Firestein: What were your impressions of The American when you first became acquainted with it? To start with, do you remember what year it was that you joined?
Stone: To tell the honest truth, I don't know. It may be recorded somewhere. It was around the onset of American participation in the war, because I remember people in uniform coming to my first meeting as a member. I was disqualified at least twice on application for a commission, and later by the Selective Service, so I remained a civilian throughout the war. I'm not sure, but I think it was 1941 that I became a member. It was very informal in those days. I'd gone to a couple of meetings before I became a member, something advanced students often did. And I remember Sam Atkin coming over to me and handing me a card, saying that I was a member of The American! And all of this was done in an informal, friendly sort of way. I had finished all the courses and done my stint of supervision, and I just became a member. Oh, I almost forgot: I had also presented my graduation paper—then required by the New York Institute.
Firestein: Did you in those days have to submit an application form, summaries, and all that kind of thing?
Stone: No summaries. If there was an application form, it didn't take any length of time. There was no fuss about it. I suppose your name and address, a few essential things like that sufficed. It was all rather simple. It depended entirely on the Institute that graduated you. Since I was a graduate, I automatically, unless I objected, became a member of The American. And I didn't object: I was perfectly glad of it. At that stage of the game every step forward is welcome, and membership meant that I had demonstrated my qualifications. That was the way most people I knew felt. People opting not to become members of The American, or delaying it? We didn't hear of anything like that going on. Graduation from the Institute was a different matter. Then there was more ritual connected with it than it has now. Today candidates have to write up cases for The American, stuff like that. Each of us had to present a paper before the Institute. I gave a case study that was later published in the International Journal, the one about the man with a duodenal ulcer and various allied problems. It was a regular thing, these student presentations. Somebody else presented the same night I did—I can't remember now whether it was Marcus Schatner or Peter Goolker—or both. These “graduation papers” were not heavily attended. I remember that Bert Lewin usually attended them. I say usually with some hesitation because I wasn't there all the time, but on the few occasions I did go he was there, and he discussed the papers seriously. Few of the other older people that I can remember were there. Just a few of your classmates and some younger graduates might come.
Firestein: What you have said is fascinating, in light of all the current brouhaha over who is a member and who not. Can you tell us what the meetings were like, what “presence” the organization had or tried to have, as well as what a practitioner's life was like in those days? After all, this was fifty years ago.
Stone: Well, I think that the “presence” was different. As you said, there was much less folderol. I'm sure the national meetings were smaller because the organization was smaller. But the essential pattern was the same. I mean, maybe there were sometimes a few things going on at once—not as many as now, nor as heavily attended. But I think we felt that attendance was somewhat less optional than it is now. Now people go or don't go, depending on how they like the program. Then you graduated, became a member, and—unless it was particularly inconvenient for you—went to the meetings.
There may have been a little more informality then about how things were arranged. For example, very early on I was interested in psychotherapy based on analysis. There was a group formed, of which I think Bernie Bandler of Boston was the informal chairman. We used to get together at meetings of The American—a few people from various parts of the country were quite active and we'd talk things over. Once I was scheduled to give a paper on psychoanalysis and brief psychotherapy. Rudy Loewenstein was interested in the paper and had included it in the main program. Ives Hendricks, who was President at the time, objected that this was a paper on psychotherapy and therefore belonged in the psychotherapy subgroup. And so it was moved over that way. The only reason I mention this is to suggest the greater degree of informality then: somebody of importance said that it shouldn't be on the main program, so it wasn't.
Firestein: My next question will perhaps strike you as funny. How did you manage to avoid becoming involved in the administrative activities of the Association over all these years? I've had the impression that your participation has been from the other side almost exclusively.
Stone: You mean from the local side?
Firestein: No, rather from the standpoint of presenting papers and participating in panels.
Stone: You want me to answer frankly? It's partly that I was not interested in the political aspects of the organization and partly that some temperamental thing would make me avoid positions of importance for which I didn't think I was especially qualified, either by history of participation, or actual interest, and so on. I was once approached about being chair of the Board on Professional Standards. Somebody called and asked if I would accept the nomination for it. And without hesitation I said no. It would not have occurred to me to accept because I would feel, Hell, I haven't been involved with these things, I don't know about them, and in a perverse sort of way don't even care too much about them. I'm still perhaps influenced by, or think along somewhat similar lines as that analyst who settled in San Francisco, wrote against the concept of the institute, and later modified his position—Siegfried Bernfeld. He was an analyst of some prominence who wrote this paper on the disadvantages of institutionalization in general; he recalled that Freud once said, to someone who expressed the wish to be an analyst, “Well, go and get analyzed, and then have some patients,” or something to that effect. I don't think Freud was much concerned with supervision and Bernfeld apparently thought that too much organization and institutionalization had a cramping and stunting effect that made fledgling analysts too imitative of their elders.
