To deal with life-history psychoanalytically means to engage in a kind of circular chronology: our inquiry always points to selected periods in the past which, in throwing new light on the present, suggest new forays into the more distant past.
Together we represent aspects of the circular chronology of the Austen Riggs Center. Margaret Brenman-Gibson first came to Riggs during its “golden age” when, in 1947-48, Robert Knight gathered a group from the Menninger Clinic that included David Rapaport, Merton Gill, Roy Schafer, Stuart Miller, Allen Wheelis, and later Erik Homburger Erikson. Edward Shapiro arrived at Riggs in 1991 from McLean Hospital to direct the institution at a period in which the possibility of engaging patients as human beings who create meaning was being questioned. The 1950s were an opportunity at Riggs to formulate aspects of the essential nature of the psychoanalytic inquiry; in the 1990s we are facing a treatment scene that is becoming increasingly biological and precipitating questions about the relevance of psychoanalytic insights to a world with limited resources.
These issues compel us to attempt to deepen Erikson's quantum leap in his study of the relation between the inner and the outer world. In his life work (he called it, jokingly, “The Works”), Erikson developed the first genuinely “biopsychosocial” model of human development. Today we find ourselves returning to Erikson's focus at the Austen Riggs Center, just at the time when psychoanalysis itself is moving beyond the narrow study of the internal world of the patient to the study of the mind of the therapist at work, and then to the study of the context mutually created by the pair with its interactive enactments of what cannot be remembered.
The development of psychoanalysis at the Menninger Clinic began in 1931 when Karl Menninger's intellectual and emotional restlessness spurred him to begin commuting from Topeka to the Chicago Institute of Psychoanalysis, where he was analyzed by Franz Alexander. “Dr. Karl,” as he was called, hoped this exploration would make his next book “less superficial” than his popular The Human Mind. It took more than a decade for the psychoanalytic training and research programs at the Menninger Clinic to move into high gear. This coincided with the arrival, in 1940, of David Rapaport, whose unique intellectual role, combined with Karl's charisma and managerial skills, established the Menninger as “the Athens of psychoanalytic training and research.”
Rapaport was one of those highly gifted refugees Karl could “smell” hundreds of miles away. One of the group of Hungarian Jews who swell the roster of science quite disproportionately, he was a brilliant theoretician who, though analyzed, was not a psychoanalyst. In fact, when he arrived in this country in the late 1930s to escape Hitler, Lawrence Kubie (see TAP 23/2–3) placed him at the Osawatomie State Hospital in Kansas, where he began administering a peculiar psychological instrument, the Szondi Test. Menninger lost no time in bringing him back to Topeka, where at 28 he became the clinic's first real psychologist. I was his first psychological intern, initially posted at the children's unit, the Southard School. There I worked a sixty-hour week, much of the time bathing schizophrenic children and reading to them. Almost at once I began to remind Rapaport that I had been promised a third of my time for research.
Rapaport quickly assembled a small group of young people passionately interested in psychoanalytic research. They were psychologists, with the exception of Merton Gill, who soon began a collaboration with me on theoretical aspects of non-ordinary states of consciousness and their possible uses in psychotherapy, most particularly in the posttraumatic stress syndromes of the war neuroses. With Rapaport's help, both of us were shortly in formal training analyses at the Topeka Psychoanalytic Institute with the Menninger Chief of Staff, Robert Knight. I was the first nonmedical American to receive full training. The in-house analysis was an incestuous arrangement, to be sure, but a routine occurrence in the isolated situation of the Menninger Clinic. And, in fact, it was from the couch that I was invited later to join Knight in his journey to Austen Riggs. I leave the reader to fill in the profound “side effects” of such arrangements.
Rapaport supplied the intellectual passion and directorial coherence behind the entire research enterprise for the eight years he remained at the Menninger, stimulating the beginnings of a vast range of research projects, including a groundbreaking dynamic study with Roy Schafer on diagnostic psychological testing. He prodded Sibylle Korsch-Escalona to conduct a highly significant study of infant development and, over time, inspired Schafer, George Klein, Philip Holzman, Robert Holt, and Herbert Schlesinger into pursuing studies of perception, psychotherapy, and psychoanalytic theory. Still later, Gill's theoretical explorations and his careful work on the analysis of transference bloomed into full flower from the seeds planted by Rapaport. It was remarkable to watch the creative freedom Rapaport stimulated in his students, a freedom that often became corseted in his own written work. A severe critic, his Hungarian accent often led him into wildly funny slips, as on the occasion when he told a student to attend more closely to a female patient's productions and to “look into every cran and nooky”! Soon he became an internationally respected psychoanalytic teacher, offering seminars not only at many American universities but also in Europe and Israel.
