This is the second of a three part series on John Nathaniel Rosen. The first part has already been posted: https://corticalchauvinism.wordpress.com/2013/04/10/the-dark-side-of-psychoanalysis-1-john-nathaniel-rosen-and-the-refrigerator-mothers/ The first blog dealt with the concept of “refrigerator mothers”. This blog will deal primarily with Dr. Rosen’s clinical practice methods. The next paragraph (from my first blog) is intended as both an introduction and a reference source for those who would like to read more on the subject.

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 Nathaniel Rosen: Therapy or Outright Patient Abuse?

Despite repeated assurances of his love and solitude for patients, Rosen time and again lost his temper. One patient carried a pillow around with her, rocking it, reading to it, and calling it her son Stevie. Rosen attacked her fantasies: “I grabbed the pillow and banged it on the floor, saying, ‘see, that can’t be a baby. I threw it on the floor with all my might and it didn’t cry’.” He argues unconvincingly that his violent, abusive methods appealed “to that tiny portion of the ego that is in contact with reality,” inducing the patient “to renounce some of his delusions and hallucinations.” Confronting a patient fearful of being cut up and fed to tigers, Rosen blandished a knife and threatened to castrate, kill and eat him. Admitting that “disgusting annoyances” often elicited a “considerable amount of anger and resentment,” he and several aides once pinned a long¬haired patient to a chair for a haircut. By his “counter-aggressive anger,” Rosen hopes to regain the patient’s attention for therapeutic ends.

Rosen not only reported physical abuse and coercion in his practice but openly displayed them before audiences. In Observations on Direct Analysis: the Therapeutic Technique of Dr. John N. Rosen, Morris W. Brody recounts a dialogue before a group between Rosen and a young woman. Rosen repeatedly demands the woman have intercourse with him, threatening to knock her through a wall. At a meeting attended by a large number of observers, Rosen demeaned and humiliated the young woman as “stupid” and “low class.” [Against Therapy, 152]

The generally favorable comments of six psychoanalysts follow the text of “The Treatment of Schizophrenic Psychosis” in Selected Papers. The eminent internist Paul Federn (who invented the term “direct analysis”) finds Rosen’s method “in full accordance” with Federn’s “assertions in regard to psychoanalysis of psychoses.” Yet he doubts that Rosen’s “cases are cured in the sense of having been freed of the unknown pathologic entity causing schizophrenic or paranoiac psychosis.” [SP, pp. 77, 76] [Italics mine]. Federn also recommends confining experimentation with Rosen’s method to “trained psychiatrists who are also fully qualified psychoanalysts,” failing to note Rosen is neither. Suggesting Rosen’s “cures” might be somewhat ephemeral, Joseph Meiers asks that final judgment on his methods be “reserved for a duration of a few years of maintained cures.” Remarkably, Jule Eisenbud finds Rosen “has absolutely no hostility … toward the psychotic patient,” despite blatant evidence to the contrary. Typical among so many of Rosen’s colleagues, Hyman Spotnitz gushes uncritically: “It requires a great deal of courage, devotion, and sincerity to do this type of work.” [SP, p. 91]. Though most of the panel members called for reassessment of Rosen’s results after five years or so, the profession ignored follow-up studies refuting his claims.

Even after Rosen was officially stripped of his credentials in 1983, his former colleagues failed to fault him. Contacted by Jeffrey Masson in 1986, O. Spurgeon English doggedly defended his previous sponsorship of Rosen and denied the relevance of the charges of abuse to the effectiveness of his methods. Dr. Morris W. Brody admitted growing disillusioned and suspicious of Rosen, recounting an exchange between Rosen and a patient. After repeatedly threatening a patient for insisting she heard voices, Rosen hit her. Brody, however, denied he was being sadistic. Brody questioned Masson’s interest in Rosen, blaming his wealthy clients for allowing themselves to be fooled. Rosen’s unwavering support from prominent professional colleagues not only during his career but after his disgrace make it difficult to refute Masson’s charge that “emotional tyranny is at the heart” of psychotherapy.

Unsurprisingly, Rosen’s reputation and influence led many wealthy, prominent families to turn over dysfunctional relatives to him for treatment—usually with no formal legal proceedings. The media baron and ambassador Walter Annenberg placed his son in Rosen’s care. While there the young man shot himself in 1962, an incident which enraged Annenberg. However, the private investigator he hired was unable to penetrate the secrecy surrounding Rosen’s operation. Rosen also had custody at various times of Barbara Hooker (related by marriage to the Rockefellers), Barbara Stuart (wife of the chairman of the Quaker Oats board), and both Anne Morrow Lindberg and her niece Connie Morrow, among others. Treating such patients was extremely lucrative. His 1981 deposition records that he sometimes charged as little as a dollar an hour, but “also with X and Y I charged $10,000 a month. And Mr. John D. Rockefeller, III, who was our trustee, Mrs. X’s trustee, when I sent him the bill for the year of $120,000, he said if I added a zero, he would have no objection” (p. 162). Unlike his grossly inflated credentials and claims of effectiveness, his fees had a factual basis. The parents of Sally Zinman, a patient who sued him for mistreatment, paid him $5,000 a month for “therapy” lasting as little as 15 minutes a day.

In 1983 Rosen voluntarily gave up his medical license to avoid being tried for incompetence and malpractice by the State Board of Medical Education and Licensure of the Department of State of Pennsylvania. His disgrace raises intriguing questions. Was Rosen, as Millen Brand suggests, initially a sincere but misguided self-promoter? If so, did easy wealth seduce him into neglecting and abusing his patients, placing them in the hands of brutal, untrained assistants? Or was he criminally negligent, even sadistic and corrupt, from the outset of his career? The record clearly supports the latter. A series of lawsuits attacked Rosen beginning in the 1960s for fraud and violence, several patients died in his custody, and careful studies exposed the inefficacy of his treatment. Yet neither government agencies or officials, medical societies, nor parents of patients intervened effectively to restrain or punish him. Rosen asserted his “assistant therapists would generally be people with degrees in psychology up to even a doctor, doctorate” (1983 deposition, p. 16). However, his so-called “assistant therapists” as a rule were often former patients, untrained and uncredentialed despite Rosen’s protests. Brand commented that after Rosen “had cured those [patients], he used them for nurses and attendants” a practice Rosen announced in 1947. More bluntly, Dr. Isidor Scherer of the Department of Public Welfare repeated Rosen’s comment, “I will not hire anybody unless he’s an ex-nut.” Hiring patients to work as aides is now illegal.