dolls, calling some of them “boy” for the first time; examined their perineal areas; and smilingly used the family word that had been offered her for both genital and anal areas . . . [p. 57].
Galenson’s theoretical conclusions, however, raise issues. Despite her being a keen observer, when it came to interpretation of the observable behavior, her imposition of theoretical constructs, such as Freud’s ideas about penis envy in girls and the baby-phallus equation, is questionable. Much of this theory of female development has since been discredited. The tendency to interpret so much of girls’ behavior as the result of penis envy and castration anxiety is a particularly good example of Galenson’s imposition of a theory on observable data: Ruth had begun to use the concrete doll to take the place of the longed-for phallus. Her use of the name “baby” for this doll-phallus signals the establishment of a very early phallus-baby equation [p. 62]. Suzy’s persistent need to repeat the observation of the penis over and over again in a relatively unvarying manner suggests that she reacted to the sight of the penis in a traumatic fashion [p. 100]. [Janet] loved earrings, both in identification with her mother and as possible phallic replacements [p. 172].
In addition to her theorizing about female development, Galenson’s tendency to blame the mother for severe psychopathology such as autism and psychosis, and her pathologizing of nonconforming gender expression, make these papers seem outdated. For example, she writes about “gender-disordered” boys who “adopt all the feminine accoutrements” and suffer from “a problem not only with genital representation but with the total self and object representation” (p. lviii).
The way to deal with these children in therapy is to help them and their parents to recognise and tolerate their anger at their mother. . . . The mother of the gender-disturbed child is often bound in a sadomasochistic relationship with her own mother. . . . Such mothers have to make the boy into a female because they have come to connect hostile aggression with maleness [pp. lviii–lix].
Ken Corbett (2009), who has done research for over twenty years on nonnormative gender behavior, especially in boys, has critiqued the notion of trauma transferred from mother to son as the catalyst of boyhood femininity. In addition, the idea that gender identity unfolds in linear fashion, along single, universal developmental lines of inborn masculinity and femininity, has been challenged in recent years (see, e.g., Yanof 2000).
However, in working with her patients’ mothers, who were obviously having an impact on their children, Galenson showed extreme sensitivity and skill in helping them understand how their own anxieties and histories might be interfering in their ability to parent. As I have mentioned, the conjoint treatment approach was extremely effective in this regard.
Galenson was not on the reading list in any of the courses in the psychoanalytic program at the William Alanson White Institute where I trained and now teach. However, I had become familiar with her work even before my training as a psychologist, by way of a rather obscure article, “Assessment of Development in the Deaf Child” (Galenson et al. 1979). In the late 1970s, it happens, Galenson ran a nursery at New York’s Lexington School for the Deaf along the lines of the one at Albert Einstein. At the Lexington School nursery, all the children were profoundly deaf, while the mothers included both deaf and hearing. In the 1979 paper, Galenson claimed to have observed that the deaf children of deaf mothers exhibited delays in many areas of ego functioning, including the development of the symbolic function. Comparing the deaf mothers unfavorably to the hearing ones, she concluded that “the characterology of these four congenitally deaf mothers, as it impinged on their mothering, appears to contribute to the infant’s unstable sense of both self and other. Emotional attachment in the infant is shallow, and there is marked oral fixation and delay in the autonomous unfolding of the anal phase” (p. 140).
My experience as an interpreter had led me to conclusions exactly opposite from Galenson’s. I found that deaf people who had deaf parents were, on the whole, more psychologically healthy than those raised by hearing, non-signing parents. Because from infancy these children were able to learn American Sign Language from their parents and to communicate with them, I hypothesized, a more “normal” or typical course of development ensued. In a research project, my hypothesis was confirmed (Kolod 1994).
Galenson, unable to communicate directly with her deaf subjects, had imposed a theory on the behavior she was attempting to observe that interfered with her ability to see what was really going on. In reading this volume I found in these papers the very same problem: the imposition of theory on observable data, a pattern obvious in Galenson’s work with deaf children and their deaf mothers.
This volume of Galenson’s papers raises important questions, and doubts, about the role and usefulness of psychoanalytic theorizing in clinical work. While Galenson’s observational skills and clinical acumen were outstanding, some of her inferences and thus interpretations have not stood the test of time. However, even more important, the papers illustrate that therapeutic techniques can have value independent of theory. What does that tell us about our field, with its plethora of theories? How do we assess the value of one theoretical construct over another?
There is a great need for research into the efficacy of psychoanalytic treatments. Galenson’s keen observation and meticulous recording are impressive and her conjoint therapy modality highly effective. But as to her theoretical conclusions, Galenson’s work stands as a cautionary tale on how research to validate analytic theories can go wrong if the investigator interprets the data to find what she is looking for.