Shrinks (11 page)

Schizophrenogenic Mothers and World Peace

From their positions of influence in university medical schools and the APA, psychoanalysts could now dictate the training of future psychiatrists. Curricula based upon biological and behavioral theories were minimized, while Freud-influenced ideas became the core of virtually every medical school program in psychiatry—and, indeed, became an all-embracing worldview that permeated the training of every aspiring psychiatrist. In addition to attending lectures on psychoanalysis and having their cases supervised by analysts, if a medical student wanted to be a psychiatrist she had to undergo a “successful” psychoanalysis herself during postgraduate training.

Think about that for a minute. The only way to become a psychiatrist—a bona fide medical professional—was to share your life’s history, innermost feelings, fears, and aspirations, your nightly dreams and daily fantasies, with someone who would use this deeply intimate material to determine how devoted you were to Freudian principles. Imagine if the only way you could become a theoretical physicist was to confess an unwavering and unquestioning dedication to the theory of relativity or the precepts of quantum mechanics, or if the only way you could become an economist was to reveal whether Karl Marx appeared as an angel (or devil) in your dreams. If a trainee wanted to rise within the ranks of academic psychiatry or develop a successful practice, she had to demonstrate fealty to psychoanalytic theory. If not, she risked being banished to working in the public-hospital sector, which usually meant a state mental institution. If you were looking for an indoctrination method to foster a particular ideology within a profession, you probably couldn’t do much better than forcing all job applicants to undergo confessional psychotherapy with a therapist-inquisitor already committed to the ideology.

If an established psychiatrist who had somehow been trained outside of the Freudian paradigm questioned the validity of psychoanalysis, he was shouted down at conferences and/or branded with a diagnosis such as passive-aggressive personality disorder or narcissistic personality disorder or termed a sociopath. In 1962, the influential psychiatrist Leon Eisenberg offered a few critical remarks about the unscientific nature of psychoanalysis at a medical educators’ meeting. “There was a veritable stampede of Department Chairmen to the floor microphones. Just about every eminent figure present rose to defend the primacy of psychoanalysis as ‘the basic science’ of psychiatry,” lamented Eisenberg, according to Hannah Decker’s excellent book
The Making of DSM-III
.

Under the psychoanalytic hegemony, psychiatrists in training were discouraged from bothering with the kinds of patients who usually ended up in asylums and mental institutions, patients like Elena Conway, in preference of treating patients with milder ailments and more amenable to psychoanalysis. The treatment of the seriously mentally ill—psychiatry’s original and primary mandate—was subordinated to the treatment of the worried well. Edward Shorter’s
A History of Psychiatry
shares the recollections of a psychiatry resident at the Delaware State Hospital in the 1940s:

It was urgently driven home that we should view institutional psychiatry merely as a brief transitional stage for us. Our ideal professional goal was doing psychoanalysis in private practice in combination with supervising training at one of the psychoanalytic institutes independent of a university department. From the viewpoint of the psychoanalytic theories of the 1940s, our daily therapeutic activities at Delaware Hospital were considered highly questionable. The somatic therapies, so we were told, were stopgaps. They concealed instead of uncovering. Ordering a sedative for an agitated psychotic patient was not therapeutic for the patient but instead considered an anxiety reaction on the part of the doctor.

Having conquered academic psychiatry and created an industry of private practice for this specialty, American psychoanalysts reevaluated the potency of their therapeutic métier and now concluded it was even stronger medicine than originally believed. Freud himself had declared that psychoanalysis was not easily applied to schizophrenia and manic-depressive illness, and the master’s words had prompted the majority of psychoanalysts to avoid treating patients with severe mental illness. But as the twentieth century progressed, American psychoanalysts began to assert that it
was
possible to convince the schizophrenics to give up their delusions, coax the manics out of their mania, and cajole the autistics away from their autism. The American psychoanalytical movement launched a new initiative: turning alienists into analysts.

