2
“Intangible Difficulties”
Dr. Fredric Wertham and the Politics of Psychiatry in the Interwar Years
In May 1928, Dr. Friedrich Ignanz Wertheimer sent out greeting cards to his friends and colleagues notifying them that on the occasion of his naturalization as a U.S. citizen he had changed his name to Frederick Wertham.1 Born in March 1895 in Nuremberg, Bavaria, Wertham, after receiving an MD and becoming a psychiatrist in 1921, sailed to the United States in 1922 to join the staff of Baltimore’s Phipps Psychiatric Clinic at Johns Hopkins University. Wertham was one of the many European Jewish scientists, scholars, and artists who immigrated to the United States between the two world wars. Attracted to the Phipps Clinic because of the innovative clinical psychiatry of its director, Dr. Adolf Meyer, Wertham brought with him a wide training in somatic psychiatry with its emphasis on the organic basis of mental illness, as well as training in psychoanalysis with its opposing emphasis on the relation between instinctual drives, repression, and intrapsychic sources of mental disorder. “With the long distance between psychoanalysts and those who would rather solve the problems of psychiatry without psychiatry,” Adolf Meyer himself once wrote, “Wertham is apt to be the best prepared person…to find and establish sound relations.”2 He arrived prepared to make his mark in the burgeoning field of psychiatry in America, both as a clinician and as researcher. Yet at the very moment he committed himself to being an American citizen, Wertham’s position both at Phipps and within American psychiatry as a whole was in jeopardy.
Wertham may have embraced formal American citizenship through naturalization, but the young doctor apparently had failed to adapt culturally to American norms of collegial exchange and identification with the group. At least that was how his supervisors and colleagues perceived him. Adolf Meyer later explained to Wertham the core of his problems fitting in at Phipps in terms of assimilation: “One simply has got to surrender all concern of priorities and a lot of those appertinences [sic] that go with European grades and positions. This is the critical point and question everywhere—an issue of vital importance in matters of Americanization.” Meyer explained that publications alone would not “make superfluous a sense of the dependability and spontaneity of give and take and having things to offer and a tendency to share and stimulate that mean a lot to the whole group one wants to join. Just what it is that makes a man wanted is probably less dependent on formal status and record here than anywhere in the world.”3 Wertham’s early problems at the Phipps Clinic would have a lasting effect on his relationship to American psychiatry. Wertham quickly earned a reputation for being a troublemaking outsider, which became common knowledge throughout American psychiatry.4
Wertham desired nothing more at this time of his life than to become a leading figure in the field of psychiatry. Perspicacious, energetic, and rigorous, he seemed destined to assume a leading role in the expanding field of American psychiatry after World War I. Yet throughout his career in psychiatry Wertham would continuously fail to observe the codes of professionalism that marked one as a candidate for elite institutional leadership and unimpeachable prestige in the wider field. And he compounded this with a strident advocacy for linking psychiatry to social justice. His seeming lack of collegiality, along with his politicizing of psychiatry, repeatedly alienated the very people and institutions upon which he might have had the greatest influence. For that failure, Wertham became a marginal figure within psychiatry, irrespective of his many contributions to the field—from original studies of the human brain to studies in the psychopathology of violence.5
Wertham’s relation to American psychiatry mirrored Richard Wright’s outsider relationship to the main social and cultural institutions of segregated black society, as well as Wright’s critical distance from the mainstream of white American culture. Like Wright’s experiences with black churches, schools, and politicians, as well as white philanthropists and cultural brokers, Wertham’s contact with the central institutions of American psychiatry enabled him to grasp the habits of mind that governed the field’s inner workings. Wertham developed, though, a critical perspective on psychiatry’s fundamental claims to scientific truth and institutional power. And, mirroring Wright’s role in the official work of race relations in the years surrounding World War II, Wertham inhabited a paradoxically prominent though marginal place within psychiatry.
This chapter argues that Wertham’s marginal position in American psychiatry created a space for him to develop a radical critique of the science of medical psychology.6 In that space he fashioned a philosophy and practice of psychiatry he termed social psychiatry that culminated in the establishment of the Lafargue Clinic.
Wertham and Wright were in many ways deracinated from the traditions and disconnected from the institutions that gave sustenance to the vast majority of the peoples from which they came. Wright famously dislodged himself from the bounds of traditional black American Christianity and from established black political discourses, namely liberal integrationism and black nationalism. Most of all Wright used both fiction and autobio-graphy to challenge traditional representations of black consciousness and black cultural life. Wertham was Jewish by birth, but there is no indication from any of his writings or public statements that Judaism held any place or meaning in his personal or cultural life. Early in his life Wertham committed himself to the study of medicine, and this embrace of science propelled him on a quest for associations with the best representatives of medical knowledge wherever they might be found. In the process he left behind any meaningful identification with Bavaria, the land of his birth, or the small Jewish community of Nuremberg from which he came.
Both Wertham and Wright became marginal men in the sense that the Chicago School’s Robert Park had described, men uniquely positioned to negotiate between the identities ascribed to them through social categorization and their own self-chosen identifications with the modern, cosmopolitan consciousness of the polyglot social world of the metropolis.7 They both possessed a relentless hunger for truth that militated against any form of mystification or soft-pedaling. Behind each man’s hunger was a very mundane expectation of social justice born of a desire to eradicate the sources of social misery for all people. Wright’s questioning of the strictures of his family and community, and his fight against discrimination and oppression, are well known—as are the violent repercussions unleashed upon him by those closest to him and by white authorities, including the U.S. government.8 The story of Wertham’s quest, his struggle, his failures and successes, is not as well known.
There are three major phases of Wertham’s life that shed light on how he came to cofound the Lafargue Clinic. The first phase centers on his youth and education in Germany and England before and after the Great War; the second encompasses his experiences in Adolf Meyer’s Phipps Psychiatric Clinic in Baltimore and his sojourn back to Germany in 1930–32, the very moment of the Nazi Party’s ascendance; and the third phase revolves around Wertham’s time in New York City, as he entered the fields of criminal psychopathology and forensic psychiatry and developed his own brand of social psychiatry while working in the psychiatric clinic of the Court of General Sessions (renamed the New York City Supreme Court), the Bellevue Hospital Psychiatric Department, and the Queens General Hospital Psychiatric Division. It was in these phases of his life that Wertham encountered the institutions, discourses, and personalities with which he would wrestle to find a place, in the end opting for a place on the margin.
Wertham’s path to founding the Lafargue Clinic with Wright in 1946 was a circuitous journey filled with mishaps, accidents, and unpredictable consequences of even the best intentions. Yet his story parallels Wright’s in that both men were migrants, displaced initially by far-reaching, world-historical events—in Wright’s case the Great Migration of blacks into the metropolises of the North, and in Wertham’s the Great War and the troubled peace in Europe. These displacements ignited in each man a particular type of restless search to understand the new contexts they had entered, as well as the social forces that shaped the people they encountered in such places as Chicago, Baltimore, New York, and for Wright ultimately the whole world.
