Many in the medical profession believed these women were defective, just as hysterics were weak. But a neurologist named Pierre Janet disagreed. Working in France alongside Charcot, he came to believe that some children had a hard time dealing with traumatic events in their lives. Seeing something frightening, being sexually abused—such experiences could cause a little girl’s or boy’s mind to dissociate impressions of the terrible event. The dissociated memory would lie outside of consciousness but push against it, causing hysteria. In particularly stressful situations, the dissociated recollection might even erupt as a fully formed alternate self—a second personality.
The cure was to hypnotize patients and push them to remember the trauma which caused the splitting. People thus hypnotized often moaned, screamed, and shook as though they were reliving something horrible. This response was called “abreaction” and “catharsis.” Janet thought it was the only thing that could heal hysterics.
Freud was impressed with Janet’s theory of childhood trauma as the cause of hysteria. It made much more sense to him than Charcot’s idea of inherited brain lesions, and Freud suspected that the problem was usually sexual abuse. He began hypnotizing his hysteria patients and asking them over and over to verify his suspicions. Many denied being molested, but Freud refused to take no for an answer. Eventually, virtually all his patients “abreacted” memories of childhood sexual assaults by older relatives and nannies.
But some patients described impossibly bizarre scenarios during their relivings, including mass, Satanic rapes straight out of the medieval witch hunts. Freud was stunned by these phantasmagoric stories and did not believe they were true. Eventually he concluded that his patients were fantasizing. He stopped using hypnosis because he worried it was too easy for doctors to inadvertently encourage people to “remember” events that had not in fact happened.
Freud’s theory about the cause of hysteria began to evolve. No longer did he believe it was provoked solely by sexual abuse. Instead, he now said, the normal child had sexual impulses beginning in infancy, including Oedipus and Electra complexes—desires to possess their fathers and mothers. Children before adolescence successfully suppressed these fantasies, but during the sexual storms of puberty they could reactivate, creating conflicts and guilt feelings that were powerful but remained unconscious. Neurosis could result, including hysteria. The trick during therapy was to dredge up repressed sexual memories and fantasies, using a technique Freud called “free association,” with the patient saying whatever came to mind. Often their utterances were not overtly sexual. But when Freud interpreted them, he always found sexual meanings.
Thus was born psychoanalysis, a theory about repressed childhood wanting, not forgotten childhood trauma. In this new context, patients with multiple personalities were nothing special, and neither were hysterics. They were simply people—mostly women—who badly needed to uncover their repressed childhood desires. Bring on the couch, and the talk.
With the rise of psychoanalysis, multiple personality theory died out as a mainstream psychiatric diagnosis. So did Charcot’s hysterical seizures and postures. For middle-class, urban women, fits, paralyses, deafness, and blindness became bemusing things of the past. It was as though hysteria were a fashion of clothing: first worn in Paris, then exported to citified Americans who eventually tired of it, and finally remaindered as a behavioral style for women in small towns and the countryside.
In the summer of 1933, Dr. Robert Dieterle—the Michigan psychoanalyst with the beautiful voice and the penchant for hypnotism—was working at the State Psychopathic Institute, a charity hospital in Ann Arbor. One day a dark-haired, fair-skinned sixteen-year-old girl was admitted. Her left arm was paralyzed for no physical reason, she couldn’t walk, and sometimes she went blind and lost her sense of taste and smell. She could be hypnotized very easily, and while in a trance she walked with no problem. But once on her feet she went deaf.
When Dieterle talked about his new hysteric to people outside the hospital, he called her by her initials, L.M., to conceal her identity. Just as Charcot had done fifty years earlier with his women patients in France, Dieterle started using L.M. as a teaching subject at the University of Michigan. He would hypnotize her and place her on display in front of the (mostly male) medical students. He was preparing L.M. for a demonstration one day in late October when she offhandedly remarked that she was only two years old. Dieterle was intrigued.
