WHEN SIGMUND FREUD DIED IN SEPTEMBER 1939, with Europe on the brink of war, W. H. Auden, who had recently arrived in America, wrote a poem lamenting his passing:
To us, he is no more a person
now but a whole climate of opinion
under whom we conduct our different lives.1
It was an acute comment, one that captured how influential Freud’s ideas had become. Ultimately, psychoanalysis would capture the imagination of American psychiatrists, but this postwar success threatens to distort our understanding of history, for before 1940, it was only among intellectuals and the urban elites—and emphatically not among those working in asylums who claimed expertise in the treatment of mental illness—that psychoanalysis achieved its greatest influence. This divergence of perspectives is one of the most striking features of the interwar years. One is tempted to speak of a cultural schizophrenia.
To the chagrin of most American psychiatrists, Freud’s ideas about the sources and treatment of mental illness drew considerable public interest in the years immediately following the First World War. America’s belated entrance had spared its troops some of the horrors of trench warfare, but the United States army and its medical corps was nonetheless confronted, like other combatants, with a raft of psychiatric casualties, the victims of shell shock or what the Germans called Schreckneurosen. To some observers, these breakdowns under the stress of combat emphasized the role of psychosocial factors in the genesis of serious forms of mental illness, and the limited success of crude forms of psychotherapy in treating shell shock’s victims, gave some credence to the idea that talk therapy might prove useful.
One American psychiatrist who had experienced the horrors of trench warfare wrote movingly of what he had seen: “Streams have been choked with the dead and rivers have run red with the blood of the wounded.… The terrible pictures of the war have been pictures of death en masse: death of men, women and children; death of trees and shrubs, even the grass; death of hope and everywhere the despair of death.”2 Emotions seemed to be converted into physical symptoms: nightmares haunted the traumatized and caused them to relive their trauma. It would be some decades before anyone spoke of post-traumatic stress disorder, but the catastrophes of war appeared to be inextricably connected to the flight into illness.
Intellectuals exhibited a growing fascination with Freud’s ideas. Even before the Great War, those who frequented the salon in Greenwich Village presided over by the wealthy banking heiress Mabel Dodge couldn’t resist the chance to debate sex and psychoanalysis. Lincoln Steffens, the leading muckraking journalist, recalled an occasion when the discussion was led by Walter Lippmann, then just beginning his distinguished career: “There were no warmer, quieter, more intensely thoughtful conversations at Mabel Dodge’s than those on Freud and his implications.”3 Here were doctrines that promised emancipation from American puritanism and provincialism. Mabel Dodge was a living exemplar of the liberation that these ideas could bring in their train, embarking as she was on the third of a string of marriages, adorned by a series of affairs with lovers of both sexes. Her money and charm, and willingness to serve as a patron of the arts, had attracted people such as John Reed, Margaret Sanger, Emma Goldman, and Max Eastman to her soirées, where they could discuss art, revolution, and psychoanalysis, confident that they constituted the new cosmopolitan avant-garde.4
Nor were they mistaken. By the 1920s and 1930s, among cultural critics, novelists, and visual artists—even in the venal new world of Hollywood—simplified versions of psychoanalytic ideas and speculations came to enjoy a remarkable influence. Freud’s ideas were popularized and spread to wide swaths of the literate middle class. Here was a set of novel notions about human psychology that almost became part of the ether, surfacing in the pages of the New York Times or the most widely circulated and influential magazine of the age, the Saturday Evening Post, as matter-of-fact, unexceptionable revelations with which their readers were assumed to be familiar.
Dodge herself had become a nationally syndicated columnist for the Hearst newspapers in 1916, and her postwar circle of acquaintances now extended to Gertrude Stein and Pablo Picasso, D. H. Lawrence and Willa Cather, Georgia O’Keefe and Aldous Huxley, among many others. Freudian and Jungian ideas were a frequent topic of conversation. Although Jung, the Crown Prince (as Freud once dubbed him), had long since been excommunicated from the ranks of orthodox psychoanalysis, to Freud’s dismay Americans still gave him their attention and the richest among them—Edith Rockefeller McCormick and the Mellons—patronized Jung, not Freud.