The Education of Fredric Wertham
Wertham was born at the beginning of Wilhelm II’s tumultuous reign as kaiser of Imperial Germany. He was one of five children born to Sigmund and Mathilde Wertheimer, nonreligious Jews whose families had resided in Bavaria for several generations. At the time of his birth, Jews were a very small percentage of the total population of Nuremberg.9 Little is known about Wertham’s parents or their influence on the person Fredric became later in life; they scarcely figure in their son’s memoirs. Wertham once described his father to a friend as a prosperous businessman. Yet the year before Fredric was born, his father Sigmund and his uncle Adolphe lost the family business, a firm that distributed hops to beer makers in Central and Eastern Europe. (Adolphe later referred to Sigmund as “dear, but unsuccessful.”) In “Episodes: From the Life of a Psychiatrist,” an unpublished collection of reminiscences, Wertham made no reference to his family or his youth growing up in Nuremberg. According to one biographer, Wertham would remain detached from his family throughout his life, maintaining a “studied distance” even from his two brothers and two sisters, one of whom, Ida, became a prominent medical historian.10
Wertham’s most important familial connection was to his uncle’s family in London, a relationship that would have a profound influence on his orientation toward social justice. The year before Fredric was born, his uncle Adolphe had moved his family from Nuremberg to Melbourne, Australia. Baptized as Christians in Melbourne, Adolphe and his wife Frieda changed their surname to Winter. They moved back to Europe in 1910, settling just outside London. The Winters were responsible in large part for Fredric coming into contact with English literature and culture, and in many ways for him becoming an Anglophile. Over several summer visits to the Winters, he became enamored with the English language, its literature and modern ideas emerging in pre–World War I Britain. It was in the Winters’ home that Fredric first read Charles Dickens and heard discussions on Fabian socialism, which foresaw the transition from capitalism to socialism through enlightened reform rather than proletarian revolution. Accompanied by his cousin Ella, who would soon be attending the London School of Economics, Fredric heard Sidney and Beatrice Webb speak on Fabianism, and with Ella he read and debated Marx and Engels’s Communist Manifesto. It must have been a liberating and enlivening experience for Wertham on these summer trips, because after one year at the University of Munich, where he began his studies in medicine, he left Germany to enroll in King’s College at the University of London.11
Wertham’s university education was interrupted by the beginning of World War I in August 1914. Under Britain’s Aliens Restriction Act, Wertham was required to report to the British War Office in June 1915 for internment. He was sent to Lofthouse Park, near Wakefield, Yorkshire, in north central England. A former amusement park, Lofthouse Park was divided into three smaller camps, one of them designated as a “gentlemen’s camp,” for those “prepared to pay ten shillings a week for the privilege of being there.”12 Wertham paid the fee and lived in the gentlemen’s camp for a short while before being relocated to another camp on the Isle of Man.
Wertham never discussed publicly the emotional impact of being held in an internment camp, but his time at the Isle of Man camp had a clear influence on the direction of his broader intellectual development, especially deepening his interest in medical psychology. During his interment he worked with several doctors, especially with an interned doctor who was formerly with the Pasteur Institute in France. He also gained practical experience working in the camp hospital. During this time, Wertham immersed himself in reading psychology, “particularly medical psychology,” including psychoanalysis. But for his internment, Wertham might never have developed a professional interest in medical psychology.13
At the end of the war, Wertham was released from the Isle of Man camp and returned to Germany, where he continued his medical studies. His foray into medical psychology attracted him to a career in psychiatric medicine. After attending the University of Erlangen for a brief period, he enrolled at the University of Würzburg in Bavaria, receiving his medical degree in 1921. Soon after, he served as an intern in a series of psychiatric clinics on the road to being certified as a psychiatrist.
It is worth stopping to consider why Wertham decided to return to Germany after the war. His rationale remains unclear, given his love for British intellectual culture, as well as his connection to the Winters. Perhaps it was to be closer to his family in Nuremberg. Perhaps he wished to join in the rebuilding of his homeland—by treating the war-fractured veterans and civilians.14 Whatever his motives may have been, his decision to continue his studies in Germany rather than England would engender a quest to democratize the practice of psychiatry.
The Growth of Clinical Psychiatry in Europe
In the early 1920s, Wertham encountered a version of clinical psychiatry that would influence his approach to the science of human thought and behavior throughout his life. Over the previous quarter century, psychiatrists working primarily in Switzerland and Germany had begun to develop a science of medical psychology devoted to explaining how mental disorders related to the biology of the human organism, most especially the workings of the brain and nervous system.15 The new psychiatry aimed to medicalize the study and treatment of madness. Beginning in the late nineteenth century, mental disease was increasingly seen as an illness—it could be diagnosed, and a prognosis could be pronounced, just as with any other medical disorder. A mental disorder had a history—onset, course, outcome, and a variety of possible interventions and therapies.
By the time of Wertham’s medical education in Germany, much of psychiatry conceived of mental diseases in terms of discrete clinical entities that required distinct protocols for treatment. Confinement in asylums decreased, and more inpatient and outpatient hospital clinics were established. This change in Germany had begun before the Great War but accelerated rapidly in the postwar years, primarily because of the need for such clinics in industrial centers. Urban clinics affiliated with universities such as Berlin, Heidelberg, Leipzig, and Munich proliferated as the population of cities increased. “These clinics,” writes historian Eric Engstrom, “became loci about which the nascent discipline increasingly congealed and expanded and on which the prestige and influence of late nineteenth and twentieth-century psychiatry came to rest.”16
Upon completing his degree, Wertham served as an intern in Emil Kraepelin’s Munich Institute (the German Research Institute for Psychiatry), one of the premier psychiatric research institutes in Europe.17 Though brief, Wertham’s time under Kraepelin’s guidance would provide him with a model of scientific rigor as well as a cautionary tale regarding the use of psychiatry toward reactionary political ends.
Kraepelin dominated the field of German medical psychology. Born in 1856, the same year as Sigmund Freud, he received his medical degree in 1878 at the University of Würzburg. He was instrumental in directing psychiatry toward the university and developing psychiatry as a clinical science and subspecialty within medicine. He worked to identify and study discrete disease entities, to classify and understand the different forms of chronic mental disorders in the same way that a general physician dealt with organic diseases. Kraepelin devised the fundamental framework for classifying mental illness (nosology) and was the first to discover, study, and treat systematically what he named dementia praecox (premature dementia, later termed schizophrenia) and manic-depressive disorder (later bipolar disorder).18 In the process, Kraepelin established clinical psychiatry as a viable branch of medicine. Prior to the wide acceptance of Kraepelin’s diagnostic and classification system, general physicians and biological scientists had tended to view alienism, as psychiatry was termed at the time, as unscientific and nonrational, more bound by custodial care than scientific methods of diagnosis and treatment. Kraepelin changed that.19
The Kraepelinian model, part of a broad medicalization of psychiatry in post–Great War Germany, influenced profoundly Wertham’s early career. “Working in his clinic in Munich was an important part of my psychiatric education,” Wertham later remarked.20 The clinic was designed for “the study of the essence and origination of the mental diseases.” It included a “clinical-experimental department with a small ward and serological, chemical, and psychological laboratories, an anatomic-histological department and a demographic-statistical department for the study of degeneration.” During his time at the clinic, Wertham’s research interests moved toward questions of the somatic, or physical, sources of mental disease. He indeed learned a great deal at the clinic in Munich, as several of his first publications in the United States consisted of studies in the relationship between histopathology of the brain (organic problems) and mental disorders among adult men and women.21
“This Haven of German Science”
