The Unsung Psychoanalyst: The Quiet Influence of Ruth Easser 9781442682511

Table of contents :
Contents
Foreword
Acknowledgments
Introduction
1. Beginning: The Background
2. Becoming
3. Being
4. Integration
Epilogue
Afterword
Appendix 1: Collected Papers of Ruth Easser
Appendix 2: Interviewees
Notes
References
Index

Citation preview

THE UNSUNG PSYCHOANALYST: THE QUIET INFLUENCE OF RUTH EASSER

Ruth Easser, 1975

The Unsung Psychoanalyst The Quiet Influence of Ruth Easser

Mary Kay O'Neil

UNIVERSITY OF TORONTO PRESS Toronto Buffalo London

www.utppublishing.com © University of Toronto Press Incorporated 2004 Toronto Buffalo London Printed in Canada ISBN: 0-8020-8978-X

Printed on acid-free paper

Library and Archives Canada Cataloguing in Publication O'Neil, Mary Kay The unsung psychoanalyst / Mary Kay O'Neil. Includes bibliographical references and index. ISBN 0-8020-8978-X 1. Psychoanalysis - History. 2. Easser, Ruth. 3. Psychoanalysts. I. Title. RC451.4.P79O532004

150.19'5

C2004-903324-7

This book has been published with the help of a grant from the Canadian Federation for the Humanities and Social Sciences, through the Aid to Scholarly Publications Programme, using funds provided by the Social Sciences and Humanities Research Council of Canada. University of Toronto Press acknowledges the financial assistance to its publishing program of the Canada Council and the Ontario Arts Council. University of Toronto Press acknowledges the financial support for its publishing activities of the Government of Canada through the Book Publishing Industry Development Program (BPIDP).

Contents

vii

Foreword

xi

Acknowledgments

Introduction 3 1 Beginning: The Background 14 2 Becoming 60 3 Being 101 4 Integration

171

Epilogue 199 Afterword 209 Appendix 1: Collected Papers of Ruth Easser Appendix 2: Interviewees Notes

219

References 235 Index

241

215

211

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Foreword

Psychoanalysis was described by Sigmund Freud as one of the 'impossible' professions, along with teaching and government. Psychoanalysis has also been a rather mysterious profession. A variety of mystiques and idealizations have grown up around the process of psychoanalysis and the person of the psychoanalyst. Awe, envy, anger, dread, longing, and many other profound emotions have been aroused by the image of the all-knowing, silent, impenetrable, immovable, powerful psychoanalyst 'who could read one's mind,' knew the meaning of one's dreams, and could relieve one's personal agonies. The many psychoanalytic jokes and cartoons that have been a mainstay of middle-class humour for so many years represent, in part, an effort to humanize, deflate, and demystify the psychoanalyst. For most of the past century, psychoanalysts and their organizations facilitated this atmosphere of secrecy and lofty aloofness. Under the theoretical concepts of neutrality and personal anonymity psychoanalysts were strongly discouraged from revealing anything of themselves to their patients or from participating in public activities that might bring individual psychoanalysts or psychoanalytic organizations into the open - whether mental health movements, educational activities, social welfare initiatives, research projects, or politics. The intent behind these strictures was to maintain what were then considered the best conditions under which psychoanalyses could be conducted. The less the patient knew of the analyst's personality, private life, or views on a range of public and private matters, the more latitude the patient had to develop his or her own fantasies about the analyst. This fantasy structure was, and is, a deep source of information about the patient's own inner life. The patient's fixed, automatic, and unconscious expectations of the