In April 1915, five months after he had helped to found the New Republic, Walter Lippmann provided its readers with a laudatory piece, “Freud and the Layman.”5 Not to be outdone, Max Eastman and Floyd Dell regaled readers of The Masses with essays titled “The Science of the Soul.”6 Theodore Dreiser, whose sexual life was nearly as colorful as Mabel Dodge’s (albeit confined to members of the opposite sex), soon published his own pamphlet, “Neurotic America and the Sex Impulse.”7 Mass-market magazines such as Vanity Fair and Ladies Home Journal rapidly followed suit. A nodding acquaintance with Freud was de rigueur in educated circles in 1920s America. Among fashionable intellectuals, and those who followed them, to profess ignorance of psychoanalysis was to reveal oneself to be hopelessly provincial and unsophisticated.
Freud had spoken wistfully about the fact that “the case histories that I write should read like short stories and that, as one might say, they lack the serious stamp of science.”8 This was, of course, precisely what attracted many readers to his work: the narratives that showed the analyst as detective, painstakingly decoding behavior, uncovering the hidden wellsprings of action, stripping away surface disguises and finally revealing the secrets of the soul. In the hands of popularizers, these features were played up as readers were assured that all sorts of troubles could now be smoothed away.
Writing in Everybody’s Magazine, Max Eastman extolled Freud’s discoveries as “a kind of ‘magic’ that is rapidly winning the attention of scientific minds in the world of medicine.” So convinced was he of its value that he set aside any pretense of objectivity and embraced, as he put it, “the language of the patent medicine advertisement”: “Are you worried? Are you worried when there is nothing to worry about? Have you lost confidence in yourself? Are you afraid? Are you nervous, irritable, unable to be decent-tempered around the house? … Do you suffer from headaches, nausea, ‘neuralgia,’ paralysis, or any other mysterious disorder?”9 Never fear, a miraculous cure for all these ailments was now at hand.
In advancing such an optimistic view of the prospects for curing mental upsets, Eastman was entirely representative of the new generation of Freudian popularizers. In the 1920s, Freud’s work was moving in a darker, more pessimistic direction. He wrote of the fundamental tension between civilization and the individual and spoke openly about a death instinct.10 Repression and perpetual feelings of discontent were, he argued, all-but-inevitable concomitants of civilized existence. Those aspects of psychoanalysis were ignored or played down in most American discussions of the new “science.” The audience that encountered psychoanalysis in the popular press absorbed a version shorn of its most troublesome features, one that seemed to promise a facile resolution of life’s problems.
Like their European counterparts, American artists, dramatists, and novelists were quick to grasp the possibilities of psychoanalysis. Religious and cultural conservatives reacted with hostility and dismay to the more open discussion of sexuality that Freud’s ideas had encouraged, rushing to the defense of “civilized morality.” Many shared these traditional views, but especially in urban settings, many did not. In the decade we know as “the roaring Twenties,” authors and artists pushed back against notions of propriety and reticence, and they found in the idea that repression led to neurosis a useful prop for their determination to break with the prudery of the past. The emphasis on psychological introspection, on hidden motives, and on the complexities of language all appealed to novelists and dramatists and found echoes in their work, as did Freud’s stress on the importance of sex.
Broadway in the 1920s and 1930s saw a host of plays by dramatists now forgotten that embraced and exploited the theories of Freud and Jung. Guilt, repression, Oedipal problems with overbearing mother figures, and sex (repressed and overt) became staples of the stage. The drama critic for the conservative The Sun pandered to its largely working-class readership by denouncing the newfangled ideas: “Keep Freud and Jung and the horrors of their psychoanalysis, their subconscious repressions, their complexes and inhibitions off the stage, and let them flourish on the printed page, where they belong.”11 But it was a forlorn protest. The audiences that frequented Broadway plays demanded more psychodrama and they got it.
