Psychoanalysis arrived in Rochester in 1942, the year Sandor Feldman set up practice. James Bartlett recounts that Feldman was recruited by Lawrence A. Kohn, a Rochester internist, through the efforts of Lawrence Kubie, a medical school classmate. Kubie, a former president of the New York Psychoanalytic Society, was very active in helping emigré analysts escape the destruction then engulfing Europe (see TAP 23/2–3). He assisted Feldman, who had immigrated to New York City in 1939, to settle in Rochester. Feldman, whose training analyst was Imre Hermann, was authorized by the New York Institute to conduct didactic analyses; within a year of his arrival in the upstate city, he was analyzing three candidates and developing plans for courses. Robert Grayson recalls Feldman as a man of humor and zest who drew upon a seemingly inexhaustible font of stories from middle Europe, which he told in his rich Hungarian accent. “With each patient, I get healthier” was a typical Feldman aphorism. Grayson praises Feldman as a clinician and scholar who taught analytic concepts to generations of psychiatric residents in Rochester.
Rochester, in New York's Finger Lakes region, was settled after the completion of the Erie Canal in the early 1800s. The University of Rochester, which began as a small Baptist college in the middle of the nineteenth-century, grew by leaps and bounds under the impetus of endowments by George Eastman, founder of Eastman Kodak, the photographic giant headquartered in the city. Following the Flexner report criticizing American medical education, the Rockefeller Foundation organized and supported national reforms and helped establish a new medical school at the University of Rochester to serve as an example of medical excellence. Soon the school became the dominant medical force in the region.
In the early 1940s, psychiatry was part of the department of medicine, and Richard Jaenike served as a one-man psychiatric staff. Helen Woodward Rivas, a wealthy patient of William McCann, chair of the department, endowed a separate department of psychiatry, and McCann sought to recruit an exceptional faculty. In June 1946, John Romano became chair of the new department of psychiatry at the University of Rochester School of Medicine and Strong Memorial Hospital. A colleague, George Engel, accompanied Romano to Rochester. Together they created a department that earned an international reputation.
Engel was raised in the household of his uncle, Emanuel Libman, one of the most prominent physicians in New York. During medical school at Johns Hopkins, Adolf Meyer “planted the seed of interest in human behavior,” Engel later reflected. He completed a residency in internal medicine and at the time had no interest in psychiatry or psychoanalysis. He wished to study delirium with the renowned internist Soma Weiss at Peter Bent Brigham Hospital in Boston, but to his initial disappointment he was sent to work with Romano, who was performing EEG studies. Sanford Gifford comments that when the two first met in 1938, it was “the beginning of a continuing relationship between two complex, powerful personalities that shaped the future of psychiatry and psychoanalysis in Rochester, and widely influenced American psychosomatic research and general hospital psychiatry.”
Romano, a brilliant young psychiatrist, was the only full-time member of the department of psychiatry at Brigham. He, along with Charles Brenner and George Gardner, were the first Sigmund Freud Fellows in Psychoanalysis at the Boston Psychoanalytic Institute. Grayson characterizes Romano as a man of “extraordinarily wide culture and learning and with a charismatic personality.” He “inspired innumerable medical students, psychiatric residents, and analysts-to-be.”
In 1942 Romano became chair of the department of psychiatry at Cincinnati. He and Eugene Ferris, a professor of medicine there, proceeded to recruit Engel. During his tenure at Cincinnati, Romano developed relations with the Chicago Institute of Psychoanalysis. This initial contact later blossomed into the establishment of the Cincinnati Psychoanalytic Institute.
At Cincinnati, internists and psychiatrists participated in weekly psychosomatic case conferences. Engel considered them “far and away the best psychosomatic conferences, certainly of the time and maybe of any time.” But he questioned why professionals from two separate disciplines were necessary for an understanding of patients, and resolved to “incorporate this discipline in my one person.” When Milton Rosenbaum persuaded Engel to see a patient suffering chronic pain, Engel agreed, on condition that Rosenbaum supervise him: thus began Engel's contact with psychoanalytic thinking. Engel quickly became intrigued with the possibilities of integrating psychoanalytic understanding with his research and scientific interests.
In Rochester, Romano and Feldman became colleagues and friends. Joining the small group of psychiatrists were Walter Hamburger and Myrtle Logan from Cincinnati.
Romano was dedicated to education. Teaching medical students became a priority; a major amount of time in the medical school curriculum was allotted to teaching psychiatry. Psychiatric residency training was an unqualified success; currently, 410 pictures of graduate psychiatric residents and fellows line the walls of Wing R at Strong Memorial. The teaching of dynamic psychiatry to nursing students also became renowned.