One of the progenitors of this professional transmutation was the Swiss-educated psychiatrist Adolf Meyer, who immigrated in 1892 to the U.S., where he initially practiced neurology and neuropathology. In 1902, he became director of the New York State Pathological Institute (now called the New York State Psychiatric Institute), where he began to argue that severe mental illness resulted from personality dysfunction rather than brain pathology—and that Freud’s theories offered the best explanation of how these personality dysfunctions led to illness. In 1913, Meyer became chair of the first psychiatric inpatient clinic in a general hospital in the U.S., at Johns Hopkins University, and began to apply the newly arrived psychoanalytic methods to the clinic’s schizophrenic and manic-depressive patients.

Influenced by Meyer’s pioneering work in Baltimore, two nearby institutions in Maryland became flagship hospitals for using psychoanalysis to treat the severely mentally ill: the Chestnut Lodge Sanitarium and the Sheppard and Enoch Pratt Hospital. In 1922, psychiatrist Harry Stack Sullivan arrived at Sheppard Pratt. In Sullivan’s view, schizophrenia was the result of “anxiety reactions”—the unsuccessful adjustment to life’s stresses—and only occurred in individuals who failed to have satisfying sexual experiences. Under the mentorship of Adolf Meyer, Sullivan developed one of the earliest psychoanalytic methods for treating schizophrenic patients. Since he believed that schizophrenics were having difficulty integrating their life experiences into a coherent personal narrative, he sought out hospital staff members with personal backgrounds similar to each schizophrenic patient and encouraged these staff to engage in informal conversation with the patient in hopes of providing meaning and coherence to the schizophrenic’s “masses of life experience.”

Soon, other psychoanalytic hospitals opened around the country. Along with Chestnut Lodge and Sheppard Pratt, McLean Hospital near Boston, Austen Riggs in Stockbridge, Massachusetts, and the Bloomingdale Insane Asylum in New York City became bastions of psychoanalytic treatment for the severely mentally ill—for those who could afford it. It was the Menninger Clinic in Topeka, Kansas, that most famously exemplified the marriage of psychoanalysis and asylum psychiatry. Operated by three generations of the Menninger family, the clinic was a self-contained compound in a pristine rural location (as had been described by Johann Reil over a century earlier) patronized by affluent patients who remained for long periods of time—sometimes years—while undergoing free association, dream analysis, and the other ingredients of intensive psychoanalysis. The Menninger Clinic became the leading American institution for psychiatric treatment for about five decades; during that time, trekking to Topeka was the psychiatric equivalent of a miracle-seeking invalid’s journey to a holy shrine. (Woody Allen joked ruefully about the unending duration of analytic therapy and slow pace of results, “I’m going to give my analyst one more year and then I am going to Lourdes.”) Among the celebrities who availed themselves of the clinic’s revitalizing services were Dorothy Dandridge, Judy Garland, Robert Walker, Marilyn Monroe, and, more recently, Brett Favre.

Mental illnesses that had eluded explanation for one and a half centuries—defying alienists, biological psychiatrists, and psychodynamic psychiatrists alike—now became the subject of a new form of post-Freudian psychoanalytic interpretation. In 1935, Frieda Fromm-Reichmann, a psychoanalyst émigré from Germany (best known as the fictionalized psychiatrist in
I Never Promised You a Rose Garden
), arrived at Chestnut Lodge, where she set about revising Sullivan’s ideas about schizophrenia. In Fromm-Reichmann’s view, schizophrenia was not caused by anxiety reactions in the patient; it was induced by the patient’s mother. “The schizophrenic is painfully distrustful and resentful of other people,” she wrote, “due to the severe early smothering and rejection he encountered in important people of his infancy and childhood—as a rule, mainly in a ‘schizophrenogenic’ mother.”

According to Fromm-Reichmann, a schizophrenogenic mother provoked psychosis in her child through a toxic pattern of behavior. Naturally, this formulation did not come as welcome news to the parents of schizophrenic children. But not to worry, Fromm-Reichmann assured them; since schizophrenia reflected buried psychological conflicts placed there by the parents, it could be treated with an extended course of talk therapy.

