To Redeem One Person is To Redeem the World: The Life of Frieda Fromm-Reichmann (Book Review)

Author:  Hornstein, Gail A.
Publisher: New York: Free Press, 2000
Reviewed By: Karen W. Saakvitne, Summer 2001, pp. 51-53

I have to begin by confessing that Frieda Fromm-Reichmann is one of my long-time heroines. So, when I received this book as Christmas gift, I promptly immersed myself in it--all 444 pages! But one reads a biography of a hero or heroine with some anxiety. On the one hand, you want to understand the intimate influences on your heroine’s life choices and decisions and, on the other hand, you do not want to lose respect or affection for one who has inspired you. In particular, a heroine to one’s therapist-self embodies a professional ego ideal, and serves as an internalized object imbued with wisdom and vision, helping to sustain the therapist’s own hope and idealism. None of us can easily afford to lose that which gives us hope in our work.

Hornstein’s book is a tour de force; she is a meticulous researcher and elegant writer. She works wonders with minimal information about much of Fromm-Reichmann’s life without straying into wild analysis or romanticized fiction. What she does instead is elaborate the essential contexts of Fromm-Reichmann’s life: growing up as a German Jew between the world wars; being trained in the developing fields of psychiatry and neurology in the first half of the twentieth century, and forging the direction and identity of Chestnut Lodge, a unique American psychiatric hospital, after fleeing Nazi Germany and coming to the United States. The contexts of Fromm-Reichmann’s life are everything.

In a life profoundly shaped by the devastation of World War I and the horrors of the Nazi Holocaust, her refusal to give up on humanity or hope is the fundamental aspect of Fromm-Reichmann. Throughout the biography, Hornstein strives to understand and make understandable Fromm-Reichmann’s drive and complete dedication to her work from this perspective. One of the central strengths of this biography is Hornstein’s ability to integrate complex clinical, religious, philosophical, personal and historical perspectives. She makes it clear that one must understand the confluence of these influences on who Frieda Fromm-Reichmann was and how she chose to live her life.

An essential concept, and one that gave rise to the title of the book, is the Jewish tradition of Tikkun. The worldview of her Orthodox upbringing was embodied in this story, told by the great sixteenth-century rabbi Isaac Luria:

“During the process of creation, God’s divine emanations were gathered together and stored in sacred vessels. But the vessels, unable to contain the light pouring into them, shattered, fragmenting the divine sparks, which fell to earth. The world became chaotic: nothing was in its proper realm. The task of human history and the responsibility of every Jew is to rescue the divine sparks and restore order to the world. This is the work known as tikkun. When it is fully accomplished, redemption will come to everyone.” Tikkun is a collective task; no one person can perform it on his own. A divine spark is attached to each prayer, each charitable act, each moment of goodness. If a person fulfills her duty and strictly follows the ethical path, that spark is restored to its source in the divine realm. To assist another is to do God’s work. To redeem one person is to redeem the world” (Dan, 1986, pp. 94-103), (p. xvi).

What I found most fascinating and moving was Hornstein’s ongoing analysis of Fromm-Reichmann’s “revolutionary” belief that mental illness, including psychosis, was treatable by analytic treatment. Throughout the book she contrasts Fromm-Reichmann’s conviction in a meaning-based approach to psychopathology with the fundamental pessimism and helplessness of the psychiatry as a field. In doing so Hornstein offers a fascinating history of psychiatry in the twentieth century. Her research is extensive (in fact, I found the notes to be as much fun to read as the text), and the point of contrast is a dramatic one. Nowhere is this clearer than in her chilling discussion of the prevalence of lobotomies in American psychiatry in the mid-twentieth century.

Fromm-Reichmann’s first job as a physician was with brain-injured German soldiers wounded in the trenches during World War I. In this context, she learned two important principles: the impact of brain trauma on otherwise healthy men, and the remarkable adaptive capacity of the brain. She worked under the tutelage of Kurt Goldstein, whose treatment and research was inspired by an emphasis on the remarkable adaptations made by brain-injured patients, a radical change in focus for the field of neurology. Goldstein’s remarkably patient-centered approach to neurology and brain injury both influenced Fromm-Reichmann’s attitude toward patients and symptoms and was consonant with her early respectful, collaborative instincts in patient-care. He was probably her most influential teacher. Hornstein writes,

