The roots of psychoanalysis in the United States stretch back to three East Coast cities: New York, Boston, and Washington. In the last, an early focal point was St. Elizabeths Hospital. Established in 1855 as The Government Hospital for the Insane, its affair with psychoanalysis began in 1903 when, at the age of 33, William Alanson White became superintendent. White, who had first read Freud while studying dissociative states with Boris Sidis, was an early adherent of psychoanalysis. Although untrained in analysis, he taught, organized, and proselytized on its behalf throughout the thirty-four years of his superintendency. His “The Theory of the Complex,” written in 1909, was one of the first psychoanalytic papers to be published by an American, while his Outlines of Psychiatry, an influential textbook for medical students (it went through fourteen editions), contained a chapter on analytic concepts. In 1911 he published Mental Mechanisms, the first American psychoanalytic monograph. Two years later he and his close friend, Smith Ely Jelliffe, founded the first English-language analytic journal, The Psychoanalytic Review. Under his leadership at St. Elizabeths, psychoanalytic understanding was introduced into the treatment of psychotic patients.
White and his institution were a magnet for individuals with an interest in psychoanalysis. As Kenneth Gorelick, a staff member at St. Elizabeths who has investigated its early history, observes, “the names of its staff members appear over and over in the nexus of connections leading, after many fusions, fissions, buddings, and redivisions, based on personalities, their extension into politics and on purity of allegiance to Freud, to the founding of our contemporary organizations … with radiations to Freudian and neo-Freudian institutes elsewhere.”
Mary O'Malley followed White to St. Elizabeths and served as a clinical director. Bernard Glueck, who joined the staff in 1908, translated Adler's The Neurotic Constitution and used Adlerian concepts in his investigation of criminals. In 1915 White hired Edward J. Kempf, an assistant to Adolf Meyer at Johns Hopkins and a pioneer in the treatment of psychosis using analytic understanding, as a full-time psychotherapist. Kempf
later wrote the masterful text Psychopathology. Lucille Dooley, having obtained a Ph.D. from Clark University, joined the staff in 1916 and was encouraged to take a medical degree at Johns Hopkins. Because of Whites desire to provide the best treatment for his patients, the psychotherapy staff soon grew to five analytically oriented psychiatrists and psychologists. At this time only Manhattan State Hospital in New York devoted so much effort to psychotherapy.
On July 6, 1914, White and several colleagues—O'Malley, Glueck, Percy Hickling, John E. Lind, and James Hassel—met at St. Elizabeths and founded the Washington Psychoanalytic Society. The society gathered several times a year at the hospital to present clinical cases and papers. White served as the society's first president and Kempf as its second. After the United States entered World War I in 1917, a hiatus occurred in these organizational activities. During this time, however, a small group of women staff members who were interested in analysis met each morning under Dooley's leadership. Following the war, the staff expanded to include many well-known clinicians, among them Anna Colomb, Philip Graven, Ross McClure Chapman, Nolan D.C. Lewis, and—most significant for Washington psychoanalysis—Ernest E. Hadley and Harry Stack Sullivan. Although Sullivan is today far better known, Hadley was an extremely influential and important figure.
Born in 1894, Hadley grew up on the family farm near Alton, Kansas, where he attended a one-room school. Financial problems delayed his graduation from the University of Kansas School of Medicine until 1920. He then took an internship at Walter Reed and in August 1921 began his residency at St. Elizabeths. There he was befriended by White, who once commented, “This is my beloved son, in whom I am well pleased.” Because Hadley lacked the financial resources to undergo a personal analysis in Europe, which following the war was a common practice, he was analyzed by Graven, an analysand of Wilhelm Stekel. Hadley received supervision on at least three patients, and completed his training analysis and residency in 1924. Remaining on staff for five years and left free to experiment by Whites undogmatic attitude, he began analyzing schizophrenics on the couch. As Christopher Bever has reflected, “The psychiatric residency at St. Elizabeths Hospital provided a special opportunity for those interested in the expanding theories of Freud. At the time these represented the exciting new scientific frontier of psychiatry.”
In 1924 the Washington Psychoanalytic Association was founded, and Benjamin Karpman, another analysand of Stekel then on the staff at St. Elizabeths, became an important leader. The following year the old Society was revived by O'Malley and Hickling. Eight of its fourteen members were associated with St. Elizabeths. In 1926 the Society changed its name to the Washington Psychopathology Society to reflect the broader interests of its members, who included many laypersons and nonanalyst psychiatrists. Despite overlapping memberships, there apparently was a strong rivalry between the Association and the Society.
