THE ROLE OF T H E FATHER IN T H E PREOEDIPAL YEARS : Chaired by SELMAKRAMER,M.D. : : Reported by ROBERTC. PRALL,M.D. In her introduction to the panel, Dr. Selma Kramer offered a historical review of psychoanalytic interest in the role of the father in child development, beginning with Freud's attention to the Oedipus complex as well as to the preoedipal role of the mother. She pointed out that until recently attention to the preoedipal father has been very sparse in the psychoanalytic literature. She noted contributions of T. Benedek. D. Burlingham, P. Greenacre, R. Greenson, H. LoewaId, M. Mahler, and others who have approached the subject on the basis of adult and child analysis and early childhood direct observations. Kramer cited Loewald's 1951 paper wherein he postulates the role of the father as a positive supporting force for the preoedipal child against the threat of reengulfment by the mother. This leads to an early identification with the father, preceding that of the Oedipus complex. Kramer also referred to the recent blurring of maternal and paternal roles and increased participation by fathers in the nurturing of their children. She observed that the analysis of some young men reveals potential conflicts related to the birth of their children. With others, fatherhood aids resolution of conflicts, especially over masculinity, and enhances maturation and increased separateness and independence from their own parents. Improved self-esteem and confidence and a revived identification with his own Held at the Annual Meeting of the American Psychoanalytic Association, April, 1977. Panelists: Ernst L. Abelin. Robert J. Stoller; Discussants: Jules Glenn. James A. Kleeman. 144 SCIENTIFIC PROCEEDINGS "good mother" and "good father" of early childhood may occur. When pathology is excessive, there may occur regressive forces, envy of his wife's capability to procreate, shame instead of pride, fear of loss of his wife-mother-especially as a repetition of birth of a younger sibling, identification with his "bad mother or father," and age-inappropriate dependency or homosexuality all of which may intensify existing conflicts to the point of precipitating serious neurosis or even psychosis. Kramer cited Greenacre and Mahler who note the importance of the father to the preoedipal child as a "less contaminated" figure, a "breath of fresh air" during the child's practicing and rapprochement subphases of the separation-individuation process. Mahler highlights the father as a "knight in shining armor," with whom the child can romp and play in ways quite different from his play with mother. Greenacre and Mahler call attention to the important part father plays in helping the child resolve the symbiosis with the mother. "The father of separation" and of "individuation" thereby becomes a facilitator of the separation-individuation process. Kramer also cited Ann Freud's statement that identifications develop out of the very early imitation of the parent during the preoedipal years. These identifications become part of the child's ego ideal and form an important forerunner of the superego. Kramer then referred to M. R. Leonard who indicates that when the father of a girl holds himself aloof or is absent there is insufficient opportunity for day-to-daycomparison and testing of the fantasied object with the real person. Moreover, consistent lack of attention is experienced as rejection, which is destructive to the sense of self-esteem. Ignored by her father, the girl has no real basis for competition with her mother and lacks incentive to relinquish her preoedipal attachment. Kramer described a type of father-son relation which she had often seen where the father's demands on his child were difficult from the beginning. Often the marriage was sterile or unloving, and the father's relation with the son occupied too important a position. The father, usually a successful but tortured man, felt that he could not match his own father's success. In treating such men. Kramer found serious problems both with self-esteem and masculinity. Each father, in his conscious wish for a son, hoped to rework his life. T h e son was experienced as an extension of himself, ambivalently loved and hated, who served as the parental object by a complex mechanism of projective identification, reversal of roles, and rationalization. Each responded with anger and depression to his son's growing up and away from him, but was also conflicted about closeness. Kramer summarized her discussion of these fathers as showing: (1) serious problems with their own fathers during their preoedipal years, having been looked down upon and derided for ineffectuality and being sissies; (2) poor self-esteem and a yearning to be loved by their fathers whom they could never please, much unresolved hatred for the father, but even greater self-hatred and fear of their own passivity, which might mean homosexuality; (3) unenthusiastic and loveless marriages predicated on dependency and the strong need to relive and improve their own father-son relation by producing a superson for their fathers. (4) Preoedipal involvement with their sons caused much greater conflict than that with their daughters because the fathers reacted to their daughters more comfortably, although at times they treated them as masculine girls, and seemed less threatened by their daughters than by their sons in terms of their own homosexuality. These fathers often were able to treat their daughters with tenderness while becoming involved in sadomasochistic battles with their sons. (5) They had conscious wishes that their sons prove their masculinity. but were ambivalent toward and unable to tolerate their son's masculinity and success. (6) These fathers may be upset by their boy's passivity, but at the same time they are comforted by it. One father of a nine-year-old boy with learning problems told Kramer, "Doctor, change him in any way you can, but don't change his sweetness. He's all I have." This father, however, showed sadistic tendencies toward the child. As the analysis