The term “refrigerator mothers” was probably first applied to autism by Leo Kanner in the late 1940’s when he noted a “genuine lack of maternal warmth”, “parental coldness”, and children who “were left neatly in refrigerators which did not defrost”. Even though Kanner himself abandoned use of the term, other psychoanalysts adopted the same, using it as a branding iron for useless therapeutic attempts whose scar is still felt today (see France’s autism treatment “shame”: http://www.bbc.co.uk/news/magazine-17583123). Two psychoanalysts, championed this notion and were primarily responsible for its embrace by the medical profession. Coincidentally, both psychoanalysts greatly exaggerated their credentials and indulged in aggressive physical interventions that even during their time should have been judged as cruel. Most people know about Bruno Bettelheim who compared both autistic children and schizophrenic patients as prisoners in a concentration camp. In this blog we will narrate the biography of the lesser-known John Nathaniel Rosen whose vitriolic writings offered a synoptic view to those of Bruno Bettelheim.

John Nathaniel Rosen (1902–1993) rose to prominence in psychiatry in the 1950s, ‘60s and ‘70s through his invention of a therapy he called “direct psychoanalysis.” Rosen impressed wealthy patrons, fellow psychiatrists, and the general public with his claims of quick, compassionate cures of schizophrenic patients. His theories, methods, and conduct have recently been detailed. In Against Therapy (Atheneum, 1993) Jeffrey Masson treats Rosen as a prime example “showing how emotional tyranny is at the heart” of psychotherapy. Edward Dolnick’s Madness on the Couch (Simon & Schuster, 1998) couples Rosen with Harold Searles as fraudulent practitioners of “talk therapy” to treat schizophrenia. Readers interested in full-scale exposes of Rosen’s rise and fall might consult these books and Rosen’s own Direct Analysis: Selected Papers (Grune & Stratton, 1953).

John Rosen was born in 1902 and graduated from high school in 1920. After completing the required premed courses at Syracuse University, he earned his M.D. in pathology in 1927 from the George Washington College of Medicine. In a 1981 deposition taken in connection with Rosen’s suit against the Miami Herald for alleged slander, he cited a number of positions occupied while he was in general practice in New York: a rotating internship at Cumberland Street Hospital (late 20s), a two-year internship at Brooklyn Jewish Hospital (1928-1930), six-month clinical training in psychiatry at Brooklyn State Hospital (1939), and a residence at Columbia-Presbyterian Medical Center (1945) when he began practicing psychiatry. Phyllis Friedman, once Rosen’s patient and then therapist, reported in 1977 that Rosen claimed he did psychological research and later held the rank of professor emeritus at Albert Einstein.

Certification by a New York State licensing agency as a Q.P., Qualified Psychiatrist, was evidently legitimate. However, when contacted by Virginia Snyder, a private investigator later hired by one of Rosen’s patients, none of these schools named above found any record of Rosen’s service. According to Millen Brand, Rosen did undergo a personal psychoanalysis with Dr. Ferdinand Nunberg, president of the New York Psychoanalytic Society. In a rare admission, he states that “my knowledge of psychoanalysis was limited to what I had learned in the first months of my personal analysis and from my reading on the subject,” [5P, p. 3] and in his 1981 deposition, that he had never taken board exams in psychiatry. Throughout his career Rosen exaggerated his credentials, cure rates, and support while minimizing his responsibility for damaging his clients. Thus, any characterizations of Rosen as a “psychiatrist” or “psychoanalyst” rest on flimsy grounds.

In 1947 Rosen published his most influential paper in Psychiatric Quarterly, “The Treatment of Schizophrenic Psychosis by Direct Analytic Therapy,” re-published in Direct Analysis: Selected Papers (1953). In this paper he reports resolving the psychosis of 36 patients suffering from “deteriorated schizophrenia,” ranging in age from fifteen to fifty-two. Physicians other than himself, he says, diagnosed his patients’ schizophrenia. He purportedly got results in months, even weeks. A lengthy chart details their symptomatology; types, duration, and (in)effectiveness of prior treatments, and duration of direct psychoanalysis among other details. Viewed closely, the chart reveals egregious flaws in methodology. Interestingly, 24 of his 37 patients are female: almost two thirds, exactly reversing their proportions in the general population: “Approximately two males are affected for every female” (Torrey, Surviving Schizophrenia, p. 123). Nor does he confirm his “cure” rates with any objective criteria or impartial evaluation. He defines “recovery” subjectively, meaning that, such a degree of integrity is achieved that the emotional stability of the patient and his personality and character structures are so well organized as to withstand at least as much environmental assault as is expected of a normal person, that is, of a person who never experienced a psychotic episode. [Selected Papers, p. 46]. Examined closely, the apparent “objectivity” of his chart collapses.