After leaving St. Elizabeths in 1929, Hadley remained active in analytic circles and, according to Gorelick, was a “pillar of the analytic community.” He discussed with A. A. Brill, president of the American Psychoanalytic Association, the feasibility of establishing a society and institute in Washington which would be acceptable to both The American and the International Psychoanalytical Association. In 1930 he organized the initial meeting of the Washington-Baltimore Society, which was held in his office. The charter members were White, Colomb, Dooley, Lewis, Sullivan, Graven, Chapman, Edward Reede, William Silverberg, Clara Thompson, Loren B. Johnson, Adolf Meyer, and G. Lane Taneyhill. Thompson became its first president. Karpman, whether by design or accident, was not included.
Although Sullivan spent only two years at St. Elizabeths, in the early twenties he developed a tremendous respect for White. He also formed a friendship and a productive working relationship with Hadley. In 1933 Sullivan, Hadley, and Dooley established the William Alanson White Psychoanalytic Foundation in the hope it would attract donations to support training. In 1936, in an attempt to attract even broader support, its name was changed to the William Alanson White Psychiatric Foundation. Its operating entity was the Washington-Baltimore Society. Hadley and Dooley were among the first training analysts in the program. Sullivan's interest in interpersonal psychiatry was reflected in his proposed tripartite structure for the school: a Division of Psychiatry headed by himself; a Division of Biological Science headed by Hadley; and a Division of Social Science headed by the linguist and anthropologist Edward Sapir.
This article is based on the Oral History Workshop held at the Annual Meeting of the American Psychoanalytic Association on April 29, 1992, in Washington, D.C. Milton Engel chaired, with Christopher Bever as co-chair.
An era ended when White died in 1937. He had served four years as president of The American and was the national advisor for the formation of an institute in Chicago. Important outside analysis, he was deeply interested in the national and international mental hygiene movements. During his long tenure as superintendent of St. Elizabeths, he and his staff published 104 articles on psychoanalysis.
Winfred Overholser, the new superintendent, was an excellent administrator; charming, affable, and political, he met frequently with congressmen and cabinet members. However, his interest in psychoanalysis did not run deep. Sidney Berman, who was training at St. Elizabeths at the time, recalls that Addison Duval, one of the administrative assistants, was quite supportive of analysis. Nonetheless, after White's death most analysts drifted away.
Zigmond Lebensohn, who arrived in 1935, comments that “psychoanalysis at St. Elizabeths Hospital was a leaven and a ferment, but it was not the kind of psychoanalysis we see today. People who called themselves psychoanalysts could not have made it today. The movement was already divided into at least three schools—the Freudians, the Stekelians, and the Rankians. But it was a very heady period.” Judd Marmor is perhaps the best known figure among those at St. Elizabeths in the thirties who went into analysis. But there were others, including Herbert Wiggers; Bill Murphy, who left to practice psychoanalysis in Boston; Mortimer Ostow, who moved to New York, and Sidney Maughs, who set up practice in St. Louis.
Paul Chodoff was at St. Elizabeths from 1941 to 1942, when he left for military service. He considers that time “the calm before the storm.” St. Elizabeths was quiescent not only because of the war, but because the vigor of White's administration was missing. Chodoff recalls the meticulous detail in which cases were worked up; for a single case, he once dictated five tapes on a primitive cylinder recorder. Training was by preceptorship, and Alex Simon and Karpman were particularly influential teachers. An apocryphal story from that time has it that Karpman wrote Freud that he planned to treat psychotics with psychoanalysis, to which Freud replied, “After you do that send me a postcard and tell me the results.” When Chodoff asked Karpman for a reading list, he was told to read Janets The Major Symptoms of Hysteria. After reading it, and asking for more help, he was told by Karpman to read a second book by Janet. At that point Chodoff thought, “To hell with it.” That was the extent of training.
But though the formal teaching was minimal, Chodoff recalls the fine quality of the St. Elizabeths residents, many of whom went on to become analysts. David Farber, Leslie Farber, Herb Spiegel, Joe Kepecs, Charles Fisher, Joe Abrams, Stanley Olinick, and Albert Ackerman all trained on the proving ground of St. Elizabeths.