proceeded, and the boy extricated himself from interaction with his father, the father became depressed and angry and withdrew his son from analysis-a frequent occurrence in this type of family constellation. Kramer then introduced the panel, Ernst L. Abelin presented the first paper, "The Role of the Father in Core Gender Identity and in Psychosexual Differentiation." Abelin gave a comprehensive presentation of his theoretical postulate of "early triangulation." He reviewed his three previous contributions on the role of the father in the separation-individuation process, starting with his study of families of schizophrenic children, which led him to a new structuralistic model of early normal child development based mainly on Spitz's three organizers and on Piaget. He postulated that the third organizer, around eighteen months, must consist of an early triangulation in which the toddler identifies with the rival father's wish for mother; 146 SCIENTIFIC PROCEEDINGS this is the only way in which a symbolic mental image of the self can originate; the child is separate from the mother and desperately longing for her. This third organizer assures the transition from sensorimotor, here-and-now functioning, and from mirroring one-to-one interaction to symbolic representation of more than one object in space, including the self. T h e period before the third organizer he called the "mirror stage." In psychosis, maturational and family factors converge to prevent early triangulation. Parental discord is associated with splitting, lack of ego synthesis, poor symbolization, and poor reality testing. Core gender identity also tends to be disturbed. Abelin also proposed that the product of early triangulation is at first a rudimentary image of the self longing for mother. On the new symbolic level, the development of symbolic images will recapitulate the development of the mirroring sensorimotor relationships. T h e self will now be represented in oral, anal, phallic, and oedipal relationships with its symbolic objects. From this model, it follorvs that the normal toddler must have established specific mirroring object ties with both mother and father before eighteen months. In the second phase of his investigation. Abelin began to confirm this theoretical assumption in an intensive study of fourteen children at the Masters Children's Center under Mahler's direction. He noted that the father becomes a specific attachment object very early and a favorite of the practicing toddler. During the rapprochement subphase, the father remains uncontaminated by the severe ambivalence that affects the maternal image, and he may play an indispensable role in the resolution of that ambivalence. In addition to the specific attachment to the father, attachments developed with siblings, other children, grandparents, and other familiar adults. However, triangular rivalry with other children was more obvious than rivalry with father during the weeks preceding rapprochement. Abelin calls the triangular situation of self, mother, and a rival baby. the "Madonna constellation." In the third phase of his investigation, the longitudinal study of Michael within his family was reported. Abelin described various derivatives of early triangulation, which, as a theoretical construct. can itself never be clearly seen. In the fourth phase of his investigation, Abelin compared Michael's development with that of his three-year younger sister. Kathy. This comparison led him to refine his model of early triangulation in order to account for crucial gender differences. It appeared to him that Stoller's core gender identity is another aspect of the first mental image of the separate, longing self resulting from early triangulation. Unlike Michael, Kathy always remained more closely attached to her mother than to father during the subphases of differentiation and practicing. At nine months her "flirtatiousness" with father was noted for the first time. As a toddler, she would excitedly run away from father in order to be chased by him. This suggests, as noted by Kleeman, an earlier erotization of stranger anxiety. Throughout the practicing subphase, Kathy experienced father as a "knight in shining armor" beckoning from outside the symbiotic orbit. By contrast. Michael seemed as close to father as to his mother during the practicing subphase and began to imitate playfully some of the father's patterns in his absence, Michael had what Greenson has called "disidentqied from mother." Kathy began to play more and more at imitating her mother at seventeen and a half months. Observations of both children confirmed masturbation and the awareness of genital differences and sensations late in the practicing subphase. After the onset of rapprochement crisis around eighteen months, both children experimented with various solutions of the basic rapprochement conflicts. Michael sought out his father and preferred to play with boys, especially older ones. He seemed very conscious and proud of being a boy and was keenly aware of gender differences among family members. At a corresponding age, Kathy was almost exclusively involved with mother, now with an ambivalent, clinging tinge. She seemed to have traded off father to Michael in order to have mother to herself. She saw herself as "Mommy's baby," and there was evidence that this self-image was sexually neutral. Only around the age of three years did the oedipal triangulation gradually emerge, when she could begin to accept herself as having two sexually differentiated love objects and as being sexually different from boys. T h e comparison of Kathy and Michael seems to confirm Abelin's previous impression that early gender identity is more readily established in boys and early generational identity in girls. He defined generational identity as establishing the self between two objects along one linear dimension, "I am smaller than mother but bigger than baby," or in terms of wishes, "I wish to be taken care of by mother, and I wish to take care of the baby." Specific gender does not seem to enter