Shrinks (9 page)

Rush believed that another source of mental illness was sensory overload. Too much visual and auditory stimulation, he claimed, unhinged the mind. To combat excessive mental input, he invented the Tranquilizer Chair. First, a patient was strapped to a sturdy chair. Next, a wooden box that vaguely resembled a birdhouse was lowered over his head, depriving him of sight and sound and rendering sneezing a very awkward affair.

But Rush’s preferred method for treating insanity was more straightforward: purging the bowels. He fabricated his own customized “Bilious Pills” filled with “10 grains of calomel and 15 grains of jalap”—powerful laxatives made from mercury, the poisonous quicksilver found in old thermometers. His patients endowed the pills with a more colorful moniker: “Rush’s thunderbolts.” Opening up the bowels, Rush attested, expelled any deleterious substances causing mental illness, along with the previous day’s breakfast, lunch, and dinner. Unfortunately, modern science has yet to uncover any evidence that mental illness can be cured through defecation.

Rush recognized that the very individuals whom he regarded as most in need of his gut-clearing remedies—the manic and psychotic—often actively resisted the good doctor’s medicine. Undeterred, he devised a solution. “It is sometimes difficult to prevail upon patients in this state of madness to take mercury in any of the ways in which it is usually administered,” he wrote. “In these cases I have succeeded by sprinkling a few grains of calomel daily upon a piece of bread, and afterwards spreading over it a thin covering of butter.” Between the nauseating spinning chairs and the constant evacuation of bowels, one guesses that a psychiatric ward in Rush’s hospital could be a very messy place.

Rotational Chair and Tranquilizer Chair, nineteenth-century treatment for mental illness in the U.S. (U.S. National Library of Medicine)

Rush’s medical celebrity came less from his Rube Goldberg–like treatments than from his policies and advocacy for the mentally ill. After seeing the appalling conditions of mental patients in Philadelphia’s Pennsylvania Hospital, Rush led a successful campaign in 1792 for the state to build a separate mental ward where the patients could be housed more compassionately. And while Rush’s thunderbolts and whirligigs might seem misguided and even a bit harebrained, they were certainly more humane than the beatings and chains that were the norm in asylums at the turn of the eighteenth century.

When Freud arrived in New York in 1909, American psychiatry was firmly established as a profession of alienists toiling in mental asylums. There was precious little originality in psychiatric research, which consisted of uninspired papers with titles like “The Imbecile with Criminal Instincts” and “The Effects of Exercise upon the Retardation of Conditions of Depression.” In an intellectual landscape as dry and barren as this was, any new spark might set off a conflagration.

Freud’s first and only visit to the United States occurred in September of 1909, shortly before World War I. He crossed the Atlantic on the ocean liner
George Washington
with Carl Jung, with whom he was still on intimate terms. It was the height of psychoanalytic unity, just before Freud’s acolytes started splintering off, and Freud believed that his novel ideas about the mind might shake American psychiatry from its lethargy. When the ship docked in New York, he reportedly said to Jung, “They don’t realize that we are bringing them the plague.” Freud’s comment would eventually seem more prescient than he realized.

Freud had come to the States at the request of G. Stanley Hall, the first American to receive a doctorate in psychology and the founder of the American Psychological Association. Hall had invited Freud to receive an honorary doctorate from Clark University, in Worcester, Massachusetts, where Hall was president, and to give a series of public lectures. These talks marked the first public recognition of Freud’s work in the United States.

It is interesting to note that it was psychologists who expressed the interest and took the initiative to invite Freud and expose America to his ideas. Psychology (translated as “study of the soul”) was a fledgling discipline that the German physician Wilhelm Wundt is credited with founding in 1879. Wundt was trained in anatomy and physiology, but when the anatomical study of mental functions led to a dead end, he turned to the outward manifestations of the brain reflected in human behavior and established an experimental laboratory devoted to behavior at the University of Leipzig.

William James, also a physician, almost contemporaneously became the leading proponent and scholar on psychology in the United States. Like Wundt, James was a devoted empiricist who believed in the value of evidence and experimentation. It is notable that the lack of a path forward in the traditional research paradigms of medical research led psychiatrically minded physicians to invoke psychology as their scientific discipline. Hence the invitation to Freud.

It is interesting to note that the discipline of psychology stems from physicians whose work, in the late nineteenth and early twentieth centuries, to understand mental functions using (then) traditional methods of medical research had been thwarted and who were compelled to pursue their goals by unconventional means. It is also notable that the early pioneers of psychology (Wundt, James, Hermann von Ebbinghaus, and subsequently Ivan Pavlov and then B. F. Skinner) were ardent empiricists devoted to research. And while Freud was similarly driven to develop psychological constructs to explain mental functions and illnesses by the same obstacles, he eschewed systematic research or any form of empirical validation of his theory.

At the time of his visit, Freud was virtually unknown in America; he wasn’t even the headliner when Clark sent out notices of his talk. There was no media coverage of Freud’s arrival before his talk and precious little afterward, apart from
The Nation
’s coverage of the event: “One of the most attractive of the eminent foreign savants who came was Sigmund Freud of Vienna. Far too little is known in America of either the man or his work. His views are now beginning to be talked of in Germany as the psychology of the future, as Wagner’s music was once dubbed the music of the future.”

Freud was an articulate and persuasive speaker who rarely failed to impress educated men and women. In both Europe and America, some of the greatest scientific and medical minds met with him and almost all came away converted. Attendees at Freud’s talks at Clark included James, who was so impressed by Freud that he said, “The future of psychology belongs to your work.”