Rachel Barton Butler’s rather frivolous Mamma’s Affair reached Broadway in 1920 and drew considerable critical attention. Its plot revolved around an unhealthily close relationship between mother and daughter, who is rescued when the physician who diagnoses her pathology falls in love and marries her—a happy resolution all around, as the mother consoles herself with the thought that there is now a doctor in the family. Sex surfaces more openly two years later in Ruth Woodward’s Red Geranium, whose country-girl heroine moves to Greenwich Village, where she discovers Freud and free love and takes up with a lover who presents each of his many mistresses with a red geranium when he tires of her. More melodramatically, Mary Hoyt Wiborg’s Taboo, which opened the same year, has a child hitherto mute recovering her speech at the crucial moment, allowing her to save a black man unjustly accused of murder. Freudian themes surface repeatedly in the plays of Susan Glaspell, from the one-act Suppressed Desires, through her portrait of a homicidal psychotic in The Verge, to her Pulitzer Prize–winning drama Alison’s House, a fictionalized account of Emily Dickinson’s life, which has Dickinson sublimating her unfulfilled sexuality into poetry. Frank Stammers and Harold Orlob produced the first Freudian musical, Nothing but Love, as early as 1919. Later on, comedies like Preston Sturges’s Strictly Dishonorable and Dorrance Davis’s Apron Strings revolved around sexual repression and the means to overcome it. Alongside these lighter riffs were many plays dealing with sexual suppression and frustration, puritanical matriarchs, and the unconscious drives lurking barely beneath the surface of civilization.
Dreiser, never one to shy away from the dramatic possibilities of sex, created the story of a deformed young man, Isadore, obsessed with young girls, whom he molested and in one case murdered, before ultimately resisting his frustrated urges, releasing his last potential victim, and killing himself. Dreiser had formed a close friendship with the Freudian Smith Ely Jelliffe, and the play drew heavily on his psychoanalytic studies. Lest the audience miss the point, The Hand of the Potter closes with an Irish reporter instructing them what it all means:
I’ve been readin’ up on these cases for some time, an’ from what I can make out they’re no more guilty than any other person with a disease.… This felly could no more help bein’ what he was than a fly can help being a fly an’ naht an’ elephant.… If ye’d ever made a study ave the passion ave love in the sense that Freud an’ some others have ye’d understand it will enough. It’s a great force about which we know naathing as yet an’ which we’re just beginnin’ to look into—what it manes, how it affects people.12
Dreiser touched on a crucial new issue—the exculpating nature of insanity—but of all the dramas of the 1920s and 1930s, it is the plays of Eugene O’Neill that have had the most lasting impact. The son of an alcoholic father and a mother addicted to morphine, packed off to a Catholic boarding school and expelled from Princeton after his freshman year, O’Neill was acquainted at first hand with the trials and tribulations of family life. His older brother Jamie drank himself to death at the age of forty-five, and O’Neill’s own battles with depression and alcoholism persisted throughout his life. O’Neill was an appalling parent, who had disowned his daughter and had to come to terms with the suicides of his two sons; his dramas (with the single exception of the comedy Ah, Wilderness!—a fantasy of the happy childhood he had been denied—heaped tragedy on top of tragedy, culminating in the autobiographical A Long Day’s Journey into Night, a play he sought, unsuccessfully, to hide from public view until he had been dead for twenty-five years, so raw were the intimate details it exposed to public view.13 O’Neill was close friends with the psychoanalytically inclined psychiatrist Smith Ely Jelliffe and underwent a brief six-week analysis with G. V. Hamilton in 1927 (who informed him that he suffered from an acute Oedipal complex). Hatred of father figures, near-incest, guilt, repression, and hidden secrets surface repeatedly in his plays.