into the core self image of the girl a t that point. Putting his observations in a nutshell, Abelin stated that during the mirror stage before rapprochement, the father remains a peripheral if exciting object for the girl, tinged with eroticized stranger anxiety. On 148 SCIENTIFIC PROCEEDINGS the other hand, before early triangulation has taken place, the boy has disidentified from the mother. and his father has become the primary mirroring attachment object. For the boy, the core rapprochement wish seems to be, "I [male] want Mommy [a female]." For the girl, the corresponding core-self-image constellation would be "I [small child] want Mommy [big]," alternating with "I [a child] want baby [small]." Abelin stated the major hypothesis for his theoretical constructs to account for these gender differences: Unlike objects, the self can only be represented on the level of symbolic images. It cannot be a sensorimotor schema; it must be the result of an early triangulation of two sensorimotor schemata or attachments. In the loving interaction of one attachment object with the other one, the toddler perceives and recognizes for the first time his own frustrated wish for the object. However, while the symbolic self-image always emerges around eighteen months as a result of early triangulation, it is the result of a full-blown identification with the rival father only in boys, and this is why sexual-core-self classification is achieved only in boys at that age. In girls, the self-image is feminine because they still mirror the mother's body. but this is only implicitly feminine, not in reference to another gender. In both boys and girls, sexualcore-self classification must derive from an identification in the mother-father-self triangle. In the girl this takes place later on the classical oedipal level. In the boy there is an early sexual triangulation, which is then replicated'on a higher level of symbolic images at the oedipal phase. Abelin was not certain whether penis envy results in a defensive retreat which leads to a disregard of sexual differences in the girl. He cited research in academic psychology and among French psychoanalysts, much of which supports his observations. He hypothesized a tendency for babies to react to likeness between themselves and others and cited recent research supporting the thesis that girls prefer their mothers and boys their fathers. Abelin's impression that girls are more wary of strangers than are boys has been confirmed by some researchers. Girls seem to respond more positively to similarity and boys to differences. Abelin referred this hypothetically to the basic sexual differences in central nervous system reactivity beginning with the intrauterine priming of the hypothalamus with androgen hormones in boys. This developmental thrust seems to be related to the greater shift away from mother and toward the father in boys leading to the "disidentification from mother." Abelin's concept of "father thirst" can be observed in children deprived of contact with father. An extensive review of the literature confirmed Abelin's impressions that the absence of the father contributes to feminine core gender identity in boys. The absence of the father seems to affect the boys far more than it does girls, and it may be related to selective cognitive and other ego deficits in boys, as shown in some of the cited research. Absence of the father later in the girl's life, around the oedipal phase, contributes more profoundly to disturbances in her core femininity than does earlier absence. Abelin concluded that all of the research findings cited can be explained by interferences with early triangulation. In particular, maternal dominance seems to prevent the perception of the father's actively loving and "possessing" the mother. It therefore interferes with early triangulation and has the same effect as absence of the father. The data seem to support the hypothesis that there is a maturational program leading boys toward a triangular identification with the father around eighteen months, while the girl's identifications remain confined within the mother-baby-self triangle at that time. Any factors interfering with early triangulation in boys interfere with masculine core gender identity and also masculine interests, autonomy, competitiveness, and aggressiveness, and certain cognitive abilities, and the boy is left with an implicit feminine core identification with the active mother and a feminine cognitive profile. Abelin sees three levels of triangular identification: identification with a rival baby, with the active mother, and with the rival father. In regard to feminine gender identity in females, Abelin identified two factors: (1) the girl's identification with the active mother in the "Madonna Constellation" an,d (2) oedipal triangulation in which the father is included and which leads to genital self-differentiation and heterosexual relationships. Abelin reviewed Lacan's work on the transition from the mirror stage to the level of symbolic functioning which is forced upon mother and child by the father. Lacan's work parallels that of Abelin in many respects. Abelin distinguished between the two levels, the mirror level and the symbolic level, indicating that the father plays an important role in both levels and that his presence is a precondition for gender-appropriate transition to the symbolic realm for the boy. On the symbolic level, the image of the father enters during the phallic-oedipal stage and may be distorted by fantasy and defense and be exaggerated into the image of the intruder, castrator, or policeman. In conclusion, Abelin stated that intra- 150 SCIENTIFIC PROCEEDINGS psychic triangulation represents a specifically human achievement. All the mirroring, instinctual, energetic currents, and sensorimotor resources are funneled to master one "primal constellation," which lies just beyond reach of the sensorimotor schemata. Only in man is the father internalized into the psychic structure. It is the truth of the father-mother relationship that is