Another of Romano's goals was to develop a relationship between his department and the New York Psychoanalytic Institute, in order to make analytic training available to members of his staff. The New York Institute initially favored the project, and in 1948 a member of the Rochester department was accepted as a candidate. Others soon applied.
In January 1949, however, the New York Institute decided to withdraw the affiliation, though candidates already enrolled were allowed to complete the year. The training of students beyond normal commuting distance would require weekend instruction, and the New York program was structured around weekday evening classes. Faculty members did not wish to repeat their courses on weekends. New York then proposed a six-year course for Rochester candidates that would require weekday evening classes in New York. The suggested commute meant two successive nights of train travel to cover the seven-hundred-mile round trip—at the time, air travel was impractical during the winter—with a full and mostly idle weekday sandwiched between them. Inasmuch as the Rochester candidates worked and taught at the medical school, the proposal was not feasible.
For some reason now unclear, the New York Institute also began to question the psychiatric education provided by the Rochester department. In early 1949, Sara Bonnett, chair of the institute's education committee, wrote Romano that candidates who completed psychiatric training at Strong Memorial would be given credit for only one year of residency. (This unusual dictum was the subject of some disagreement within the New York Institute.) Engel and Romano met with Ruth Loveland, Rudolf Loewenstein, and Phyllis Greenacre in New York to attempt to reach a new agreement, but eventually decided that it was not possible to continue the relationship. Feldman was informed in July 1950 that he would no longer be listed as an instructor with the New York Institute, a decision that in effect rescinded his training analyst status.
Because of the mounting problems, in July of 1949 Romano wrote to Franz Alexander at the
Chicago Psychoanalytic Institute seeking to establish a formal connection. While at Cincinnati, Romano had developed a good relationship with the Chicago Institute. By October, a satisfactory liaison was in place, and three candidates began to travel from Rochester to Chicago for training. A fourth candidate began in 1950, and three more were accepted in 1951. Five of this initial group were former candidates at New York: Engel, Hamburger, Murray Lewis, Gordon Pleune, and Myrtle Logan Pleune.
The problems of the Rochester group did not end, however. Unfortunately, because of a shortage of supervisory time, the Chicago Institute felt it could not accommodate more than the seven students already accepted. Chicago tentatively decided that each Rochester candidate who graduated would be replaced by a new candidate from Rochester. Because of the demand for analytic training, however, this was not a satisfactory solution for Romano.
In July 1953 Romano wrote to The American inquiring about forming a study group and was advised to obtain sponsorship from one of the established institutes. Correspondence was undertaken with the Western New England Institute, the Philadelphia Psychoanalytic Institute, and the New York Psychoanalytic Institute, but these attempts proved unfruitful. In 1955, however, relations were established with the recently formed Downstate Psychoanalytic Institute. Howard Potter, chair of the department of psychiatry, and Sandor Lorand, director of the institute, were extremely supportive. In November 1956 the first meeting of the Western New York Psychoanalytic Study Group was held. In 1961, the Western New York Psychoanalytic Society, under the leadership of Feldman, was founded.
Sidney Rubin arrived from the Menninger Clinic to become the second training analyst in Rochester. James Bartlett, a candidate at the time, considers Rubin “an accomplished teacher and accomplished clinician” and in addition an “accomplished showman” in the many classes he taught. Candidates now had their training analysis in Rochester with either Feldman or Rubin. They traveled on Friday to New York, where they had supervision and evening seminars. The following day they attended Saturday morning seminars, and then flew back to Rochester. Bartlett commends the Downstate supervising analysts as generous and understanding with their schedules. Among the New York travelers were Bartlett, Robert Atkins, Alex Braiman, Paul Dewald, Edwin Freeman, Sanford Meyerowitz, Daniel Schuster, Arthur Schmale, and Otto Thaler. Thaler comments wryly that the Rochester students were considered “experts in the rural matters that occurred somewhere upstate” and recounts that William Niederland, during a discussion of the Little Hans case, asked the travelers to share their expertise on the anatomy of cows.
George Mizner reminisces that “Rochester in the fifties provided an exciting and nurturing educational environment that instilled ethical principles, ways of listening and thinking about patients that became a large part of the way I have tried to practice medicine ever since.” He commends Bartlett, Romano, Engel, and Franz Reichsman. Sy Rabinowitz describes this time as “the golden age of Rochester psychiatry.” Norman Margolis calls the era “the halcyon days of the department,” during which he developed “sound grounding in psychiatric diagnosis and phenomenology which was informed by the dynamic understanding afforded by the concepts of psychoanalysis.”
Mizner does mention, however, that to some it appeared that Romano later developed an antagonism to psychoanalysis. Romano, he recalls, “questioned whether there was sufficient evidence to make psychoanalytic psychology a general psychology, and he certainly did not feel that it constituted a sufficient body of knowledge for the teaching of psychiatry to residents in medical school.” Bartlett believes that Romano's questions were both “necessary and overdue,” and Rabinowitz is “thankful for the counterbalance of pragmatism, skepticism, and the abiding allegiance to the scientific method” of Romano and Engel.