Visual artists, too, were attracted to these new theories—none more so than the surrealists, whose desire to épater la bourgeoisie found in Freudian dream symbolism and psychosexual imagery an ideal rationalization for their approach to art and its creation. Art could at once draw on and reveal the secrets of the unconscious. Salvador Dali, who met with Freud in London, attempted without much success to engage him in a discussion of his painting The Metamorphosis of Narcissus. But other surrealist artists were equally open about their debt to psychoanalysis and about its linkages to their efforts to free their imaginations from the constraints of social and psychological censorship. They dabbled in dreams, their paintings dripping with distortions and subliminal references to sex and the unconscious. Experiments proliferated with “automatic” painting and writing, blurring the boundaries between dreams and waking life.14 And with the scandalous and subversive film Un Chien Andalou (1929), psychoanalysis began its entry into the cinema.
Yet any focus on the penetration of psychoanalytic ideas into highbrow and (to a more limited extent) middlebrow culture in the interwar years runs the risk of grossly overestimating the importance of Freud’s ideas in American psychiatry of the 1920s and 1930s, and even more so its impact on the treatment of the mentally ill. Mainstream psychiatry remained implacably hostile to psychoanalysis and clung desperately to its feeble claims to medical identity. The popularity of psychoanalysis in some lay circles may well have hardened psychiatrists’ opposition to Freud’s doctrines. Throughout the 1930s, analysis as a treatment for mental illness was distinctly a minority taste. The limited marketplace for its wares, exacerbated by the Great Depression, ensured that only a small number of psychoanalysts could successfully earn a living from their craft.
IN THE YEARS IMMEDIATELY after the First World War, the problems psychoanalysis faced were exacerbated by an almost complete lack of control over who counted as a trained practitioner. All sorts of people claimed to be analysts—some of whom had no more claim to the title than a few weeks spent in Vienna or Berlin. The deep splits in the analytic community created yet further problems, as followers of Jung and Adler set up shop, and a number of American analysts eclectically drew on the work of these apostates. Contributing to the chaos, Freud had personally selected one of his own analysands, Horace Frink, to bring the Americans to heel. It was a disastrous choice.
In the course of Frink’s first round of treatment, Freud had counseled him to leave his wife and marry another former patient. (The lady in question was unfortunately already married to someone else, an older gentleman who objected strenuously to being cast aside.) The divorce was eventually secured, but the struggle precipitated a series of manic-depressive episodes in Frink, which in turn required more analytic sessions before Freud pronounced him cured. In early 1923, the great man informed the New York Psychoanalytic Society and Institute that they should elect Frink their president, and they dutifully obliged. Sadly, Frink’s cure proved evanescent. Not long after his return to the United States, his second wife divorced him. He became psychotic and sought treatment at the Phipps Clinic at Johns Hopkins from Adolf Meyer.
Meyer’s initial cautious welcome of psychoanalysis had by now disappeared. He found Freud’s psychosexual reductionism and determinism unpalatable and sharply at odds with his own eclectic views. Freud spoke of the unconscious and relied on the couch and free association. Meyer talked of faulty habits and emphasized the use of hospital routines and a carefully orchestrated environment to accomplish habit training. Rather than seeking to make the unconscious conscious, Meyer urged the need to “build up a foundation of habits and interests of a conservative character which will crowd out the feelings which have become morbidly habitual,” and whereas Freud regarded transference as a vital tool in the therapeutic process, Meyer dismissed it as trivial.15
If the first attempt to bring order to the American psychoanalytic scene failed miserably, others were soon under way. In Europe, with the formation of the Secret Committee in 1912, Freud created a Praetorian guard to fend off heresy and enforce orthodoxy, but there was no comparable body in the New World until the formation of psychoanalytic training institutes in the 1930s.16 The New York Psychoanalytic Society and Institute, founded in 1911 by one of Freud’s earliest American enthusiasts, Abraham Brill, who also served as the American translator of Freud’s work, included a number of analysts who had been trained at psychoanalytic institutes in Vienna, Budapest, and Berlin. It was not until 1931, however, that the society created the first American training institute, modeled on these European precedents, and brought Sándor Radó from Berlin to run it. In Chicago, Franz Alexander, who had also emigrated from Berlin, soon founded another institute, which he would dominate for decades. Boston’s psychoanalytic society, founded in 1914 and headed by the Harvard neurologist James Jackson Putnam, had ceased to meet on Putnam’s death in 1918, though it began to reestablish itself a decade later. It, too, opted to form a training institute in the early 1930s. The Boston Institute was led by an American, Ives Hendrick, who had undergone a two-year training analysis at the Berlin Institute, so here, too, the basic training plan followed existing European precedents, with one crucial difference.