internalized. Thus, sexual triangulation is the psychological birth of man: the self engendered by father and mother, grid, with it, the explosion of symbolic thought. James A. Kleeman, in a prepared discussion, emphasized the significance of Abelin's study and disagreed with him in only one respect, that concerning the relative importance of the environmental and cultural factors in the emergence of gender identity. In an earlier paper presented in San Francisco, Abelin felt that Kohlberg's idea that "sex-role development" was dependent on the child's awareness that he was a boy or girl was antithetical to Abelin's belief in early triangulation. Kleeman reads Kohlberg differently and indicated his belief that the minute the child is born, anatomy is assessed and male or female assignment is made, setting into action the cognitive factors first in the minds of the adults and, gradually, in the awareness of the child. This cognitive reinforcement, starting at birth, works hand in hand with the biological factor set in motion in intrauterine life and with the early triangulation with boys and the early intrapolation with girls. No doubt, the cognitive messages taught by the specific environment are of powerful consequence-a predominant theme in Stoller's work. He indicates that biology and maturation are important, but that they need to be in tune with conditioning because, if not, the conditioning is the force to be reckoned with in the areas of masculinity and femininity. Kleeman reminded us of Lois Murphy's observation that mothers treat girls differently from boys in early infancy, and he included Murphy's observations under the broad umbrella of "cognitive" in Kohlberg's sense. In Erikson's terms, society has a different goal for the two genders and conveys meanings differently to insure these goals. Kleeman also reported research on Rhesus monkeys, which treat their male babies quite differently from female babies, punishing the males much earlier and more frequently while protecting and showing more physical contact with the female babies. Kleeman felt that Abelin had made contributions to our knowledge of the origins of self. Abelin's offering of a biological basis for the boy's disidentification from the mother is notable. Kleeman reminded us of the important fact that one in eight children in America today is being raised by a one-parent family, in the majority of cases by the mother. Thus, it is important to determine what the critical points are for substitute father figures. Children are capable of a number of significant attachments and, where the ideal of an emotionally mature father is lacking, one must delineate at what moment and in what ways siblings and other male adults can offer the young child the essential experience he needs and how the single parent can make compensation. Kleeman concluded his discussion with his personal observations of clinical material on the treatment of patients who lost their father during their rapprochement crisis where the analytic material reflected the seriousness and implications of the loss. It was difficult, however, to distinguish how much of the effects were due to the loss of the father and how much to the mother's grieving, depression, and other preoccupations. His final remarks related to his direct observation of a male infant beginning when the child was two weeks old. At four weeks, the child responded differently to his mother and father, and this difference became more striking as the weeks went by. By five months, mother meant "business" and father meant "fun and games" to the child. The child's relation with his three-year-older sister confirmed Abelin's observation of the pre-established familiarity between small children. A thirteen-year-old boy who visited occasionally elicited a different response. A girl infant at two months of age had eyes only for her breast-feeding mother and showed much less father-attachment than did the little boy at this same age. In inviting the audience to participate in the discussion, Kramer reported that Jules Glenn had indicated tb her that, in families with incomes under $3,000,the fathers are not in the home in 55 per cent of the households, which has considerable bearing on today's discussion. Robert C. Prall pointed out that in the psychoanalytic literature there is much material about motherhood as a developmental process including papers by Benedek, Kestenberg, Parens, and others, who note that the child's attitude from early childhood onward influences thinking about procreation and about motherhood. With children in analysis and from direct observations of children, we often note that little girls have already formed, at a very early age, firm attitudes about childbearing. For example, one little girl, the subject of a case seminar, was determined that she would have six children like her mother. Two would die and two would be boys 152 SCIENTIFIC PROCEEDINGS and two would be girls. Her youngest daughter, like herself, would have a lifelong sadomasochistic struggle with her mother (herself). She would become divorced just as her mother had and would live with her mother and maternal grandmother in a prolonged multigenerational sadomasochistic struggle akin to what she had experienced with her mother and her grandmother. Thus, she would continue with her daughter the hostile dependent struggle so clearly evident among the three living generations. Pregnant women often have conscious and unconscious attitudes toward the assigned sex role of their unborn children. Very often the mother has a firm preconception as to what sex she expects her baby to be, and this would influence psychopathology since she is often severely disappointed if she has what she considers to be "the wrong sex." We recognize that these assignments of gender identity often antedate, not only the birth of the child, but also 'the conception, and that they reflect early childhood attitudes and thus have deep and powerful roots. Alan 2. Skolnikoff asked Abelin about the influence of different types of fathers, particularly