When Engel came to Rochester, he was an internist with academic appointments in both psychiatry and medicine. However, he found himself in the awkward position of teaching in the department of psychiatry without having taken formal training in the field. Because of his renown everyone assumed he was a psychiatrist, but, he confessed, “I was barely a hairsbreadth ahead of the residents.” He applied for, took, and passed his boards in psychiatry without anyone having inquired whether he had taken a psychiatric residency. He began psychoanalytic training at the Chicago Psychoanalytic Institute because he considered analysis “an extraordinarily productive and promising way of understanding human behavior.”
Romano and Engel established the “special medical clinic” in the department of medicine: this was actually the first outpatient psychiatric clinic. Using the framework of psychoanalysis, Engel founded what became the Medical/Psychiatric Liaison Service, which was unique to Rochester. Romano obtained grants for over a hundred fellows trained in internal medicine to work with Engel. In 1962, Engel published his influential text, Psychological Development in Health and Disease. Two outstanding contributions from the Med/Psych Liaison were the research of Arthur Schmale on the relationship between loss and the onset of physical illness, and Engel and Reichsman's long-term developmental study of Monica, an infant with a gastric fistula.
As in many other centers, a cluster of apocryphal stories about the founding fathers surrounds the initial Rochester group. Jose Barchilon recounts an anecdote about Engel's analysis with Feldman. “Dr. Feldman,” Engel said in one session, “I think you are asleep. I counted your breathing, your motions. I can't quite tell, but I think that you are asleep.” To which Feldman replied, “And you are a scientist? Why didn't you turn around?”
Lyman Wynne, coming from NIMH and the Washington Psychoanalytic Institute, succeeded Romano as chair of the department of psychiatry in 1972. Wynne comments, “The Rochester department seemed dedicated to maintaining an integrative balance between the rapidly growing fields of neurobiology and psychopharmacology and the study of clinical and dynamic processes.”
Wynne wished to establish an analytic institute in Rochester and entered into negotiations with institutes in New York and Chicago. The major impediment at the local level was the lack of training analysts. Feldman died within a year of Wynne's arrival, and Rubin died a few years later. Local analysts did not meet The American's immersion standards for training analysts. Thaler and Bartlett were dedicated analysts but were full-time university professors, and thus had only limited time to devote to analysis. Repeated attempts to recruit training analysts were unsuccessful; times had changed, and there was no guarantee of a full-time analytic practice for an incoming analyst.
Although attempts to establish an institute in Rochester were unsuccessful, the influence of psychoanalytic thinking was profound. This influence is exemplified by Engel's use of psychoanalysis in the creation of the internationally known biopsychosocial model of health and disease, which he formulated in 1977.
Thaler, who became an important teacher in the medical school, explains the biopsychosocial model and its relation to psychoanalysis. The model is derived from two sources: the theory of evolution and the concept of information. Implied in the model is a hierarchical structure of organisms from the atomic level to the psychological and social levels. Each level is regulated by basic biological principles, such as adaptation, dynamic steady state, and ontogenesis. In addition, each level has its inherent structure and regulatory system. Psychoanalysis provides a theory of organization at the psychological level. But even more important than the theory, psychoanalysis is a highly useful method of listening and involving the observer. “What in psychoanalysis influenced me to turn to the biopsychosocial, Engel remarked, ”was that it reversed the dictum that the human part of medicine cannot be approached scientifically.“
The history of psychoanalysis in Rochester raises the question of why an institute was never
established after a promising, if difficult, beginning. Margolis observes that only those individuals who left Rochester maintained a prime professional identity as psychoanalytic practitioners or educators. Those remaining saw themselves primarily as medical educators, although heavily informed by psychoanalysis. He wonders if analysis could not flourish independently because its viability was too closely linked to a single department of psychiatry with its own set of priorities.
Be that as it may, at the present time the Western New York Psychoanalytic Society holds regular meetings, and psychoanalytic thinking is still appreciated in the medical school. Thaler reports that Eric Caine, current acting chair of the department, has encouraged the staff “to create innovative settings in which we can teach our residents how to talk with, listen to, and treat patients from a psychodynamic point of view.” In these days of the bottom line, the Rochester experience continues.
This article is based on the Oral History Workshop “Psychoanalysis in Rochester and Western New York,” held December 16, 1993. Robert S. Grayson chaired the workshop, in which James W. Bartlett, Norman M. Margolis, and Otto F. Thaler were interviewed by the late Sanford Meyerowitz. George Engel appeared on a 1977 videotape. A special thanks goes to Robert Grayson for his many helpful comments.