Another attendee, the anarchist Emma Goldman, known for founding
Mother Earth
magazine, distributing birth control, and trying to assassinate the chairman of Carnegie Steel, was also smitten. “Only people of depraved minds,” she later claimed, “could impugn the motives or find ‘impure’ so great and fine a personality as Freud.” The great and fine personality of Freud was invited by James Jackson Putnam, the highly influential professor of nervous system diseases at Harvard, to visit him at his country retreat. After four days of intensive discussion, Putnam embraced Freud’s theory and publicly endorsed the man and his work. Not long afterward, Putnam co-organized the first meeting of the American Psychoanalytic Association (APsaA), which would quickly become the most influential psychoanalytic organization in the United States, not that there was much competition.

Despite the warm reception and lavish kudos, Freud’s impact on American psychiatry was initially quite modest. Two decades later, the American Psychoanalytic Association had still only attracted ninety-two members nationwide. Though psychoanalysis had begun to catch on among wealthy and educated patients in New York City suffering from mild disorders—duplicating Freud’s earlier success in the cosmopolitan city of Vienna—it did not penetrate into universities and medical schools, and failed to make any dent whatsoever in asylum psychiatry, still the hegemonic force in American mental health care.

In 1930, if you had told a psychiatrist that Freudian psychoanalysis would soon dominate American psychiatry, he would have considered that preposterous. There was little reason to believe that psychoanalysis would ever spread outside of a few cities on the East Coast. But then Hitler’s rise to power and aggression abruptly brought Europe to the brink of war, destabilizing the governments and boundaries of countries. It had a similar effect on the state and boundaries of psychiatry. While fascism spelled the end of psychoanalysis in Europe, it launched the unexpected rise of a psychoanalytic empire in America.

In the late nineteenth and early twentieth century, anti-Semitism was disturbingly common in Europe. Though Freud was an avowed atheist, he was ethnically Jewish, and he feared that if psychoanalysis developed a Jewish association in the public mind it would be doomed. From the start he worked hard to downplay any potential connection between psychoanalytic ideas and Jewishness. This was one of the reasons—probably the main reason—that Freud pushed for Carl Jung to become the first president of the International Psychoanalytical Association. Jung, who was Swiss, was neither Viennese nor Jewish, and his presidency would send a strong public signal that psychoanalysis was not a Jewish cabal. Nevertheless, Freud’s advocacy for Jung drew angry protests from Adler and Stekel. Freud’s oldest supporters felt that a member of the original Viennese group should be given the post. When Adler and Stekel confronted Freud, Freud declared that he needed the support of another country (Switzerland) to counter the perceived anti-Semitic hostility surrounding them in Vienna, dramatically pulling off his coat and shouting: “My enemies would be willing to see me starve; they would tear my very coat off my back!”

But despite Freud’s best efforts, psychoanalysis was inextricably linked to Jewish culture. Freud’s inner circle was almost entirely Jewish, as were the vast majority of the first generation of psychoanalysts, and they tended to believe that being Jewish helped one appreciate Freud’s wisdom. Many early psychoanalytic patients were drawn from affluent Jewish communities. At the peak of the Wednesday Psychological Society, the only non-Jewish member was Ernest Jones, an English neurologist from London. Sándor Ferenczi, a close confidant of Freud and an early president of the International Psychoanalytical Association, remarked about Jones’s lonely presence: “It has seldom been so clear to me as now what a psychological advantage it signifies to be born a Jew.” According to historian Edward Shorter, the subtext of much of the early psychoanalytic movement was: “We Jews have given a precious gift to modern civilization.”

As Hitler’s Nazism strengthened its hold on central Europe—especially in Austria, the capital of psychoanalysis—many psychoanalysts fled to safer countries. Shortly after Hitler’s ascent to power, there was a bonfire of psychoanalytic books in the center of Berlin, including all of Freud’s. Dr. M. H. Göring (cousin of Hermann Göring, Hitler’s second-in-command) took over the German Society for Psychotherapy, the leading psychiatric organization in Germany, and purged it of all Jewish and psychoanalytic elements, remaking it into the Reich Institute for Psychological Research and Psychotherapy.

Freud stayed in Vienna as long as he could, even enduring a swastika flag draped across his building’s doorway, until one spring day in 1938 Nazi soldiers raided his second-floor apartment. His wife, Martha, asked them to leave their rifles in the hall. The commander stiffly addressed the master of the house as “Herr Professor” and bid his men to search the entire apartment for contraband. Once the soldiers had finally left, Martha Freud informed her husband that they had seized about $840 in Austrian shillings. “Dear me,” the eighty-two-year-old Freud remarked, “I have never taken that much for a single visit.”

But Freud would end up paying even more to the Nazis for an exit visa that would allow him to take both his family and possessions to Britain: about $200,000 in contemporary currency. The money for the “exit tax” was raised by sales of Freud’s papers and artifacts and by the generous contribution of an admirer of Freud named Marie Bonaparte; the entire exit operation was surreptitiously facilitated by the Nazi “commissar” who directed the raid on Freud’s home. (Another Jewish refugee fled Vienna with his family around the same time but with much less notoriety: nine-year-old Eric Kandel, who would be inspired by Freud to become a psychiatrist and go on to win the Nobel Prize for brain research.) Practically overnight, the movement launched by Freud was snuffed out in Europe.

Although Freud himself immigrated to London, most psychoanalyst émigrés sought refuge in America, particularly in the big cities and especially New York. For those in the movement, it was as if the Vatican and its cardinals had shifted the site of the Holy See from Rome to Manhattan. Having been analyzed or trained directly by the master himself, these émigrés were welcomed as royalty by the fledgling psychoanalytic movement in the United States. They were granted professorships in leading universities, wrote popular books, and established psychoanalytic institutes.