Akhtar: I would like first of all to thank you for agreeing to be interviewed. I'll begin by asking bow and when you became interested in psychoanalysis.
Kramer: I enjoyed psychiatry courses in medical school, finding them so much more appealing than other clinical courses or the basic sciences. In my medical school days pediatrics and obstetrics-gynecology were considered most appropriate for women. Between my sophomore and junior years I took a junior internship at the Philadelphia State Hospital (known in those days as “Byberry”). It was poorly run, but I was impressed by the scholarly approach of some staff members as they tried to fathom the reasons for their patients' illnesses, and to decode their psychotic productions. I felt a desire to learn more about the human mind. Then, during my rotating internship, an orthopedic surgeon whom I had assisted during surgery asked whether I knew about a fascinating new field—child psychiatry! Well, the very next year I joined the psychiatric residency at Norristown State Hospital. It was there, in 1945, that I got “turned on” to psychoanalysis. Herbert Herskovitz, who was assistant superintendent then, was an advanced candidate in psychoanalysis. Robert Bookhammer had gone on to private practice by the time I arrived, but his “analytic imprint” on residents and staff was indelible.
Akhtar: I suppose it was after your residency that you applied for analytic training.
Kramer: Actually, three years after. I applied for training in 1948. In those days applicants were graded A or B. The year I applied, only one was designated A (he later suffered a psychotic episode!); the rest of us were rated B. After a year of analysis, with LeRoy Maeder, I was eligible for classes. I was awed by the teaching of most of the faculty, and I found the older candidates to be very impressive. They knew so much!
In 1949, candidates began to hear rumbling about the split in the Philadelphia Psychoanalytic Society, which eventually resulted in the two institutes that exist today. As I remember, most candidates “chose” the institute of their training analyst; graduates may have done so, too. Robert Waelder and Herbert Herskovitz remained in both institutes for a couple of years. Waelder was a marvelous teacher, and when he opted to be only in the “other group,” many of the candidates in the Philadelphia Psychoanalytic Institute felt his loss deeply. Another significant event around the same time was that Margaret Mahler agreed to travel to Philadelphia to teach child and adolescent analysis. I was permitted to take her courses along with the first-year adult curriculum.
Akhtar: One frequently hears candidates talk about the difficulties of doing analytic training these days. An implication in these complaints is that training was easier in “earlier days.” Is that really true?
Kramer: No, I don't think so. The rigidity of analytic training when I was a candidate made for many difficulties. Most classes were held at night, and it was considered impossible to take more than one adult course a night. I had asked about whether we could take more than one course each night, because I had a young child, Karen, and I was told that it would be “too much” for the candidates to absorb! And courses could not be given during the day. Finances were also difficult, especially since I had quite a small private practice. Insurance reimbursement was unavailable. I remember a heated discussion some years later, at a meeting of The American, in which many senior members argued vociferously that insurance claims should not be signed by training analysts, since candidates were there not to be treated but to be taught.
I wanted to keep as much time as possible open for my daughter. Later I was able to build a practice with referrals from fellow candidates and even some from Margaret Mahler. Fees were low. I preferred not to wait for that high-fee case some of my colleagues waited for; I felt that having as many child and adult patients as possible would make for richer training.
Akhtar: Did your being a woman affect your experience as a candidate in any way?
Kramer: Yes. First of all, I could not accept some of the beliefs about female development prevalent in those days, especially regarding the female superego. For the most part, however, I disagreed silently. As I was the only woman in the beginning courses, it seemed better just to listen and keep silent. Second, I felt that I knew much more about women, childbearing, and the role of the mother than did my male colleagues and even some of the teachers. I would not join them in “mother-bashing,” a popular sport at the time. Experience with puberty, menses, pregnancy, and parturition had given me a firsthand understanding of my female patients. Then there was the issue of female masturbation, which was reported rarely by male colleagues. Virginia Clower agreed with me and said that our male colleagues tended to see women as grown-up versions of “sugar and spice and everything nice.” At the same time, I do not feel that I was put at any disadvantage in my training or subsequent career because I was a woman.
