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Social and Integrative Approaches with the two complementing one another. The
book series started in 2004 and by 2012 had 13 volumes with several more in
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publications/journal

Psychosis, Psychoanalysis and Psychiatry in Postwar USA: On the

borderland of madness
Orna Ophir

Meaning, Madness and Political Subjectivity: A study of schizophrenia and

culture in Turkey
Sadeq Rahimi

Models of Madness: Psychological, Social and Biological Approaches to

Schizophrenia 1st Edition
Edited by John Read, Loren R. Mosher & Richard P. Bentall

Psychoses: An Integrative Perspective

Edited by Johan Cullberg

Evolving Psychosis: Different Stages, Different Treatments

Edited by Jan Olav Johanessen, Brian V. Martindale & Johan Cullberg

Family and Multi-Family work with Psychosis

Gerd-Ragna Block Thorsen, Trond Gronnestad & Anne Lise Oxenvad

Experiences of Mental Health In-Patient Care: Narratives from Service

Users, Carers and Professionals
Edited by Mark Hardcastle, David Kennard, Sheila Grandison & Leonard Fagin
Psychotherapies for the Psychoses: Theoretical, Cultural, and Clinical
Integration
Edited by John Gleeson, Eión Killackey & Helen Krstev

Therapeutic Communities for Psychosis: Philosophy, History and Clinical

Practice
Edited by John Gale, Alba Realpe & Enrico Pedriali

Making Sense of Madness: Contesting the Meaning of Schizophrenia

Jim Geekie and John Read

Psychotherapeutic Approaches to Schizophrenia Psychosis

Edited by Yrjö O. Alanen, Manuel González de Chávez, Ann-Louise S. Silver &
Brian Martindale

Beyond Medication: Therapeutic Engagement and the Recovery from

Psychosis
Edited by David Garfield and Daniel Mackler

CBT for Psychosis: A Symptom-based Approach

Edited by Roger Hagen, Douglas Turkington, Torkil Berge and Rolf W. Gråwe

Experiencing Psychosis: Personal and Professional Perspectives

Edited by Jim Geekie, Patte Randal, Debra Lampshire and John Read

Psychosis as a Personal Crisis: An Experience-Based Approach

Edited by Marius Romme and Sandra Escher

Models of Madness: Psychological, Social and Biological Approaches to

Psychosis 2nd Edition
Edited by John Read and Jacqui Dillon

Surviving, Existing, or Living: Phase-specific Therapy for Severe Psychosis

Pamela Fuller

Psychosis and Emotion: The Role of Emotions in Understanding

Psychosis, Therapy and Recovery
Edited by Andrew Gumley, Alf Gillham, Kathy Taylor and Matthias
Schwannauer

Insanity and Divinity: Studies in Psychosis and Spirituality

Edited by John Gale, Michael Robson and Georgia Rapsomatioti
Psychotherapy for People Diagnosed with Schizophrenia: Specific
techniques
Andrew Lotterman

Creativity and Psychotic States in Exceptional People: The work of

Murray Jackson
Murray Jackson and Jeanne Magagna
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Psychosis, Psychoanalysis and
Psychiatry in Postwar USA
On the borderland of madness

Orna Ophir
First published in 2015 in English as Psychosis, Psychoanalysis and
Psychiatry in Postwar USA: On the borderland of madness
by Routledge
27 Church Road, Hove, East Sussex, BN3 2FA
and by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa
business
© 2015 O. Ophir
The right of O. Ophir to be identified as author of this work has
been asserted by her in accordance with sections 77 and 78 of the
Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or
reproduced or utilised in any form or by any electronic, mechanical,
or other means, now known or hereafter invented, including
photocopying and recording, or in any information storage or retrieval
system, without permission in writing from the publishers.
First published in Hebrew as On the Borderland of Madness:
Psychoanalysis, Psychiatry and Psychosis in Postwar USA 2013
by Resling
Trademark notice: Product or corporate names may be trademarks
or registered trademarks, and are used only for identification and
explanation without intent to infringe.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
Ophir, Orna.
Psychosis, psychoanalysis and psychiatry in post war USA :
on the borderland of madness/Orna Ophir.
  pages cm
Includes bibliographical references and index.
1. Psychoanalysis—United States—History. I. Title.
BF173O546 2015
616.89'17097309045—dc23
2014045747
ISBN: 978-1-138-82352-5 (hbk)
ISBN: 978-1-315-74201-4 (ebk)