viii

Foreword

behaviour of another person, and the ways in which the patient unconsciously shapes the relationship to fit these fantasized expectations, are major sources of enlightenment about the prior relationships that led to these unconscious and interpersonal manoeuvres. In psychoanalytic jargon, this is labelled the transference. Although the study of transference responses remains an essential source of therapeutic information, a major shift has taken place in psychoanalytic thought concerning the nature of the psychoanalytic process. Where the transference has initially been conceived as almost solely the construction of the patient, the experiences of several generations of psychoanalysts have convinced most practitioners and theoreticians alike that the therapeutic situation is inevitably interpersonal and intersubjective. It is always and ineluctably the case that patient and therapist are influencing each other and revealing themselves to each other both in subtle, unconscious, and unintended fashions, and overtly and intentionally. This shift in viewpoint, occurring over several decades and with great debate and considerable acrimony, is often referred to as the change from one-person psychology, the study of the patient, to a two-person psychology, the study of the interaction of patient and psychoanalyst. This change has been a major focus of new developments in psychoanalysis during the past several decades and it was at the start of this debate that Dr Ruth Easser, the subject of this moving and informative book, came of age professionally and thrived. Dr Easser received her psychoanalytic education and achieved her psychoanalytic maturation just at the time when this change had begun in American psychoanalysis. The Columbia University Clinic for Psychosomatic and Psychoanalytic Medicine, where Easser trained and taught, was founded by Dr Sandor Rado in 1944. Its purpose was the pursuit of what was then a new vision of the psychoanalytic enterprise - psychoanalysis as an academic activity maintaining close ties to a variety of other disciplines including biology, neurophysiology, anthropology, sociology, and hospital psychiatry, among others, and devoted to empirical research. A handful of other psychoanalytic training centres that had similar notions of expanding the confines of psychoanalytic theory and technique beyond the bounds acceptable to the standard 'orthodox' Freudian ego psychology that dominated American psychoanalysis until the late 1960s, but none of those institutions had managed to remain within the American Psychoanalytic Association (APsaA). A special agreement between the APsaA and the International Psycho-Analytical Association (IPA) automatically barred members of these 'unorthodox' societies from concurrent membership in the IPA. An important and regrettable consequence

Foreword

ix

of this was that it became practically impossible for the ideas of such psychoanalysts to reach publication in the major psychoanalytic journals where they could have been seriously considered. As a result, non-members of the American Psychoanalytic Association were consigned to a psychoanalytic fringe. Initially the American Psychoanalytic Association refused to accept Sandor Rado's new institute and society. Rado fought hard, and ultimately successfully, to assure that the Columbia group would retain its place within the organized psychoanalytic community. Columbia received a grudging official stamp of legitimacy, in being recognized as a component institute and society of the 'American.' The general atmosphere in the American, however, was that the Columbia group and its graduates were contaminated by culturalist, interpersonalist, and empiricist thought. The prevailing viewpoint was that these were not 'really' psychoanalysts, and they did not represent the 'true' goals of maintaining a psychoanalytic focus on instinctual development and intrapsychic conflict. Columbia faculty and graduates were rarely accorded appropriate positions in the organizational structure of American psychoanalysis, and their papers were routinely rejected by the official psychoanalytic journals. Dr Easser, blessed with extraordinary intellectual powers and an unusual charisma, was an exception to this state of affairs. Esser's early publications on the hysterical personality were critical in helping to change the intellectual and interpersonal insularity of the profession. Psychoanalysis enjoyed huge prestige during the first three-quarters of the twentieth century. The refusal, however, of psychoanalytic organizations to participate in the media interest in psychology, psychotherapy, and mental illness, and an apparent lack of interest in the revolution in psychopharmacology, led to a gradual erosion of the elite medical and public position of psychoanalysis. There was a concomitant rise in prominence of other briefer psychotherapies and pharmacotherapy. This volume, beautifully clear in its theoretical expositions and descriptions of psychoanalytic practice, is particularly timely in this respect. In recent years a huge wave of anti-Freudians have aggressively been touting a variety of claims, including the following: Freud was fraudulent and a charlatan; there were never any data for unconscious processes or for the methodology of psychoanalysis; cognitive science has made psychoanalysis irrelevant; pharmacological treatments have made psychoanalytic ideas superfluous. This surge of angry rejection of psychoanalytic ideas seems to have crested. Now it would appear that a more moderate and exploratory atmosphere of interest in the integration of mentalist and neuroscientific concepts prevails. Dr Mary Eiay O'Neil's careful and