Akhtar: All of us are aware of the profound influence of Margaret Mahler on you. Could you tell us when you first met her and about her impact on you?
Kramer: Mahler first came to Philadelphia in the fall of 1950 to initiate the program in child and adolescent analysis. What began as a relationship between a brilliant, dynamic teacher and a frightened candidate changed over the years into a warm, loving relationship between her and my entire family. Margaret's teaching was unique and excellent. No one in the group but Earl Loomis had ever studied child analysis, if I am correct. Mahler had undertaken a tremendous job, one that gave us the education we needed and gave her the pleasure of fostering the growth of her “Philadelphia children.”
An interesting group phenomenon emerged during the years Mahler taught us. She encouraged members of the class to comment on and to criticize the material each of us presented at her continuous case seminars, or even in individual supervision, which we were invited to sit in on. We learned to criticize, but kindly. It was as if we had formed a coalition of Mahlers students, whose aim was to learn as much as possible, as well as to critique without hostility. I was aware that I was being taught by an impassioned teacher who expected a tremendous amount. I minded it less when I realized that Margaret expected much more from herself than from any of us, and that she demanded a great deal only of those she respected.
After the first five years, Cal Settlage and I suggested that evening seminars be held in Philadelphia, alternating with the continuous case seminar in New York; soon all the classes were conducted in New York. Mahler initiated a program of “supervised supervision” in which Settlage or I would supervise a candidate's case and present our supervisory work to her.
Akhtar: Besides Mahler, who else has influenced your theoretical and clinical thinking?
Kramer: Margaret took great pleasure in introducing us to her professional friends. She invited them to the continuous case seminars now held at her house. I remember visits by Max Schur and Helen Ross, among others. We also met Bertram Lewin, Peter Blos, Sr., Robert Bak, Annemarie Weil, Marjorie Harley, Judith
Kestenberg, and many more of Margaret's friends. Back in Philadelphia, classes with Maeder, English, and many others teaching the adult curriculum were exciting. Morris Brady's supervision was very valuable, too. I learned a great deal from my contemporaries (many of whom had moved geographically but still remained close friends) and from candidates whom I taught, many of whom later became cherished colleagues and friends.
Working with Harold Blum on the editorial board of JAPA provided me with a most stimulating and exciting postgraduate learning experience. I had the opportunity to get to know Otto Kernberg and his work well, as both of us were promoted from the editorial board to be associate editors at the same time. Others who influenced my career were those I worked with while chairing the Child Analysis Committee of The American. Certain delicate issues with the institutes required the help and guidance of the chair of the Board on Professional Standards. Ed Weinshel and Stan Goodman were especially helpful.
Akhtar: What do you consider the highlights of your analytic career?
Kramer: I have already mentioned JAPA and my tenure as chair of the Committee on Child Analysis. But helping to form the Mahler Foundation was really unique and exciting. I remember sitting in our kitchen with my husband, Ernest Witkin, together with Bob Prall and Margaret herself, laying the groundwork. Bernard Pacella, too, was active in it from the start. We knew we were creating an important structure.
Another exceptional occurrence was your own effort, together with Henri Parens, in compiling a festschrift in my honor (Beyond the Symbiotic Orbit, Analytic Press, 1992). Both of you, of course, are my former students and now my dear friends. The book is a collection of exceptionally fine papers by a group of distinguished individuals who are also my friends. As I received the book and read it, I felt strongly that Margaret would have loved it.
Akhtar: I wonder if you could comment on the perception that there is a declining number of publications that employ or elaborate Mahler's concepts.