Typeset in Galliard
by Apex CoVantage, LLC
Contents

Acknowledgments xi

Introduction1

1 Freud’s dual view of schizophrenia (1894–1940) 13

2 Ravens in white coats: The medicalization of American

psychoanalysis (1909–1954) 27

3 Psychoanalysis, psychopharmacology and community psychiatry

(1954–1970)43

4 The “dopamine hypothesis” and evidence of genetic factors in

schizophrenia (1971–1980) 69

5 The emperor’s new clothes: DSM-III and the abandonment of

psychodynamics in favor of the biomedical model (1980–1990) 97

6 The last battle of psychoanalysis? The Decade of the Brain

(1990–2000)133

7 The many faces of Schreber as the face of American psychoanalysis

(1954–2000)171

Epilogue187

Index 191
This page intentionally left blank
Acknowledgments

This book is based on a study conducted at the Cohn Institute for the History
and Philosophy of Science and Ideas at Tel Aviv University. I want to thank Pro-
fessor José Brunner, who at the time of writing was the Director of the Minerva
Institute for German History, whose sustained interest and serious investment in
this project transformed a troubling question of a clinician working in a mental
hospital into a rigorous research project in the history of psychiatry and psychoa-
nalysis. Thanks to the generous support of the School of History at Tel Aviv Uni-
versity, I was able to take time off my other obligations and devote the necessary
concentration to this archival and methodological research.
The deep passion I developed for exploring the historical and institutional
relationships among psychoanalysis, psychiatry and the phenomenon and treat-
ment of psychosis was largely due to the many years I was an active member on
the staff of the Shalvata Mental Health Center in Israel. I will always be in debt
to the many patients I met there, to their families and to the dedicated colleagues
on the hospital’s staff whose total commitment to the humane care of severely ill
patients is truly exceptional and exemplary. I am especially grateful to Dr. Shlomo
Mendlovic, the Head of Department C, whose energy and involvement in the
field of dynamic psychiatry and hospitalized patient care has inspired me ever
since I was fortunate enough to meet him. He has inspired many generations
of clinicians and continues to do so to this day. I owe a special thanks to Joshua
Durban, an exceptional psychoanalyst and mentor, whose psychoanalytic work
with primitive states of mind has been essential in writing this book.
I also want to thank my translators Adi Avivi, a sensitive and clearheaded psy-
chologist, and Zvi Weiss, promising Ph.D. student, both of whom are among
the finest products of a very special doctoral program in clinical psychology at
Long Island University, which has welcomed me among its faculty for the last
two years. I want to thank Maryellen Lo Bosco, my copyeditor, who checked
and corrected the manuscript with meticulous care. Thanks to Alison Summers
and Nigel Bunker, coeditors of ISPS book series, who showed interest in bringing
this book to publication, and to Clare Ashworth and Emily Bedford for helping
to make it happen.
I am deeply grateful to Professor Danielle Knafo, a faculty member in the Seri-
ous Mental Illness concentration of Long Island University’s doctoral program in
xii Acknowledgments
Clinical Psychology. She demonstrated unwavering faith in my writing and teach-
ing. Her trust and good advice provided important support at a crucial moment,
and her paradigmatic role in training young clinicians to use psychoanalysis in the
treatment of severe mental illness remains, in my view, unmatched.
Since I arrived in New York in August 2008, I have found two professional
homes: the Kleinian clinical group, led by Ms. Karen Proner, and the DeWitt
Wallace Institute for the History of Psychiatry at Weill-Cornell Medical College.
Ms. Proner and the members of the Klein group, and especially James Peel, Ali-
son Bruce and Aleksandra Wagner, were a constant reminder that psychoanalytic
work with very primitive mental states is possible and beneficial.
At Weill-Cornell, I have been privileged to meet many of the people who were
an integral part of the very history I was writing. I would like to thank Professor
George Makari and Dr. Nate Kravis for the warm hospitality and scholarly feed-
back, which they have unfailingly offered over these last few years. I have greatly
profited from the contributions of all the members of the Richardson Seminar, as
well as from deeply motivating conversations with the members of the History of
Psychoanalysis Working Group, both at Weill-Cornell. I especially want to thank
Larry Friedman, Leni Goopman, Barbara Stimmel, Ted Shapiro, Bob Michaels
and Kathy Dalsimer for their curiosity, attentiveness and intellectual generosity.
I’m grateful to my friends at Das Unbehagen, a free association of psychoanaly-
sis in New York that collects the finest young minds in psychoanalysis and proves
that psychoanalysis is not only alive, but also kicking!
Ruth Weinberg, Antal Tsur, Aya Seker, Efrat Shamgar, Tsibi Geva, Smadar Eli-
asaf, Sefi Rosen, Daphna Spigelman, Gil Talmi and Shiri Broza have always been
there through many years of friendship, which I deeply cherish.
I thank my beloved family members: my husband Hent, whose presence in my
life is nothing short of a miracle, my daughters Britt and Alma, whom I absolutely
adore and profoundly admire, and my brothers Ori and Arnon, who have always
been surprisingly tolerant and forgiving whenever their sister decided to immerse
herself more and more deeply in the theorization and treatment of madness.
Most of all I am grateful to my parents, Aliza and Avigdor Ophir, who were
always a safe haven in my life, thereby allowing me to take intellectual, emotional
and other journeys into the borderlands of madness. This book is dedicated to
them with love and gratitude.
Orna Ophir
New York, September 2014
Introduction