As a matter of fact, some of the early lay analysts in this country did just the sort of thing Freud suggested. They got training on their own. And there was maybe a little of that in my temperament, if not in my behavior. Otherwise, I accepted the organizations as they were, as useful, if not beyond criticism. I wasn't an anarchist, by any means, and I certainly participated in my local institute, but as a decidedly secondary interest. Lately I have hardly participated at all, except for going to meetings occasionally, and certain matters (like this!) that arise because of my seniority. Early on, I was interested only in the scientific aspect, and did not want to become too much of an “organization man.” In the case of The American, which was even more remote, these feelings were even greater. Papers or panels, yes, but that was it.
Firestein: I'm reminded of that special arrangement, made with the IPA, that The American would be the regional organization for the U.S. and that its membership decisions would be accepted. This got started as the war began in 1939, and ended two years ago. What I'm wondering about is what people locally—say, at the New York Institute—felt about either The American or the IPA. Were they just “out there” somewhere? Was it a
matter of interest at all, or just something they knew about but that didn't concern them?
Stone: Well, I think most of the people I knew took them rather seriously, but also somewhat for granted. Another thing: there was no question then about the certification of nonmedical analysts. The American was a physicians' organization, and certain very gifted nonmedical people, like Ernst Kris, Berta Bornstein, Peter Blos, and so on, would be accepted on the basis of their previous training and experience in Europe. But nobody, so far as I know, mentioned changing that arrangement or any other aspect of things. The American was taken seriously enough: if you could, you went to the meetings, and not just because it might be an interesting city, although that always played some part, since we're all human. But it was taken for granted. Though it was regarded as important, there did seem to be some feeling that it was declining as the years went on, at least until certain “infighting” began to enliven things, for better and for worse.
The International, too, was taken for granted, but it was regarded more as a remote thing that went on more or less automatically. You became a member of the local society, and thus of The American, and thus of the International, and that was it. If you liked to go to Europe and could afford it, you'd go to meetings of the International. Whether, as meetings, they were highly esteemed or not, I'm not sure that they ever ranked very high as far as the average member was concerned. Now, of course, the Europeans would naturally be more devoted, as the IPA was their original contact and its meetings were more accessible. To the average American it was simply nice to go wherever it was—Paris, Stockholm, or some other interesting place—and incidently attend a meeting. I may be a little too harsh there, because there were occasionally, early in the game, some very important meetings. Take that famous meeting in the thirties at which the therapeutic process in analysis was discussed by several excellent people, a discussion often referred to even today.
“… I don't think we should deceive ourselves that we are preserving analysis by having a schedule full of patients seen three times a week.”
That Alexander period was a stormy one. It led to the “Four-Five Rule”: your analysis could not be accepted for admission to The American unless it was at least four, preferably five hours a week. You know, when I was a candidate I never even knew who was writing recommendations for me. You just went along in a quiet way. But there were requirements. I think they required an analysis of at least three hundred hours. And I think two supervisions, though I think at one point even one was acceptable. You know, on this same subject of requirements, I remember a man whose admission was in some question, a man who did a lot of work on psychosomatic problems. He was very gifted, with more than the average background in physiological matters, and he went through the usual steps—was analyzed, had supervisions, was recommended—but for some reason, somebody fussed about whether this was a “real” analyst. Was he a scientific investigator who had just taken some analytic training? That was in the atmosphere. Now, why they chose me for his committee I don't know, but I remember making a report after I had interviewed him two or three times in some detail. The man had met all of the requirements, and the people who trained him were responsible people. I just don't think we had any right to deny him membership. I think that's the only official thing I ever did for The American, other than giving the occasional paper or being on a panel. And once, yes, the so-called “Sunday Sermon.” But today, admission requirements are much better defined and accepted. More standardized.
Firestein: You know today we are facing, increasingly, a situation where a lot of people, including fellow psychiatrists, are very dubious about the relevance of psychoanalysis in the field of mental health.
