To Redeem One Person Is to Redeem the World: The Life of Frieda Fromm-Reichmannby Gail A. Hornstein
A fascinating and dramatic account of a controversial figure in twentieth-century psychiatry.
In this “dazzling and provocative”* biography, Gail Hornstein brings back to life the maverick psychiatrist Frieda Fromm-Reichmann. To Redeem One Person Is to Redeem the World tells the extraordinary life story of the German-Jewish refugee analyst who/b>
A fascinating and dramatic account of a controversial figure in twentieth-century psychiatry.
In this “dazzling and provocative”* biography, Gail Hornstein brings back to life the maverick psychiatrist Frieda Fromm-Reichmann. To Redeem One Person Is to Redeem the World tells the extraordinary life story of the German-Jewish refugee analyst who accomplished what Freud and almost everyone else thought impossible: she successfully treated schizophrenics and other seriously disturbed mental patients with intensive psychotherapy, rather than medication, lobotomy, or shock treatment. Written with unprecedented access to a rich archive of clinical materials and newly discovered records and documents from across Europe and the United States, Hornstein’s meticulous and “delightfully lucid”** biography definitively reclaims the life of Fromm-Reichmann. The therapist at the core of Joanne Greenberg’s I Never Promised You a Rose Garden is also the analyst who had an affair with, and later married, her patient Erich Fromm. A pioneer in her field, she made history as the pivotal figure of the unique and legendary mental hospital, Chestnut Lodge.
“A lively, well-written account of a charismatic leader in an important period of psychiatry’s history.”
“At a time when little pills are seen as a quick fix for almost everything, this book is well worth taking time to read and contemplate.”
*Publishers Weekly **Kirkus Reviews
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To Redeem One Person Is to Redeem the WorldA Life of Frieda Fromm-Reichmann
By Gail A. Hornstein
Free PressCopyright © 2000 Gail A. Hornstein
All right reserved.
PrologueThere are no goals, only the goal ... to lift up the fallen and to free the imprisoned ... to work toward the redemption of the world.
September 28, 1948. The evening was mild. The air, misted with the memory of rain, smelled of catalpa and breeze. Paths through the grounds at Chestnut Lodge were deep in shade, the broad-brimmed trees thick with birds and leaves. A family-owned asylum in the Maryland countryside, the Lodge was often mistaken for a country estate. No fences or gates enclosed the sweeping grounds, but patients did not try to leave. Those not on locked wards walked aimlessly along the paths, watching offices in the main building flare to light in the sudden dusk. It was the first evening in weeks that no one needed seclusion or restraint, and the hallways echoed with the sound of nurses unclenching their teeth.
From the heavily screened porches at the south end of each floor, a white clapboard cottage was visible just across the path. A lamp at its side window illumined a figure at the desk. Frieda Fromm-Reichmann sat heavily in an old leather chair, a half-smoked Chesterfield in one hand, black coffee in the other, drafts of the book she was struggling to finish scattered like leaves across her desk. In less than a month, she would be fifty-nine. It had been thirteen years since she had come to work at the Lodge, and on nights like this, she could imagine herself still in Heidelberg. War and the ironies of psychoanalytic history had made her - a woman, a Jew, a refugee - the most distinguished member of Chestnut Lodge's staff, but no American questioned her place. For three decades, she had chosen to work primarily in hospital settings and with the most disturbed patients. She still spent hours each week with people considered beyond reach by most psychiatrists, although seniority now permitted her to treat only those who particularly interested her. For the first time in six months, she had taken on a new patient, a young woman who was, at that moment, sitting silently on a locked ward pretending not to be terrified, unable to imagine the relationship that would transform her life.
At sixteen, Joanne Greenberg was one of the youngest patients ever admitted to the Lodge. Her diagnosis of schizophrenia did not distinguish her from most others; every mental hospital in America was filled with schizophrenics in the late 1940s. She had been seriously disturbed since the age of nine. Her behavior had the oddness we find so unsettling in mental patients - an embarrassing attentiveness to rules unknown to anyone else. Having finally become too strange to stay in school, she had been sent for an indeterminate stay at Chestnut Lodge.
There was little pattern to the strangeness, which frightened Greenberg's parents as much as the symptoms themselves. The pieces didn't seem to fit together. She refused to let anyone stand behind her, making for a slinking walk and a suspicious air. She claimed to smell odors and heard whispering from people who weren't there. She spoke aloud to them sometimes, in a language no one could recognize. She ate bits of paint or wood, pieces of string, movie tickets, unprepared gelatin. Lightning petrified her. Sudden stomach pains made her double over in agony, but doctors could find no physical cause for the attacks. The plodding gait and stringy hair gave her a dull awkwardness, which seemed at odds with the biting sarcasm that took the place of ordinary talk. There was no family history of mental illness, no obvious trauma in childhood. Yet when people met Joanne Greenberg, they knew something was terribly wrong with her, even though the look on her face made them want to leave before they found out what it was.