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Foreword

deeply personal account of the life of one psychoanalyst helps to place in perspective the seriousness, dedication, and intelligence that informed the psychoanalytic movement - at least when at its best. Ruth Easser and her colleagues were aware of the many problems and the many unanswered questions in psychoanalytic theory and technique that Freud left unresolved. Most psychoanalysts have practised their pro fession with the combination of conviction and doubt that all doctors are educated to adopt as a core attitude in helping their patients using the best methods available, while searching for new and better ways to pursue their art and science. In recent years a shift has taken place. In response to the loss of public esteem, there has been a concerted effort on the part of organized psychoanalysis, largely in North America, to present psychoanalysis more openly and in more realistic terms. Psychoanalysis is to be seen as a seri ous profession that studies mental life, especially unconscious mental life, and aims to provide patients with the means to better understand themselves so that they may alter fixed patterns of feeling and behaving that could be crippling their capacities to live their lives to the fullest. This volume, describing the development and life of one particular psychoanalyst, Dr Ruth Easser, provides a unique window on knowing who and what a contemporary North American psychoanalyst is, could be, or should be. There surely is no such thing as a typical psychoanalyst - that is the stuff of cartoons. Yet the description that Mary Kay O'Neil provides of the life of her psychoanalyst, Dr Easser, offers us the opportunity to better understand what sort of person becomes a psychoanalyst how one becomes a psychoanalyst, and what the life of a psychoanalyst might be like. Ruth Easser was unusual in all sorts of ways. She was unusually intelligent, Canadian, and a woman doctor before that was common. She maintained her career while bearing children and raising a family, had more than her share of personal tragedy, was highly successful - and died much too young. Dr Ruth Easser might be considered more as an exemplary psychoanalyst than a typical one. Paradoxically, that makes her story even more informative and compelling. For all these reasons, Ruth Easser deserves this book, and this book deserves to be read by all of us who are interested in biography, psychoanalysis, and the history of ideas. ARNOLD M. COOPER, MD

Acknowledgments

The words generosity and openness best describe the many extraordinary people who brought this book to fruition. For some, their generosity stemmed from affection and admiration for Ruth Easser whose 'quiet influence' touched their lives. Their openness was expressed by their willingness to give freely of their thoughts and feelings. Others who did not know Dr Easser contributed their ideas and their time because they considered the project worthwhile. Several groups of people have joined me during this twelve-year odyssey, and, of course, my dear family have been with me throughout the journey. The enduring support of all has been invaluable. Thank you to Paul Lerner (and also Carol) for mourning with me, for our long talks about Ruth Easser's way of working, and for sharing the rights to her papers. Paul introduced me to John Kerr, editor par excellence. As my ideas developed, John's astute comments and careful reading of earlier drafts led to the book's shape, ultimately making Ruth Easser's story stand for something larger than itself. David Staines, the eminence grise of Canadian literature, who discussed versions of the manuscript, and provided useful advice in seeking a publisher, gave me the courage to complete this book. The substance of the book derives from the interviewees without whom Ruth Easser's story could not be told. They - psychoanalytic colleagues and students, the Easser/Lesser family, and their friends - shared personal aspects of their lives and memories. They trusted that their confidences would be used judiciously to portray Ruth Easser and to present psychoanalysis as a 'possible profession.' I am especially grateful to Joan Milling, Ruth's sister, and Dena Wechter, her closest friend, for allowing me to enter Ruth's personal world; Arnold Cooper for his foreword; and