Stone: No doubt about it. In fact, in some of the large hospitals you get the impression that even psychotherapy in the broader sense is losing its place in residency training programs. Now they're more concerned with pharmacological treatments, with family therapy, marital therapy, everything except individual psychotherapy. I don't mean that it has disappeared. They do give it some lip service, but not the role it once had. Long ago, I was on the psychiatry staff at Mount Sinai. I was there with Kubie, who resigned because they wouldn't give him a separate psychiatric service. Psychiatry was just another subdepartment of neurology, and remained such under Wechsler. Nonetheless, Kubie had the place full of refugee analysts. I ran one of the two clinics, and had people working there who were twenty years my analytic seniors—people like Annie Reich, Loewenfeld, Ed Kronold—any number of them. They all came because of Kubie, who had been remarkably helpful to many of the refugees, in the ways that a well-established person could be—affidavits, that kind of thing (see TAP 23/2-3). When Kubie finally resigned in protest, they all left Mount Sinai with him. Not long after, Moe Kaufman got out of the Army and was given a psychiatric service at Mount Sinai, which he built up into a large and very effective service. By that time I was quite heavily involved at the Institute, and wasn't so keen on this big corporate undertaking that was going on. Not that Moe was a bad guy—he was certainly a very capable administrator, and certainly he knew psychiatry and was a trained analyst, too. But when I had first come to Mount Sinai, Lorand and Oberndorf were the two visiting psychiatrists, and Arnold Eisendorfer and I were the adjuncts. We were in charge
Firestein: Was this about the time that you became director of the New York Institute's Treatment Center?
Stone: No, it was a few years before that. I became director following Heinz Hartmann in 1951.
Firestein: He started it, as I recall.
Stone: Yes, he was the first director. However, the history of the period preceding it is sometimes rather muddled, especially in recent years. For example, some colleagues speak of the fact that we ran a clinic for war veterans, and that they would do the same thing for the Gulf War. But it was very specifically a clinic for treating veterans for neuroses that were not service-connected. I am certain, because I ran that clinic even before the Treatment Center was established. An important and enthusiastic proponent of the clinic's creation was Marian Kenworthy. Remember her?
Firestein: I never met her, but I worked at the Social Work School at Columbia, where her foundation had given this enormous endowment out of which we, the faculty, received honoraria.
Stone: She was tremendously energetic. Some analysts used to make a little fun of her, ungenerously, I think. She taught analysis, at the School, as you say, and she was an analyst. She had some simple formulations—“ego” and “libido” charts, for example.—but everybody respected her energy, her devotion, and her work. She used to have a meeting, at least monthly, to discuss the formation of the clinic. But, yes, I did follow Hartmann in 1951, and stayed until around 1957. Vic Rosen, who had come in as my assistant director, followed me, and he was followed by Leo Loomie, who I think had the longest tenure, ten years at least.
Firestein: Currently The American is trying to do something about the changes going on around us, and is addressing some of the problems of private practice development. We also encounter problems at the institute level, when we're looking for suitable patients as control cases. I was wondering if you have any thoughts about how to approach these problems in the nineties.
Stone: Everything was fine in the “good old days”: at that time the question wasn't whether you could get patients, but whether patients could find an analyst with time. Many of us would take a patient and say, “I can see you beginning next October or thereabout.” People would wait a whole year. Of course, it's utterly different now. I just want to correct one thing, to be fair to Moe Kaufman. He did remain an analyst, in his heart at least, and most of his personnel were analysts. There's no question about that. He favored them, and the psychotherapy they practiced was analytically grounded. The real change at Mount Sinai came later, after Kaufman died.
Firestein: That was, I believe, at Marienbad.
Stone: Yes, the Marienbad Symposium. Some of those things were very good, and, of course the writings of the earliest pioneers were of inestimable importance. But as time went on, I think, the meetings seemed less important. Although occasionally a good paper would be presented, a lot of people feel that, on balance, the meetings are not as good as many local meetings or the meetings of The American. True, national and ideological differences have also been important, and are sometimes linked. Sometimes over there they kick about The American too! Now, The American livened up when Alexander broke out of his shell and began his dispute, with Tom French as an ally, over the “corrective emotional experience.” People remember the phrase, but they often forget much of what went with it—changes in the frequency of sessions, cessation of analysis for a period and then a return to it, and then of course the acting of roles, which many complained about. There Alexander, I think, misfired grossly.
But the debate did generate a lot of discussion about the basic concepts of analysis, even though this created considerable tension in the organization. I remember a chap from Chicago who would blatantly say, “These people from New York, you can always expect what they are going to say.” I know that a special meeting was called, because I attended it. Sterba, Ed Kronold, and I—I don't know how we came to be selected—traveled by train out to Atlantic City, and there was a kind of “sub-meeting,” with several societies represented, just to discuss Alexander's work. Alexander was there himself, as was Karl Menninger, and I never saw such an overt display of hostile tensions. You can reduce the schedule, Menninger argued—I remember him gesturing: “bring the schedule down.” Then you want to “up” the schedule, he said, but in the meantime your schedule has gotten full. So how do you “up” it then? The question per se was legitimate. Alexander, I must say, had one faculty, he could keep his cool and smile through these things. Greenson, I remember, was a calming influence, emphasizing the importance of a “basic rhythm,” as did a number of other moderates. The idea of a regular frequency of visits was strongly emphasized. That was the backdrop of the whole thing, that this meddling with schedules was all wrong.
of the clinics, and we saw consultations as requested by the other services. That was the whole psychiatric service. Fred Weil was there, and at one point ran one of the clinics, and Marcus Schatner, too, in a similar role. But when Moe came, he built this huge organization, which included many of our colleagues. I stayed on for a few years, and then I left.