Kramer: There are a couple of reasons for this perception other than the implication that Mahler's work is no longer significant. First of all, many “Mahlerian” papers have been published as book chapters and perhaps have escaped notice. There are twenty original papers in the festschrift alone. Also, the proceedings of the last four Mahler Symposiums have been published as books, accounting for another twelve original papers and almost as many discussions and commentaries. In addition, a book containing papers from the Second International Mahler Symposium, held in Cologne in August 1993, is currently being prepared for simultaneous publication in English and German. Another important factor that might create the impression of a decline is that Mahler's concepts are by now part of the psychoanalytic lexicon and are often used without attribution, much as happens with Freud's concepts and those of Anna Freud, Kris, Hartmann, Spitz, and Winnicott. (Alfred Margulies has recently made the same point.)
Akhtar: The festschrift in your honor contained a biographical sketch of you, and from it we know some things about your personal life. Could you tell us a bit more, something extra?
Kramer: The biography written for the festschrift by my dear colleagues Leroy Byerly, Leo Madow, and Joseph Rudolph was laudatory and kind. But it presented a picture out of Ozzie and Harriet. In reality, no family is like that. There were normal family conflicts and troubles, intensified by my brother's illness and the Great Depression. Growing up in my father's pharmacy taught me to be a quiet observer and listener, because of the multitude of interesting
“Growing up in my father's pharmacy taught me to he a quiet observer and listener, because of the multitude of interesting things I could make note of, as long as adults did not discover my curiosity.”
things I could make note of, as long as adults did not discover my curiosity. The soda fountain of the pharmacy (and a luncheonette added during the depression years) helped us out financially. (Among my talents I count being a fine soda jerk!) Regardless of the depth of the depression, it was always clear that we children would be supported through college and any professional education we sought. We were encouraged to read, to learn, to seek knowledge. In this connection, an interesting episode of my childhood comes to mind. In early latency I was excited to encounter a child rearing column in the daily paper by a New Yorker, Angelo Patri. For the most part, he answered parents' questions; in fact, I don't recall whether other children wrote to him for advice. But I did, asking whether parents should open their children's mail. He answered quickly, in a personal letter to my home, agreeing with me that a child's mail should be set aside for her, unopened. My pleasure was not unalloyed, however, for I had found Patri's letter to me discarded, in the waste basket!
My marriage of forty-nine years to Ernest Witkin has been a very happy one. Ernie is a retired electronic engineer, a source of great strength to all members of the family, and he has always encouraged my work. Ernie was special to Margaret Mahler, too. She relied on his advice in many areas, not believing that there was anything he did not know or would not do for her. Our daughter Karen and our son Jim are a source of pride to us. Karen received her Ph.D. in child development from Bryn Mawr, and Jim is a lawyer. Each has two sons and is married to a talented, loving mate; all four are hardworking. When I told my daughter that she works too hard, she said to me wryly, “Mom, it's about forty years too late for you to tell me that.”
Akhtar: We have talked about past and present. Let us conclude now with the future, especially your thoughts about the future of psychoanalysis.
Kramer: When I was a young candidate, pharmaceutical companies were rushing to develop a variety of antibiotics. I remember joking with a classmate. “Some day,” I prophesied, “they will produce ”psychomycin,“ sell it through street corner vending machines, and where will we be?” Well, that day is here. “Psychomycin” has been developed, and we are using it in our practices, where it is indicated, together with psychodynamic treatment and even psychoanalysis. Does this mean that analysts have no future? No, but we have to work harder in a number of ways. First, too few people understand the aims and purposes of psychoanalysis, for adults or for children. It therefore behooves us to educate our colleagues. So many of us used to lecture at schools, medical meetings, and other public forums; we must not let that lapse. We cannot exclude ourselves. Also, our reluctance to be involved in the administration of the American Psychiatric Association has resulted in analysts and analysis being swept aside, even demeaned. We must teach in medical schools and in residency programs. We must counter hostile and untrue articles about psychoanalysis, such as the recent one in The New York Review of Books, to which excellent responses were published by Harold Blum, Bernard Pacella, and Mortimer Ostow, among others. The future of psychoanalysis is in our hands.
Akhtar: Thank you so much for sharing your thoughts with us. It's been enlightening.