xii Acknowledgments

Robert Michels for the afterword; Ethel Person and Joseph and Judy Schachter for their free-hearted contributions; and Roland Forrester and George Boujoff for a deeper understanding of the life-changing effect of psychoanalysis. The other interviewees (acknowledged in Appendix 2), whose thoughts and quotes also added substance, are much appreciated. Unfortunately a number of them are now deceased but are remembered in Ruth Easser's story. Thanks also go to the Columbia Center for Psychoanalytic Training and Research, directors Roger MacKinnon and Robert Click, administrator Joan Jackson, and librarian Judy Kronenberg for making available information about Ruth Easser and the history and program of the center; Nellie Thompson of the New York Psychoanalytic Society for the opportunity to first present my work on Ruth Easser; and to Brian Shelley for his spontaneous letter, which provided a sensitive and apt ending for this book. I am grateful to the University of Toronto Press for risking the publication of a book about a little-known person in a currently undervalued profession. They recognized that not only did Ruth Easser deserve recognition as a psychoanalyst but also as a pioneering Canadian woman and an accomplished graduate of the University of Toronto. The financial support of the Canadian Federation for the Humanities and Social Sciences, and the editorial skill of U of T Press staff facilitated the production of this book. I wish to express my deepest appreciation for the loving and unsparing support of my husband, Frederick Lowy, who, in the midst of his demanding academic career, gave valuable hours for discussion, editorial critique of multiple drafts, and psychoanalytic expertise. Our four children patiently and enthusiastically cheered me on. The encouragement of sons David, Eric, and Adam and their partners increased exponentially as their four daughters chimed in. In the tradition of my mother Eileen and mother-in-law Mitzi, our daughter Sarah taught me much about attachment and autonomy in a woman's life. Opportunity and the freedom to use it with the support of facilitating mentors, colleagues, friends, and loved ones are among life's most valuable gifts. MARY KAY O'NEIL

THE U N S U N G PSYCHOANALYST

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Introduction

Then came the gifted teachers, and with them the moment when knowledge is passed from one mind to another. He showed her the teachers poised on the edge of the moment ... And everywhere around was the quiet that accompanies the act of passing skill from one mind and hand to another ... gently breaking open the marks of the alphabet to reveal meaning and the light of understanding on her own face. The phrases of lessons he placed before her. 'No, like this,' he said, and 'Let me show you,' and 'Now you try.' 'This is what you carry with you,' he repeated, 'this is your ship's cargo. And when you go, this is what you become part of.' 'And you,' she asked, 'will I take you with me?' 'Yes and no,' he said. Jane Urquhart, Away

This book is about psychoanalysts. It is about the unsung psychoanalysts and their careers. It is about living one's professional life as a psychoanalyst. It is about beginning, becoming, being, and integrating as a psychoanalyst. It is about people who happen to be psychoanalysts, about their social and cultural context, the time and place within which they live and work, about the passing of knowledge, the psychoanalytic legacy from one generation to the next. It is about the professional heritage of psychoanalysts. It is about their future and the future of their profession. This book is written first for today's psychoanalyst. It is not only for those who are already members of the profession, whether new or sea-

4 The Unsung Psychoanalyst soned members seeking to integrate their personal and professional selves, but also for those interested in being psychoanalysts, the aspirants, the candidates in training. It is for those people who have aspired to be psychoanalysts and were disappointed. Unable to realize their aspirations because of lack of opportunity or because of rejection by training institutes, they might wish to ease their disappointment and examine either idealized or overly negative illusions they may have about life as a psychoanalyst. It is also for those people who are not connected with this profession and have no wish to be. They are interested, however, because they experienced the healing power of psychoanalysis and the helpfulness of a psychoanalyst in achieving self-understanding, or because they recognize the influence of psychoanalytic thought on Western intellectual and cultural life, or they are curious enough to want to know about the work of those who have taken the psychoanalytic path. This book is for those people who are critical, even reproachful, of psychoanalysis because it has failed them, failed to relieve their emotional suffering or to contribute more to their understanding of themselves, of others, or of the human condition as they experience it. Nevertheless, they wonder why psychoanalysis could not fulfil its promise for them and why it feels so foreign, even hostile to their experience of themselves and their lives. Sigmund Freud was the first psychoanalyst. More than a century ago, psychoanalysis began in the passionate outburst of Freud's creativity, especially during a critical ten-year period from 1895 to 1905. Breaking away from his academic and cultural background, Freud challenged the existing psychological theories and paradigms. His richly detailed and vibrant case histories, Studies on Hysteria, were published with Josef Breuer. These were followed by The Interpretation of Dreams, The Study of the Dora Case, and Three Essays on Sexuality. Freud developed a new psychological paradigm and a corresponding body of knowledge. In parallel with his promising theory, a method of treatment was born. Freud became its first practitioner and first teacher. By 1915, Freud had outlined most of the major concepts that characterize psychoanalysis to this day: the distinction between conscious and unconscious, the role of infantile sexuality and aggression in human development, psychic conflict, the occurrence of transference in all human relationships, and the affective influence of one's past on one's present and future. Further observations and fresh understanding led Freud to revise repeatedly many of his earlier constructs, forge new insights, and identify areas for future exploration and development. Subsequent psychoanalysts inher-