Firmly established as a bold and creative innovator, Rosen deeply awed O. Spurgeon English, Chair of the Department of Psychiatry at Temple University Medical School and author of a widely-used textbook, Introduction to Psychiatry. Rosen appears to have impressed peers and benefactors alike as charismatic, preternaturally capable, and compassionate. English secured a three-year Rockefeller Brothers grant in 1956 to establish the Institute for Direct Analysis within the Psychiatry Department. With this funding he provided Rosen with three buildings for his practice, treating patients chosen by a committee of two psychiatrists and a psychologist. Three years later, in 1959, English obtained an associate professorship for Rosen. English has disputed Rosen’s claim to have been promoted to full professor in 1960, a rank he supposedly held for 12 years until retirement at the age of 70. English told Jeffrey Masson, author of Against Therapy, that Rosen remained an associate professor throughout his career at Temple, leaving in 1965 when English retired (p. 150).

Rosen’s reputation as a creative and effective therapist continued to grow. In 1968 Millen Brand explicitly based an adulatory novel Savage Sleep on Rosen’s work, lavishly praising his approach. A 1970 survey of psychiatrists and psychoanalysts rated Rosen the second of fourteen most controversial living psychiatrists in the United States. In 1971 the American Academy of Psychotherapy named him Man of the Year. Rosen later asserted that the Doris Duke Foundation and Webster Foundation contributed to the support of his Institute, and that the Rockefeller Brothers Foundation and “other benefactors” established his Institute in Doylestown, Pennsylvania—all untrue.

Given Masson’s and Dolnick’s extended treatments, Rosen’s approach can be summarized. Freud never believed he could cure psychoses with his “talking cure.” However, Rosen drew explicitly on Freudian theory, with unique emphases. In “The Perverse Mother” Rosen blames his patients’ schizophrenia on a lack of maternal love, stunting their normal development in the earliest, oral stage. Twinned with this putative cause is an equation of dream with psychosis, into which patients have escaped to muffle their anguish at being unloved. The patient’s resulting psychosis, he claimed, was an “interminable nightmare.” The therapist must awaken the sufferer “by unmasking the real content of his psychosis.” In extended exercises of “naive Freudianism,” Rosen simplistically labeled his symbolic clients’ “productions” with cursory, stock interpretations. Snow-capped mountains were a mother’s frozen breasts, he liked to say. He told patients their mother’s milk had been sour, that women had incestuous fantasies about or actual encounters with their fathers.

Rosen reports that the mothers of patients often expressed an anguished concern for their sons or daughters, verging on the self-sacrificial. Their protests, he admits, seemingly fly in the face of blame for bad mothering. Yet he has discovered, because he believed his unconscious deeply in tune with that of the patients, the patient recalls the mother’s non-verbal cues in the earliest, oral stage of life: the patient remembers an unloving mother’s message, saying, in effect, “Be still. Be quiet. Be dead.” If schizophrenia stems from disturbances in a patient’s earliest infancy, why then does the illness appear in late adolescence or early adulthood? Rosen invokes a Tower of Pisa metaphor. The patient’s selfhood was “built on a shallow, uneven foundation.” Thus, succeeding stages of development—the onset of puberty, independence, marriage, and parenthood—shake an already faulty structure, leading to collapse.

Because bad mothering caused the disease, the therapist must replace her. He must use “cunning, guile, shrewdness, and seductiveness” that are buried in his own unconscious to ferret out the patients’ secrets and return them to their pre-psychotic state. To paraphrase, the therapist surrenders to his or her own unconscious, primitive impulses to unravel the patient’s conflicts. Rosen suggests his own “capacity for loving” is a “divine gift” enhanced by psychoanalysis. To treat patients left largely “unimproved” by previous treatments, Rosen says, the therapist needs a high “degree of inner security.” He makes up for his patients’ “tremendous deficit of love” by forcefully, lovingly, and informally breaking through their defensive, psychotic shells. Sometimes—quite implausibly—he claimed “bringing the patient up all over again” by spending four to ten hours a day with her for months.

Sprinkled through Rosen’s published writings are strong hints of misogyny, an obsessive homophobia, implausible rationales for lies and impostures, and briefs for verbal, physical and sexual abuse of patients. Rosen openly expresses distaste for women who step outside traditional homemaking roles. He attacks their threatening desire to “wear men’s clothes, try for commanding positions in business, and prefer not to care for their own children but hire nurses to play the role of make-shift mother” as “a perversion of the maternal instinct.” [Selected Papers, p. 101]. Time and again he strains at interpretations that purportedly uncover veiled homosexual tendencies. Typically, Rosen uncovers “a homosexual defense against incest temptations and the danger of the lofty position, i.e., manhood.” [SP, 31]

To shock patients out of denial, Rosen would tell them he’d once been psychotic himself with the patients’ symptoms. He called this device “the trick against the trick.” He would assume the roles of priest, mother, or mother-in-law, among others. Or he would stage psychodramas. In one instance, psychiatric aides impersonated FBI agents to unmask a patient’s fantasies of criminal wrongdoing. Another skit led to near-disaster. Confronting a patient believing her father was condemned to death, he brought the family together and announced a spurious reprieve from the governor, followed by a celebration. The patient reacted by refusing to eat and losing 40 pounds. Rosen justified his bizarre roles and enactments as “helping patients re-establish contact with reality.”