Photo: Walt Odets
Historian Lawrence Friedman has said that “perhaps the greatest contribution of Rapaport's circle was to provide national leadership in transforming the role of psychologists outside of academia” (Menninger, Alfred Knopf, 1990). More significant, however, was Rapaport's central role in systematizing and clarifying the psychoanalytic theory of human behavior, not only while he was at the Menninger Clinic but for the remaining twelve years of his life after 1948, when he left Topeka for the Austen Riggs Center.
When Robert Knight went to Riggs in 1947, he persuaded Rapaport and his research group to join him. Together, this group created in Stockbridge and New Haven what later became the Western New England Psychoanalytic Institute. As Karl Menninger put it, “Bob creamed off my top staff to bring them to Riggs.” In the setting of this small, open hospital, Knight, Rapaport, and the clinical research group developed the beginnings of a formulation of psychoanalysis as a general psychology and its clinical applications. Even my study of moral masochism was shaped by Rapaport's “organismic” approach. Many of the students involved in the development of the Western New England Institute, who now train analysts in New Haven, remember the Saturday
morning car pool treks up what was called “The Sigmund Freud Highway” from New Haven to Stockbridge, there to take supervision and classes with Knight, Rapaport, Gill, and myself.
It was during this period that Rapaport developed the idea of a new journal (first published two years before his death), to be called Psychological Issues. Its mission was to publish monographs consisting of “diverse source-materials for a general psychoanalytic theory of behavior.” He appointed as its first editor-in-chief the late George Klein, a lifelong friend whom I had brought to the Menninger from Columbia University, where he was studying experimental psychology and I, psychology and anthropology. Under Rapaport's tutelage, Klein, then codirector with Robert Holt of New York University's Psychological Research Center, had integrated his experimental views with a psychoanalytic perspective. In 1952, while working at NYU, Klein began to spend summers in Stockbridge, where Knight offered him an office and an invitation to case conferences. The exposure to the analytic work at Riggs, according to Philip Holzman and Merton Gill, was a critical event in Klein's professional life, moving him into a “less mechanistic and more psychoanalytic theory of behavior,” resulting in his classic work, Psychoanalysis: Two Theories or One? This transformation from the mechanical to the dynamic reflected the influence of the open setting created at Riggs by Knight and his colleagues, and the intensive analytic involvement with disturbed patients that led the group of scholars to expand the framework of analytic theory.
In the Editorial Statement that opened the first volume of Psychological Issues, Klein noted: “The advances in ego psychology during the last quarter of a century are good examples of how psychoanalytic theory has broadened in scope and altered in perspective…. Issues of…adaptation and reality have become increasingly important…[and] concomitantly, revisions have evolved in its developmental propositions.”
Rapaport and Klein chose for the very first monograph of Psychological Issues Erik Homburger Erikson's theoretical masterpiece, Identity and the Life Cycle. In his introduction, Rapaport set forth one of the products of the developed psychoanalytic culture at Riggs—a closely reasoned and coherent account of the conceptual evolution of psychoanalysis as a general psychology. Though the account is couched in the language of ego psychology, it goes far beyond it, particularly when he gets to Erikson. Rapaport was the first to recognize, in theoretical terms, the quantum leap beyond Freud taken by Erikson in his joining the inner with the outer world and, accordingly, the significance of reality relationships over the course of the “whole life cycle.” Erikson much later, commenting to me on Rapaport's statement that his contribution was “an organic extension of Freud's theory,” remarked with characteristically wry humor, “I suppose one might say that David was the only person who knew enough to put me in my place.”
My professional career has been shaped by the Boston Psychoanalytic Institute, the Massachusetts Mental Health Center of Elvin Semrad, the psychoanalytic studies of families and adolescents at NIMH by Roger Shapiro, the group and social systems work of the Tavistock Institute of Human Relations, and the psychosocial developments at McLean Hospital under Shervert Frazier. When the pressures of shorter stays hit McLean, I turned to Austen Riggs to find a way to continue in-depth work with patients and their families. I learned that in the 1950s Erik Erikson had developed a focus at Riggs on the outer social realities that connected deeply with the inner ego psychology so well described by the former Menninger staff there. For Erik had a deep recognition of the individual in the social and cultural environment. His ground-breaking psychobiography, Young Man Luther, which was written at Riggs, was subtitled A Study in Psychoanalysis and History. Inspired by his clinical work with a psychotic patient, the book represents the first psychoanalytic statement of the dynamics of an individual's creative process in relation to society.