Introduction 5

ited the tasks of expanding, reformulating, and resolving the inconsistencies in Freud's ideas, collecting new data and generating further concepts and theories. Succeeding generations, each within the framework of the intellectual and scientific climate of the time, contributed to major revisions and constant development in psychoanalytic thought and practice throughout the first century of psychoanalysis. Cooper, Kernberg, and Person succinctly summarized the progress, noting that 'during this century, while psychoanalysis was changing the world, psychoanalysis was itself changing from a relatively simple positivist model of mental mechanisms to a brilliantly complex synchronic system of models more attuned to current thinking in science and the humanities.'1 Progress was by no means smooth. As Martin Bergmann suggests, to understand the history of psychoanalysis, the heretics, the extenders, and the modifiers of psychoanalytic knowledge require differentiation. He notes that while 'heretics were expelled, extenders extend psychoanalysis into areas as yet unexplored, but their findings demand no revision of psychoanalytic theory. Their contributions evoke no enmity and are universally appreciated ... Modifiers threaten the continuity of psychoanalysis and create controversies, but they also keep psychoanalysis alive and are a source of new creative ideas ... Modifiers demand that we give up the cherished belief that psychoanalysis is developing along a straight line, that every new generation merely adds to the findings of the previous one.'2 The creation of psychoanalysis was stimulated by Freud's attempts as a physician to relieve psychological symptoms, pain and suffering, and thus assist his patients. He first tried the available therapies of the day (rest, nursing care, massage, hydrotherapy). Committed to medical science, he experimented with innovative techniques (hypnosis, pressure, suggestion). Freud's interest in the workings of the mind was influenced by his medical speciality, neurology, and by his teachers and the scientific world view of his time. His discovery of the psychoanalytic method, however, was inspired by his patients. Through attentive listening to and reflection on what his patients said, Freud learned. By meticulous observation of his patients' responses, he continued to learn, experiment, discover, and record. Freud learned from looking inward, from selfobservation, and from astute attention to the interpersonal interaction that occurred between himself and his patients. He relinquished earlier techniques and developed the quintessential method of psychoanalysis: the purposeful use of words within a relationship meant to facilitate self-

6 The Unsung Psychoanalyst

understanding and thereby ease psychic suffering. Freud applied an innovative intellect to his clinical observations and honed the tenets of psychoanalytic theory and therapeutic technique. Almost unwittingly, as psychoanalytic knowledge and treatment methods developed, Freud, from personal and cultural stimuli, also founded a new profession. His own comments reveal the personal stimulus: After forty-one years of medical activity, my self-knowledge tells me that I have never really been a doctor in the proper sense. I became a doctor through being compelled to deviate from my original purpose; and the triumph of my life lies in my having, after a long and roundabout journey, found my way back to my earliest path ... In my youth I felt an overpowering need to understand something of the riddles of the world in which we live and perhaps even to contribute something to their solution. The most hopeful means of achieving this end seemed to be to enrol myself in the medical faculty ... Thus I passed from the histology of the nervous system to neuropathology and then, prompted by fresh influences, I began to be concerned with the neuroses.3