Hidden behind the flatness, however, were unmistakable sparks of someone still present. These were rare in a schizophrenic, except in one still a teenager. Psychosis is unrelenting anguish, a torment beyond most people's endurance, and those who end up as mental patients instead of suicides have found a way to blunt the edge. They pay a high price for this. As the lattice of lies, woven more and more tightly, blocks out the light, defenses turn parasitic, destroy the few remaining healthy parts, and then there is no way out.
Joanne Greenberg was too young to have reached that burned-out stage, but she was well on her way. Her absent stare had the look of someone "being beaten to death from the inside." What made her different from a typical schizophrenic was that the battle was still taking place. Trickles of feeling seeped through the brittleness and appeared as expressions on her face. Her indifference had a studied quality, as if she weren't quite sure of it herself. People had yet to become interchangeable objects in her mind.
Frieda Fromm-Reichmann had built her reputation on the claim that no patient, however disturbed, was beyond the reach of psychotherapy. Even as a medical student, listening to wildly hallucinating patients as they screamed or raved, or sitting quietly by the beds of those who lay mute and unresponsive for days, she had been convinced that buried inside the avalanche of illness was a terrified person crying out for help. Her job was to do whatever was necessary to get that person out. She did not think of this as heroic or even particularly worthy of note; a physician's responsibility was to help patients, and she had chosen to do that work.
Frieda - almost everyone, even some patients, called her by her first name and it would be odd to refer to her in any other way - was legendary for her ability to gain the trust of even the most disturbed patient. But even she acknowledged that psychotherapy can work only if a person can stay present to the panic, at least a moment at a time. There has to be a tiny part of the mind that can separate itself from the terror long enough to see what it looks like. People who have reached the point of psychosis usually can't tolerate this; it feels too much like being in a collapsed mineshaft, told to crawl straight toward the danger just to see how bad it is. Literally paralyzed from years of fear, they choose the lesser evil, retreating to a place no one can reach.
Joanne Greenberg didn't end up like this. She began treatment with Frieda a week after arriving at Chestnut Lodge. Four years later, she was successfully attending college at nearby American University. Despite months on the disturbed ward, ripping her arms to shreds with jagged tin cans and crushing lighted cigarettes into the wounds, Greenberg made a recovery so complete she was able to marry, have children, and become an accomplished writer of novels and short stories.
It was highly unusual for a schizophrenic patient to recover at all, and the fact that Greenberg had been treated solely with psychotherapy - no drugs, shock, or any other biological methods - made her cure even more remarkable. But few people outside Chestnut Lodge knew of these events or would have believed them if they had. Frieda presented the case in disguised form in her book, Principles of Intensive Psychotherapy, and in various lectures to professional groups, but it was one among many clinical illustrations she used in the early 1950s, and she called no special attention to it. The successful outcome was satisfying to be sure, but it was also perplexing, and Frieda, always given to understatement, didn't endow it with any of the dramatic qualities it would later come to have.
In 1964, Greenberg published a "novel," I Never Promised You a Rose Garden, which presented a thinly fictionalized account of her illness, treatment, and cure. Frieda was dead by that point. Joanne used a pseudonym ("Hannah Green") to protect her family, but neither that detail nor the fact that the story portrayed real events was anywhere evident in the book. To the considerable surprise of Greenberg and her publisher, Rose Garden gained a huge following and has been continuously in print for thirty-five years. It has sold 5.7 million copies, been translated into a dozen languages, and been transmuted into a movie, a pop song, and a cultural cliché.
Mental patients hailed Rose Garden, psychiatrists denounced it, and it became the lightning rod for controversy about schizophrenia and its treatment. Eventually Joanne's and Frieda's identities were revealed, and they became one of those couples - like Freud and Dora, Breuer and Anna O., or Ferenczi and R.N. - that psychoanalysts revere like martyred saints.
Their story posed two fundamental questions, questions we still cannot answer today: Can relationship heal severe mental illness? and Why are psychiatrists the people fighting hardest against this idea?
Frieda Fromm-Reichmann would have been astonished by the adoring attitude that Greenberg's readers have taken toward her fictional incarnation, "Dr. Fried." She never saw herself as having special gifts as a therapist; she attributed her success with patients to commitment and diligence. Frieda always told people she had been a psychiatrist since earliest childhood. The eldest of three daughters in an Orthodox Jewish home, she had taken on responsibility for illusions of family harmony and was brilliant in the role. Like a simultaneous translator, listening past words to murmur, to the half glance, the tonality of a room, she interpreted everything everybody did with a grace that seemed effortless. Even as a toddler, she could execute this pas de trois so perfectly that neither of her parents knew she was doing it, and her vigilance transformed a thousand potentially incendiary moments into minor misunderstandings. Gliding back and forth between the sensitivities of her father and her mother's fierce control, Frieda learned to intuit a person's need the way dogs sense danger - with her whole body. Her own neediness went unnoticed, a sacrifice so complete it seemed deliberate.