After Fromm-Reichmann, the parents—and particularly the mother—became the appointed source of all varieties of mental illness: Since a person’s early psychosexual development was the soil from which all illness grew, psychoanalysis declared that Mom and Dad were the prime candidates for psychopathic culpability. The prominent anthropologist Gregory Bateson, husband of Margaret Mead and a researcher at the Mental Research Institute in California, postulated a “double bind” theory of schizophrenia, which appointed the mother as the sickest member of the family. According to Bateson, mothers fostered schizophrenia in their children by issuing conflicting demands (the double bind)—for example, by simultaneously insisting, “Speak when you are spoken to!” and “Don’t talk back!” or telling a child to “take initiatives and do something” and then criticizing her for doing something without permission. He argued that the ego resolved this no-win situation by retreating into a fantasy world where the impossible became possible—where, for example, turtles could fly and one could simultaneously speak and be silent.

Autism? Engendered by the “refrigerator mother”—a caregiver who was cold and emotionless toward her children. Homosexuality? Induced by domineering mothers who instilled a fear of castration in their sons along with a deep-seated rejection of women. Depression? “The ego tries to punish itself to forestall punishment by the parent,” declared the eminent psychoanalyst Sándor Radó. In other words, suicidal thoughts were the result of your childhood anger toward Mom and Dad getting turned inward onto yourself, since you couldn’t express your true feelings to your parents without fearing their reprisal. Paranoia? “It arises in the first six months of life,” pronounced analyst Melanie Klein, “as the child spits out the mother’s milk, fearing the mother will revenge herself because of his hatred of her.”

It was not enough that parents had to endure the tragedy of a child’s mental illness; after this onslaught of inane diagnostic formulations, they also had to suffer the indignity of being blamed for the illness because of their own misbehavior. Still worse were the prescribed treatments. Schizophrenia and bipolar disorder—illnesses that for centuries were so mystifying that the only effective treatment was institutionalization—were now believed to be curable through the right kind of talk therapy. Like a pet cat in a tree, a deranged individual merely had to be coaxed into climbing down to reality. This belief led to situations that ranged from the ridiculous (a psychiatrist urging a psychotic person to talk about his sexual fantasies) to the disastrous (a psychiatrist encouraging a suicidal patient to accept that her parents never loved her). As someone who has worked with thousands of schizophrenic patients, I can assure you that they are just as likely to be talked out of their illness as they are to be bled or purged out of it.

By 1955, a majority of psychoanalysts had concluded that
all
forms of mental illness—including neuroses and psychoses—were manifestations of inner psychological conflicts. But the hubris of the American psychoanalytic movement didn’t stop there. At this point, if it had been able to lie upon its own therapeutic couch, the psychoanalytic movement would have been diagnosed with all the classic symptoms of mania: extravagant behaviors, grandiose beliefs, and irrational faith in its world-changing powers.

Having folded the seriously mentally ill into their expanding diagnostic tent, psychoanalysts now wanted to include the rest of the human race under their circus Big Top. “Gone forever is the notion that the mentally ill person is an exception,” wrote Karl Menninger (William’s older brother), in his 1963 bestseller,
The Vital Balance
. “It is now accepted that most people have some degree of mental illness at some time.” The book gave detailed advice to readers on how to cope with the stresses of “everyday human life” and “mental disorganization.” By embracing psychoanalysis, Menninger declared, it was possible to achieve “a state of being weller than well.” Thus did psychoanalysis cross over from a medical profession into a human potential movement.

It was no longer acceptable to divide human behavior into normal and pathological, since virtually all human behavior reflected some form of neurotic conflict, and while conflict was innate to everyone, like fingerprints and belly buttons, no two conflicts looked exactly alike. Starting in the late 1950s and early ’60s, the psychoanalysts set out to convince the public that we were
all
walking wounded, normal neurotics, functioning psychotics… and that Freud’s teachings contained the secrets to eradicating inner strife and reaching our full potential as human beings.