those with a nurturing attitude versus a typically more masculine father and inquired about the differential influence on child rearing with young boys and girls. In reply, Abelin stated that from his model it would follow that both the nurturing and masculine aspects of the father are important and that the father should be somewhat dominant in the family constellation, but not in a sadomasochistic way, and that cooperation between parents would help to foster early triangulation. He cited research by P. H. Mussen and L. S. Distler who described fathers who were only punitive or only nurturing as contrasted to those who were both punitive and nurturing; the latter behavior resulted in the most masculine boys. Abelin indicated that the father's nurturing attitude is important for attachment to the father in the early months. Alan Gurwitt asked why psychoanalysis has not dealt with this very important subject before today. In response, Abelin suggested facetiously that it is Freud's fault that we have just looked at mothers and infants. (Abelin indicated to this reporter later that he failed to mention the inevitability of Freud's oversight: it is not possible to reconstruct the presymbolic father from psychoanalytic data.) Gertrude R. Ticho asked for clarification of the difference between early triangulation and the oedipal triangular situation. Abelin said there is a structural difference. The early tri- angulation is not a real triangle until early triangulation has already taken place. It is the infant relating sometimes with father and sometimes with mother, with no self-concept and no evocative memories and no inner images, so there are short-lived triangular situations when two objects are there. There is conflict when there are two sensorimotor schemata in the same sensorimotor field and the child doesn't know which way to go. But this is different from intrapsychic conflict which will be possible only after symbol formation and after the processes of early triangulation have taken place and the oedipal triangle occurs.' By three or four years of age, when the real oedipal conflicts occur, they are in fantasies and are internalized and intrapsychic, are often exaggerated, and don't have much to do with the real parent. John M. Ross asked Abelin to comment upon the place of the generational and generative strivings in little boys. Abelin indicated that Ross himself has written on this subject and added that when early triangulation has not been satisfactory, boys would have a similar identification to girls. T h e boy goes through rivalry with the baby and the mother and then goes on to identification with the father, which acts to repress the boy's generative fantasies and wishes. By kindergarten age, boys are less often observed to play with dolls and little children than are girls. Martha Kirkpatrick described a pilot study of children of lesbian mothers in Los Angeles. Most of these women were divorced, so their children have had some contact with father early in their life. There are some cases, however, where there is absolutely no.fathering, because the child was conceived by artificial insemination in the homosexual relationship. In one case, a five-year-old girl, artificially conceived by a mother who had no relations with males, seemed, nevertheless, to be a feminine little girl with many heterosexual interests and fantasies about men as love-objects. She seemed to have a concept of father in her mind, perhaps through a brief contact with the maternal grandfather at age three. There had been minimal contact with men prior to that, and she had never seen her mother involved with men. Another interesting case was a little boy with very early gender problems whose interest in his mother's clothes led to concern on the part of the mother. The mother then undertook to do masculine things with him, taking him fishing and hunting and working on the car, for example. This led to a more masculine identification through her help. Shera Samaraweera described her study of pregnant mothers in which she had found phenomena similar to those described by Prall, 154 SCIENTIFIC PROCEEDINGS where fantasies of assigning of sex roles to the unborn baby were very common. Many of these couples have tremendously strong expectations and some of them even go so far as to register their unborn boy child in Harvard. Phyllis Greenacre expressed her appreciation for the paper and the discussion adding that she has not been a consistent observer of infants since her work has been mainly with adults. However, she agreed with Prall who had indicated that the mother's expectations are of importance and added that the father's expectations are also important. Greenacre reminded us that, in past generations, social influences on the mother in relation to her attitude toward the child as to whether the baby should be a boy or a girl were of great importance. These influences have been crowded out by the more recent emphasis on penis envy and the tendency to focus on one sex to explain a great deal. There has been marked emphasis on feminine masochism. She indicated that we have to look back only a few generations to see how much there was of actual danger to the mother's life in childbirth as well as for death of the infant. In larger families, the older children often took part in the rearing of the younger child, who was born at home, and often they never married but became excellent aunts or else they became very hostile. Changing conditions and times cause us to lose sight of these earlier conditions. Glenn commented that, as he understands Abelin's clinical observation, early triangulation in the boy does not simply involve identification with the father, but also has a drive element, an affection on the boy's part for his mother. The description of the father and the little girl chasing each other suggested the beginnings of conflictual elements, .in addition to -the unconflictual basis. He asked Abelin how early conflict involving the father develops and how the development of internal