The cultural stimulus arose out of adversity. This adversity, described by Freud as 'the unfriendliness and indeed the animosity with which the medical profession treated analysis from the very first,'4 necessitated the establishment of a psychoanalytic movement. Followers of Freud, many from medicine, some from other walks of life, grouped together to protect and foster the growth of his new theory and method of therapy. To claim that the growth of psychoanalysis was soundly rooted, supported, and well-nourished outside Freud's own circle or that internally it was constructive and co-operative without serious turmoil or self-destructive conflict would be naive. To suggest that Freud and his contemporaries, followers, and competitors were without human frailties and problems would be equally erroneous. Contemporary literature on the history of psychoanalysis is replete with evidence of the early external and internal controversies, stultifying orthodoxy, heresies, envies, intrigues, ostracisms, dogmatic controls, and constrictions. Despite this external adversity and the often bitter internal turmoil, psychoanalysis managed not only to survive but to develop as a theory, a therapy, and a profession. Separate from medicine, yet with an evolving body of knowledge and tools for the practice of a new medical psychology, the profession emerged and, concomitantly, professional training programs and national and international organizations. Much was left unclear, however, as to the

Introduction

7

nature and the professional identity of psychoanalysis. Freud and the other early founders were far from clear about how this profession should be constructed. Psychoanalysts continue to clarify their professional identity. Nevertheless, what psychoanalysts do has proved valuable. Though difficult, an analytic career is a worthwhile human endeavour, a profession honed over the greater part of one's adult lifetime. The profession's growth, its survival, and how these occurred at the grassroots, human level, in the day-to-day of being a psychoanalyst, provide the background for a dynamic portrait of life as a psychoanalyst. The early founders and five subsequent generations of psychoanalysts have carried forward Freud's legacy and professional responsibility. The contributions of Freud, his followers, and each succeeding generation were influenced by, and in turn influenced, shifts in the contemporary cultural and scientific world view. Yet, to this day, although influential, it is not this external world that is central to psychoanalytic investigation, discovery, and development. Rather, it is the internal world of the individual explored within the unique relationship between psychoanalyst and analysand that has remained fundamental to psychoanalytic theory and practice. What happens between and within the minds of these two people endures as the living core of psychoanalysis. Psychoanalysis has always been and remains an interpersonal profession, one that, by its nature, is clinically based. As psychoanalysis moves into its second century, one person talking with another remains its essence. Whether between analyst and analysand or teacher and student, this talk involves the participants in a purposeful relationship in which, primarily, words are used to pass knowledge from one mind to another. The story of the birth, growth, and development of psychoanalysis as a revolutionary theory of the mind, a method of investigation and treatment, and a way of thinking which has permeated Western intellectual and cultural life, has been told and retold. Whether praised or criticized, psychoanalysis has always aroused strong, even passionate reactions. Volumes have been written elucidating and critiquing developments in psychoanalytic theory. Freud's life and the lives of a number of the other founders, the great theorists and leaders have been chronicled, examined, analysed, fairly and unfairly criticized - indeed, vilified or idealized - as well as praised and endorsed. Little has been written, however, about living and working as a psychoanalyst. Little is known about the lives and influence of the many clinicians, teachers, and role models, the psychoanalysts who, on a daily basis,