Several weeks after L.M.’s hypnotic declaration of toddlerhood, another teenaged hysteric, L.R., was admitted onto the ward. She was nineteen years old. L.R.’s main problem, Dieterle decided, was “convulsive attacks in which her body arched.”3 He looked at Charcot’s old book of photographs from Paris, the one that showed the “circle arch,” and it looked a lot like L.R.’s posture. She also licked her lips, something else Dieterle had noticed in Charcot’s work (he called it “tongue eroticism”). Dieterle thought tongue eroticism looked babyish.
Once he noticed that L.R. was hypnotizing herself by staring at a light. He got the idea to put a baby bottle filled with milk into her mouth while she was in her trance. He did this several times, and on each repetition L.R. acted younger. It was as though she was changing from an adolescent into a newborn.
One day, while he was showing his students how L.R. liked to drink from baby bottles, Dieterle brought L.M. to the room and put her in bed with L.R. Until then, L.R. had been the only patient to get a bottle. But this time, Dieterle gave it to newcomer L.M. instead. Old-timer L.R. then went into convulsions until she got a bottle for herself. But when L.M. started whimpering that Dr. Dieterle—she called him “Dada”—“had a new girl,” L.R. responded by making strange, primitive sounds that the hospital staff swore were the cries of a newborn. Throughout the afternoon they plied L.R. with additional baby bottles. L.M. responded by sucking her thumb. L.R. sucked her thumb. L.M. wailed. Not to be outdone, L.R. peed in her pants, drenching herself from head to foot.
The doctors and nurses were in a tizzy at seeing adolescents acting like infants. Nurses clapped their hands to the chant of “patty cake.” Young male psychiatrists blew into the faces of attractive young female patients and yelled, “booh!” Someone came and took photographs, including at least one of L.R. in the throes of a trance. In the photograph, L.R. is wearing nothing but panties, her breasts completely exposed.
Dieterle also made a movie of L.M. and L.R. together. It features the young women on their backs with their bottles, kicking, stretching, and cooing when Dieterle’s colleague, a thirty-something, mustachioed psychiatrist named Edward Koch, walks by. Koch rocks the young women’s shared hospital bed up and down like a horsy ride. He jingles his keychain. And he sneakily tweaks L.R.’s right breast.
The four-minute film was shown in 1935 in Washington, D.C., at the annual convention of the American Psychiatric Association. Hundreds of psychiatrists attended, nine out of ten of them men. No doubt they were a rapt audience. In an article the two doctors published in 1937 to accompany the film, they assured readers they had done nothing to cue abnormal behavior in their patients. They were merely trying to determine some “laws” of hysteria, the doctors said.4
While the doctors seemed to be enjoying themselves, it is far less clear that they were helping these very troubled young women. Not long after she awoke from her “babyhood” trance, which had lasted almost three weeks, L.M. tried to commit suicide. Her life after that is a mystery, and so is L.R.’s. Dieterle and Koch declined to say publicly what happened to the young women after they left the Psychopathic Institute.
It was Dieterle who ignited Connie Wilbur’s passion for treating hysterics. In 1937, the same time he was publishing his paper and touting his film about women regressing to infancy, he was teaching at the University of Michigan medical school. Connie was a junior then, with middling grades: mostly B’s and C’s. Early in her studies, however, she made an A in psychiatry,5 and Dieterle may have noticed. He recommended her for a summer job at a state mental hospital.
Of more than one hundred students in Connie’s class, only eight were women,6 but Michigan was gender-equality heaven compared to even worse ratios at other schools. Still, it had long been recognized—for reasons of modesty and perhaps to avoid accusations about male physicians tweaking their patients’ breasts—that female doctors were needed to treat female patients. That is the reasoning that sent Connie, in summer 1937, to Kalamazoo, a small city one hundred miles east of Ann Arbor.
Kalamazoo State Hospital was top-notch compared to most public facilities for the mentally ill—at least in the “hopeful wards.” Separated from the back wards, they were dedicated to patients who weren’t very ill and who were expected to stay only a short time before being discharged. They were concentrated in an area of the grounds called Fair Oaks. It looked like a country club.