From her earliest days as a psychiatrist, long before she had ever heard of Freud, Frieda had insisted that no matter how bizarre a patient's behavior, it had an unconscious meaning that could potentially be deciphered. This might take months, even years, but if the doctor could stand the uncertainty, the pattern would emerge. Interpretation wasn't the key, especially with psychotic patients, already prone to imbuing their actions with too much symbolic significance. Frieda's main technique was waiting, a method she deployed so skillfully it looked like magic.
Waiting was her forte, although this was sometimes hard to realize. Her indifference to politeness could seem impatient, but mainly she just couldn't stand to lie. This didn't always endear her to friends or colleagues, for whom her matter-of-factness could have too blunt an edge. But psychotics appreciated her directness more than they could say, and they rewarded her patience by revealing themselves.
Frieda's capacity to wait had been honed as a child, when she trained herself to expand to infinity the time she gave her parents to tire of misunderstanding. Medical school in Königsberg was one long act of patience, designed to prove that she and the handful of other women deserved to be there. Later, working at a Prussian army hospital during World War I, she learned from brain-injured soldiers what it was like to have a shell explode in your face and still be alive. Their muteness became her measure. When she took up treating schizophrenics in the 1920s, they seemed so intact by comparison that she found the work a pleasure. Most psychiatrists, accustomed to treating the "worried well," find the unbearably slow pace of therapy with psychotics intolerable. But Frieda could wait cheerfully through years of infinitesimal gain; the knowledge that recovery was anatomically possible was enough to keep her going. She could tolerate any behavior, no matter how disgusting or bizarre, so long as it seemed necessary to protect a vulnerable person. It was only when symptoms became ruses or habits that she started badgering patients to give them up and get better.
People were sometimes surprised to hear of Frieda's lack of pretense with patients, given how presumptuous she could be with everyone else. She would think nothing of calling colleagues on an hour's notice, announcing that she needed to be driven to a meeting or felt like playing with their child. She took for granted that her wishes would simply take precedence over whatever else was going on in their lives. But with patients she never pulled such stunts. To act willful or superior would risk mocking their pain. Frieda had an unerring eye for exploitation, and never used patients for her own ends.
She was willing to try practically anything that might help them, which was a great deal more than most other psychiatrists were willing to do. She saw one patient at ten o'clock at night because that's when he was most likely to talk. She took others on walks around hospital grounds, or to symphony concerts, or to country inns for lunch. Those too distraught to leave at the end of an hour were permitted to stay for two. If a patient was violent and couldn't be let off the ward, she went to his room or saw him in restraints, if necessary. "She would have swung from the chandelier like Tarzan if she thought it would help," Joanne Greenberg later observed. A colleague remarked, not admiringly, that Frieda's patients got better because she simply gave them no other choice.
From earliest childhood, Frieda had been imbued with a deep sense of responsibility. No event, however insignificant, occurred in isolation; every act had implications for the lives of other people. The worldview of her Orthodox upbringing was embodied in this story, told by the great sixteenth-century rabbi Isaac Luria:
During the process of creation, God's divine emanations were gathered together and stored in sacred vessels. But the vessels, unable to contain the light pouring into them, shattered, fragmenting the divine sparks, which fell to earth. The world became chaotic; nothing was in its proper realm. The task of human history and the responsibility of every Jew is to rescue the divine sparks and restore order to the world. This is the work known as tikkun. When it is fully accomplished, redemption will come to everyone.
Tikkun is a collective task; no one person can perform it on his own. A divine spark is attached to each prayer, each charitable act, each moment of goodness. If a person fulfills her duty and strictly follows the ethical path, that spark is restored to its source in the divine realm. To assist another is to do God's work. To redeem one person is to redeem the world.
Fields of medicine define themselves by the cases they take as prototypes, and psychiatry's hopelessness is painfully evident in the poor choices it has made. Perversely claiming only disorders that defy understanding or can't be treated, it has ended up with whatever has been seen as least curable in every historical period. For two centuries, psychiatrists have felt themselves unable to do much but pity their patients' deterioration.
Excerpted from To Redeem One Person Is to Redeem the World by Gail A. Hornstein Copyright © 2000 by Gail A. Hornstein. Excerpted by permission.
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Meet the Author
Gail Hornstein is Professor of Psychology at Mount Holyoke College and was the Founding Director of the Five College Women's Studies Research Center for its first ten years.
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