The years immediately following the end of World War I were among the most chaotic in modern German history. There was considerable strife between old and new political parties vying for rule in postwar Germany. The region of Bavaria, particularly Munich, was the theater in which battles raged between the majority Social Democrats and new, radicalized Independent Social Democrats (USPD) led by the Jewish journalist Kurt Eisner.22 All the while, right-wing groups were trying to counter both parties’ versions of social democracy. In the wake of the briefly successful leftist revolution in Bavaria and the short-lived Bavarian Soviet, “the obsessive fear of a new Bolshevik rising led the military and civilian authorities to encourage political movements of a nationalist character.” In an effort to subdue dissent and establish order in the land, a newly installed conservative government in Bavaria declared “a state of emergency to restrict socialist parties and encourage ‘anti-Marxist’ ones.”23
In the midst of German political turmoil, the language of psychiatry gained significant explanatory power. Apprehension about the collapse of German society and the collapse of individual psychic health pervaded the psychiatric profession and suffused public discussions of the nation’s future. “The great majority of our people have suffered an enormous loss of nervous strength and resistance through the frightful excitements and deprivations of the long war,” wrote one prominent psychiatrist, “with the result that they are far more susceptible to incitements and provocations than in times of good health, and lend an open ear to wild rumors and agitation which, if nervously strong, they would reject. Thus the sickly mental state of the individual as well as the masses has contributed to the upheavals in which Germany now finds itself.”24
Some German psychiatrists restricted their concerns about German psychic health to the revolutionary German Left, especially its “Jewish element.” Emil Kraepelin was particularly instrumental in pathologizing left-wing activists and inciting suspicions of Jewish radicals in particular. Writing in 1919, Kraepelin used the language of social Darwinism to argue that “in every mass movement we encounter traits which clearly indicate a deep affinity with hysterical symptoms. Above all, we assume that the actual leaders of such movements, the greater part of the mentally deficient comrades, are unsuited for the intuitive, instinctual resolution of the struggle for existence.” One historian notes, further, that Kraepelin argued that the Jewish race “showed an abnormally high disposition toward psychopathology, as revealed by their ‘talent in languages and in acting,’ their ambition, and their skill as ‘piercing critics.’”25
Kraepelin aligned his psychiatric research and clinical practice with reactionary political forces, including groups advocating eugenics and restrictions on social welfare programs.26 He was one of the most ardent opponents of the Bavarian Soviet and the traditional Social Democratic Party. He was suspicious of the idea of democracy in general; life’s experiences, explained Kraepelin, “had made me doubt whether rule by the people with its vulnerability towards merciless social climbers, screamers, and demagogues could bring happiness to humanity.” Kraepelin was also a strong German nationalist and conservative who linked his scientific pursuits to the strengthening of the nation-state and the Teutonic race in the wake of its defeat in the Great War. Concluding his memoirs in 1919, Kraepelin wrote of the importance of his clinic: “We hope that the intended further development of this haven of German science will help reconstruct our national integrity effectively.”27
The unseemly marriage of reactionary politics and science in Germany in the wake of the Great War left a mark on Wertham. His recollection of one particular case at Kraepelin’s clinic in Munich provides some sense of his perspective at the time. “The case discussed that of a youth who had killed an old man in a cellar for a gold watch,” wrote Wertham. “This took place in the Germany after World War I, with its poverty, unemployment, unrest, and bloody struggle between the democratic forces of the people and the well-organized political reaction.” Without so much as “studying the young man’s inner life history,” Kraepelin pronounced him a “common murderer.”28 This unscientific indifference to the question of this young man’s mental state must have grated on young Wertham. Perhaps witnessing the alignment of psychiatry with rearguard politics in Kraepelin’s clinic propelled Wertham toward a deeper embrace of progressive politics. Perhaps he began then to imagine a place away from Germany, where he could practice psychiatry and conduct research in a more hospitable atmosphere. Maybe there was a place where psychiatry and progressive politics met, where the science of mental health was integrated into a broad effort at social betterment.
Spurred by such experiences in Munich, Wertham began to inquire into prospects of immigrating to the United States, where the field of psychiatry was burgeoning. With the support of two prominent American neuropsychiatrists, whom he had met when they visited the Munich Institute, Wertham persuaded Dr. Adolf Meyer to accept him as member of the Phipps Psychiatric Clinic staff at Johns Hopkins University.29 And so, in August 1922, at twenty-seven years old, Wertham sailed to the United States. As he embarked on his journey across the Atlantic he must have been both daunted and dazzled by the prospect of practicing his craft in a foreign land. He had by then developed into a cosmopolitan, progressive intellectual, with few links to his family or his home in Nuremberg. Unlike Richard Wright, who famously documented his mixture of hope and anxiety on the eve of leaving the known world of the Jim Crow South for Chicago, Wertham unfortunately left no record of his state of mind as he left Europe for the United States.30
A Pragmatist Psychiatry
American psychiatry in the early twentieth century initially embraced many aspects of German models of treating mental disorders. Dissatisfied with the custodial work of monitoring the chronically mentally ill, American psychiatrists, like their German counterparts, sought to develop the distinctly medical, particularly therapeutic, aspects of their specialty. They began to shift the locus of their profession from the “asylum…to the research institute and psychopathic hospital.” The Phipps Psychiatric Clinic at Johns Hopkins epitomized the transformation of American psychiatry in this period. Launched in 1908 through the philanthropy of Henry Phipps, a Pennsylvania-based entrepreneur associated with Andrew Carnegie, the Phipps Clinic became the model for university-based psychiatric teaching institutions, echoing the clinic model of the German universities.31
Through such institutes as Phipps and the Boston Psychopathic Hospital, American psychiatry was in the process of distinguishing itself as a viable branch of medicine—most especially in contradistinction to nonscientific but widely popular forms of mental healing, including “mind cures” such as Mary Baker Eddy’s Christian Science. One Boston neurologist explained the adoption of the term “psychotherapy” in this context: “Psychotherapy is a most terrifying word, but we are forced to use it because there is no other which serves to distinguish us from the Christian Scientists, the New Thought people, the faith healers, and the thousand and one schools which have in common the disregard for medical science and the accumulated knowledge of the past.”32 Responding both to nonscientific mind-cures and to general medicine’s increasing effectiveness in establishing the source of disease, preventive measures, and productive therapeutic techniques, psychiatrists repositioned themselves as practitioners of a dynamic science.
In distinction to the general physician, psychiatrists claimed to integrate the physical and psychic dimensions of mental functioning. Dynamic psychiatry developed “a new model of psychic distress” in opposition to the sharp distinction between health and disease; the aim was now to assess why and how an individual with a unique physical and psychic history had developed a disordered mental state. Rather than employ a dichotomy between fixed states of normality and abnormality, the new psychiatry imagined a continuum of order and disorder. The result of this new orientation in psychiatry was an eclectic blend of somatic, psychogenic, and environmental or sociocultural explanations for mental health and illness.33
No figure was more instrumental in developing and promoting the new dynamic psychiatry than the Swiss-born Adolf Meyer. From the time he arrived at Chicago in 1892 until his death in 1950, Meyer changed the scope and practice of psychiatry in America. In successive positions at Kankakee Hospital in Illinois, Worcester Sate Hospital in Massachusetts, the Pathological Institute of New York State Hospitals, and finally as director of the Phipps Psychiatric Clinic at Johns Hopkins, Meyer systematized the treatment of mental patients through a strict method of integrating information from life histories with the results of psychological and physiological tests. He was one of the first psychiatrists in the United States to incorporate Kraepelin’s system of classifying the major mental disorders, including dementia praecox and manic-depressive psychosis.34 Though he maintained a lifelong skepticism about the practical utility of psychoanalysis as therapy, Meyer was also one of the first in the United States to incorporate psychoanalytic principles into psychiatric education.35
But what distinguished Meyer most, and what must have appealed to young Wertham, was that he went beyond his Swiss training as a neurologist and beyond Kraepelin, both scientifically and politically. He crafted a uniquely American brand of psychiatry he termed “psychobiology,” and he became a founding participant in the mental hygiene movement of the Progressive era. Meyer’s science and his politics went hand in glove and had a profound influence on Wertham’s development as a psychiatrist and as a politically engaged intellectual.