Fair Oaks was a collection of elegant Victorian cottages. As their nineteenth-century architects put it, they were meant to be so beautiful that people “sitting upon the capacious porches” would look just like “summer resorters, rather than patients suffering from mental disease.”7 Fair Oaks’ gauzy idyll was reserved for Kalamazoo’s “hopefuls.” Young women diagnosed as hysterics usually qualified, and during the summer of Connie’s externship, one of the most appealing of this group was a seventeen-year-old who refused to come out of her room.
The girl’s mother had unexpectedly died not long before, and she had suddenly developed agoraphobia—the fear of going outdoors. She could not even get near windows: She was terrified of the vastness of the sky and afraid she would die.
Connie was twenty-eight that summer, barely a decade older than the troubled girl, and Kalamazoo’s director asked her to help treat the patient. Connie entered the girl’s room and coaxed her to venture out. “I’m with you,” she soothed, and as she spoke her normally hard-edged, clipped voice slowed and softened. She clasped the girl’s hand in hers, and the two exited the cottage and inched through ranks of tall trees, in a slow-motion walk that turned transcendent for Connie. Never before had she felt so free of physical boundaries. Guiding the girl, she would later remember, was like “dissolving the walls the souls [were] looking at.”8
The medical director later told Connie that the patient’s problem was a severe Oedipus complex, involving unresolved childhood sexual desires for her father which had flared up after her mother died. Hence her hysteria, expressed as fear of going outside. Connie was impressed by this explanation and even more struck by the girl’s rapid recovery after they started taking walks. She was completely well by late August and never suffered a relapse. Her case convinced Connie of two things. First, it was easy to cure hysteria. And second, Connie herself was—as she would boast to interviewers years later—“a genius,” at treating hysteria, “a magician.”9 What she had accomplished at the hospital was not just science but poetry—another subject in school she had always loved. She committed herself to becoming a psychiatrist.
She started an internship in neuropsychiatry in 1939, and very quickly found herself involved in a controversial procedure: shock treatment.
For most people today, that phrase conjures images of patients with electrodes wired to their skulls. In fact, electricity was not the first modern method for shocking the brains of the mentally ill. In 1933, at a Viennese clinic for drug addicts, a doctor, Manfred Sakel, was treating a diabetic morphine addict and accidentally gave her an overdose of insulin that put her into a coma. To Sakel’s surprise, the woman had no more craving for morphine when she regained consciousness.
Later, Sakel accidentally overdosed a second diabetic who happened to be psychotic. He, too, seemed better, and Sakel started deliberately putting schizophrenics into insulin comas. He claimed stupendous results, though by today’s research standards, his claims of improvement are completely unscientific. For one thing, a certain, large percentage of schizophrenics always got better no matter what treatment they got (or even if they got no treatment at all). For another, judgments about which patients were “cured” and “improved” were very subjective in Sakel’s time, made by the very people who were promoting the treatment. It would be years before psychiatrists began using control subjects, double-blind procedures, and other scientific techniques now mandatory for medical research.
But by the end of the 1930s, mental institutions worldwide were using “insulin-coma therapy” on patients. It may not have helped them, but it definitely was a boon for the psychiatrists, for many wanted to use chemicals in their work. They were university trained and tired of merely warehousing their patients. They wanted to cure them with medicines and operations, just as other physicians cured their patients.
