But along with prescient insights, Freud’s theories were also full of missteps, oversights, and outright howlers. We shake our heads now at his conviction that young boys want to marry their mothers and kill their fathers, while a girl’s natural sexual development drives her to want a penis of her own. As Justice Louis Brandeis so aptly declared, “Sunlight is the best disinfectant,” and it seems likely that many of Freud’s less credible conjectures would have been scrubbed away by the punctilious process of scientific inquiry if they had been treated as testable hypotheses rather than papal edicts.
Instead, anyone who criticized or modified Freud’s ideas was considered a blaspheming apostate, denounced as a mortal enemy of psychoanalysis, and excommunicated. The most influential founding member of the psychoanalytic movement, Alfred Adler, the man Freud once admiringly called “the only personality there,” was the first major figure to be expelled. Prior to meeting Freud, Adler had already laid out his own views on therapy, emphasizing the need to perceive the patient as a whole person and understand his whole story. In contrast to Freud’s theory of a divided consciousness, Adler believed the mind to be indivisible—an Individuum. Freud’s insistence on interpreting all of a patient’s conflicts as sexual in nature, no matter how improbable and far-fetched, also bothered Adler, since he felt that aggression was just as potent a source of psychic conflict.
But there may have been other reasons for their schism. When asked about acrimony among psychiatrists with an obvious reference to the members of the Wednesday Society, Freud replied, “It is not the scientific differences that are so important, it is usually some other kind of animosity, jealousy, or revenge, that gives the impulse to enmity. The scientific differences come later.” Freud was aloof, cold, with a laser-focused mind better suited for research than politics. Most of his patients were well-educated members of the upper strata of Viennese society, while the convivial Adler had greater affinity for the working class.
Like Stalin declaring Trotsky persona non grata, in 1911 Freud publicly declared Adler’s ideas contrary to the movement and issued an ultimatum to all members of the Psychoanalytic Society to drop Adler or face expulsion themselves. Freud accused Adler of having paranoid delusions and using “terrorist tactics” to undermine the psychoanalytic movement. He whispered to his friends that the revolt by Adler was that of “an abnormal individual driven mad by ambition.”
For his own part, Adler’s enmity toward Freud endured for the rest of his life. Whenever someone pointed out that he had been an early disciple of Freud, Adler would angrily whip out a time-faded postcard—his invitation to Freud’s first coffee klatch—as proof that Freud had initially sought his intellectual companionship, not the other way around. Not long before his death, in 1937, Adler was having dinner in a New York restaurant with the young Abraham Maslow, a psychologist who eventually achieved his own acclaim for the concept of self-actualization. Maslow casually asked Adler about his friendship with Freud. Adler exploded and proceeded to denounce Freud as a swindler and schemer.
Other exiles and defections followed, including that of Wilhelm Stekel, the man who originally came up with the idea for the Wednesday Psychological Society, and Otto Rank, whom Freud for years had called his “loyal helper and co-worker.” But the unkindest cut of all, in Freud’s eyes, undoubtedly came from the Swiss physician Carl Gustav Jung, his own Brutus.
In 1906, after reading Jung’s psychoanalysis-influenced book Studies in Word-Association, Freud eagerly invited him to his home in Vienna. The two men, nineteen years apart, immediately recognized each other as kindred spirits. They talked for thirteen hours straight, history not recording whether they paused for food or bathroom breaks. Shortly thereafter, Freud sent a collection of his latest published essays to Jung in Zurich, marking the beginning of an intense correspondence and collaboration that lasted six years. Jung was elected the first president of the International Psychoanalytical Association with Freud’s enthusiastic support, and Freud eventually anointed Jung as “his adopted eldest son, his crown prince and successor.” But—as with Freud and Adler—the seeds of discord were present in their relationship from the very start.
Jung was deeply spiritual, and his ideas veered toward the mystical. He believed in synchronicity, the idea that apparent coincidences in life—such as the sun streaming through the clouds as you emerge from church after your wedding—were cosmically orchestrated. Jung downplayed the importance of sexual conflicts and instead focused on the quasi-numinous role of the collective unconscious—a part of the unconscious, according to Jung, that contains memories and ideas that belong to our entire species.
