The disease in question was psychoanalysis, the controversial practice Freud had developed to treat mysterious mental illnesses in his mainly female patients. It first became fashionable in Freud’s native Vienna in the early years of the 20th century, and soon spread to Paris, London, Berlin, Budapest and elsewhere.
In the United States, New York is the city perhaps most frequently associated with the practice— it is home to more psychoanalysts than any other U.S. city, as any Woody Allen fan knows. Yet Baltimore, too, played a major role in the early days of psychoanalysis. Many of the field’s first luminaries lived here, and the city witnessed the development of several groundbreaking psychological treatments. In fact, the very first meeting of the American Psychoanalytic Association, on May 9, 1911, was held in the Stafford Hotel in Mount Vernon.
When Freud, along with Carl Jung, visited America in 1909, it was at the invitation of the pioneering psychologist G. Stanley Hall, president of Clark University in Massachusetts, where Freud gave a lecture on his controversial new method of treatment. His talk was attended by a group of prominent U.S. physicians who were so vitalized by the new ideas that they gathered together to form an American branch of the Psychoanalytic Association, which was established, with Freud’s blessing, two years later here in Baltimore.
Looking back, psychoanalysis doesn’t seem all that radical— at least, not compared with such drastic treatments as lobotomy and electro-convulsive therapy. But in 1911, the men who gathered in the Stafford Hotel were cutting-edge in their embrace of the controversial practice, which quickly became notorious for the emphasis it placed on sexuality. Using a technique adapted from hypnosis, Freud required patients to lie on a couch and say anything that came to mind, however irrelevant or embarrassing it might seem. By paying careful attention to patients’ random associations, especially from their dreams and childhood memories, Freud believed he often got to the root of their current problems, which generally lay in the unconscious.
Before Freud, many psychiatrists believed that the mentally ill could not be cured; the root cause of mental illness was widely believed to be either heredity, or such vices as alcoholism and masturbation. Freud, on the other hand, believed neurosis was a condition of civilization that affects us all, to some degree or other. His aim was to turn “hysterical misery” into “ordinary unhappiness,” which may seem modest in the age of Prozac and pharmaceutical advertising. But for the middle-class Victorian in a desperate struggle with depression, it was a major achievement.
The early records of the American Psychoanalytic Association have been lost, but we know that 15 eminent psychiatrists were present at the Baltimore meeting, including Hall; Freud’s close colleague and biographer Ernest Jones; and the Austrian-born psychiatrist Abraham Brill, who went on to translate a number of Freud’s works and introduce them to the American public. Also present was the influential New York neurologist Smith Ely Jelliffe, who counted among his patients the playwright Eugene O’Neill. (“Just consulted Jelliffe, famous specialist here, on Mama’s case,” O’Neill wrote to his eldest brother Jamie in 1924. “He says hopeless.”)
The association’s charter members also included a number of Baltimore-based physicians such as Adolf Meyer, a professor of psychiatry at Johns Hopkins University. Meyer had attended seminars conducted by Jung, and later became known as the first psychiatrist to make a habit of collecting detailed case histories of his patients, and to insist they could best be understood through consideration of their past in the context of their family lives.
He later adopted Freud’s ideas about the importance both of sexuality and the formative influence of early rearing on the adult personality. Two years after the first meeting of the American Psychoanalytic Association, Meyer founded the Henry Phipps Psychiatric Clinic at Johns Hopkins Hospital, which was the first inpatient facility in the United States for the mentally ill. The Phipps, where Zelda Fitzgerald was treated, was an architectural masterpiece in its own right, with marble floors, lush gardens, grand porches, fireplaces and even its own pipe organ. Meyer not only treated Zelda with psychoanalysis, he infuriated her husband by suggesting that he, too, undergo the process.
F. Scott Fitzgerald refused, asserting that such treatment would undermine his creativity.
Less famous but equally influential was the Baltimore-based psychiatrist Trigant Burrow, who earned a Ph.D. in psychology from Johns Hopkins in 1909, and who came to be known as the founder of group therapy. Burrow met Freud and Jung in 1909 on their visit to New York, and the following year, Burrow left Baltimore and traveled to Zurich, accompanied by his wife and two young children, to undergo a yearlong analysis by Jung. A letter written home to his mother in 1910 revealed that, although its reputation was growing, psychoanalysis was still stigmatized. “Mother,” wrote the 35-year-old doctor. “Please never say to anyone that I am interested in the insane or visiting an insane asylum … no one, especially no one in America, wishes to believe there is any analogy, however remote, between a neurasthenia and a true insanity, but the fact is a morbid psychology underlies and it is at the root of both.”
Upon his return to Baltimore, Burrow moved his family into a large house at 707 St. Paul St., where he also had his consulting room. He remained in touch with both Freud and Jung, who, at the time, were still close friends and collaborators though they differed on their perception of the New World. Freud was contemptuous of Americans, believing they had channeled their sexuality into an unhealthy obsession with money (“America is the most grandiose experiment the world has seen, but, I am afraid, it is not going to be a success,” he wrote to Jung). And he refused to consider the United States as a possible safe haven, even after World War I broke out in Europe. “Trigant Burrow yesterday assured me tenderly of his sympathy because of the plight of my country, and seriously offered me his house in Baltimore as a place of refuge!” he wrote scornfully to a colleague on Dec. 21, 1914. “That is how they think about us in America.”