Mental hygiene meant the application of a public health approach to the study, prevention, and treatment of mental “defectiveness” and disorder. Both a medical and political project, the mental hygiene movement was part of a broader political and social struggle on the part of early twentieth-century Progressives to bring scientific knowledge to bear on the order and regulation of American society.36 In 1909, the National Committee for Mental Hygiene (NCMH) was founded by a small group of former mental patients and by a “cadre of ‘psychiatric progressives,’” including Meyer. The movement’s rank and file were men and women swept up in the Progressive moment of reform. The NCMH used publicity and education to convince Americans that human personality was malleable and not fixed through heredity, and that practical measures, especially education, could be taken to prevent and alleviate mental disease. The mental hygiene movement was the primary force behind the establishment of new types of institutions that brought psychiatrists out of asylums and into the broader community, particularly into urban America. Hoping to bring a rational system to bear on the provision of mental health care, mental hygienists used both scientific and moralistic language to argue that the best care for the clinically ill required a preventive approach rather than treating the already far gone. In all, historian Sol Cohen notes, “Hygienists set out to accomplish in the battle against mental illness what medicine had accomplished in the campaign against tuberculosis.”37
Through his development of psychobiology as the paradigm for mental hygiene efforts, Meyer laid the scientific basis for the whole movement. Meyer’s approach to mental disorder, as a component of the general “organismal” life of human beings, was that of unity, of unification of each part of man’s being. His psychobiology rejected the dualism of mind and body, as well as the division of psychology and biology, often called psychophysical parallelism.38 The body, the mind, and the individual’s experience were to be approached unitarily. As Meyer explained, “My work, and indeed my whole philosophy, makes for as much unification and condensation as possible, but with a very clear right to define units and to choose them so as to satisfy my need of consistency and comprehensiveness. The person and the group being my problem, I have to take the person as one of the units and I do so without dividing it into a biological and a psychological body.”39 For psychobiology to make sense in practice, the doctor had to be trained in various physical and natural sciences, as well as what Meyer termed the nonnatural sciences of philosophy and sociology. Meyer’s orientation was founded on a grasp of what he called ergasia, “mentally integrated activity,” and looked at how the individual as a whole organism reacted to life situations. Abnormal or dysfunctional reactions were called, in Meyer’s obscure terminology, pathergasia.40
Kraepelinian classification of mental disorders as disease entities was less important in Meyer’s psychobiology than assessing the functional health of the patient as “an organismal unit.”41 Meyer and his students spoke of “reaction types” rather than mental diseases: dementia praecox or schizophrenia became schizophrenic-reaction. Such disorders represented types of response to one’s objective and subjective situation as a psychobiological unit, manifestations of “habitually inadequate adjustment to the environment.” As one biographer notes, Meyer “inaugurated a search for the specific dynamic factors that led to the schizophrenic reaction and introduced a practical emphasis on the possibility of preventing the disease by the timely adjustment of life habits…. As a result of Meyer’s dynamic approach to schizophrenia, American psychiatrists experienced a new wave of therapeutic optimism in their treatment of this formidable disease.”42 Meyer’s approach to schizophrenia exemplified his pragmatic philosophical orientation to the problem of the psychobiological life-world of the human being.
Meyer’s pragmatism emerged from direct contact with its chief philosophical architects. Upon his arrival in Illinois in the early 1890s, Meyer became acquainted with the preeminent pragmatist John Dewey and “the newly emerging Chicago school of functionalism.” Along with Dewey, Meyer developed intellectual relationships with other pragmatists, including Harvard’s William James and historian James Harvey Robinson of Columbia University. Convinced that experience superseded the abstract and deductive categories and methods of reasoning derived from Continental philosophy and science, pragmatism represented what philosopher Morton White termed a revolt against formalism.43
Following James’s and Dewey’s rejection of the Cartesian division between mind and body—function and structure—Meyer embraced the functionalism inherent to pragmatist philosophy. The focus of psychological investigation “was no longer…to be abstract mental elements…but rather the situation, defined as that which combined the human organism and its environment in one analytic scheme and in relation to which neither the organism nor the environment could be considered separately or independently.”44 For Meyer, the philosophical orientation of pragmatism could be applied almost seamlessly to the problem of diagnosing and treating mental disorders. With its emphasis on the “fundamental heterogeneity of factors that affect mental life,” including the organic, psychic, and social, Meyer’s psychobiology would frame Wertham’s own pragmatic social psychiatry.45
Wertham claimed psychobiology’s pragmatic orientation to be the most dynamic force in contemporary American psychiatry. In 1925, he wrote a long review of contemporary research in American psychiatry for a German journal. “A fundamental trait of American psychiatry seems to me to be a consciously pragmatical attitude,” he observed. “It is…not content either with sharply defined diseases and fixed fatalistic constitutions as entities, or with the static…concepts of descriptive psychology. Modern American psychiatry has as its basis a dynamic psychology.” In order to illustrate the pragmatic tendency of American psychiatry, a stamp more significant in this branch of medicine than others, Wertham pointed to Meyerian psychobiology. Praising psychobiology, he emphasized its focus on the reaction of the “organism as a whole” to its total situation. Expanding his survey of the American scene, Wertham noted that the “pragmatic-dynamic conception of psychopathological phenomena favored the ‘infiltration’ of American psychiatry with ideas and formulations of suggestive psychotherapy and psychoanalysis.” Many American psychiatrists in the 1920s exhibited a general scientific and therapeutic openness to ideas and techniques that addressed the nature, source, and treatment of various mental disorders, including both neuroses and severe chronic psychoses.46
Physique and Character
Wertham’s first monograph, The Significance of the Physical Constitution in Mental Disease, represented a probing engagement with a central problem in both German and American psychiatry, conducted within the psychobiological frame. He began with the human body and asked whether it was possible to identify any correlation between differences in constitutional type and manifestations of particular mental disorders. Using a combination of visual observation, anthropometric measurement, and clinical diagnosis, he sought to provide precision to the definition of constitutional types and to establish any correlation with psychopathology. The 1925 publication of an English translation of Ernst Kretschmer’s Physique and Character was the obvious prompt for Wertham’s investigations. In this influential work, Kretschmer had correlated distinctive body types with schizophrenia and manic-depressive psychosis, producing a typology that quickly became the standard in both European and American psychiatry. Unfortunately, noted Wertham, “The constitutional types of Kretschmer have already led with some authors to a terminology in which morphological and psychiatric expressions are mixed.” “Although we must assume that structure and function have a definite relationship…in the sphere of psychobiological integration,” Wertham explained, “both the extent and nature of this relationship are as yet unknown and a field for investigation.” Thus, “to use morphological constitutional signs for psychiatric diagnosis or prognosis is premature.”47
Wertham’s exploration of the relationship between physical constitution and mental disease led him directly to the central question in the social and medical sciences in the early twentieth century: What role did heredity play in determining the normal or abnormal functioning of the human organism? The concept of human constitution reflected new scientific conceptions of heredity. Refusing a “theoretically binding” definition of the human constitution, Wertham provisionally referred to those psychophysical elements in the individual “which are definitely more influenced by heredity than by environment.” In order to investigate the possible psychobiological import of the human constitution in the study and treatment of psychopathology, he began with an internal critique of modern psychiatric studies, questioning the utility of “heredo-biological” determinism. He noted, for example, that “knowledge of even a complete family history does not give a clue to the pathogenetic factors of psychoses.” He argued that the modern dynamic and analytic orientation in psychiatry had proven to be most effective in diagnosing and treating mental disorders.48
The dynamic orientation led Wertham to reconsider the question of normality and abnormality in human psychology. Wertham noted from the outset of his study that through anthropometric quantification, physical anthropologists had achieved effective classification of normality and abnormality in the human species.49 “It is, however, exceedingly difficult in psychopathology to make a generic distinction between abnormal and normal,” he continued. The new dynamic study of psychopathology, derived largely from Freudian analysis, had demonstrated, according to Wertham, “that elements of certain psychopathological reactions reach far into the sphere” of not only those persons whose constitutions may have predisposed them to abnormal functioning, but “even into the group of normal people.”