Freud, in sharp contrast, was an atheist and didn’t believe that spirituality or the occult should be connected with psychoanalysis in any way. He claimed to have never experienced any “religious feelings,” let alone the mystical feelings that Jung professed. And of course, in Freud’s eyes, sexual conflict was the sina qua non of psychoanalysis.
Freud became increasingly concerned that Jung’s endorsement of unscientific ideas would harm the movement (ironic, as there were no plans to develop scientific support for Freud’s ideas either). Finally, in November of 1912, Jung and Freud met for the last time at a gathering of Freud’s inner circle in Munich. Over lunch, the group was discussing a recent psychoanalytic paper about the ancient Egyptian pharaoh Amenhotep. Jung commented that too much had been made of the fact that Amenhotep had ordered his father’s name erased from all inscriptions. Freud took this personally, denouncing Jung for leaving Freud’s name off his recent publications, working himself into such a frenzy that he fell to the floor in a dead faint. Not long after, the two colleagues parted ways for good, Jung abandoning psychoanalytic theory entirely for his own form of psychiatry, which he called, with an obvious debt to Freud, “analytical psychology.”
Despite the tensions within the fracturing psychoanalytic movement, by 1910 psychoanalysis had become the traitement du jour in continental Europe and established itself as one of the most popular forms of therapy among the upper and middle classes, especially among affluent Jews. Psychoanalytic theory also became highly influential in the arts, shaping the work of novelists, painters, and playwrights. But although by 1920 every educated European had heard of Freud, psychoanalysis never wholly dominated European psychiatry. Even at its high-water mark in Europe, psychoanalysis competed with several other approaches to mental illness, including Gestalt theory, phenomenological psychiatry, and social psychiatry, while in the United States, psychoanalysis failed to gain any traction at all.
Sigmund Freud’s inner circle of the Psychoanalytic Society. From left to right are Otto Rank, Freud, Karl Abraham, Max Eitingon, Sándor Ferenczi, Ernest Jones, Hanns Sachs. (HIP/Art Resource, NY)
Then, in the late 1930s, a sudden twist of history obliterated psychoanalysis from the face of continental Europe. After the rise of the Nazis, Freud and his theory would never regain their standing on the Continent they had enjoyed in the early decades of the twentieth century. At the same time, the chain of events initiated by German fascism roused psychoanalysis from its American slumber and invigorated a new Freudian force in North America that would systematically take over every institution of American psychiatry—and soon beget the shrink.
A Plague upon America
While nineteenth-century European psychiatry oscillated like a metronome between psychodynamic and biological theories, before the arrival of Freud there was precious little that could be mistaken for progress in American psychiatry. American medicine had benefited, by varying degrees, from advances in surgery, vaccines, antiseptic principles, nursing, and germ theory coming from European medical schools, but the medicine of mental health remained in hibernation.
The origins of American psychiatry are traditionally traced to Benjamin Rush, one of the signers of the Declaration of Independence. He is considered a Founding Father of the United States, and through the sepia mists of time he has acquired another paternal appellation: Father of A
merican Psychiatry. Rush was considered the “New World” Pinel for advocating that mental illness and addictions were medical illnesses, not moral failings, and for unshackling the inmates of the Pennsylvania Hospital in 1780.
However, while Rush did publish the first textbook on mental illness in the United States, the 1812 tome Medical Inquiries and Observations upon the Diseases of the Mind, he did not encourage or pursue experimentation and evidence-gathering to support his thesis and organized his descriptions of mental illness around theories he found personally compelling. Rush believed, for instance, that many mental illnesses were caused by the disruption of blood circulation. (It is interesting to observe that before the advent of modern neuroscience so many psychiatrists envisioned mental illness as some variant of a clogged sewage pipe, with disorders arising from the obstructed flow of some essential biological medium: Mesmer’s magnetic channels, Reich’s orgone energy, Rush’s blood circulation.)
To improve circulation to the mentally ill brain, Rush treated patients with a special device of his own invention: the Rotational Chair. The base of the chair was connected to an iron axle that could be rotated rapidly by means of a hand crank. A psychotic patient would be strapped snugly into the chair and then spun around and around like an amusement park Tilt-A-Whirl until his psychotic symptoms were blotted out by dizziness, disorientation, and vomiting.
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 fin
e 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.
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