Frieda’s whole approach to treatment emerged from her research with Goldstein, and it is impossible to understand her later work with psychotics without appreciating this fact. Years of daily contact with brain-injured patients accustomed her to so wide a range of symptoms that schizophrenia never seemed especially bizarre to her (as it did to most analysts, trained solely in work with outpatient neurotics). Goldstein’s insistence that there was no such thing as “the brain injured patient” made Frieda highly sensitive to individual differences, and his ingenuity at locating strengths in even the most severely impaired person taught her never to regard any one technique as sacrosanct. And because the patients in Goldstein’s clinic had experienced traumas about which there was no ambiguity--unlike the many shell-shock victims being treated elsewhere, the “reality” of whose symptoms was contested both by physicians and military authorities--she never doubted that even the most mysterious behaviors had identifiable causes (p. 27-28).

To develop her psychotherapy skills, she next worked at a sanatorium with Johannes Schultz who taught her methods linking mind and body and introduced her to Freud’s written work. She subsequently pursued psychoanalytic training at the Berlin Institute founded by Karl Abraham. Her primary psychoanalytic teacher was Georg Groddeck, an iconoclastic and charismatic physician who ran a spa and employed a variety of techniques, including psychoanalysis, to “stimulate each patient’s hidden reservoir of health” (p. 34). She blended the approaches of Goldstein and Groddeck: “using whatever worked with each individual and relying on the patient’s own inherent capacity for healing to guide the treatment…. she began to evolve a unique clinical style that turned the therapeutic relationship into a fulcrum for change” (p. 37).

Although Hornstein does not elaborate the relational aspects of Fromm-Reichmann’s approach, what comes across clearly throughout the detailed reports of Fromm-Reichmann’s clinical work and clinical theories is her profound respect for the person who is a patient, and for the patient’s illness, his or her psychological processes. She was convinced that mental illness made sense, that symptoms reflected the desperate measures necessary to respond to desperate danger. This adaptation focus led her to remain calm and curious in the face of seemingly nonsensical language and bizarre behaviors. It also led her to be courteous and straightforward with patients. It is a shameful truth that this approach of basic respect for the personhood of psychiatric patients stands in such stark contrast to common psychiatric practice, then and now.

One testament to the power of Fromm-Reichmann’s willingness and capacity to engage in a deep relationship with her clients is the central role in this book of Joanne Greenberg, Frieda Fromm-Reichmann’s former patient and author of I Never Promised You A Rose Garden. Greenberg did not write Rose Garden intending it to be a biography of, or memorial to, Frieda Fromm-Reichmann, although she and Frieda had discussed collaborating on a book about their work together. Yet Greenberg has proved to be an important source of information about Fromm-Reichmann. Because Fromm-Reichmann’s clinical style was to be present and knowable to her patients, perhaps it is fitting that we know her most intimately through the account of her patient.

In a videotaped lecture to mental health professionals on the topic of the use of metaphor in psychotherapy, Greenberg reported that when she retreated to her own inner world during a psychotherapy session, Fromm-Reichmann would say gently, not “come back,” but “take me with you.” The relational implications of that choice of words to a person living in a terrifying delusional world are profound. Fromm-Reichmann brought both conviction and humility to her therapeutic relationships, and that combination helped her create safety with patients who lived in terror of contact. Her unromanticized understanding of the risks to the patient of the process of psychotherapy made her empathy far more genuine. She recognized the role of trauma in mental illness, and the trauma of mental illness and maintained her esteem for the sufferers of both.

Fromm-Reichmann’s practical application of the theory of interpersonal psychiatry enriched the theory and furthered its dissemination. Both as an analyst and as a supervisor and teacher, Fromm-Reichmann modeled the application of Sullivan’s central constructs and added to our understanding of dynamics of the therapeutic relationship. Her combination of responsibility and hope were sources of Frieda Fromm-Reichmann’s indomitable spirit in her professional work. In her lifetime, it made her a teacher, mentor, and stern taskmaster, as well as an exceptional clinician. She expected the same dedication and stamina from all others, seemingly unaware of the enormity of the demand. A story told by Martin Cooperman, a young psychiatrist at the Lodge in the 1950s, captures the quality and impact of this sturdy optimism:

“He was treating a woman who was very regressed and had been on the fourth floor for months. When he first saw her, she was hanging from a screen on the outside porch. He took a chance and had her transferred to a more open ward. She perked up and began talking to him in their sessions. A month or two went by, and he started to think she was improving at last. Then one day she showed up in a totally deteriorated state, looking as bad as she had on that first day. Cooperman was devastated. Walking dejectedly over to the dining room, he ran into Frieda, who asked what was troubling him. He blurted out the story and said he had no idea what to do. Frieda gave him a long look and said, “Well, there’s movement.” It had never occurred to him to look at it like this. It mattered less whether the patient was up or down at any given moment than whether change was taking place. Forty years later, Cooperman called this, “the single most important statement ever made to me about psychotherapy” and said it had given him the courage to go on working with psychotic patients” (p.296).

