TO REDEEM ONE PERSON IS TO REDEEM THE WORLD (Book)

REDEEMING FRIEDA

(Free Press, 2001) Gall Hornstein, Ph.D.

You may have missed the news item about the demise of Chestnut
Lodge, a psychiatric hospital near Washington, D.C. The bankrupt hospital
was sold at auction last spring, a victim, in part, of managed care. The
news disturbed me, for Chestnut Lodge was the domain of Frieda
Fromm-Reichmann, whom I met more than 50 years ago in the course of my
psychoanalytic training.

Frieda, one of the 20th century's most prominent psychotherapists,
was deeply committed to the American belief that a determined effort can
solve any problem. She devoted her optimism--and her life--to treating
the most intractable of all mental health problems: schizophrenia. Her
efforts are the focus of Dr. Gail Hornstein's book, To Redeem One Person
Is to Redeem the World.

Born in 1889 to an Orthodox Jewish family in Germany, Frieda held
onto her heritage throughout her life. Indeed, the mystical doctrine of
Tikkun--to redeem one person is to redeem the world--was key to her
approach to treating schizophrenics. Bright and energetic, Frieda
completed medical school and became a psychiatrist. During World War I
she worked with Kurt Goldstein, who did groundbreaking research on brain
damage.

After the war, Frieda undertook training in psychoanalysis in
Berlin, first somewhat negatively with Hanns Sachs, one of Freud's
disciples, then more positively with Georg Groddeck, one of Freud's
contemporaries. Groddeck's conviction that psychotherapy could cure
anything--even cancer--certainly influenced Frieda's attitude toward
schizophrenia.

As Frieda's career prospered, she opened a sanitarium in Neuenheim,
Germany, where she became Erich Fromm's analyst--then his lover. Today
her behavior would be considered a serious breach of ethics, but then it
was merely the stuff of gossip. They married in 1927.

In 1935--after Hitler's rise shattered her career-Frieda left
Germany and eventually ended up at Chestnut Lodge. She remained at the
lodge for 30 years and, with Harry Stack Sullivan, led a group of young
analysts devoted to treating schizophrenics. Underlying Frieda's approach
was the assumption that schizophrenia's symptoms are the patient's
desperate efforts to escape terrors induced by childhood psychological
trauma. Frieda regarded schizophrenia not as a medical illness but as a
way of living. She believed that psychotherapy could vastly improve the
lives of some patients, provided that the therapist rejected all dogma
and was willing to do anything to help.

How successful was the effort? Do Frieda's methods have merit, or
are they rightly condemned by the biological juggernaut that psychiatry
is becoming? The book offers no clear answer. Hornstein, a psychology
professor at Mount Holyoke College in Massachusetts, attempts to be fair,
but her heart is clearly with Frieda and psychotherapy. She acknowledges
that many patients had prolonged hospitalizations with persistent and
serious symptoms, but she also makes frequent, rather vague assertions
that many patients did well.

Chief among the apparent successes is Joanne Greenberg, who later
wrote about her illness and treatment in her autobiographical novel, I
Never Promised You a Rose Garden. The book made Frieda into something of
a cult icon. Yet there is considerable controversy about the case: While
some point to Greenberg as proof of psychotherapy's healing powers,
others argue that Greenberg never had schizophrenia. Among the failures
is Herman Brunck, who did not recover and later committed suicide.
Hornstein defends Frieda against the allegation that Frieda's
incompetence was responsible for his continued illness and subsequent
death. She also defends Frieda's use of the term "schizophrenogenic
mother," a phrase that suggests mothers cause the disorder.

Perhaps the most cogent piece of evidence offered on the efficacy
of the lodge is found in a footnote summarizing results between 1910 and
1960. Of the patients discharged during this period, more than 70 percent
were judged improved. This is not very informative, however, since
Hornstein asserts that "the lodge counted almost any change as
improvement."

Readers will no doubt argue the merits of Frieda's views on the
nature of schizophrenia and the value of psychotherapy in its treatment.
But I think they will agree that Hornstein's book is a lively,
well-written account of a charismatic leader in an important period of
psychiatry's history. A period that now appears to be fading fast.

Reviewed by Paul Chodoff; Edited By Paul Chance, Ph.D.

Paul Chodoff, M.D., has been a practicing psychiatrist for more
than 50 years. He met Frieda Fromm-Reichmann in 1950 during his training
in psychoanalysis.