Frieda Fromm-Reichmann was a pioneering psychoanalyst who spent the major portion of her professional life treating psychotic patients. Born in Germany, she escaped the Hitler Anschluss in 1935 and became a staff member at the Chestnut Lodge Hospital in Maryland where she wrote and treated patients until retirement.  Although schooled in all of Sigmund Freud's psychoanalytic treatment precepts, she went beyond these to treat types of patients that Freud himself and most other psychoanalysts or mental health practitioners considered untreatable, primarily those suffering from severe breaks with reality—schizophrenia, manic-depressive bipolar disorder, and patients with psychotic depression. To do this, she used many daring and effective methods such as entering into the figurative and symptomatic world of the patient, treating symptoms as metaphors and smoke screens for underlying conflict and guilt, always focusing on and presenting reality and, both beneath and combined with all these, employing broad empathy, flexibility, courage, and special understanding.

    One instance she has described concerns a professional male patient who had nightly grave and disturbing persecutory delusions, reported by the nurses, of people of various nationalities pursuing him during the night. Trying to escape, he pleaded with each of his persecutors in the person's own language. On the following day, he was in rational contact and could provide no opportunity for discussing the delusions because he could not remember them. After many futile therapeutic attempts, Fromm-Reichmann decided to ask the nurses to awaken her at night at a time when his delusions were apparent. They did so, and she came to the ward to watch him as he climbed from one piece of furniture to another indicating he was running from his persecutors and pleading with them in English, French, German, and Hebrew. She followed him and, also speaking sequentially in each one of the languages, she reassured him that she could not see the persecutors but would try to protect him against them. Then, after 15 or 20 minutes, he quieted down and went to sleep. During the subsequent days she met with him and reminded him of their nocturnal experience several times, ultimately breaking through his denied recall and enabling the beginning of a successful interpretative psychotherapy.[1]

      Another very moving beginning concerned a severely paranoid schizophrenic prior economist from the U.S. Department of Labor who had regressed in the hospital to an animal-like state. Fromm-Reichmann came to his room and found him lying naked on the floor covered with his own excrement, masturbating, and mumbling incoherently. She asked if he would speak up so she make out his words but he gave no response. Moving closer to him, she quietly told him she wasn't trying to be aggressive against him but to find out what he needed. When he continued only to mutter, she sat down on the floor next to him, saying that she hoped to understand him better. He then seemed suddenly to awake and with a fearful expression, shouted "No, you cannot do that for me, that is impossible. You will run the same risk as I do....I cannot accept it." Immediately, she responded that she was perfectly willing to go with him through all the dangers of his sickness and be his comrade in overcoming them. Then, he took a blanket from the bed and covered himself, saying "Even though I have sunk as low as an animal, I still know how to behave in the presence of a lady." He looked startled, as if he returned from some far off place.[2]

   A last illustrative instance, this one of her interventions during the course of psychotherapy, is from her treatment of the schizophrenic patient, Joanne Greenberg. This report comes from Greenberg's famous published account of this treatment and recovery under the pseudonym of Hannah Green entitled "I Never Promised You a Rose Garden". Early, Greenberg painfully describes the she was living in a world called Yr which was populated by attacking creatures called Collect and Anterrabae. It was a fearsome and demanding world filled with anxiety and guilt, including impenetrable guilt about destroying her sister. At one point in the mid-course of this treatment, Green (Greenberg) describes the following interchange with her therapist:

   "How did you destroy your sister?"...[Dr. Fromm-Reichmann] asked ...[Joanne] who was huddled on the couch, shivering in Yr's cold through the heat of Earth's August.

    "I didn't mean to--she was exposed to my essence. It's called by an Yri name—it is my selfness and it is poisonous. It is mind poisonous."

     "Something you say that destroys? Something you do, or wish (emphasis: mine)?

     "No, it's a quality of myself, a secretion, like sweat. It is the emanation of my ...[Joanne-ness] and it is poisonous."

      Suddenly ...[Joanne] felt an explosion of self-pity for the miasma-creature she was, and she began to elucidate, drawing larger and larger the shape of herself and the virulence of her substance.

      "Wait a moment—" The doctor put up her hand, but the joy of self-loathing had taken ...[Joanne] as fully as if it had been love, and she went on and on, decorating and embellishing the foulness, throwing the words higher and higher.... The doctor waited until ...[Joanne] could hear her and then said flatly. "So you are still trying to throw dust in my eyes..."          

       The doctor pressed her to continue about the destruction of ...[her sister], and she did, telling of the early jealousy and the later love that had been so racked and guilty...Everyone she knew was tainted by it through her—... [her sister] more than anyone because she was loving and impressionable.[3]     

     In public lectures later, Joanne Greenberg stated that the key to Fromm-Reichmann's approach was flexibility. In terms of her practice and theoretical approach to schizophrenia this flexibility was applied to a beneficially meaningful creativity in psychoanalytic treatment. This is borne out in an incident from my personal experience. When I was one time treating a patient who had formerly been at Chestnut Lodge, I pointedly made an empathic comment to her about her bitter experience of leaving that hospital. The next day, she familiarly told a previous friend of hers who had also been a patient at the Lodge about my comment and her friend immediately replied, "Frieda! You've got Frieda for a therapist." I have cherished the honor of this characterization throughout all my years of psychiatric practice.   

[1] Fromm-Reichmann, F. Principles of Intensive Psychotherapy. Chicago: University of Chicago Press, 1950.  

[2] Hornstein, G.A. To Redeem One Person is to Redeem the World. N.Y.: The Free Press, 2000.

[3] Green, H. I Never Promised You a Rose Garden. New York: Holt, Rinehart and Winston, 1964, pp.82-83.