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The first woman patient I had in my training as a psychiatrist undoubtedly remains the most memorable. A young female, in her mid or late twenties whom I shall call Estie K., suffered a psychotic breakdown while aboard ship on the way to the United States. She had become acutely agitated believing that the Nazis were directing malevolent rays at her from the electric bulb in her cabin and from her steamer trunk. She had to be physically restrained, and when the boat docked in New York, she was transferred by the Immigration Service to the United States Public Health Service Marine Hospital on Ellis Island. In due course, a certificate of insanity was issued, and she was awaiting deportation to her native Germany. She was Jewish; the year was 1938.
I had completed a two-year internship in internal medicine and was in the process of arranging for a program of training in psychiatry. While in high school I had come across a copy of Freud's Introductory Lectures to Psychoanalysis. His insights were like a revelation to me, and I decided that psychoanalysis was to be my life's work. In the 1930s there were hardly any integrated programs for residency training in psychiatry. Those who were interested in entering the field would shop around for some position in a psychiatric facility, usually a state hospital. Such positions were not easy to come by in those days. First of all, they were civil service jobs, but more importantly they paid a salary and for that reason the competition was very keen. In general, in those days hospitals did not pay the members of their house staff, and this was particularly true of those programs affiliated with medical schools. As a matter of fact, just a year before, a group of us in the hospital system of New York City organized a demonstration