Firestein: Let me pose a question. If a recent institute graduate were to ask your advice on developing a private practice (since there is no institutional practice of analysis, after all), what would be your response?
Stone: That's a tough question. We have to recognize the fact that analysis is under fire, and there are many people who've practically given in. Some have given in without knowing it. For example, treatment two times week is a frequent practice even among analysts of experience, presumably in order to maintain what they regard as a satisfactory level of fees. Now the truth is that with twice a week you can do better than two times what you can do with once a week. I've always maintained that. But, subtly and below the surface, twice-a-week therapy is coming to be thought of as a substitute for analysis, and that's a development in response to socioeconomic facts extrinsic to the work itself. In the past, analysts saw a fair number of people four or five times a week. But now in America, with the speedup, it's four times a week. Very few analysts today practice what used to be an imperative—five times a week. Four times a week: that's analysis. Pushed too hard, maybe we can take advantage of that one line in Freud about three times a week for “milder cases.” Four times a week is “modified” analysis, but nobody mentions it. People will have a few cases treated four times weekly, and those who have rich patients may have more than a few, but the majority, I think, have mostly what would be called psychotherapy cases. Now, that's a psychotherapy that's practiced by well-trained analysts, and should be superior to what often passes for psychotherapy. That's good. But I don't think we should deceive ourselves that we are preserving analysis by having a schedule full of patients seen three times a week.
Now what to do about that when the press is openly unfriendly to psychoanalysis? I have seen articles claiming that the cost of a full analytic schedule is prohibitive for most people. Even people with well-paying professional jobs, or something like that, paying several hundred dollars a week for many years is a tremendous burden, no question. That's a reality. On the other hand, I don't know how it was when you came in, but I can remember when three dollars an hour was a quite acceptable fee, and I saw one young man for two dollars an hour. And others did essentially the same. Five dollars was a good fee. I remember one analyst saying of another that “so and so won't touch anything under five dollars.” That was just an observation about the other fellow: that he was getting finicky and would no longer accept three dollars. Anyway, that changed, of course. It seems like a different world, an altogether different world. Ten dollars. I remember a rich man who argued about a ten-dollar fee. You know what has happened since then, and there's no turning the clock back. But it's clear that fees have risen even when adjusted for inflation.
I remember an after-dinner speaker at one of those dinner-dances The American used to have. He was a very plainspoken man, and essentially he said, “We have a problem with analysis. When analysts learn to live the way other committed scientists do, then I think we can look for much more genuine flourishing of the science itself and of its practice.” Everybody knew he was speaking the truth. Analysts took it for granted that they frequently went to Europe, and some took off the whole summer, or a good part of it, as a matter of course. They lived in nice apartments, and had as much help as was needed, sent their kids to private schools, and so on, and this we took for granted, not like some fellow in biochemical research who has to find an institution that will pay him. People who go into private practice want to earn a decent living and are entitled to. They don't have to live in luxury, although some aspire to that. I know that I have often been regarded as kind of a “sucker” because even at the height of my practice I never charged the fees that many younger people did.
Firestein: What you're saying about private practice fits with what I mentioned before. There is no institutional practice of psychoanalysis, so people are not salaried to do this kind of work.
Stone: Yes. You asked me earlier what advice I would give a young analyst regarding private practice. I never thought of it that bluntly before. I suppose I would say that we're all interested in the survival of this field, to which we've committed ourselves, and that there's a lot still to be learned, and many improvements to be made. The further development of psychoanalysis requires that its practitioners conduct a certain reasonable number of analytic cases with worthwhile people, and for this they should be willing to make reasonable sacrifices. Obviously, the number of people who are going to be analyzed will always be small. That's been a perennial fact. But each analyst should try to take on a few cases from less prosperous groups. Once you do that, the rest of the time you can look to your financial well-being and practice psychotherapy, if you wish. But know that that's what you're doing, and try your best to do it with people for whom it is the treatment of choice. In any case, the young analyst should try, even at some financial sacrifice, to have a reasonable number of analytic cases, and so contribute to keeping the discipline alive. I don't know what else I would say. I'd have to sleep on that, perhaps quite a few nights.
I should add that I am in no different boat from my fellows. I understand only too well the importance of making a living. But I do think that there is an important distinction between reasonable needs and aspirations, and wanting too much.
Firestein: Thank you so much for spending this time and imparting to us many things that otherwise might have been lost.