Three years after Sakel introduced this risky therapy, Hungarian psychiatrist Ladislas von Meduna came up with another shock treatment, using Metrazol, a poison related to camphor. Meduna’s shots of Metrazol produced immediate, strong convulsions. And though his “science” was as primitive as Sakel’s with insulin, Meduna claimed that Metrazol shock cured many psychotics. The practice spread like wildfire through the asylums. Doctors preferred it because it didn’t kill people as frequently as insulin did. But Metrazol convulsions caused the body to arch and twist with great force. Patients often woke up with fractured spines and broken limbs. If these injuries weren’t bad enough, in the few seconds between the injection and the convulsion, many patients experienced a horrible sense of dread, or, as one doctor put it, “agonizing fears of dying and crumbling away.” The feeling was so devastating that it was hard to do second treatments. Patients fought their doctors and ran away from the nurses. The wards shook with their screams.10
By 1938 at the University of Michigan’s Psychopathic Hospital, where Connie was studying at the time, patients as young as fourteen years old were being put into Metrazol convulsions.11 Two years later, the university introduced into its mental wards yet another assault on the brain: electro-convulsive treatment (ECT), popularly known as electroshock. Invented in fascist Italy in 1938, ECT was not as frightening to patients as Metrazol. But many doctors worried about how it caused short-term side effects including massive memory loss and inability to learn new things. Medical consensus was that if ECT knocked out psychosis, it did so by damaging the brain. Many psychiatrists found that revolting.12
Dr. Dieterle agreed. He stopped teaching to register his disapproval of convulsive therapies, and thereafter he raised a family on a farm near Ann Arbor and set up a private psychiatry practice on the property. Patients, mostly women, came from all over Michigan for treatment. He diagnosed many as hysterics and developed idiosyncratic theories (he believed, for instance, that blondes had a higher propensity for developing hysteria than brunettes did).
It was at this time that Dieterle diagnosed one of his patients as suffering from multiple personality disorder. The young woman drove hours each week to see him, and even when she got better she stayed in touch for years, keeping him apprised of her ability, thanks to him, to marry and raise a family. Dieterle never published any articles or books about this patient, but he often mentioned her case to Connie.13 Connie became intrigued by multiple personality disorder and started reading up on it. Although interest in the subject had waned, especially among psychiatrists, she was fascinated with her mentor’s work. But she was too ambitious to get stuck in psychiatric backwaters. She strove to forge ahead. By 1941 she was in Pontiac, Michigan—a General Motors factory town with a giant, crisis-ridden asylum, and plenty of work for the bold.
Upon her arrival some two thousand patients were jammed into Pontiac, virtually all very sick and very poor. In the early 1940s the press began publishing revelations about patients being beaten to death by staff. A state legislator sent in a young investigator disguised as an attendant. She worked for a month and constantly witnessed hospital workers assaulting and abusing patients. Even if they didn’t get hit, they slept with no bedding, on cold, tile floors covered with urine and feces. No one got enough to eat. The only therapy available was heavy drugging with sedative
s, and patients were never examined by doctors, though a few psychiatrists did “walk through the halls, at times noting to this one and that one as they go along.” The investigator was unnerved.14
It certainly was not clear what a person who was mentally ill might get from such a place except for warehousing and mind-numbing drugs. But there were definite benefits for an ambitious psychiatrist like Dr. Cornelia Wilbur. Through no fault of their own, she and the other doctors found it impossible to give quality care to patients. There were just too many of them and far too few staff. But their sheer numbers created a vast human Petri dish for experimentation. For anyone wanting to research heroic, cutting-edge interventions into psychosis, a colossal asylum like Pontiac was the place to be. Soon Dr. Wilbur was injecting and shocking patients in ways that had never been done before, then writing up her “scientific” experiments for publication.
Pontiac only had Metrazol convulsive therapy while Dr. Wilbur was there, but she made do.15 Ever since Metrazol and the other shock treatments had been launched in the 1930s, doctors had argued about which diseases responded best to these radical new treatments: Schizophrenics? Manic depressives? Psychoneurotics?
Dr. Wilbur decided to find out once and for all, using a group of chemicals called barbiturates. These are powerful drugs that cause long-lasting unconsciousness in large doses, and in smaller ones a trance state popularly known as “twilight sleep.” In the 1920s and 1930s, police departments were trying all kinds of coercive (and today illegal) techniques to get suspected criminals to confess their alleged wrongdoings. The “third degree” included sleep deprivation, beatings with rubber hoses—and injections with barbiturates. Detectives had noticed that people shot up with these drugs became woozy and talkative, chattering away and not remembering what they said after the drug wore off. Barbiturates, the police thought, lowered inhibitions so that telling lies would be impossible. Hence Pentothal’s nickname “truth serum.” For years, it was used it during interrogations.
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