To Freud’s dismay, and contrary to his own strongly held views, as these institutes consolidated their curricula they all insisted that candidates must already possess an MD degree. It was a step their leadership considered vital if they were to exclude the wilder forms of analysis that had emerged in the 1920s and secure a rapprochement with mainstream psychiatry and medicine. Equally consequential, and indicative of the marginal and embattled state of the field, the institutes were freestanding and completely independent of universities. That setup had its immediate advantages at the time, allowing the founders absolute control over training, and since universities had not yet transformed themselves into the knowledge factories they would become, the drawbacks were, for the moment, largely invisible. They would become starkly apparent with the passage of time.
These institutes and others that followed became the organized centers of psychoanalysis in America. Training was initially quite informal. At Chicago, for example, the first analyst certified by Franz Alexander was Karl Menninger. Initially drawn to psychiatry at Harvard by his work under Elmer Southard, Menninger had learned what little he knew of Freud from conversations with Smith Ely Jelliffe, the New York neurologist and editor of the Journal of Nervous and Mental Disease. It was on this slender basis that he had returned to his hometown of Topeka, Kansas, and decided to found a family clinic modeled on the Mayo Clinic in Minnesota, but specializing in psychiatry, not surgery.
Founded in 1919 as a partnership between Karl Menninger and his father, Charles, the Menninger Clinic’s emphasis on psychiatry was driven by the interests of the son, who had returned from training at Harvard Medical School and the Boston Psychopathic Hospital.17 By 1926, Karl’s younger brother William had joined them. His presence allowed Karl to take a leave to undergo more formal training in analysis by the Freudian refugee Franz Alexander at the Chicago Psychoanalytic Institute.
Karl spent the winter of 1931 in Chicago, coupled with a few brief visits between then and February 1932.18 His brother William, who managed the family clinic in his absence, also sought analysis with Alexander, though his encounter was briefer still.19 Alexander had encouraged both brothers to keep a mistress, and they were quick to comply. Karl and his wife, Grace, had for a time entered into a ménage-à-quatre with a local judge and his wife, till the prospect of scandal prompted the two couples to separate. Karl then turned his attentions to his secretary, with whom he conducted a years-long affair. Will, meantime, had engaged in his own longtime affair with the clinic’s director of nursing, which was an open secret around the hospital. Other doctors and staff were strictly warned to avoid romantic entanglements. In the puritanical environment of 1930s Kansas, it is remarkable that gossip and scandal were somehow contained.
Karl’s best-selling writings, particularly The Human Mind (which appeared in 1930 and became the best-selling mental health book of its time, despite or more probably because of its shallowness and superficiality), helped raise the clinic’s visibility on the national stage.20 It was Karl’s brother William who took charge of running the hospital and the organization, tasks for which Karl was temperamentally unfit.
Conscious of how limited his encounter with Alexander had been, Karl sought further training. In October 1938 he undertook a second analysis with Ruth Mack Brunswick in New York. Brunswick had been one of Freud’s closest Viennese colleagues, but she was by this time addicted to drugs, prone to falling asleep during the analytic hour, and often more concerned with shopping and talking on the phone than focusing on the patient in front of her. Menninger stayed in New York for a little over eighteen months. How much he learned about psychoanalytic practice in this period is unclear, but the long separation from his wife did lead to a decision about his private life: he divorced and married his longtime mistress. (Neither his children nor his wife reacted well to his desertion, and his now ex-wife became acutely depressed.)
