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Book Forum: Diagnosis and Treatment   |    
To Redeem One Person Is to Redeem the World: The Life of Frieda Fromm-Reichmann
RICHARD D. CHESSICK, M.D., PH.D.
Am J Psychiatry 2002;159:1068-1069. doi:10.1176/appi.ajp.159.6.1068
View Author and Article Information
Evanston, Ill.

By Gail A. Hornstein, Ph.D. New York, Free Press (Simon & Schuster), 2000, 480 pp., $35.00.

As a young resident I absolutely idealized Frieda Fromm-Reichmann. I studied her two wonderful books (1, 2), which had just been published. I spent many hours, days, and months struggling in intensive psychotherapy with patients with schizophrenia at a time before we had the aid of the neuroleptics. Her approach, developed along with that of Harry Stack Sullivan, has influenced my work with all patients to the present day, and I am still writing and teaching about her (3, 4). I met Dr. Fromm-Reichmann (1889–1957) only once at a meeting of APA and was enormously impressed by the sensitivity of this little woman, who with a gesture could convey more than a lecture. I was never privileged to observe her actually performing psychotherapy with patients with schizophrenia, and, although I am not a movie aficionado, it is my intuitive feeling that the middle-aged male therapist portrayed in the wonderful classic David and Lisa used a technique and had a personality quite similar to hers. She of course was also the therapist in the best-selling book I Never Promised You a Rose Garden(5).

The book under review here is a biography written by a professor of psychology at Mt. Holyoke College who is also listed as the director of the Five College Women’s Studies Research Center in Pioneer Valley, Mass. Anyone interested in the practice of psychoanalytically oriented psychotherapy needs to be familiar with Fromm-Reichmann’s work, which has a contemporary value quite unusual for publications written half a century ago, so readers can imagine my delight when greeted by the appearance of a full-scale biography of Frieda Fromm-Reichmann. The reader can also imagine my disappointment, then, when I found that from the beginning it is extremely hostile to psychiatrists. We are told, for example, that psychiatrists are "the people fighting hardest against this idea" (p. xiv), i.e., the idea that relationship can heal severe mental illness, and that "most psychiatrists, accustomed to treating ‘the worried well,’ find the unbearably slow pace of therapy with psychotics intolerable" (p. xv). The author claims that "psychiatry’s despair is so profound the field can scarcely be imagined without it" (p. xix) and that "the very idea of psychotherapy with schizophrenics had been made to seem preposterous by a mental health establishment addicted to drug treatment" (p. xxii). Since the author was born in 1951, she is perhaps unaware that in the 1950s the entire psychiatric establishment was working furiously to establish the principles of psychoanalytically oriented psychotherapy for schizophrenia and that working intensively with such patients was part of the training in every reputable residency program in psychiatry in the United States. The prodigious cost of such therapy over many years of time was borne by the insurance industry.

In the second half of the 20th century there was a dramatic breakthrough in psychopharmacology. At that time the profession was engaged in "schizophrenogenic mother"-bashing, which finally came to an end, not under the influence of increased understanding of the psychodynamics of schizophrenia but because of the dramatic improvement shown after pharmacotherapy by many patients with schizophrenia, especially with the latest wave of neuroleptics. It does not follow from this that psychotherapy for schizophrenia is to be abandoned, but since the use of psychopharmacological agents in the psychoses has been demonstrated by the strictest scientific standards to produce improvement in many cases, every patient deserves a trial of such agents by experienced practitioners. There is no need for a polarization between psychopharmacological treatment and the use of intensive psychotherapy in psychiatry; such a polarization is simply a mark of narrow-mindedness.

The author of this book sets up a dramatic controversy that I do not think Frieda Fromm-Reichmann would approve of because, as the author herself correctly states, "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" (p. xv). Furthermore, it is simply not true, as the author claims, that Fromm-Reichmann’s approach "had been repudiated and then literally expunged from the history books" (p. xxiii). There has been no secret plot and no conspiracy, only the search for cost-effectiveness.

I do not think that Fromm-Reichmann would care for such a grandiose title as To Redeem One Person Is to Redeem the World. The proper title of the book should be A Biography of Frieda Fromm-Reichmann and a History of Chestnut Lodge. In the early chapters we are acquainted with standard biographical information about Fromm-Reichmann. There is a curious emphasis on the influence of her background of orthodox Judaism on her thought and theoretical approach, and I am not qualified to judge whether this is accurate or overdone. Her first and only husband, Erich Fromm, was originally her patient and had an affair with her during the analysis. They "later married to preserve appearances" (p. 60). The author tells us that Fromm-Reichmann treated her husband (and men in general) like an amusing child and indulged his whims; eventually they divorced, and Erich Fromm began an affair with Karen Horney. We are treated to such psychoanalytic interpretations as, "Unconsciously, in other words, Frieda had been pregnant with Erich’s child" (p. 69). We are told that in Königsberg she was raped but "she always blamed herself for everything bad that ever happened" (p. 70). The author feels that this explains to some extent why she "downplayed the role of sexual factors in pathology" (p. 71) and had "buried sadism in her attitude toward men" (p. 72).