The implication was that constitution, or biological inheritance, did not necessarily determine an individual’s reactions to experience, or his or her relative normality or abnormality. While entertaining the possibility of hereditary determinants of psychopathology, Wertham remained suspicious of theories of mental disease that did not account for the individual’s life experience. Wertham’s scientific orientation at this time thus reflected Meyer’s tutelage and influence: he expressed an openness to the integration of somatic and dynamic approaches to the mental functioning of the human organism.50
“Intangible Difficulties”
For his first five years at Johns Hopkins, Wertham seemed to have settled well into the clinical structure of the Phipps Clinic. But a professional dispute over his role at the clinic erupted in late 1927, permanently affecting the direction of his career. As a resident psychiatrist and later associate in psychiatry, Wertham initially served as a clinician and medical instructor within the inpatient division. It was through this clinical work that he was able to accumulate research subjects for his study of constitution and mental disease. Because it was a research and teaching department of Johns Hopkins Hospital, the Phipps Psychiatric Clinic primarily offered inpatient treatment to men and women who exhibited early signs of mental disorder, patients who might be both “diagnostically complicated and therapeutically promising.”51 There was also a dispensary, or outpatient treatment division, attached to the clinic. The dispensary reflected the preventive orientation that had emerged from the mental hygiene movement.52 Beginning in the fall of 1927, Dr. Meyer placed Wertham in a supervisory and teaching role in the dispensary.
Wertham was now to share duties in both the main hospital and the dispensary. He and Dr. Esther Richards, the resident in charge of the dispensary, had previously worked together on a number of cases in the hospital, but the new dispensary arrangement provoked considerable tension and disagreement over the division of labor. Though Dr. Richards was the supervising staff member, she was expected to share the clinical and instructional administration of the dispensary with Wertham. According to Wertham, she refused to do so, assigning him the least interesting patients and making him more of a babysitter to the Hopkins medical students and interns than the instructor he wished to be. Conversations gave way to a series of letters, with Wertham initially requesting clarification of his responsibilities and later accusing Richards of marginalizing him. “The work I have a chance to do in the dispensary at present is really only the least important odds and ends which do not leave me a chance to satisfy my desire for real responsible work,” he complained. “As far as my present work in the dispensary goes, I could be easily replaced by someone—be it said in all modesty—with much less experience than I have had. If you feel that you cannot turn over to me some definite and circumscribed part of the dispensary work (either with patients or teaching or both) then my present function could be easily turned over to one of the house staff on one of the days he is in the dispensary.” Richards, stung by Wertham’s reproachful tone, dismissed him as a malcontent, a view that Meyer apparently came to share.53
The conflict at Phipps coincided with a pivotal point in Wertham’s life. In 1928, he was naturalized as an American citizen, an event he marked by changing his name to Frederick Wertham. At about the same time, he married Florence Hesketh, a young artist from Maine who had contributed figurative drawings to his study of human constitution. But the dramatic changes in his life did little to temper Wertham’s problems at Phipps, where he faced a swarm of hostile colleagues. According to Meyer, Wertham exhibited a number of “intangible difficulties” working with his fellow staff members, exemplified not only in the row with Dr. Richards but also in personal antagonism with another German expatriate psychiatrist, Oskar Diethelm. In the case of Dr. Diethelm, Wertham was forced to write a formal explanation to Meyer after Diethelm accused him of deliberately countermanding the treatment plan for a particular patient. Wertham denied the charge: “Dr. Diethelm used as usual a trivial incident to stir up feeling against me.” He added, “What I cannot explain is Dr. Diethelm’s continued only badly-concealed hostility against me, since I have done very much to help him in his early and later adjustments.”54 The dispute culminated in Meyer’s suggestion that Wertham seek a position away from Johns Hopkins. As he had with Dr. Richards, Meyer sided with Wertham’s opponents. In later recommendation letters for Wertham, he made specific reference to the circumstances of Wertham’s problems fitting in at Phipps.
The Americanization of Fredric Wertham
Wertham’s departure from Phipps coincided with the opening up of the field of neurology and psychiatry. And he sought a place for himself in the revision and reorganization of programs and facilities at major universities, including the University of Chicago, where he visited soon after leaving Johns Hopkins. In the spring of 1929, Dr. Franklin C. McLean wrote to Adolf Meyer inquiring about whether Wertham was qualified to head the psychiatric division of Chicago’s Department of Medicine. The university as yet had no department of psychiatry, nor had it established a psychiatric clinic akin to the Phipps Clinic at Hopkins. “Our problem at present is a double or perhaps a triple one,” wrote McLean. “We want immediately a man who can take charge of the work in psychiatry with students…. At the same time we want an individual who can be appointed in the Department of Medicine and who can assist us with psychiatric problems arising in the hospital and out-patient department.” This same man would be in line for the chairmanship of a new Department of Psychiatry at Chicago. “I have outlined our needs in detail in the hope that you could tell me quite candidly your opinion as to how Dr. Werthan [sic] might fit into the picture.” Another University of Chicago administrator, who had met Wertham at Phipps, had expressed concern to McLean over Wertham being German and whether students would be receptive to him. “While I have not seen Dr. Reed since he talked with Dr. Werthan,” McLean continued, “I suspect that his doubts with regard to Dr. Werthan are based on the question of personality rather than of nationality.”55
In a long and remarkably revelatory reply to Dr. McLean, Meyer presented a portrait of a complicated and troubled figure, brilliant but failing. Declaring that Wertham’s German background had not elicited any prejudice among the Hopkins medical students, Meyer went on to praise his intellectual acuity and his ability to translate a command of the current medical and psychological literature into his practical work at Phipps. But he also conceded Wertham’s difficulties working with colleagues. “You are quite right in surmising that the questionable part of his psychiatric equipment lies in the personality ingredient,” he wrote. “In temperament he is shy, reserved, and shows an embarrassment in group discussions which puts him at a disadvantage in expressing the contribution which he has to offer. I have felt that these characteristics were accentuated by the fact that he has while here with us been in a psychiatric environment where the opinion of myself and other seniors on the Staff unconsciously inhibited him in an expression of himself.” Despite his reservations, Meyer concluded his assessment of Wertham with a tentative gesture of support for his candidacy for the Chicago position.56
Without knowing about Meyer’s account of his personality to McLean, Wertham wrote a memorandum to Meyer assuring him that he had learned from his time at Phipps and that he had “sufficiently adjusted to American conditions.” Wertham reminded Meyer that “you said of me more than once: that I take criticism much more easily than other people.” “I believe,” he surmised, “that Dr. McLean keenly feels the responsibility of introducing a psychiatrist into his clinics, and that if I do not receive from you the highest recommendation, or if the slightest qualifications about my character are made, he will drop his plans.” Wertham was clearly worried that Meyer’s doubts about him would doom his chances of being hired by McLean. He pleaded to Meyer, “My feeling is that Dr. McLean is a very cautious man (especially with regard to psychiatry) and that this whole matter is entirely in your hands. Please do the best for me you can.” Unfortunately for Wertham, Meyer’s letter was in the mail two days before this note. After receiving Meyer’s qualified endorsement of Wertham, McLean decided ultimately not to hire the young doctor.57
In the summer of 1929, Wertham faced the prospect that he would not secure a position commensurate with his qualifications as a clinical psychiatrist, researcher in neurology, and instructor in psychiatry. Such was his reputation that neither Chicago nor any other prominent institution was willing to gamble on hiring him. Following a letter in which Meyer frankly explained to Wertham why he had not been promoted and rehired at Phipps, and why he could not offer his highest recommendation, Wertham decided to look for opportunities outside of clinical psychiatry.