In its early days, the Menninger Clinic admitted around forty patients, the majority of whom were quite disturbed. There were alcoholics among them, as well as those the Menningers diagnosed as psychoneurotic or outright psychotic. Most were rich—essential if they were to afford the high fees the institution charged in return for generous levels of staffing and close personal attention—but they came from relatively newly wealthy midwestern families, not the East Coast old-money types who frequented places like the Channing Sanitarium or Chestnut Lodge (or the McLean or Institute of Living if the sanitaria found them impossible to manage). A handful of patients were treated with classical psychoanalysis; the rest lived in a closely supervised and regulated environment that Will Menninger called milieu therapy, including programs of occupational therapy, recreational therapy, and exercise. By the hospital’s own account, only between 5 and 10 percent of those under treatment were ever discharged as fully recovered.21
By the late 1930s, the place had a dozen or more doctors on staff, along with an array of female nurses and male attendants. Patients certainly didn’t suffer from a lack of attention. “Firm kindness” was enjoined of the staff, and the place in many ways ran like a patriarchal Victorian family. Money was tight, however, and the survival of the clinic was by no means assured. Staff lived on the premises and were basically trapped within its walls.
As in many such families, strife and turmoil lurked beneath the beneficent face the institution presented to the world. Nor were financial and romantic rifts the only sources of tension. The two brothers could scarcely stand each other, a situation temporarily solved by the war, when Will left to run psychiatry for the US army.22
Unlike the very brief and informal instruction the Menninger brothers received at Chicago, other recruits to psychoanalysis soon found themselves forced to undertake a lengthy and demanding apprenticeship. Instruction at the institutes became increasingly rigid, hierarchical, and time-consuming. Would-be analysts were forced to spend five years or more engaging in supervised training treating patients under the oversight of a teaching analyst before they could become full-fledged psychoanalysts. It was even longer before they could join the magic circle of those who performed the training. Training analysts alone set the curricula, determined who qualified to join their ranks, and secured the fees that would-be analysts had to pay as the price of qualification. In 1938, the American Psychoanalytic Association further lengthened the period before someone could become a full-fledged analyst by requiring candidates to complete a psychiatric residency before they could begin their training.
Lengthy training programs are typical of modern professions, of course, serving at once to transmit esoteric knowledge, socialize would-be practitioners into the worldview of the occupation, and curtail the supply of new recruits, thus creating artificial scarcity. The training offered by the institutes, however, created extreme dependency among those who sought its blessings, for the very nature of the analysis entailed the exposure of much potentially discrediting information to a supervisor who, in many cases, controlled vital referrals to future patients.23 For all the claims of analysts to have reconstructed their own personalities and moved beyond the petty neuroses that consume the unanalyzed, one of the most remarkable features of their intraprofessional lives is how prone they have been to bitter arguments, splits, and schisms. Over the years, three institutes begat many, and even within a given institute, backbiting, scheming, and dissatisfaction were often the order of the day.24 Still, psychoanalytic training now had a definite structure, and there was a measure of control over who could set out his or her shingle as a qualified practitioner.
But what of the market for what these therapists had to offer? With only a small handful of exceptions, the gates of the public asylums that catered to the hundreds of thousands of seriously disturbed patients were shut tight. The somatically oriented psychiatrists who ruled over these institutions wanted nothing to do with analysis, preferring their shock therapies, induced comas, and lobotomies. Besides, even setting aside the question of whether psychoanalysis had anything to offer the psychotic (which Freud believed it did not), the prospect of treating patients in these massively overcrowded and impoverished establishments with individual talk therapy for five hours each week was absurd on its face. True, William Alanson White, who had read Freud, allowed one or two junior staff members at the massive St. Elizabeths to experiment on a handful of the inmates. But White’s token hires were mere window-dressing (the St. Elizabeths patient population was between 6,000 and 7,000).25 The possibility of employment in state mental hospitals simply didn’t exist for most analysts, even supposing that an institutional career would have interested them.
A handful of the private hospitals and homes for the nervous catering to the wealthy provided one possible alternative way of making a living. Alan Gregg’s older brother offered some version of psychoanalysis at the Channing Sanitarium, the institution he had inherited from his father-in-law in 1921. Many other sanitaria followed this family-based business model. Chestnut Lodge in Maryland, for example, was founded after Ernest Bullard purchased a failing hotel in Rockville at auction in 1906. Remodeling the building, he reopened it as a sanatorium for nervous patients in 1910, passing it on to his son Dexter Bullard on his death in 1931.26 In Dexter Bullard’s hands, it employed a number of prominent psychoanalysts fleeing Nazi Germany, including Frieda Fromm-Reichmann, and became nationally prominent, for a time drawing wealthy patients from all over the country.