During the same period, Joan Erikson originated and developed the Riggs Activity Program as an “interpretation-free zone” where patients could work as students, gardeners, nursery school teachers, theater people, or artists. This highly original program rested on a set of premises about the individual's self-integrating powers, a stance significantly different from that of “occupational therapy.” In the Activity Program the staff are “teachers” rather than “therapists.” The model is now being used in many hospitals and prison systems.
The recognition that disturbed individuals can be engaged and helped by a combination of depth-psychoanalytic sessions and the freedom for self-expression and environmental engagement constituted the unique “open setting” at Riggs. During an era of increasingly closed, restricted hospitalization, the open setting provided for the kind of respectful attention to the integrity and strengths of patients that allows even severely disturbed and suicidal patients to negotiate the small and supportive community of Stockbridge without major difficulties. As Knight put it, “a dynamic effort to help a patient to acquire the ability to direct and discipline himself would not be consistent with a highly authoritarian, regimented, or paternalistic program, however benevolent and wise this might be” (Lawrence Kubie, The Riggs Story, Hoeber, , p. 73).
The continuing focus on examined living in an open setting allowed scholars at Riggs to learn about the holding capacities of a psychotherapeutic situation for the most disturbed patients. The resultant development of a still-evolving therapeutic community structure is a product of the activities and studies of Marshall Edelson, Otto Will, Ess White, Martin Cooperman, Elizabeth Oakes, Daniel Schwartz, Gerard Fromm, and others. The community offers a vital “third” presence for the therapeutic dyad, within which aspects of potentially interpretable enactments that are not contained within the therapy can be grasped and put into perspective. The setting has facilitated psychotherapeutic investigations of schizophrenia and personality disorders, as well as Albert Rothenberg's studies of creativity and Sidney Blatt and Eric Plakun's outcome studies.
As Austen Riggs approaches its seventy-fifth year, the Center is again occupying an important niche in the psychoanalytic enterprise. For in an era of short-term hospitalizations, with a focus on behavioral and psychopharmacological approaches to the brain, there are few places where patients can find the setting they need for internal reflection and growth in a community of examined living. Trainees from around the world, finding it difficult to locate opportunities to learn in depth about patients' internal experience, apply to Riggs for training. And patients and families are finding their way in increasing numbers to our differentiated set of programs, all of which cohere around the focused deepening of a psychotherapeutic relationship. We are learning that engaging the attention of patients and families in the management of the realities of the external world facilitates their freedom to engage in a deepening interpretive process as regards their internal experience. And so, having come full circle, we find ourselves organizing an international scientific meeting to be held at Riggs in 1994 to celebrate our seventy-fifth anniversary, on the theme “The Inner World in the Outer World.”
The scientific program will “review and build on the ongoing contributions of the Austen Riggs Center to clinical thinking and research. A generation ago, under the leadership of Robert Knight, a group of staff members at the Center offered to psychoanalytic theory a systematization and revision of ego psychology, significantly expanding Freud's original concept of the ego's role in managing the interface of the internal world with external reality. Erik Homburger Erikson took a great leap in articulating the complexity of the individual's development within a social human context. Calling society a ‘gigantic metabolism of intersecting life cycles,’ Erikson's call for the development of a ‘universal therapeutics’ applies both to the suffering of the individual patient and the suffering world.
“Theory in this generation has focused on interaction and the elaboration of what are now called ‘enactments’—the creative ways in which the individual and his or her human context consciously and unconsciously collaborate to re-create or to transcend their histories. And the recent developments in gender studies have added the long missing perspective of the woman's voice to this developing notion of the interdependency of human beings. Recognition of this contextual human collaboration has led to a deeper understanding of how we live together and an increasing ability to face the truth patients bring us.
“As these theoretical developments have occurred, the world has shifted. We are more aware of the impact of our external world on our inner lives, as previously stable social structures change with dizzying rapidity. Diminishing resources and rapid social change can be discovered in the outer world and vice versa. As Erikson has demonstrative over the last fifty years, attention to this interweaving offers us some hope of making collaborative interpretations of our reality—both in the clinical encounter and in our social lives.”
So the development begun almost forty-five years ago in the transition from Menninger to Riggs is continuing. And our focus on the relationship between the inner and outer world has so deepened that we can scarcely discern the boundary. But our framework at the Austen Riggs Center remains now—as it was then—focused on an increasingly clear sense of the need to hold the notion of person and context as we move toward a negotiated interpretation of the meaning of our patients' lives.