When Karl Menninger died on July 18, 1990—he had been hospitalized a bit over a month for abdominal cancer—he went “gentle into that good night,” quite in contrast to the restless, impatient, involved, and churning life he had led. Although his relations with others could be abrasive, rude, and intimidating, he was often inspiring, gallant, and brilliant. Menninger even disagreed with St. Paul, when he argued in his paper on Hope that, of the triad faith, hope, and love, the greatest was not love, as St. Paul had written, but hope.
Karl Menninger was the principal pioneer of American psychiatry when that discipline was trying to find its way in American medicine. In the course of that effort he founded the world-renowned Menninger Clinic; joined the effort to disseminate psychoanalysis in America; reformed the custodial care of chronic psychotic patients; championed the rights of children, women, and American Indians, set up the world's largest center for psychiatric training; campaigned for prison reform; and spurred the movement for innovative child care first with The Southard School and later with “The Villages.”
As Menninger lay dying, many visitors, including a delegation from the Navajo tribe, came to pay their respects to him. One of these was Mary Cerney, a psychologist who is also a nun. Karl, a Presbyterian, asked her to pray for him, and Dr. Cerney began to recite the Lord's Prayer, which seemed to her to be nondenominational. But she got no further than the first two words, “Our Father…” “Stop, Mary,” said Karl. “Why do we say ‘Our Father?’ Why not ‘Our Mother?’ Or ‘Our Creator?’”
Karl Menninger was a restless man who defied and challenged almost every authority and dogma while he worked tirelessly for unpopular but noble causes. “I'd like to be remembered as a person who cared,” he said a few years before he died. Care he did.
Karl Menninger was born in Topeka, Kansas, on July 22, 1893, the eldest of three sons of a homeopathic physician, Charles Frederick, and his forceful, resolute wife, Flo, a teacher. Religion played a prominent part in their household. Karl was always studious, and his physical awkwardness, which kept him from the athletic activities that draw youths together, isolated him but thrust him even further into scholarly and religious objectives. He attended Washburn, a small municipal college in Topeka, and after two years transferred to the University of Wisconsin. He received his medical training at the Harvard Medical School and was graduated in 1917. His training with Harvey Cushing and then with Ernest Southard, the influential superintendent of the Boston Psychopathic Hospital, now the Massachusetts Mental Health Center, were seminal in turning his direction toward “neuropsychiatry.” He developed a meliorative vision of what psychiatry could do. At about this time, there was a breakthrough in the diagnosis and treatment of neurosyphilis. Syphilis, which was then a very common, but incurable disease, was known to mimic many other diseases, and, in its tertiary stage, produced psychotic disorganization. The gold-sol test for diagnosis and the Salvarsan therapy for the treatment of these conditions infused in Menninger a therapeutic optimism that never left him.
After Southard's untimely death in 1920, Menninger decided to remain in Topeka to work with his father and later his brother, William, in a group medical practice. The middle brother, Edwin, suffered a disabling accident that prevented him from entering the medical profession. After a few years, they purchased a farmhouse on the outskirts of Topeka and in 1926 acquired 20 acres of land, which included a hamburger shack, and set up a modern psychiatric hospital.
This hospital was the first one in America in which psychological illnesses were explored intensively over a long period of time. In the 1920s, an atmosphere of therapeutic nihilism pervaded American psychiatry, and the new hospital appeared to be the only place that offered any hope for improvement of serious mental disorders. There, the patients received the devoted attention of an entire staff that included not only psychiatrists, but nurses, attendants, cooks, occupational therapists, and a barber. The hospital was inspired by psychoanalytic principles as understood by the Menningers, principles that, in the main, prescribed understanding not only of symptoms but of the patient's life and circumstances and on that basis prescribed activities that helped to restore “disequilibria.”
The clinic not merely revolutionized how one treats mental illnesses and how one regards those afflictions, but transformed the entire set of public attitudes toward mental illness. In addition to insisting on humane and devoted treatment, the two Menninger brothers insisted on a research presence. Only by generating new knowledge could diagnosis and treatment be improved. And this research presence eventually supported the work of a number of distinguished scientists, including David Rapaport, George S. Klein, Merton M. Gill, Margaret Brenman-Gibson, Robert R. Holt, Sibylle K. Escalona, Lois B. Murphy, and Gardner Murphy.
Karl taught that clinical and scientific ability and creative ideas belonged to no particular profession or discipline. He was attracted by excellence and he was not picky about where he discovered it. He was drawn by intellectual agility and he thrived on playing with ideas no matter who presented them. He was never intimidated by new ideas and by people with quick, incisive minds. But he could, and usually did, rudely and scornfully dismiss people whose thinking and writing were unclear and fuzzy.