Other European psychoanalysts arrived in Kansas in the late 1930s, as refugees from Nazi persecution who were rescued from certain death by the offer of positions at the Menninger Clinic. They worked for what they increasingly regarded as inadequate salaries while adding to the psychoanalytic gloss of the establishment. Bernard Kamm, a Viennese analyst, hired in 1936 at a salary of $3,000 a year, generated several thousand dollars of income for the clinic each month. When he asked Karl Menninger for a raise after a year, Menninger flew into a rage. Others had the same experience. Privately, Karl Menninger complained bitterly about their “audacity” and added, “They are not in Europe now, and ought to be damned grateful.”27
Antisemitism lurked only just below the surface. Karl wrote to his father that he was “not at all averse to Jews, but I think we must not get too many Jews in the Clinic, or it will be bad for them and us.” Thereafter, he made sure only two Jews a year were allowed into his residency program.28 The refugees found Topeka a cultural desert, a cow town, and left as soon as they could find other stable employment. Eventually, those who remained on staff collectively demanded pay more commensurate with their qualifications. By threatening to withdraw their labor, they finally succeeded.29
Another institution for wealthy, mildly disturbed patients, the Stockbridge Institute for the Study and Treatment of the Psychoneuroses in Massachusetts, founded in 1913, had started out as hostile to analysis. Originally a New York internist, Austen Riggs conceived of the idea for his home for nervous invalids while recuperating from tuberculosis, and the Stockbridge Institute (renamed the Austen Riggs Foundation in 1919) soon accommodated forty patients. Like many physicians of his era, Riggs was fiercely critical of Freud and what he called his “mental gymnastics.” Instead, he provided his patients with a structured routine of work, play, and exercise, coupled with commonsense “psychotherapy.” The sanitarium’s setting, on the main street of an idyllic New England town, proved attractive to the moneyed classes, and the prosperous business easily survived the death of its founder in 1940.
Given Riggs’s hostility to psychoanalysis, it is more than a little ironic that within a few years, its leadership had been taken over by Robert Knight, David Rapaport, and Margaret Brennan-Gibson, under whom it became (as it remains to this day) a facility attempting to apply psychoanalytic principles to the treatment of deeply disturbed patients.30 Perhaps that shift was unsurprising, given the growing popularity of Freudian ideas in the circles from which its patients were drawn.
FREUD HAD LONG EXPRESSED DOUBTS about the applicability of psychoanalysis in the treatment of the psychotic, and though a minority of American analysts would eventually dispute this conclusion, most of those deciding to practice psychoanalysis in the 1930s and 1940s sought an extra-institutional clientele. Besides those who traveled to Vienna to secure Freud’s ministrations at first hand—a large fraction of his paying clientele, whom he despised but whose money he gladly took—a small but growing number of wealthy Americans had begun to dabble in psychoanalysis. But these were the years of the Great Depression, many analysts struggled to find enough patients, and often these patients could afford only sharply reduced fees. Still, a handful of analysts did manage to earn more, by some accounts, than most doctors.31
Given the dramatic increase in the number and prominence of psychoanalysts after the war, it is important to bear in mind how small the numbers of practicing analysts were in the 1930s. Most analysts belonged to the American Psychoanalytic Association (APsA), which in 1930 had the grand total of sixty-five members.32 In 1932, the association had reconstituted itself as a federation of the three recognized psychoanalytic societies then in existence in New York, Chicago, and the Baltimore-Washington area. Its membership in that year was ninety-two analysts.33 (All members of its constituent societies were automatically members of the APsA and of the International Psycho-Analytic Association.) By the end of the decade, the New York Psychoanalytic Society and Institute, which was the largest and most powerful in the country, boasted a total of just over twenty analysts who, between them, were training 106 students.34 The larger society was at that point engulfed in what has come to be called “the second psychoanalytical civil war,” one of the many schisms that have been so central to the enterprise from its earliest years. The first had erupted in 1930, when attempts were made to tighten the definition of who qualified as an analyst and to exclude members of the older generation whose acquaintance with the field was minimal. The number of native-born American analysts had grown slowly, but from the mid-1930s onward, their ranks were steadily augmented by analysts fleeing Hitler and the Nazis, whose arrival doubled the numbers of analysts in the United States. (In 1940, the APsA counted 192 members.)35 This suggests around 1,000 or 2,000 patients were receiving analytic treatment in 1940, a far cry from the more than 400,000 patients confined in state and county mental hospitals that year.
