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It is a sad fact that the name of
Frieda Fromm-Reichmann has almost been forgotten and her contributions to the
field of clinical psychoanalysis considered at best irrelevant, and at worst
dangerous. Yet Fromm-Reichmann was instrumental in founding the first, and only,
hospital devoted specifically to the psychoanalytic treatment of psychotic
patients. For more than two decades Fromm-Reichmann was the hospital's most
important clinician, researcher and author. Still, just half a century after
her death, she is known only for her introduction of the concept 'schizophrenogenic
mother', which she never considered to be very significant. Therefore, this
biography, written by Gail Hornstein, is extremely important as it will,
hopefully, reestablish Fromm-Reichmann's position not only in the history of
psychiatry and psychoanalysis, but as an author relevant for contemporary
psychotherapeutic approaches to psychosis.
The book is also important as an illustration of
an excellent psychoanalytically informed biography. This "cradle to grave"
biography obviously took Hornstein, a psychology professor, many years of
meticulous work. It is obvious that she has studied everything available on
Fromm-Reichmann`s work and life, but also a lot of material considering her
relatives, friends and colleagues, who were important for her development. Hornstein
has spent hundreds if not thousands of hours in the Chestnut Loge archives and
presents us, the reader, with much previously unpublished information. The
author is also careful to contextualize the biography: she puts Fromm-Reichmann
in the perspective of her growing up in Central Europe, of her Jewish identity
and its influence on her decision to pursue a career in medicine, of the First
World War and her work with traumatized soldiers, and of working within the
East Coast, predominantly WASP environment of the "Chestnut Lodge" hospital.
Furthermore, Hornstein writes in detail about persons whom Frieda
Fromm-Reichmann considered her teachers: Kurt Goldstein, Georg Groddeck, and
Harry Stack Sullivan. Although this treatises of Fromm-Reichmann`s teachers is
short it does reveal their profound influence on her; not in theory or
therapeutic technique, but in her stamina and devotion to the principle that
human contact, and psychotherapeutic relationship, can help patients overcome
almost every traumatic experience, at any point of their lives. A kind of
special emphasis is given to Freud's influence on Fromm-Reichmann, demonstrated
during her career as an author: she never renounced Freud's ideas, in any of
her work, but claimed to be improving them. It is strange that Hornstein did not
provide more information on the possible, and probable, influence Frieda
received from Erich Fromm, her one-time husband, and a very important,
influential author in various branches of social science and psychoanalysis,
but decided to study only their personal relationship.
By far the most important part of
the book is the second half. Frankly speaking, this is the very reason the book
was written after all. This part of the book is devoted mostly to the topic of
psychoanalysis and psychosis. A full chapter is devoted to describing the founding
of Chestnut Lodge as a psychoanalytic hospital specializing in treating
psychotic patients. Many of the organizational details and psychotherapeutic
strategies are revealed in detail. The first one that deserves to be mentioned
here is the special emphasis on commitment. One should be aware that in
Chestnut Lodge psychotherapy and treatment were synonymous. The staff,
including doctors and psychologists, was living on the grounds of the hospital
which made them available to the patients at a moments notice, day or night. In
Fromm-Reichmann's case this meant something like fifteen hours of daily work,
each week, excluding two summer months that she used as a vacation. Essentially
Fromm-Reichmann was conducting something like ten to fifteen sessions, with
hugely disturbed psychotic patients, every day. After that Frieda reserved her
evenings, nights, and weekends for writing her papers.
The basic Chestnut Lodge strategy
was to try to understand what symptoms meant, and not to ridicule or scorn
them. The psychotherapeutic process itself included sometimes months of waiting
for the first effort on the part of the patient to communicate. Often patients
would mumble, keep silent or yell at the therapist for many sessions. Once the
therapeutic communication was initiated, the process would sometimes last for
years, or even decades. Usually, patients would be dismissed from the hospital
but would continue to attend psychotherapeutic sessions.
This kind of work included a
specific psychotherapeutic technique. Fromm-Reichmann insisted that the most
important aspect of the psychoanalytic process was the forming of the relationship.
Indeed she would more often answer the communication than interpret it. Of
course, given that the patients were severely disturbed the usual
psychoanalytic setting could not always be maintained. Analysts of Chestnut
Lodge would keep sessions while walking with their patients, over lunch, over
coffee, sometimes in their consulting rooms or sometimes on the locked wards.
In the early 1950s, Chestnut Lodge became a
research institution as well. Some of the most important research projects on
the psychodynamics of psychotic process were held there. Frieda
Fromm-Reichmann was included in many of these projects until her death in 1957.
One of the most important examples is her research on the phenomenon of
intuition, which showed that intuition was not a supernatural or paranormal
phenomenon, but a consequence of subliminal perceptions of patients' non-verbal
If fame could ever have been associated with
Frieda Fromm-Reichmann`s name it came after the publication of the novel I
Never Promised You a Rose Garden, written by a former patient of
Fromm-Reichmann's, whose name turned out to be Joanne Greenberg. Greenberg's
novel described her psychotherapy with Frieda, and documented a complete
recovery after a schizophrenic breakdown after several years of treatment in
various hospitals. The book intrigued many readers and thousands were writing
to the publisher hoping to be able to get in touch with Frieda, hoping to find
a solution to their own, or their relatives' problems. The popularity was such
that in 1984 the story was adapted into a film, with Bibi Anderson playing
Frieda Fromm-Reichmann, and 1997 saw book sales reach five million.
Still, even during Frieda's lifetime there were
many controversies about her approach to psychoanalysis. Many psychiatrists expressed
a deep skepticism whether a non-biological approach to psychosis could ever be
effective, and psychoanalysts thought her techniques not "psychoanalysis
proper". Frieda's contribution at Chestnut Lodge itself was such that
after her death people realized that only a person of rare and special talent
and endurance could achieve such dramatic results. For decades she had
accepted cases too difficult for others, and it seemed that her unique approach
required a therapist as talented as she herself was.
There were also controversies about
her as a person: during her last years she was haunted by progressive deafness,
an inherited problem that her parents suffered from as well. During those
years, she also found out that she knew almost no one but patients. Her family
members lived either in Europe or in Israel, and her friends were further and
further away. Ironically, the greatest controversy about her life may be the
way she died. In 1957 Frieda was discovered dead in a bathtub, and although
there was no evidence many of her friends suspected she had committed suicide.
In the following decades,
Fromm-Reichmann's The Principles of Intensive Psychotherapy was one of
the most important textbooks for students of psychology and psychiatry alike.
But, after the mid-80s the book came to be regarded more as an example of the
history of psychotherapy. It is a sad fact that most contemporary psychologists
and psychiatrists have not even heard of Frieda Fromm-Reichmann, or if they
have can say little of substance about her work.
If there is a living legacy of her
work, it is embodied in the "International Society for the Psychotherapy
of Schizophrenias and other psychosis" (www.isps.org). This organization,
which by now has several national branches, conducts research, organizes
conferences, and publishes books devoted to psychological approaches to
psychotic phenomena. Gail Hornstein's book will prove to be an important ally
in the fight to remember the importance of Fromm-Reichmann's ideas and theories.
If To Redeem One Person Is to Redeem the World, which is a product of
several years of extraordinary scientific commitment, written with elegant style,
and persuasive interpretation of data, reaches a wider audience in this
paperback edition, readers will inevitably be affected by Fromm-Reichmann`s
personal and professional ethos: an unrelenting insistence that there is no
human being whose condition is beyond hope.
© 2006 Aleksandar
Aleksandar Dimitrijevic, Faculty
of Philosophy, Department of Psychology, Belgrade, Yugoslavia.