In the 1920s, Menninger conducted an undergraduate course in mental hygiene at Washburn College, and from his lecture notes he published a book, The Human Mind, which influenced many to enter the field of psychiatry, but perhaps its greater influence was to describe to the lay public, in simple, clear English, the mysteries of human personality and psychopathology and thus helped to usher in an era of awareness of the role of mental processes in a material world. Other books followed: Man Against Himself, in which he examined man's self-destructive tendencies; Love Against Hate, which explored whether one can overcome one's self-destructiveness; The Vital Balance,
a presentation of the unitary theory of mental illness; Whatever Became of Sin, on man's moral burden and cruelty, The Theory of Psychoanalytic Technique, a rare effort to understand how psychoanalytic treatment works; and The Crime of Punishment, a penetrating analysis of our penal system. These were not mere popularizers, although the first three were immensely popular. Written in jargon-free and simple English, they tackled complex issues without adulterating simplifications.
Menninger became involved in the organizational politics of the American Psychiatric Association, and as early as 1925 he challenged what he perceived as the stodgy leadership to turn the Association's attention to the ways in which psychiatry could address legal issues, including the treatment of criminals and the control of crime. Very early he was attracted to Freud's writings because of their emphasis on psychological processes such as conflicts, unconscious ideas and motives, and the role of basic biological drives of sex and aggression. These ideas offered the restless young physician a hope of effective treatment. Menninger embraced psychoanalysis with almost religious fervor and began an involvement that preoccupied him for over 60 years. In 1942 he was elected President of the American Psychoanalytic Association.
Menninger's reading of Freud was distinctly American and Midwestern. He saw in Freud's ideas not complexity, ambiguity, and paradox, but optimism and even the promise of redemption. His understanding was surely different from that of most European analysts who had come to America, people like Franz Alexander, Karen Homey, Otto Fenichel, and A.A. Brill. He even embraced one of Freud's most thorny ideas, that of the death instinct, which most analysts either dismissed or ignored. But his understanding of the death instinct was not quite that of Freud's in Beyond the Pleasure Principle. Menninger placed great emphasis on aggression, in the form of destructiveness, in human behavior, not only in mental disorders, but also in the psychology of capital punishment, suicide, crime, international politics, and of course, war. He regarded aggression as a more powerful factor than sexuality in mental disorders. In a 1935 letter he wrote, “It is probably that no one is made seriously sick by his sexual impulses, no matter how forbidden they are or how deep or how close to consciousness. That which makes him ill either in the form of anxiety or in the form of guilt feelings, depression, etc., is the unconscious will to hurt someone, a wish which is sometimes turned upon the individual's own self.”
But where Freud was unsure or tentative about man's ability to control his aggressive instincts (“Men have gained control over the forces of nature to such an extent that with their help they would have no difficulty in exterminating one another to the last man. … And now it is to be expected that the other of the two ‘Heavenly Powers,’ eternal Eros, will make an effort to assert himself in the struggle with his equally immortal adversary. But who can foresee with what success and with what result?”), Menninger was optimistic; although, like Jeremiah, he warned of grave consequences if we did not put our intelligence to the task of reform (“For we have the courage to hope and the power to love. And for all the evil within us, we cannot escape the will to live. From that springs our determination to better our lot. By the use of our intelligence and our knowledge we can use the slave of science for the promotion of human happiness. Speed the day!”)
Yet he regarded himself as the preserver of psychoanalytic orthodoxy, and in this role he did bitter battle with Karen Homey, Erich Fromm, and even with Franz Alexander, who was one of his several analysts. In his later years, however, he regarded these struggles with some detachment and even self-directed ridicule. A few years ago he told me that Alexander was probably correct in wanting to reduce the length of psychoanalytic treatment and that he now believed he was too categorical in opposing Alexander's efforts. And he shrugged off his earlier insistence on orthodoxy in psychoanalytic theory, in the following incident. In June of 1986 he received an honorary Doctor of Science degree from Harvard University. On the day following the ceremony, Karl visited the eminent psychologist, Henry A. Murray in the latter's Cambridge home, and I was present. They were contemporaries and together had attended a number of psychoanalytic meetings in New York during the time Horney was writing her “heretical” tracts. Murray reminded Menninger that he used to argue with Homey at those meetings. At first Menninger denied that he ever did, a denial even he could not maintain for very long. “Well,” he admitted, “In those days we used to argue about everything, but most particularly about theories. No one had many facts then. If someone, for example, was treating a man who had trouble with his mother-in-law, he would make up a theory about the mother-in-law. But not about this patient's mother-in-law, but about all the mothers-in-law in history!”
He, indeed, was a caring man, and a crusading reformer. He felt a deep sense of responsibility for his fellow men and women. Many regard him as the conscience of psychiatry. In 1981 Karl Menninger received from President Jimmy Carter the Medal of Freedom, the country's highest civilian honor.
His first marriage to Grace Gaines in 1916 ended in divorce in 1941. That same year he married Jeanetta Lyle, who survives him, as do their daughter, Rosemary; three children by his first marriage: Dr. Robert who is on the staff of Menninger, Martha Nichols of Cheyenne, and Julia Gottesman of Los Angeles; nine grandchildren; and a brother Edwin of Lillington, North Carolina.