The passage to the New World for refugee analysts was far from easy. The immigration authorities placed severe obstacles in the path of Jews and political refugees, a policy that condemned most to concentration camps and death. Like other intellectuals and scientists, psychoanalysts needed sponsors, financial support, and jobs if they were to secure the vital visas necessary for resettlement, and these guarantees were in desperately short supply. The Rockefeller Foundation provided some funds, but their archives reveal how difficult it was to secure academic positions for those who looked “too Jewish” and how much antisemitism its officers faced when attempting to place refugees. Milton Winternitz, who was dean of the Yale Medical School until 1935 and himself Jewish, was particularly hesitant to accept Jewish scientists, fearing a backlash from his colleagues.36
Unsurprisingly, the sums the foundation devoted to this program to underwrite visas for refugee scientists and physicians were inadequate to meet the need. In desperation, American analysts were canvased for funds and positions. Some funds were forthcoming, but they were paltry. This reflected the straitened circumstances many analysts faced, but there was also a less noble reason: refugee analysts were potential competition for a finite patient population. In the words of Bertram Lewin, president of the New York Psychoanalytic Society and Institute, “What in the world would we do with all these additional analysts?”37
Displaced from Vienna, Budapest, Berlin, and elsewhere, the refugees arrived (mostly in New York) having “lost their birthplace and their mother tongue,” not to mention the culture that had given birth to Freud’s ideas.38 They brought with them the sense of intellectual superiority and disdain for Dollaria (as Freud contemptuously called the United States) that they had inherited from Freud, and confronted an analytic community that was at once intimidated by them and less than delighted to see them. Attempts were made to persuade the new arrivals to leave New York and spread the doctrines of psychoanalysis to the American heartland, and if that seemed too daunting, as Margaret Mahler recalled, they were invited to consider “ ‘pioneering’ to Buffalo, Utica, Syracuse, or some other upstate location.”39 But these suggestions were rarely heeded. The problem was not just that the great majority of American states prohibited foreign physicians from practicing medicine until they had become citizens, necessitating an economically impossible five- or six-year wait time before being able to earn a living, or that there was neither audience nor market for their services. It was rather that, like most immigrants, they sought the comfort and security of proximity. New York had the most established psychoanalytic culture, and the state medical licensing laws were among the most liberal in the country.
Soon, the Viennese and their allies dominated the New York Psychoanalytic Society and Institute. The institute had twenty-seven teaching faculty in 1939. A year later, it had added a further nineteen, and thereafter, European analysts dominated their proceedings.40 That change did not come about without a fight, massive ill will, and a series of schisms, with Karen Horney and four others leaving to form their own organization in 1941, and Sándor Radó (the man originally brought from Berlin to run the institute) seceding with his followers and establishing a separate institute at Columbia University at the end of the war.41 By then, psychoanalytic institutes had begun to surface elsewhere, in Topeka (1938), Philadelphia (1939), Detroit (1940), San Francisco (1942), Los Angeles (1946), and Baltimore (1947), for the Second World War had brought about a sea change in psychoanalysis’s standing and prospects.42 The New York Psychoanalytic Society and Institute remained, however, the most prestigious and powerful, its ruling members doing their best to ensure that it secured its standing as the home of Freudian orthodoxy.