The author reports that in 1935, as a refugee to the United States, Fromm-Reichmann was lucky to find a 2-month assignment at Chestnut Lodge, where she remained for about 20 years. This launches the book into a complete history of the famous Chestnut Lodge, which, under the influence of Fromm-Reichmann and Harry Stack Sullivan, became internationally famous for the treatment of schizophrenia. The author claims that "in warning against the danger of a ‘schizophrenogenic mother,’ Frieda was unconsciously praising her own mother for a sense of balance as much as she was lashing out at her for being controlling" (p. 135).

Although the book vilifies psychiatrists on many pages, the author explains at the same time that Fromm-Reichmann’s work "inspired a whole generation of young psychiatrists to try to create truly therapeutic environments for people assumed to be beyond reach" (p. 172). As a member of that generation, I can attest this is true. Her life was essentially uneventful from the time she came to Chestnut Lodge, where she was immersed in the intensive psychotherapy of patients with schizophrenia and some with manic-depressive disorder. The author claims that "by the mid-1950’s, the Lodge had become a place of last resort, where mainstream psychiatry dumped its failures and forgot about them" (p. 292).

We are given many instances of Fromm-Reichmann’s patience and intuitive skill, a skill that cannot for the most part be taught, only improved with one’s personal psychoanalysis. The author claims that the gradual abandonment of efforts to do psychotherapy for schizophrenia by the psychiatric profession was attributable to the fear psychiatrists have of psychotic patients; she does seem to understand that most people did not and do not have the kind of unique capacities that Fromm-Reichmann possessed. So when authorities complained that her approach could not be universally applied, the author attributes this hard-headed demand for empirical reality testing to malevolent motives. She has no patience with those who dare to question Fromm-Reichmann’s work. Criticism came from "orthodox analysts, irritated by Frieda’s deviations from party doctrine, and from experimental psychologists, irked at her omission of their empirical findings" (p. 301).

Fromm-Reichmann’s sad and lonely death is poignantly described, and a long chapter on the bestseller I Never Promised You a Rose Garden is appended, in my judgment for the purpose of encouraging attempts to do intensive psychotherapy with patients with schizophrenia. The famous lawsuit brought by Osheroff against Chestnut Lodge because he had not received appropriate psychopharmacological treatment there is explained as follows:

By embracing only those disorders that defy understanding or can’t be treated, psychiatrists have allowed impotence to replace failure and made abdication their creed. They cover their hopelessness with a veil of verbiage about experimental treatments and breakthroughs in the limitless worlds of genetics and brain research.… Having colluded with legislatures bent on saving money in emptying the state hospitals, sending most seriously ill patients off to nonexistent "community care," psychiatrists can’t allow themselves to consider alternatives to biological models of mental illness that open them to charges of moral negligence. (pp. 387–388)

In summary, this book presents the carefully researched life of Frieda Fromm-Reichmann but is spoiled by the author’s psychiatrist-bashing and her attempt to set up a polar opposition between psychiatrists who are oriented to the intensive psychotherapy of schizophrenia and those who are oriented to biological treatment: "Warfare in psychiatry, endemic for a hundred years, is finally dying out only because insurance companies have starved both sides into submission by refusing to pay for treatment of any kind" (p. 389). It does not seem to occur to the author, although she is right about insurance companies, who are the true enemies of psychiatry, that warfare in psychiatry is dying out because there is an increasing body of evidence indicating the best approach to the treatment of schizophrenia and many other mental disorders is a combination of intelligently applied psychopharmacological and psychotherapeutic techniques.

Fromm-Reichmann F: Principles of Intensive Psychotherapy. Chicago, University of Chicago Press, 1950
 
Bullard DM (ed): Psychoanalysis and Psychotherapy: Selected Papers of Frieda Fromm-Reichmann. Chicago, University of Chicago Press, 1959
 
Chessick R: Dialogue Concerning Contemporary Psychodynamic Therapy. Northvale, NJ, Jason Aronson, 1996
 
Chessick R: Psychoanalytic Clinical Practice. London, Free Association Books, 2000
 
Greenberg J: I Never Promised You a Rose Garden. New York, New American Library, 1964
 
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References

Fromm-Reichmann F: Principles of Intensive Psychotherapy. Chicago, University of Chicago Press, 1950
 
Bullard DM (ed): Psychoanalysis and Psychotherapy: Selected Papers of Frieda Fromm-Reichmann. Chicago, University of Chicago Press, 1959
 
Chessick R: Dialogue Concerning Contemporary Psychodynamic Therapy. Northvale, NJ, Jason Aronson, 1996
 
Chessick R: Psychoanalytic Clinical Practice. London, Free Association Books, 2000
 
Greenberg J: I Never Promised You a Rose Garden. New York, New American Library, 1964
 
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