In the fall of 1929, after a rejection for the directorship of the Psychopathic Hospital in Iowa City, Iowa, Wertham applied for a fellowship from the National Research Council (NRC) in Washington, D.C. He proposed a year of study in the laboratory of Dr. Walther Spielmeyer at the German Research Institute for Psychiatry in Munich. After the NRC’s initial denial of Wertham’s application, Meyer wrote follow-up letters to each member of the fellowship committee. It was a strong display of support, in stark contrast to his other Wertham reference letters. He stressed the importance of Wertham’s plan for research into the fundamental structure of the brain that makes it an organ with functions akin to other organs in the human body. “I have been greatly distressed about the fact that Dr. Wertham’s application for a fellowship created the impression that he was not applying for an important lift in the fundamental sciences…. I find that the basic interest in structural neurology has greatly lagged during the last twenty years…. The National Committee for Mental Hygiene is training hordes of psychiatrists and psychologists who have not a ghost of an idea of the nervous system. I consider this a misfortune. Wertham should help in creating a sense of the importance of the basic necessities.” Concluding this appeal in a manner that only “the dean of American psychiatry” could get away with, Meyer wrote, “There is no personal favoritism involved. It is a really important question concerning the soundness of psychiatric foundations. Don’t you agree with me?” Just over a month later the chairman of the NRC Medical Fellowship Board wrote to Meyer announcing that on reconsideration of Wertham’s application he was to be granted a one-year fellowship for study in the histopathology laboratory of Dr. Walther Spielmeyer at the Munich Institute.58
Of all his professional choices, Wertham’s decision to return to Munich in 1930 is the most difficult to understand. Perhaps it was professional desperation, or maybe he just dissociated his personal aims from the political climate of Germany at the time. While his research project would be conducted solely in the neurological laboratories of the Munich Institute, he must have been aware of the overarching program of the institute, which aligned psychiatric research with the broad project of German racial hygiene.
A bastard child of social Darwinism, German racial hygiene combined the ideological fear of racial degeneracy with scientific research sanctioning the promotion of biological purity through the elimination of diseased stocks. Emil Kraepelin, who had overseen the establishment of the Munich Institute, and his student Ernst Rudin, director of the Department of Genealogical Demographics, were central to the infusion of eugenic thought into German psychiatric research. Rudin was the key figure in establishing a wide-ranging investigation of the genetic basis of psychiatric diseases. “The results of [Rudin’s] psychiatric genetics,” explain two German medical historians, “would provide knowledge and techniques with the help of which Nature’s ‘remorseless weeding out’ could be replaced by a policy of preventive selection, carried out by scientifically-based political measures directed against the transmission of defective hereditary dispositions.”59 “Preventive selection” would provide the scientific sanction for Nazi eugenic campaigns.
In the years between the end of World War I and the Nazis’ coming to power in 1933, eugenics and racial hygiene were so ingrained within the mainstream of German psychiatry that perhaps Wertham simply regarded their ubiquity in the way that a progressive white person studying at Duke or Emory may have looked upon the pervasive white supremacy of the Jim Crow South. The difference, however, was that by 1930 being a Jewish medical scientist in Munich, irrespective of name changes and Americanization, could prove quite dangerous for Wertham, as the “positive” eugenics program of improving the populace had turned toward targeting Jews as the greatest stain on the purity of the “Aryan” race.60
Wertham appears to have been more concerned with the mundane issue of his own professional survival. In May 1931, away in Germany, Wertham saw no real prospects for a neuropsychiatric position in the United States. “I am afraid my future is still painfully doubtful,” he wrote to Meyer. During his time in Munich, Wertham corresponded regularly with Meyer, using the guise of updating him on his work in the Munich Institute’s laboratories. The real purpose of the letters was to glean from Meyer any leads for work back in America.
Wertham continued, however, to make it difficult for Meyer to support his candidacy for important clinical and administrative positions without qualification or reservation. Throughout 1930, Dr. Spielmeyer wrote to his old friend and colleague Meyer explaining that he had come to see Wertham as unreliable and untrustworthy. According to Spielmeyer, Wertham had misrepresented his status at Hopkins to his German colleagues, claiming that he was to return to Phipps with a promotion in the coming fall. Wertham also made it known that in the event he was not returning to Phipps, he had a great many positions to choose from in America, thanks to Meyer, who had allegedly called him America’s best psychiatrist. More troubling than the disingenuous talk was that Wertham exploited the laboratory’s technical assistants for his own purposes. When Spielmeyer pointed out these and other problems to Wertham, the latter reacted very unpleasantly, compelling Spielmeyer to take a tough stance. Spielmeyer learned also that Wertham spoke negatively in an aggressive way (“hetzen”) about him and his department to American colleagues. But this had little effect, Spielmeyer explained to Meyer, because those colleagues did not think very highly of Wertham himself.61
The impact of Wertham’s perceived unprofessional behavior—his duplicity, “aggressiveness,” and self-deception—is crucial for understanding the path he followed in his professional and intellectual life in the 1930s and 1940s. Contrary to what he told his German colleagues, the only prospect he had back in the States was a position at Worcester State Hospital in Massachusetts, with a possible teaching appointment at Clark University. Wertham suggested to Meyer that accepting a mid-level position at a second-tier institution would be a “step down” for him, adding that “the situation has very much changed since the time when you were in Worcester [at the turn of the century].” Meyer protested that rather than something to be despised, the Worcester-Clark position offered Wertham the critical test of directing “a large staff and variety of interests and a danger for you to get into difficulties in matters of sharing the opportunities and duties.” In the tone of one émigré to another, Meyer instructed Wertham that “any suggestion that a real opportunity to do good work is not satisfying one’s dignity gets a strong reaction” in America.62
Perhaps Meyer was more sensitive to issues of status and rank than some. He had experienced his own Americanization and was surely attuned to the nativist tenor of American cultural politics since the Great War. In the mental sciences, with so many contacts between native-born Americans and immigrant experts (like Meyer and Wertham), in collaboration and competition, professional assimilation often must have meant learning to be “more American.” Wertham’s reputation for being a troublemaking (foreign) outsider was now common knowledge throughout American psychiatry, placing his professional future in palpable jeopardy. What remains unclear is whether Wertham’s foreignness derived from his being German or Jewish, as there were prejudices against both groups within different sectors of American society in the 1920s and early 1930s. Perhaps at different times and in different circumstances either mark of difference intensified the feeling of his colleagues and prospective employers that he bore the stamp of the “aggressive Teuton” or the “pushy Jew.” Either way, the conflation of his personality with his race was inescapable for Wertham.63
Toward a Science of Criminal Psychopathology
Without any definite prospects for employment and without a home of his own, Wertham returned with his wife to the United States in October 1931 in the midst of the worldwide economic depression. He and Hesketh settled for the remainder of the fall in Hillsdale, New York, a small town near the southwestern corner of Massachusetts. Wertham left little record of this period in his life. It is quite likely that the Werthams were houseguests of Dr. Horace Westlake Frink, a psychiatrist whom Freud himself called America’s best psychoanalyst. Understanding the difficulties his friend faced, Frink must have offered the Werthams a haven at a troubled time. It is also likely that Frink not only discussed psychiatric theory and therapy with his guests during their fall 1931 stay in Hillsdale; he appears to have psychoanalyzed Fredric Wertham at this time.64
Frink had a brilliant start to his career, publishing one of the first important works in psychoanalysis by an American, Morbid Fears and Compulsion: Their Psychology and Psychoanalytic Treatment (1918). At Freud’s insistence, the New York Psychoanalytic Society had unanimously elected Frink president first in 1913 and later in 1923. But Frink suffered from periodic bouts of severe depression that led to suicide attempts and hospitalization. During Freud’s training analysis of Frink in 1923, the master meddled in his student’s personal and romantic life, suggesting he divorce his wife and marry another woman, who Freud argued was a more suitable match for Frink. After following Freud’s advice, Frink returned from Vienna very depressed and promptly committed himself to the care of Adolf Meyer at Phipps in May 1924. Perhaps that is when Wertham and Frink became close friends.65
The period soon after his stay with Frink marked another key turning point in Wertham’s career. Wertham shifted his research and therapeutic focus from the somatic neuropsychiatry of his constitution and brain studies to criminal psychopathology and forensic psychiatry. Perhaps his time with Frink helped Wertham to re-envision his role in psychiatry. Or, quite likely, the Depression forced him to adapt to the exigencies of the psychiatric job market.