conflicts affects the characteristics of maleness and femaleness in the process of gender formation. James M. Herzog asked about the father's role in the initial attachment process in the newborn. Abelin summarized as follows: There is evidence of a father thirst' in the fact that children pick up father substitutes wherever they can. However, it is never enough, and the kind of continuity is not available in a triangular situation to allow the normal triangulation to occur. Children can substitute older brothers, grandfathers, and other males, but it very important that their interest in men be supported by the single mother and that she endorse the child's interest in men. If the mother encourages and endorses rela- tionships with men on the part of the child and herself, this can help to overcome the absence of the father. However, it is detrimental if the mother conveys the message that it is not important or necessary to relate to men. Robert J. Stoller is his paper, "Fathers of 'Sex Change' Children," noted that in this current era masculinity is increasingly ceremonial except that fathers promote the formation of their children's identity. He started from a clinical viewpoint different from those of Abelin, Kleeman, and Mahler, who observed normal children, by studying children with markedly aberrant cross-gender behavior. Stoller remarked that the preoedipal father has four great functions early in his children's lives: he serves as mother's main support, he directly modifies behavior by reward and punishment, especially but not exclusively in boys, he is a model for identification, and especially but not exclusively in girls, he becomes a love object. Another important function for a father is to be a shield to protect a child, especially a son, against the mother's wish to prolong the symbiosis, a point with which Abelin and Mahler are in agreement. Stoller presented summaries from his data on the fathers of markedly feminine boys and markedly masculine girls in order to shed light on more ordinary fathers of more ordinary children. From his clinical data of biologically normal very feminine males, Stoller discussed those who are the most feminine of all throughout their lives, without episodes of feeling masculine or of living a masculine role, having been feminine since the first appearance of gender behavior, at about a year or so of age. The parental influences at work in childhood include a mother with strong cross-gender impulses married to a passive and distant,man who was virtually absent during the son's infancy and childhood. The mother perceived the son as lovely and graceful and used him as the cure for the lifelong depression that underlay her regret at not being male. These mothers created and sustained the most intimate and painless symbiosis, allowing nothing to interrupt it. The more profound the symbiosis and the longer it persisted, the more feminine the boy. These mothers do not enjoy the independent, rowdy behavior other people consider masculine. In a study of fifteen families, Stoller found strikingly similar attitudes in all of the mothers. All had the position of power in the family; all but three had histories of successful competition with boys, usually in sports, and conscious desires to be male in childhood. Having married a passive and dependent man, these mothers stayed with their marriage despite unending 156 SCIENTIFIC PROCEEDINGS incompatability, and they maintained an excessively close symbiosis with this son. These family features were not found in the other gender disorders Stoller had studied, including effeminate homosexuality, intersexuality, and fetishistic cross-dressing. Stoller presented detailed verbatim transcripts of conversations with mothers of these very effeminate boys. T h e common features were as follows: First, the mother, treated as a worthless female by her own frozen mother, suffers a lifelong sense of hopelessness and a powerful desire to become male. Rather than becoming a transsexual, these women married passive men who did not enter into the family and who were, in effect, castrated. T h e baby boy, because he is seen as beautiful and graceful, is chosen by his mother as her ideal phallus, grown from her own body. So she clings tenaciously to him. Unfortunately, her husband neither interferes nor is present as a model for masculinity. A masculine father would not tolerate the prolonged symbiosis seen in these cases. In most of the families, there were other sons who were more masculine and whose dynamics were different from the feminine boys. With these masculine boys, the fathers were present more in infancy and early childhood, and there was not the excessively close mother-infant symbiosis. In the second part of his presentation, Stoller described very masculine females. In this situation, too little symbiosis and too much relationship with father helped to produce their pathology. In the first of three groups described, female transsexuals, in each of the fourteen families studied, the mother-infant symbiosis was interrupted. In most cases this was due to depression in the mother, with no adequate mother-substitute provided. T h e father, however, stimulated his daughter to precocious ego development so that she would serve in his place to comfort the unreachable mother. Thus, already starved fo'r closeness, the little girl was not allowed to defend herself by rejecting her mother. These fathers were close to their daughters, but not with the controlled eroticism that stimulates the girl's femininity and heterosexual impulses. T h e father took the daughter as a buddy, encouraging her to behave as he did and to share his masculine interests. With no interference by the mother to encourage femininity, the girls were already masculine by age three o r four. T h e second group were mothers of very feminine boys. These mothers, described above, had mothers who were themselves frozen and empty, who made it clear that being female is worthless. T h e mother-infant symbiosis (in the infancy of these mothers of