Her philosophy of treatment necessitates a large commitment from the clinician. It requires patience and dedication, and an ability to delay the gratification of rapid dramatic change. Many are unable to sustain such effort and commitment. Holding hope in face of repeated frustration is often a painful endeavor. I however, am grateful that she was able to rescue Dr. Cooperman from despair, as he was one of my supervisors at Austen Riggs thirty years later. He was able to pass on that legacy of hope, the stalwart belief in the process of psychotherapy with seriously ill patients that is perhaps the greatest long-term gift of the work of Frieda Fromm-Reichmann.

It can be argued that the second half of the book is as much the story of Chestnut Lodge as of Frieda Fromm-Reichmann. This actuality reflects a truth of the woman who was an institution at the institution that was Frieda Fromm-Reichmann. It is a terrible irony that Chestnut Lodge closed its doors so soon after the publication of this book. In an editorial in her local paper, Hornstein wrote,

Mental patients have never had many options in America, but last month they lost one of the few quality care facilities they ever managed to have. Chestnut Lodge, an internationally renowned hospital outside Washington, DC, and for decades a symbol of progressive treatment, closed its doors on April 27…. By insisting that even the most bizarre patient was a human being deserving respect and thoughtful care, Chestnut Lodge allowed people to be sick and not punished for it. Chestnut Lodge embodied Frieda Fromm-Reichmann’s idealistic hope that a properly designed psychiatric hospital could be a truly therapeutic institution. Its loss denies the humanity of mental patients and cheapens our own (Daily Hampshire Gazette, May 18, 2001).

The major weakness of the volume was in its conclusion. Hornstein’s choice of epilogue was an ill-fitting one for her subject. A biography of Frieda Fromm-Reichmann, who worked to inspire generations of psychoanalysts, should end with hope and inspiration, rather than the despondent account of the lecture by Stone at Harvard Business School. In that conclusion, Hornstein asserts that a treatment has to fit the patient’s metaphor of his or her illness (giving several examples of widely diverse, but successful--by the patient’s account--treatments), yet she fails to note that each treatment modality occurred in the context of a treatment relationship. The meaning (and conscious and unconscious components) of the patient’s relationship to the psychiatrist who recommended or performed the technique also plays a role in the patient’s experience of the treatment. It is surprising after an entire biography of an analyst who epitomized the significance of the analyst to the therapeutic relationship and its outcome that Hornstein would have let her analysis stand without acknowledging the relational context. It felt as though Hornstein herself fell victim to the loss of hope and cynicism expressed by Alan Stone and other disillusioned psychoanalysts.

Fromm-Reichmann believed in the human potential for healing. She believed in the humanity of those who suffer. She neither feared nor resented that which she did not understand. Throughout her professional life she engaged in a process of learning and was, at the same time, a committed teacher. It is a sad truth that her principles continue to be “revolutionary.” Perhaps it will always be revolutionary to listen carefully to that we do not understand, to believe that we wish not to be true. Perhaps it will always be revolutionary to collaborate when we could control, to defer when we could assert authority. Perhaps it will always be revolutionary to eschew categories for individuality, and to let the patient inform our theories rather than the other way around. If so, then we must all have the courage to be revolutionaries in our work.

Although, Frieda Fromm-Reichmann would never have described herself as a revolutionary, she has inspired us to continue the battle for humane, intelligent, and relational treatment of those in psychological pain. I will not say that Fromm-Reichmann emerged unscathed from her biography. She is more human than the idealized heroine I have carried, but my respect for what she taught and believed are undiminished. We cannot afford to forget Frieda Fromm-Reichmann. Hornstein’s wonderful biography of Frieda Fromm-Reichmann is well worth reading.

Karen W. Saakvitne is the clinical director of the Traumatic Stress Institute and co-author of Trauma and the Therapist, and recently, Risking Connection: A Training Curriculum for Working with Survivors of Childhood Abuse, and its companion teaching manual, Relational Teaching, Experiential Learning. She is the former secretary for Division 39 and serves on the Advisory Committee on Colleague Assistance for APA.

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