In December 1931, Wertham accepted a position as “junior alienist” at Bellevue Hospital, where he helped to organize and run a psychiatric clinic for the New York Court of General Sessions. Prior to the court clinic’s founding, a single physician at the infamous Tombs jail who had no training in psychiatry might examine a problematic prisoner. And if the “patient” had any luck he might be referred to the prison ward at Bellevue. At the beginning of the 1930s, however, a number of important committees composed of jurists, criminologists, and psychiatrists, including the National Commission on Law Observance and Law Enforcement, recommended that “the larger courts [should] be encouraged to establish their own psychiatric clinic.”66 Through the collaboration of Bellevue Hospital’s Dr. Menas Gregory and Judge Cornelius F. Collins, and with the support of New York’s Mayor Jimmy Walker, the Court of General Sessions, the country’s oldest and largest criminal court, began to require a routine psychiatric examination of all convicted felons both prior to sentencing and probation decisions. Not only did the court clinic offer Wertham a foothold in psychiatry after years of uncertainty; the clinical work with the convicts also became the foundation for one of the most fruitful phases of Wertham’s career.
By Wertham’s own account, his interest in criminology dated back “to medical school days when I used to go regularly to court proceedings in cases where psychiatric questions came up.”67 Wertham’s own ideas about what was then called “medico-legal contacts” and his preparation for the work of the court clinic also developed from practical experience while in Baltimore of examining patients who had committed criminal acts and through testifying in court. What distinguished Wertham’s new immersion in the fields of criminal psychopathology and forensic psychiatry was that it coincided with the very moment when American courts, prisons, and asylums were beginning to look to psychiatry for scientific explanations of criminal activity, with special attention to the personality makeup of repeat offenders.68 As the case of Clinton Brewer would later demonstrate, it was through these scientific and juridical developments that the paths of Richard Wright and Fredric Wertham began to converge.
By the early 1930s, legions of psychiatrists, including some who were psychoanalytically oriented, began to look at psychopathology as the field in which answers to criminality would be found. In 1931, the year of Wertham’s appointment to the court clinic, the American Psychiatric Association formed the Committee on Forensic Psychiatry to explore the contacts between medical psychology and criminology. In the same year, one of the most influential texts representing the new developments was published. The Criminal, the Judge, and the Public, by Franz Alexander and Hugo Staub, was a psychoanalytically informed study originally published in German but then translated into English, specifically for an American audience.
At the same time, competing views of crime from the field of sociology emerged emphasizing the environment, not individual psyches, as the proper unit of analysis for illegal and antisocial behavior among adults and juveniles. Major studies in this area were published in the period that Wertham was working in the court clinic, including studies on crime and juvenile delinquency by Sheldon and Eleanor Glueck in Boston and Clifford Shaw from the Chicago School of sociology. In psychiatry, a new field of criminal psychopathology emerged in the 1930s, which Fredric Wertham would contribute to and reorient toward the social.69
Dark Legend
Wertham’s orientation toward the social bases of criminal psychopathology and human violence in general took shape in the mental hygiene institutions where he worked in the 1930s. And Wertham’s career as a public advocate for social psychiatry would emerge in the 1930s, when he turned his attention to what he termed medico-legal work. Wertham claimed that the scientific work of determining facts in questions of legal responsibility was part of a fundamental reorientation of psychiatry toward the social. “It is the historical function of psychiatry in relation to law at the present time to introduce into criminal cases facts and interpretations of facts which psychiatry and psychoanalysis have taught us,” he later explained. Such an attempt, he added, would “not only help in the proper disposition of cases but will aid in the prevention of crime and will lead more and more to adoption of the principle of safeguarding of the community. Moreover, the courageous and practical psychiatric study of criminal cases will have a healthy reverberation on psychiatry itself for the development of a long-overdue social psychiatry.”70
Wertham believed he was ready to direct a major mental hospital in New York City or Washington, D.C., where he could best develop and apply his social psychiatry without supervision. When the superintendent position at St. Elizabeth’s, the federal mental hospital in Washington, was vacant in 1937, he again wrote to Meyer, hoping to secure support for his application. He seemed to think that his reputation in the field had been rehabilitated over the last few years through his work at the Court of General Sessions clinic and as director of the Mental Hygiene Clinic at Bellevue and through his work with social agencies and the courts in New York City. Characteristically, Wertham’s letter to Meyer expressed a peculiar blend of resentment, entitlement, and self-doubt. Angry that he was not getting due recognition for the advances he was making in psychiatry, he paradoxically expressed his doubts about his own qualifications for the St. Elizabeth’s post. “Of course I do not know whether I would be able to do justice to such a difficult position…. But I cannot help taking into account some of the recent appointments in psychiatric institutions and measuring them against the standards of the ‘prospect’ of future psychiatric work.”
For Wertham the question of his “prospects” had everything to do with the established view of what was the proper work of the head of a psychiatric hospital. “Whatever interest and ability I may have for research,” he wrote, “may of course minimize my chances against somebody who was the administrator of some larger institution, since to many it seems to be so unacceptable that in psychiatry clinical research and administration are inseparable.”71 Meyer let him know that if asked he would “be glad to give expression to the appreciation with which I look back to your work as resident.” But he returned to the problem of Wertham’s nationality, noting that because “one had to deal directly with committees and not infrequently with commissions of investigation probably does not make it particularly easy for anyone not born American.”72 Perhaps Wertham’s nationality proved to be the main obstacle to his obtaining the St. Elizabeth’s position; perhaps his reputation for being difficult had reached the federal selection committee. For whatever reason, the post was given to someone else, pushing Wertham further to the margins of American psychiatry.
Disappointed and discouraged, Wertham returned to his research in criminal psychopathology and therapeutic work. As a psychiatrist for the Court of General Sessions clinic, he began testifying in a number of infamous criminal cases. Robert Irwin, for example, was a young man who committed a triple murder in 1937 using an ice pick. Prior to the murders, Irwin had been sent to Bellevue Hospital because he had attempted to castrate himself. During his stay in Bellevue, he came to Wertham’s attention because of the peculiar nature of the attempt at self-harm. Wertham began prolonged psychotherapy with Irwin, claiming later that he had in fact performed the first psychoanalysis of a murderer prior to the act of killing. The hospital released him despite Wertham’s warning that he would commit other acts of violence. After the murders, Wertham examined Irwin again and testified unsuccessfully that the young man suffered from a mental disorder at the time of the murders.73
Wertham had discovered in his work with Irwin a diagnosable disorder he termed the “catathymic crisis.” In this mental disorder an individual became fixated on the commission of a violent act against himself or an other as “the only way out.” Wertham discovered in several patients he encountered at Bellevue and the court clinic a form of disordered thinking precipitated by circumstances that were not psychogenic or organic in nature, but experiential and social, such as hardships or abuse as a child. In such cases, a crisis developed in the individual, typically through five stages:
- Initial thinking disorders, which follow the original precipitating circumstances.
- Crystallization of a plan, when the idea of a violent act emerges into consciousness.
- Extreme tension, culminating in the violent crisis, in which a violent act against oneself or others is attempted or carried out.
- Superficial normality, beginning with a period of lifting of tension and calmness immediately after the violent act.
- Insight and recovery, with the reestablishment of an inner equilibrium.