transsexual boys) was cold and bitter, and the fathers encouraged masculine behavior in the girls or were distant, and did not discourage their daughter's wish to be a boy. In the third group are females who believe they anatomically have (hidden) penises. These girls showed family dynamics similar to the first two groups. Stoller hypothesized that if one wishes a masculine boy, one should prevent excessively close symbiosis between mother and son and there should be a masculine father who encourages the boy to separate from his mother's body and psyche and who sets an example for masculinity. Confronted with such a father, a boy can learn the limitations on his wish for closeness with his mother, falling back before this powerful oedipal rival. In other words, an oedipal conflict develops, which is not so with transsexual boys. If one wishes to promote femininity in a girl, there should be a warm mother-daughter symbiosis and a father who does not promote identification with himself. Without the parental influences that produce first identification and, later, rivalry with the same-sexed parent, plus the desire for the opposite-sexed parent, the process Abelin calls "early triangulation" does not occur and the development of ordinary masculinity in boys and femininity in girls is disrupted. Stoller compared families in which the father is physically absent, but where the mother respects and keeps the memory of the father present, with those wherein the father may be present but is used only as a hated character, disparaged and ineffectual. In his discussion of Stoller's paper, Glenn raised several questions. He wondered if the parental configuration Stoller described invariably leads to effeminacy and whether the child has to bring some innate potential for effeminacy to develop. Are there other family constellations that give rise to effeminacy in boys? Do different family constellations eventuate in different clinical pictures? Glenn noted that the father's role consists of supporting the mother so that she can function more comfortably in caring for her child. He makes her burden less onerous and helps prevent aggression toward the child; he helps the mother keep her affection to the child within an optimal range and keeps her from turning to the child as a substitute for sexual gratification; he is available as a person for identification; he restrains the child from pregenital (and later genital) feelings toward mother; and he is available as a love object for the child, thus, diluting the child's attachment to the mother. Both parents must protect the child from excessive external and internal stimulation, i.e., from traumata. He described a case in which the father was available, but there 158 SCIENTIFIC PROCEEDINGS was a gross failure to protect the child. An effeminate boy who wet the bed, had asthma, and dressed like a girl a great deal was seen in analysis from age five. He wished he were a girl, but did not think he was one. His mother had undressed in front of the child who was very attached to her. The father encouraged femininity as a defense against excessive anxiety. Glenn described a long period of weekly traumatic visits to the maternal grandfather, during which the boy watched the grandfather die of a carcinoma of the face. He developed a fear of bodily injury and imagined that, because men were in danger of dying, girls were safer. His parents did not discourage his feminine identification and encouraged his feminine preoccupations. Unlike Stoller's cases, this mother was not a tomboy, and did not engage in prolonged bodily contact with her son. The child's father was an inept man who had been criticized and made fun of by his own father. The father preferred the patient's sister and found it difficult to be affectionate with his son. When he tried to compensate by rough-housing with his son, he inadvertently hurt the boy. Again, in contrast with Stoller's cases, this boy did not seem to have a distant father. The father actively participated in the child rearing, including the toilet training. Glenn stated that the patient retained his identification with his mother because seeing the deteriorating grandfather had made identification with men too dangerous. There was some identification and rivalry with the father, but he defended against the anxiety it evoked by remaining a child who would not die or a girl who was less vulnerable. Glenn concluded by wondering whether, if Stoller's child patients were analyzed, the analytic scrutiny would reveal additional etiological factors such as he found in his patient. In the general discussion following Glenn's presentation, a question was raised about the tremendous degree of hostility which the mothers must have toward the male in the cases that have been described, and why the undercurrent of the mother's hostility to the male does not aid the boy in breaking off the prolonged symbiosis. Prall commented on the existence early in boys' lives of attitudes regarding procreation dating from at least puberty and early adolescence, which influence their attitudes toward marriage and childbearing. Such attitudes, both conscious and unconscious, would have a great deal to do with fostering the development of masculinity and femininity in their own children's lives. He also pointed out that there are various gradations of absence on the part of the father from the point of view of the libidinal availability of the father-similar to Mahler's concept of the libidinal availability of the mother. The father has several roles, being available as a love object for the child, giving love and affection to the child, being libidinally available to the mother as a source of emotional support in a two-way give-and-take relationship. Since there are many shades and grades of libidinal availability, the concept of "absent father" must therefore be refined. He also noted that sometimes fathers can be libidinally unavailable while being physically present, as in the cases described by Stoller and Glenn. On the other hand, enforced physical