The relationship between American psychiatry, psychoanalysis and psychosis

belongs to the discourse that Michel Foucault calls the “history of the present.”
Although this volume offers a historiography of schizophrenia – the paradigmatic
form of madness in the modern era of psychiatry as constructed in postwar Amer-
ican psychoanalysis – its concern is with a present in which mentally ill individuals
are deprived of psychoanalytical treatment or other forms of psychological thera-
pies. Some might say this is a modern form of the incarceration of the mentally
ill, who were first released from their chains by well-known enlightenment figures
such as Pinel, Tuke, Chiarugi and Rush.
Since it covers approximately the last four decades of the 20th century, dur-
ing which psychoanalysts’ theoretical approach to psychosis and clinical work
with schizophrenic patients underwent a dramatic transformation, this volume
seeks to explore a paradox in American psychoanalysis: although psychoanalytic
discourse exhibits much concern for the “psychotic parts” of otherwise healthy
people, it seems to have very little interest in those who suffer from major psy-
choses, both in theory and in practice.
Opening with Freud and his discussion of the legendary judge, Daniel Paul
Schreber, who complained that his somatic psychiatrists were performing “soul
murder” on him, and ending almost 100 years later with the actual murder of
Dr. Wayne Fenton, a prominent specialist on psychoanalysis and schizophrenia
from the generation of Chestnut Lodge, this book explores a troubling period in
the historical development of American psychoanalysis. During the investigated
period, the age-old psychiatrists’ version of Cartesian dualism (i.e., the somatic
versus the psychodynamic paradigm) shaped psychoanalysis’s theory of madness
and its praxis with psychotic patients to the point where it almost “lost its mind”
as it ventured to put “neurons in neurosis.”
As it follows psychoanalysis’s struggles and competition with somatic psychia-
try, as well as its dialogues and negotiations with psychiatry, this volume presents
the boundaries between these diverse professional landscapes not only as markers
of difference, segregating epistemic and disciplinary jurisdictions, but also as cap-
turing a fundamental social process of fatal osmosis and blurring of boundaries.
It further demonstrates how these different interactions between psychoanalysis
2 Introduction
and psychiatry, each in its own unique way, contributed to the various construc-
tions of the idea of schizophrenic madness in psychoanalysis and to the manifold
conceptualizations of its treatment.
The eventual transformation of psychoanalytic theory and praxis in its dealings
with schizophrenic madness took place during a neosomatic revolution in Ameri-
can psychiatry that spanned four stages, beginning with the emergence of so-
called antipsychotic medication during the 1960s and ending with George H. W.
Bush’s presidential proclamation of the “Decade of the Brain” in the early 1990s.
Psychoanalytic journals, which are the archives of professional abstract knowl-
edge, are tracked to determine the ways in which psychoanalysts constructed and
articulated, defended and shifted, undermined and transgressed the boundaries
of their profession as they sought to deal with schizophrenia, its theory and its
patients. This is more than simply a formal analysis. Rather, this volume dem-
onstrates how psychoanalysts enacted their professional identity by articulating
and formalizing their knowledge and disseminating it among their fellow prac-
titioners, all the while struggling and negotiating with neighboring professions.
It is argued that among the many relationships psychoanalysts entertained with
their “strange bedfellows” – that is to say, psychiatrists – some were weakening
their own social role as providers of expert service to ameliorate the problem of
schizophrenic madness, while others made themselves equal contenders in these
jurisdictional struggles between the professions.
Being both a historian of science and a practicing clinician and psychoanalyst,
who has worked for many years in psychiatric hospitals with patients suffering
from schizophrenia, I locate this book on the borderland between these fields –
historical research and its clinical implications. Although this study offers a his-
torical examination of the development of the concept of “madness” in American
psychoanalysis, it further crystallizes around questions of sociological history –
specifically, of defining the profession.
The metaphor of territories and jurisdictions, which is used in the context of