The important factor in identifying a catathymic crisis, according to Wertham, was the “exclusion of all other mental conditions that have to be considered in differential diagnosis,” namely whether the individual’s symptoms and actions indicated a different mental disorder, such as schizophrenia with paranoid delusions.74 A person experiencing a catathymic crisis might indeed suffer from other mental disorders (hence the differential diagnosis procedure), but the most salient feature of the catathymic crisis was its transitory nature; upon completing the violent act, the individual returned to a state of equilibrium or normality. Psychoanalytic psychotherapy, argued Wertham, could intervene with the catathymic patient and redirect the belief of the patient that violence was the only way out.75
Without any knowledge of one another’s existence, Richard Wright and Fredric Wertham simultaneously began in the late 1930s to write the stories of two young men who committed murders reflecting the basic pattern of the catathymic crisis. Bigger Thomas’s response to the trauma of antiblack racist oppression was a simmering hostility toward his own people and an obsessive fear and hatred of whiteness. In Native Son, whiteness was embodied in characters like the Dalton family, yet Wright also represented whiteness in the amorphous blur that followed Bigger as his fear overwhelmed him in moments of crisis. While Bigger never consciously set out to kill off the power of whiteness by murdering a white person, his accidental smothering of Mary Dalton led him to an acknowledgment that to strike against whiteness was his wish all along.76
In the aftermath of the murder, Bigger experienced a profound “lifting of tension and calmness” in the manner that Wertham described in the fourth stage of the catathymic crisis. “The thought of what he had done, the awful horror of it, the daring associated with such actions,” Wright narrated, “formed for him for the first time in his fear-ridden life a barrier between him and a world he feared. He had murdered and had created a new life for himself. It was something that was all his own, and it was the first time in his life he had anything that others could not take from him. Yes; he could sit here calmly and eat and not be concerned about what his family” or anyone else thought or did. After being convicted and sentenced to die, Bigger attained an awareness of how the experience of oppression had shaped his relation to himself and to a racist society. He came to express a semblance of insight into the meaning of his crimes. To the dismay of his lawyer, Max, Bigger cries out, “When a man kills it’s for something…. I didn’t know I was really alive in this world until I felt things hard enough to kill for ’em…. It’s the truth, Mr. Max. I can say it now, ’cause I’m going to die. I know what I’m saying real good and I know how it sounds. But I’m all right. I feel all right when I look at it that way.” Bigger’s newfound ability to rationalize his violent acts reflected what Wertham described as the final catathymic stage, in which an inner emotional equilibrium was established.77
Gino, the true-life subject of Wertham’s 1941 book Dark Legend: A Study in Murder, was a young man vastly different from Bigger Thomas. Yet Bigger’s and Gino’s violent responses to inner conflict represented cautionary tales to a society oblivious of the suffering of its invisible youth. Sometime in the early 1930s, Gino (a pseudonym) emigrated from Italy to New York City with his mother and younger brother and sisters. By all accounts from his neighbors and family, he was happy, friendly, and a hard worker at his various jobs. But one night he waited until his mother was asleep, grabbed a common bread knife, and stabbed her thirty-two times; he then calmly walked down to the corner store and told a policeman of his crime. Gino claimed that he killed his mother because she had dishonored his family, most especially his dead father, by her promiscuity—she had had a series of lovers in the seven years since her husband’s death, refusing to marry any of them.
Wertham encountered Gino in the Bellevue Hospital prison ward and soon examined him in order to form an opinion as to his mental state when he committed the murder. Testifying before the New York State Lunacy Commission, Wertham claimed that Gino was legally insane at the time of committing the crime, arguing that Gino suffered from an “almost specific disorder” in discrimination between right and wrong. “He regarded as moral, and even heroic, a deed that was most abhorrent to the conscience of normal man,” wrote Wertham. Accepting Wertham’s opinion, the commission declared the youth insane and committed him to a state asylum for the criminally insane.78 But none of Wertham’s questions about the heart of Gino’s case had been answered. Why had a seemingly normal, hardworking immigrant young man committed the execrable act of matricide? If Gino was unable to determine right from wrong at the time of the crime, was there an underlying mental disorder that Wertham might discover through further psychiatric examination?
Anxiety about manhood was a central feature of Gino’s plight. Through extensive psychoanalysis with Gino, Wertham was able to uncover a deep-seated inner conflict with roots in the social structure of patriarchy and its attendant normative expectations. The youth’s matricidal impulse derived from his inability to manage the anxiety of becoming a man, and the unwieldy feelings associated with his anxiety were displaced onto his mother. At the same time, Gino built up an idealized image of his dead father, resulting in an unconscious fear of not living up to that father-ideal. Wertham referred to Gino’s inner conflict as the Orestes and Hamlet complexes—the blending of a distorted, negative mother-image and an idealized father-image.
Wertham’s great hope in examining the case so thoroughly was that he might identify a pattern in Gino’s thinking and behavior that would provide psychiatrists and the rest of society with signposts to prevent such acts of violence. He may have identified the broad basis of Gino’s morbid thinking that led him to matricide, but he had thus far not been able to diagnose a specific mental disorder that would fit the case. He ruled out schizophrenia, manic-depression, and any organic disorder of the brain or nervous system. Wertham discovered in Gino the archetypal case of the catathymic crisis. Through Gino’s narrative of his life leading up to the murder and his description of his state of mind afterward, Wertham identified criteria that corresponded to his clinical description of the disorder’s process. As with Bigger Thomas, and in other cases of catathymic crisis, Gino’s “violent destructive act seemed to have been a rallying point for the constructive forces of his personality.”79
In each case of the catathymic crisis, Wertham identified a social basis to the emergence of the pattern of thinking that led to a violent resolution. His patients exhibited an inability to constructively manage their feelings of powerlessness. They had no healthy outlets for expressing their fear and anger. In virtually every case of murder he encountered as a clinician, the patient had had contact with both law enforcement and social service agencies prior to committing the act of violence. If these agencies could work in concert with a new type of psychiatry that recognized the social background of the individual, the specific pressures relating to his or her position within the social order, then perhaps the individual’s fear and hostility could be redirected toward developing healthy alternatives to violence.80
The publication of Dark Legend provided Wertham an unprecedented audience for his ideas about the social basis of criminal psychopathology and the study of violence in general. Well-received by critics in the national press and among artists and intellectuals, the book launched Wertham’s career as a public voice of psychiatry. Soon after Dark Legend, Wertham became a regular book reviewer for the New Republic and the Nation.81 Unfortunately the book had little effect on his position in American psychiatry. In the year prior to Dark Legend’s publication, Wertham had had another row with a supervisor while working at Bellevue. Transferred to the Queens General Hospital Mental Hygiene Clinic, he was more marginalized than ever from the centers of American psychiatry.
Demoralized and forlorn, Wertham sought guidance from his longtime mentor, Adolf Meyer. Wertham laid himself prostrate before Meyer. “I have now worked twenty years in American psychiatry, seven of them in your clinic,” he wrote. “But I spend my time doing the most ordinary kind of routine work, and whatever I do in the line of research has to be carved out of my nights and Sundays and vacations. I am sure you will not blame me if I am longing for a position where I could use my gradually acquired facility for organizing, teaching and research and clinical work, and if I have to face a time when there may be no place in American psychiatry as it is developing for somebody with my earnestness and training, and give up psychiatry altogether.”82
Nothing practical came of Wertham’s entreaty to Meyer. Yet perhaps this low moment in his professional life led him again to reimagine and reinvent himself as a psychiatrist and as a burgeoning public intellectual. In the early 1940s, in the context of a world at war, Wertham recognized that his expertise on the problem of human violence and his ability to convey the lessons of medical psychology in layman’s terms could offer guidance to a society in crisis. In this moment he began in earnest his quest to develop a new orientation for psychiatry that incorporated the social world of everyday people. On a practical level he came to see the need to develop his science outside the prevailing order of American psychiatry. Fredric Wertham decided at this point to move beyond the walls of established psychiatry to realize his increasingly radical scientific vision.