absence, as during war, illness, or on business, is not necessarily equated with libidinal unavailability, since the father may continue his contacts with the child through such means as mail and telephone calls. In addition, Prall pointed out that there are also gradations of availability of aggression on the part of fathers, so that some are available to the child as the exciter and motor activator as well as the limiter and prohibitor more than other fathers who show varying degress of passivity and lack of aggressivity. Both of these factors, libidinal and aggressive availability, need to be more clearly defined in each individual family's dynamics in order to understand their impact on the gender identity of the children. Robert Buie questioned whether the influence of siblings and peers was not important in terms of dilution or re-enforcement of the patterns which had been set in motion by the parents. Harold P. Blum observed that the material presented has been helpful to correct adultomorphic myths and he commented that efforts should be made to correct the genetic fallacies of our reconstructions in analysis and to bring about consistency between our reconstructions and the known developmental knowledge gained from such research as that described in the Panel. Secondly, Blum pointed out that there were differences drawn between the early triangulation and the early oedipal complex and stated that it is important to distinguish between the precursors and later full-blown flowering of a developmental phase. For example, there is a difference between the early genital phase coincident with rapprochement, and the oedipal complex after the occurrence of object constancy. The internalization of parental attitudes is important in the formation of gender and sexual identity. Blum noted that what is registered and internalized is not only what you are and ought to be, but what you are not and what you ought not to be, which later becomes so important in the formation of the ego ideal and superego and in their role in the development of masculinity and femininity. 160 SCIENTIFIC PROCEEDINGS Gender and sexual identity are determined not only by the similarity of what you are and ought to be, but also by dqferences, which is one of the ways the body ego influences gender identity. It is apparent that sexual identity evolves along lines of appropriate sexual identification, but is also based upon comparison, contrast, and complementary attitudes toward the opposite sex. Identification with the opposite sex also occurs as part of a normal and nezessary bisexuality. In his closing remarks, Stoller replied to the discussion stating that his ideas could be summed up by the hypothesis that femininity in boys is maximized if the mother attempts to create a frustrationless and traumaless, blissful symbiosis starting from birth and does not try to stop it. It will eventually be ended by the outside world, however. The second essential ingredient is a father who will not interfere with this symbiosis, but is used as "an example of a man who is no good." The little boy is the ideal male to his mother as long as he does not become masculine. He represents the cure for her lifelong hopelessness, and so she gets angry at the'world for trying to break up the blissful relationship. This child represents the phallus she has always wanted. The more she maintains the syrnbiosis, with the father allowing this, the more feminine the boy will be. Stoller added that there is a continuum of conditions from excessively feminine to less so and that cases such as Glenn's, which do not fit his description of transsexual boys, seem to occur when the dynamics described above are less operative. Stoller agreed with the comment on the massive hostility these mothers feel toward men. However, he has not found evidence of this hostility being directed against the little boy as long as he remains passive and feminine. He is exempt because he represents his mother's lifelong unfulfilled wish for a phallus. Stoller has not seen these dynamics in effeminate homosexuals, fetishistic cross-dressers, or psychotic males like Schreber. He concluded by saying that the more classical the oedipal situation, the less likely will there be femininity. The feminine boys do not have classical neurotic disorders, but character disorders, there not being present the oedipal conflict necessary for normal masculinity or femininity to develop. When that conflict appears, prognosis is better for treatment. In her closing remarks, Kramer noted that the Panel made it clear that the father, during the preoedipal years, is of importance as an object for identification, as part of the ego ideal, and as a precursor to the later developing superego. He is of tremendous im- portance in the shift in the child's object relations from dyadic to triadic. He helps woo the child and the mother away from too close a relation with each other. He is of great importance in both health and pathology in terms of the child's sexual identity. If the father's role is not active and benevolent, both girls and boys who remain too close and in a.too prolonged relation with the mother may have later problems in sexual identity. She noted that there must be a constitutional compliance on the part of the child-in the boy, a degree of passivity that mitigates against the normal upsurge of aggression that, in the normal differentiation subphase and practicing subphase, drives the typical child out of his mother's arms and into the wide world. Possibly the preoedipal girl may show a greater than usual amount of aggression and splitting between the good and bad object (mother) and the good and bad self which continues and is played out in the home-versus-school situation. Home may become safe and the abode of the good mother, while school is where the terrifying bad mother is located. This may lead to the child's behaving as a "good child" at school out of fear, while at home she may be able to allow her bad self to emerge. 231 Hamilton Road Men'on Station, Pennsylvania 19066