the sociology of professions, led to Andrew Abbott’s argument that the “real”
history of a profession is the one that focuses on its struggle over jurisdictions
with neighboring professions. Taking its lead from this intuition, this study on
the development and change of American psychoanalytic theory concerning
madness and its praxis with psychotic patients explores psychoanalysis as a pro-
fession that is part of a “system of professions,” and is thus prone to engage in
struggles with its contenders.
Psychoanalysis and psychiatry were struggling over jurisdiction since the very
founding of psychoanalysis, and the concept of schizophrenia in American psy-
choanalysis and its treatment were shaped by a neosomatic revolution that took
place in American psychiatry in four stages and spanned four decades, 1960–2000.
The first two chapters of this book mainly cover Freud’s corpus and second-
ary literature concerning Freud and psychoanalysis in America. The first chap-
ter, “Freud’s dual view of schizophrenia (1894–1940),” discusses Freud’s two
theories of schizophrenia: the unitary theory, which sees schizophrenia as only
quantitatively different from neurosis, and the specific theory, which sees it as
 Introduction 3
qualitatively different and thus unsuitable for psychoanalytic treatment. This
distinction evolved as part of Freud’s efforts to professionalize psychoanalysis
and a consequence of his attempts to prove psychoanalysis’s supremacy over
psychiatry. Since he aspired to explain the mind in part by studying its patholo-
gies, Freud was preoccupied with formulating a theory of schizophrenia. How-
ever, because of his belief that schizophrenic patients were incurable – immune
to a technique that sought to establish the “ego where id was” – he could not
afford for them to spoil his initial claim to have a successful therapeutic method
vis-à-vis psychiatry, and he declared schizophrenic patients as not analyzable. In
his later writings, when Freud became more realistic about the psychoanalytic
“cure,” he gradually also became more optimistic about the analyzability of
schizophrenic patients and in fact supported Ernest Simmel, the Berlin psycho-
analyst and founder of the first psychoanalytic sanatorium at Schloss Tegel, in
his efforts to establish a psychoanalytic sanatorium in the United States for this
population.
The second chapter, “Ravens in white coats: The medicalization of American
psychoanalysis (1909–1954),” argues that the medicalization of psychoanalysis in
America was the royal road of the profession to the “homeland” of psychiatry –
that is to say, to psychiatric hospitals where schizophrenic patients were being
treated. But both American eclecticism and pragmatism, which together allowed
this process to run its course, were trends that also transformed psychoanalysis
into dynamic psychiatry. The resulting confusion of boundaries between psychoa-
nalysis and psychiatry initiated a process in which both professions regressed into
themselves to try to better define their expertise. As a result of this regression, psy-
choanalysis withdrew from psychiatric hospitals and its schizophrenic patients and
focused on private practice with the “worried well,” whereas psychiatry returned
to its origins, notably somatic medicine, but in a new guise as neosomatic psy-
chiatry, armed with a winning, quick and cheap treatment for schizophrenics –
namely, neuroleptic drugs.
Each of the four chapters that follows opens with a short discussion of the
formative event in somatic psychiatry in the field of schizophrenia during the
decade it explores. These chapters analyze the reaction of American psychoa-
nalysis to these major events, as it is found in the primary literature – that is to
say, in the archives of psychoanalysis as a profession. This discursive analysis puts
special emphasis on the theoretical construction of schizophrenia, as well as on
the suggested therapeutic techniques developed for treating those suffering from
it. Because this is a panoramic view of the psychoanalytic approach to schizophre-
nia in each decade, it examines the way in which psychoanalysis was described by
different analysts, both prominent and peripheral, and used more than just the
canonical works. This study draws on articles that are explicitly about schizophre-
nia, as well as some that touch on the subject secondarily. Other sections of jour-
nals were also examined, such as “at issue” discussions, book reviews and the like.
Perusal of all journal materials allowed for a comprehensive conceptualization
of schizophrenia during those years – and both implicit and explicit perceptions
among American analysts.