Jung, however, did not share his colleague’s disdain, and when Burrow made him the same offer, he accepted gratefully, and stayed with the doctor and his family at 707 St. Paul when he came to Baltimore to lecture at Johns Hopkins in September 1912. The visit was a success, and Jung returned the following month to lecture at St. Elizabeth’s Hospital in Washington, D.C., and to study what he described to Freud as “the dreams and fantasies of pure-bred negroes suffering from mental disorders.” He had traveled to Africa twice in the 1920s, and was particularly interested in discovering whether the unconscious was “racially inherited,” and whether Africans “have the same types of dreams that we have.” After a close analysis of 15 “negro” patients, he concluded that the unconscious mind has nothing to do with blood or racial inheritance. “In the collective unconscious,” he observed, “you are the same as a man of another race, you have the same archetypes, just as you have, like him, eyes, a heart, a liver, and so on.”
In 1921, Dr. Burrow was faced with a disturbing challenge in the consulting room of his Baltimore office. One of his patients, a working-class man named Clarence Shields, suggested to Burrow that psychoanalysis could never be complete as long as the analyst was in a position of authority. Shields demanded his analyst be more forthright, and, in an unusual experiment, the two men switched roles, Burrow lying on the couch while Shields analyzed his “patient.” At the time, there had been no questioning the analyst’s authority, and it was a shock to Burrow to realize “that, in its individualistic application, the attitude of the psychoanalyst and the attitude of the authoritarian are inseparable.” As a result of this revelation, the two men, Burrow and Shields, invited former patients, family members and other associates to join in their study, which led to the establishment of group therapy, a tradition that is still practiced today.
Hourly fees in the days before insurance were far more manageable than they are today, and a session on Burrow’s couch in the 1920s would have cost around $5, which was the same price as a night’s stay at The Belvedere, Baltimore’s grandest hotel at the time. Still, the cost of such treatment was quite prohibitive for the vast majority of citizens, including most of the middle class. When compared to the average income of people in the U.S., it is clear that privately funded psychoanalysis was strictly for the wealthy. Baltimore in the 1930s was not an especially prosperous town, and neither was it particularly sympathetic to innovations. Fewer and fewer psychoanalysts chose to call Baltimore home, and by 1938, the American Psychoanalytic Association had moved to New York City, which soon became the headquarters for psychoanalysis in the United States.
Although Baltimore no longer had a major role to play, its connections with psychoanalysis remained strong, thanks mainly to the impact of certain influential individuals who lived and practiced here. These included Baltimore-based author and social critic Robert Lindner, best known for his book “Rebel Without A Cause: The Hypnoanalysis of a Criminal Psychopath.” The title of this study of a young juvenile delinquent was adapted for the well-known 1955 movie starring James Dean (which, however, had little to do with Lindner’s original book). He gained further recognition for his best-selling collection of case studies, “The Fifty-Minute Hour,” a gripping series of true-life tales that combined traditional psychoanalytic thinking with clinical strategies that even today would be considered creative and controversial. One of these stories, “Charles,” told of a 19-year-old man who was serving a prison sentence for murder. He had impulsively stabbed a young woman to death after first beating her into unconsciousness and then sexually attacking her.
“Charles” was, in fact, a patient of Lindner’s on the psychopathic ward of Spring Grove Hospital in Catonsville. In “The Fifty-Minute Hour,” Lindner recounts how, after working with Charles for seven months, he himself was brutally attacked by his patient, who was undergoing a catatonic episode. Another patient described in “The Fifty-Minute Hour,” a fantasy-haunted genius known as “Kirk,” is widely believed to have been the writer Cordwainer Smith, the pseudonym used by American author Paul Myron Anthony Linebarger for his science fiction works. Linebarger was a noted East Asia scholar and expert in psychological warfare who received a Ph.D. in political science from Johns Hopkins and worked at the Pentagon.
In the early days of psychoanalysis, many psychiatrists expressed great interest in Freud’s ideas, and were regularly trained to use them. During the 1940s and ’50s, however, psychoanalysis started to appear less like an interesting new branch of psychiatry, and more like a different, rival discipline. With the rise of new ideas like behaviorism and cognitive therapy, many of the charter members of the American Psychoanalytic Association turned against Freud’s methods, which were starting to seem old-fashioned, and by the 1960s it was clear that psychiatry was the dominant force.
Orthodox Freudians are rare these days, now that medication and cognitive-behavioral therapy have come to be the main treatment for mental ills. Indeed, psychoanalysis is completely out of vogue in the medical world, and plays little part in the training of psychiatrists at Johns Hopkins (or anywhere else). According to the scientific consensus, classical Freudian psychoanalysis is dead as both a theory of the mind and a mode of treatment.
Nevertheless, Freud’s ideas still have an important role to play in history, philosophy, literary theory and cultural studies, and psychoanalysis continues to exert influence abroad, especially in South America, where the model for training is not Freud but the charismatic French psychoanalyst, Jacques Lacan. Lacan, too, has a place in Baltimore history. In 1966, he brought his radical ideas to the first Humanities Symposium held at Johns Hopkins. While preparing the talk in his Belvedere hotel room, Lacan observed the dawning city outside his window and came to a sudden and startling insight that has gone down in psychoanalytic history. “The image to sum up the unconscious,” he concluded, “is Baltimore in the early morning.”
Mikita Brottman is an author, psychoanalyst and professor at MICA.