Psychotherapy is increasingly being recognized for its vital role in treating psychiatric patients. Let me reminisce about what it was like to be a medical student and psychiatric resident in the heydays of psychotherapy under Dr John C. Whitehorn, head of psychiatry at the Johns Hopkins School of Medicine from 1941 to 1960. Because of the war, our class began in June of 1942. We students knew nothing of Whitehorn’s background in psychiatric research in the Harvard area; only that he was a biochemist who had recently come from Washington University to replace Dr Adolf Meyer. The scuttlebutt was that the members of the board of trustees of the hospital had been alarmed that biochemist Meyer had become interested in the psychodynamics of mental illness. They had therefore chosen Whitehorn to reverse the tide. However, unknown to the board, Whitehorn also had become interested in the importance of the interpersonal relationship in healing.
Our introduction to him was a lecture on the subject. This unassuming dignified man presented sessions from a patient he had treated. The young woman used foul words, which he repeated without blinking an eye. We naive students—many of us religious—were stunned. Then he proceeded to talk about different character types: hysteric, obsessive-compulsive, and so on. Scanning the 80 of us—looking each of us straight in the eyes—he said: “There is not a single person here who is not obsessive-compulsive!” Pausing to let this sink in, he continued: “None of you would have got through college and be here today if you were not obsessive-compulsive.” Under his words was the hidden message, bear in mind that patients are people just like you. Don’t teach them. Listen to them and they will teach you.
In our second year, Whitehorn asked us to write a paper about how someone we knew had coped with a physical handicap. I chose one of my college classmates who had one leg shorter than the other. She had adjusted well, seeming to have no self-consciousness. Whitehorn’s lesson was: The diagnosis is not as important as the patient’s previous assets, her “positive attributes.” How the person has coped with problems in the past will indicate his or her chances for recovery.
Whitehorn’s influence did not extend to the basement outpatient clinic where Dr Esther Richards held forth. The morning ended with several patients being examined by her in front of the group. She was so cruel that those people would need all the resilience they possessed to survive this inquisition. As a resident, I encountered an almost non-verbal high school girl I thought I could treat. Dr Richards called her “poor stuff” and aggressively challenged me. Tauntingly, she said I would discover for myself not to waste time doing psychotherapy with a schizophrenic. (We will hear more about her later.) But out of Dr Richard’s hearing, we were supervised by psychoanalysts who offered their time for our education.
In June of 1945, I left for the University of Iowa for a rotating internship and a year of neurology, having been invited by Dr Whitehorn to return to Hopkins for my residency. In Iowa, I saw psychiatry practiced in a pragmatic way: electric and insulin shock treatment, and even a rare lobotomy. The social workers were active throughout the state in supporting patients and making sure they were taking their medications. One of my patients was put to work in a popcorn stand that became hers after 5 years.
It was a relief to return to Phipps and speak the same language again. Twice a week we residents met in the library with Dr Whitehorn and other staff members, taking turns presenting a case. I presented my work with the young schizophrenic patient I mentioned above. She said very little in her sessions; we just sat together. I remember to this day the hot fifty-cent piece she placed in my hand at the end of the session as payment. One afternoon she arrived with a painful toothache, so phobic she had not been able to go to the dentist. I called the dental department in the hospital and accompanied her. Even with my support, she could not open her mouth.
At this point in my presentation, one of the senior members of the staff became increasingly agitated. “There must be some way this could have been handled without the doctor going with her.” Dr Whitehorn quietly said: “Well, the proof of the pudding is in the eating. Dr Young, what happened?” I told them that she had come in the next week having taken care of it herself. This “poor stuff” girl managed to finish high school, had a baby, and married a service man. The little family flew off to the Philippines, as far away from her noxious family as possible.
Occasionally Whitehorn would interview one of our patients in our presence. My patient was a very depressed college professor. Whitehorn sat back in his chair, relaxed, listening intently, his fingers making a steeple before his bowed head. They then began to discuss Shakespeare. I kept thinking: When is he going to ask about the patient’s symptoms, his wife, his mother? He never did. It was Shakespeare for an entire hour. When the man walked out of the office, his head was high. He was a different man.
Whitehorn was not telling us that we should ignore symptoms and reality problems. He was using his power as the chief of psychiatry to reawaken the man’s will to live, to remind him of his positive assets, and to give him hope for the future. As I wrote my parents, “I realized I had grown to like, respect, and appreciate this person who happened at the moment to be ill.” After he left the hospital I had one letter. He had resigned from his job, his wife and he had agreed to part, and he had moved some distance from his intrusive mother. He was traveling in a new artistic job that he loved.
Dr Whitehorn had more direct contact with the private patients on the fourth floor. But through the chief resident as intermediary, I believe he knew each patient as well as how each resident was performing. He had discretionary funds so that he could keep a patient in the hospital without charge if it was for the benefit of the resident’s education. One psychotic musician was saved by the extra time, she was able to regress and live through the agony of having been abandoned to an orphanage by her mother. As I left the ward, she would grasp her hands tightly around my legs. When she was well enough to come to my office, she would sit on the floor rocking a pillow as if it were a baby. She recovered, got a job, married, and continued her career as a musician.
One patient came from another country, seriously depressed. He did not seem to get better. How were we going to send him home like this? He had only enough money for 6 more weeks in the hospital. Whitehorn decided to cut his rate from $88 to $10 a week and then to nothing, just so he would have $500 to use when he got home. When he left, I had only one clue as to how things would go for him. When he had become depressed his black hair had turned white. Before he left the hospital, some black had begun to appear. Four years later, with no warning, he appeared in my waiting room. “Hello, Doc!” His business was going well. As he reached into his pocket and pulled out a beautiful bracelet, he said: “My wife sends this to you.”
Dr John C. Whitehorn shaped mental health policy at the national level, and his influence is still alive in his former residents and the young psychiatrists we have trained.