by: Diane Ehrensaft, Ph.D.
Published in MHPG Newsletter
Reviewed by: Gretchen Sewall, R.N., LIC.S.W., Chair, MHPG Education Committee
A short online description of the book, Mommies, Daddies, Donors, Surrogates: Answering Tough Questions and Building Strong Families suggests Diane Ehrensaft presses “parents and others to investigate emotional issues they are likely to encounter over time” in families beginning with genetic donation or surrogacy. Recently, I attempted to explain the premise of this book to a bright young friend who is soon to embark on her own journey to graduate school for advanced degrees in social work and public health. While sipping on white port and enjoying freshly roasted almonds, she cautiously asked, “Do you honestly think parents-to-be want to consider, or even discuss, Ehrensaft’s idea that their future child will have a lifelong fantasy relationship with the genetic donor, or that they will discuss that the husband (sitting in front of you) is about to create life with a young, attractive and very fertile woman who is not his wife?” “Well no”, I said, “but I do try to encourage clients to shift from the grief and losses of infertility or in cases of single or same sex couples, to move from the all-consuming hurtles of picking a bank, and donor, while mastering the art of ovulation prediction, to a more child-focused view.” Most often, I have an hour, just one chance to bring the client to a place of envisioning the intra-psychic, interpersonal and developmental tasks of families built with help from what Ehrensaft calls “the birthother”. Again, my young friend asked, “Do you think this psycho-educational session is therapeutic or educational for your clients?” This is the intent and purpose. I admitted to my inspired friend that this session is tricky, as it can dissolve into a mildly irritating, required hour before the client tries to have a very much wanted child. Like third-party family building itself, this session represents risk and opportunity for mental health professionals.
If you are among our many members who already have read Mommies, Daddies, Donors and Surrogates (2005) I’d suggest you thumb through this book again. Dr. Ehrensaft’s book is filled with almost “everything we need to know”; and now, with frozen oocytes (and embryos) on the market, it’s even more timely. Still yet to be articulated is the best delivery modality, interval and timing of her news for parents and families. Perhaps this is the content of another book, still to be written.
When I spoke to Diane Ehrensaft last month, I was reminded of the benefits of serving on the MHPG Education Committee. I am grateful for the privilege and pleasure of conversation and the chance to ask questions of one of our instrumental leaders and educators in our field.
GS: “Diane, your book covers the topics MHPG members are heart deep into–every day. How can you best capture or summarize your message?”
DE: “We know assisted technology is no longer a wave of the future; it’s a strong surge of the present. While it helps more and more families, it still doesn’t and can’t answer the new generation questions that lead to behaviors, interactions and internal lives in the family after the child is born. This is where the mental health professional (MHP) comes in and what I wanted to get at in my book. Our work is to understand the real roots and weeds, as well as recognize the health in these families. My hope is to bring together the thinking and feeling parts of the adult self to recognize and name the creative tension of making life and kinship with many others.”
GS: “Ok, you have my interest- How do you conceptualize this? Can you give it a form or structure?”
DE: “Rather than a genogram, I see these birth other constructed families as “family circles” that take place on cognitive, physical and emotional levels over the course of the developmental life span. A cross section, freeze-frame view of this gives you a developmental point in time with zoom lens capacity into any one or several elements of the family circle.”
GS: “Would you give me an example of this?”
DE: “Consider the mother-to-be. Her interpersonal life is challenged by power or powerlessness- fertility or infertility. Does she have ownership of the pregnancy (and her child), or is it a collaboration with the donor? Connected to this is the illusion of consumer control or perfectibility. The natural tension within her interpersonal life penetrates her world of belonging. Do I belong to my child, does she belong to me-or more to my partner? Identity and belonging are backdrops to the disclosure discussions of the MHPs every day.”
“Have you seen cases of the older woman using TDI/DEP who talks comfortably about sperm donation, all the while not mentioning egg donation? Parents need opportunity for their many thoughts and feelings to be “metabolized”. This is the antidote preventing the internal tension from moving into the interpersonal place of the nobody in the circle not belonging or being within the family circle.”
GS:” Yes. What happens then within the interpersonal place of mother and child when the mother privately questions her full belonging in motherhood, of her child and in her family?”
DE: “If for example, the power to be mother shifts and originates from her power to purchase ‘perfect’, the mother becomes anxious and intolerant of the emergence of the imperfect child.”
“As we know, in early childhood relationships, and people are understood based on geography. They may simply see the donor or surrogate as ‘where they came from’. By eleven or twelve, there is an unfolding of the child’s own mental life with the birthother. With language acquisition and development, he or she will verbalize this normative tension in the inner world. The parents’ state of ease or anxiety can inhibit the developmental point of view of the adolescent. Correcting the child’s language by turning the child’s ‘donor mom’ into the ‘ nice lady who helped us’, or topic avoidance aimed at soothing parental dis-ease, rewrites the child’s narrative of birthother and self by turning it inward.”
GS: “Your saying, the child’s natural fantasies of the birthother co-exist within the realities of parentage, family and genetics?”
DE: “Yes, of course. The child, like the parent, needs the emotional space of expression. Families or community with resiliency and health, have room for this ongoing process, internally and interpersonally throughout family life. On the other hand, at each critical point or stage, the inner- world tension can take primacy over the relationship and the family itself.”
GS: “This all brings me back to the one, and usually only encounter the MHP has at the critical point of pre-parenthood. How can we possibly set the stage for healthy and resilient family growth?”
DE: “That’s the first, pre baby step, the first visit is the beginning and not the end of your relationship with the family. Somewhat like adoption, this is lifelong and will be experienced anew, many, many times. What comes next is the continual challenge of creating space and opportunity for ongoing relationships which truly assist reproductive technology family building.”
GS: “A colleague suggests a way to support ongoing relationships with families is to create a ‘family building’ page on the ART clinic websites, with class offerings, resources and networking opportunities. Would this be the next step?”
DE: “Yes, that seems like a natural way to keep the connection and support alive. Could this also be a place to offer various forms of ID release for birthothers, parents and interested young adults?”
GS: “That would be my hope and dream. Thank you, Diane. We are ready for that next book!”
Diane Ehrensaft, Ph.D. Mommies, Daddies, Donors, Surrogates: Answering Tough Questions and Building Strong Families. The Guilford Press: 2005. ISBN-13: 978-1593851330.
Publications may be obtained at your local library or bookstore or in some cases ordered from the publisher’s address provided. Generally, titles reviewed on this site are restricted to those published within the last five years. This list is in no way comprehensive or intended to replace, dictate, or fully define evaluation and treatment by a qualified professional. It is intended solely as an aid for persons seeking general information on issues in reproductive medicine. The views expressed in these book reviews are those of the reviewer and do not necessarily reflect those of the American Society for Reproductive Medicine.