During the war years there, Lebensohn was the Naval Medical Officer in charge of training. Over 150 Naval Medical Officers went through the program; although it was eclectic, the group was taken to hear the best analytic teachers available. “Leon Saul gave an evening seminar on psychodynamics at my home,” Lebensohn recalls, “and Jack Lyons, now practicing in Philadelphia, attributes his decision to become a psychoanalyst to that experience. I later introduced Otto Will to Chestnut Lodge and to Harry Stack Sullivan. Otto later became the medical director at Riggs and an important contributor to the psychoanalytic literature.”
William Granatir, who arrived in 1946 and left in 1948, also recalls the intense interest in psychoanalysis and the psychodynamic approach during that time, especially among physicians recently discharged from the armed services. At the St. Elizabeths Society meeting in 1947, several staff members who had been treating patients on their own time presented their work. Sullivan was the discussant. Following this meeting, a memo was issued forbidding individual psychotherapy for new cases; Granatir considers this typical of the unfriendliness toward psychodynamics that prevailed then in official circles.
The only organized training was in a few clinical conferences. Granatir, Olinick, and Ackerman arranged to meet with Frieda Fromm-Reichmann (who was associated with Chestnut Lodge) for supervision of their psychotic patients. Residents relied on the help they gave each other, and most entered training at the Washington Institute.
Christopher Bever began training at St. Elizabeths in 1947 and remained for three years. He chose St. Elizabeths because of the influence of former staff members James Galvin, Herbert Spiegel, and George Kriegman. Although the program continued in high repute, he too experienced the lack of formal training. He recalls a good experience on the maximum security section with Bernard Cruvant, who later became a training analyst in St. Louis. Abrams and Leon Yochelson, who later chaired the Department of Psychiatry at George Washington University, were inspiring teachers.
Berman and Granatir became directors of the Washington Institute on Mental Hygiene, which employed an analytic understanding in its work. Staff at St. Elizabeths came there to treat patients at a Wednesday evening low-fee clinic and to participate afterward in a conference held from nine to eleven to discuss psychoanalytic therapy.
Centrifugal forces within American psychoanalysis, which had been building in the 1930s, struck full force in New York City in the early 1940s (see TAP 26/4). In 1941 Karen Homey and a group of colleagues, including Silverberg and Thompson (both of whom had moved to New York), broke from the New York Psychoanalytic Society and formed the Association for the Advancement of Psychoanalysis and the American Institute for Psychoanalysis. The group had close ties with Washington; Hadley, Dooley, Marjorie Jarvis (a St. Elizabeths staff member), Ralph Crowley, and Benjamin Weininger joined AAP, and Sullivan became an honorary member. However, when The American disapproved of joint membership, the Washington group resigned from AAP. Then, in 1943, a schism occurred within AAP, and Thompson, with Sullivan's help, formed the New York Division of the Washington . School of Psychiatry. In 1946 White's name was again enshrined when the New York group was renamed the William Alanson White Institute of Psychoanalysis.
Washington also greatly influenced the development of psychoanalysis in New Orleans. Colomb had moved there in 1942, becoming the first analyst in the area. When efforts were made to found an institute there, Hadley became a dedicated advisor to the project (see TAP 26/3).
Meanwhile, the tensions that emerged in New York so dramatically were affecting Washington as well. In 1941 the Washington-Baltimore Psychoanalytic Institute was established as an entity separate from the Washington School of Psychiatry. Dooley withdrew her membership later that year, and in 1945 Hadley and Sullivan, after a long and productive relationship, came to a parting of the ways. The final impetus was a disagreement over administrative policy regarding Psychiatry, the journal published by the White Foundation.
In 1949 Sullivan died, and that same year the Washington-Baltimore Institute ceased its joint teaching activities with the Washington School of Psychiatry. In 1952 the Institute, with Hadley as director, divided into the Washington Psychoanalytic Institute and the Baltimore Psychoanalytic Institute (now the Baltimore-Washington Institute for Psychoanalysis). Hadley died in 1954 while director of the Washington Institute. During these tumultuous years, when tensions between orthodoxy and innovation, as well as underlying personality conflicts, tore psychoanalysis apart, Hadley is credited with preventing further fragmentation in Washington. Throughout his long career, Hadley organized educational procedures, was a brilliant teacher, and three times served as the Society's president. He also served eighteen years as chair of The American's Committee on Standards.
Bever believes that psychoanalysis developed differently in Washington than in other American cities. Only a small number of foreign analysts settled in Washington; most of the analysts there were born in the United States and brought a distinctly American character to the analytic movement. A second difference was the great influence of the many analysts who trained and worked at St. Elizabeths and Chestnut Lodge, where large numbers of psychotic patients were treated. Together these factors lent Washington psychoanalysis a very special character.