8 The Unsung Psychoanalyst

are dedicated to their analysands and students. Their working lives are lived outside public awareness, quietly keeping the confidences of those whom they treat and teach. Enriched and privileged to share their analysands' most intimate thoughts, their emotions, passions, and experiences - their inner lives - psychoanalysts also share their strivings, disappointments, losses, confusions, and intrapsychic conflicts. They struggle alongside them to understand and overcome conflict; they share the burden of their pain and the joy of change and growth. The personal needs of psychoanalysts are put aside in order to meet their analysands' needs, and, eventually, to say good-bye when they are no longer needed. As well, psychoanalysts are challenged, stimulated, and enriched by their students, sharing in their efforts to learn and develop in their new profession. For the most part, they tell no one about these intensely lived experiences, the moments of their working days, the moments of exchanging knowledge, of mutual enlightening, of change, and growth. Psychoanalysis, perhaps more than any other profession, is dependent for the formation of its members on its teachers as clinicians and role models. Psychoanalytic theory may be learned through lectures and literature, but the practice of psychoanalysis is learned only through clinical experience and modelling by mentors, case supervisors, and personal analysts. Many of these teachers are the clinicians or practitioners of the field, and a few are also the theoreticians. Unlike the latter, who are widely known through their writing and development of theory, most of the teachers, even the great ones, are known primarily to their students and colleagues within their training institutes. Yet it is largely these teachers who inculcate into a particular way of thinking generation after generation of psychoanalysts. They are the heart of the profession. Unfortunately, the story of these analysts who devote their lives to clinical work, perhaps also teach and supervise, but who write little, cannot be easily told. No readily available record of their beginnings, their development, their work, and their lives exists. These are the unsung psychoanalysts. Although unsung, they live on as role models in the minds of their students and patients. Their legacies contribute to continuity and development within their profession. When referring to their historical roots, psychoanalysts often harken back to Freud. Yet Freud does not come to mind when today's psychoanalysts recall the people who most influenced them in their professional development, who contributed to their immediate roots. Embodied as role models these unsung psychoanalysts are the teachers who have become integrated into the way a psychoanalyst works, views patients, and understands the world. The main purpose of this book is to create a

Introduction

9

vibrant portrait of the unsung psychoanalyst. A meaningful likeness draws on interwoven images of past and present for a historically close rather than distant image. The synergism of opportunity and fortuitous circumstances led to the selection of a remarkable psychoanalyst, Ruth Easser, as the subject of this portrait: Ruth Easser, in many ways, exemplifies the unsung psychoanalyst. The story of Ruth Easser was recorded only with considerable effort.5 Her legacy emerged in her seminal papers, in the words of her colleagues and students (many of whom are today's leaders in the field of psychoanalysis), and in the author's direct experiences with her. As they spoke of Ruth Easser and her influence, interviewees were also telling of their own development, experiences, satisfactions, and struggles, and of their own work and lives as psychoanalysts. The cumulative experience of these individual psychoanalysts sheds light on the history and current complexity of life in this profession. Since much was learned from their collective history, their stories as well as Easser's story are used to give depth and colour to this portrait. Their words are utilized to weave a tapestry, a multilayered impression of the unsung psychoanalyst. Ruth Easser's life as an analyst began in 1946 just as psychoanalysis was entering the second half of its first century. On several fronts, she was a psychoanalytic pioneer. She was a pioneer as a Canadian, being among the first handful of women to leave Canada to become psychoanalysts elsewhere. She was among the first graduates of the Columbia University Psychoanalytic Clinic for Training and Research in New York, one of the three early women graduates to be on Columbia's staff and faculty, the first to be a supervising and training analyst, and the first graduate to be invited to present the prestigious Sandor Rado Lecture. During her career, she pioneered outside her institutes and was recognized to a limited extent in American psychoanalysis. Active in the American Psychoanalytic Association as a member of the Board of Professional Standards and of the membership and program committees, she served as a bridge between the American Psychoanalytic Association and Columbia, two institutions then at odds. Easser was the first Columbia graduate to be invited to join group five of the elite Center for Advanced Psychoanalytic Studies. At the height of her career in New York, she was the first Canadian woman to return to make a contribution in her home country as a training analyst at the Toronto Institute of Psychoanalysis. Ruth Easser married Dr Stanley Lesser, also a Columbia psychoanalyst. Easser and Lesser were among the postwar second generation of psychoanalytic couples. She was also mother to four children, making her one of the early role models as a woman analyst who combined her work with marriage and a family.

10 The Unsung Psychoanalyst As a gifted clinician and outstanding teacher, Ruth Easser had a formative influence on a generation of psychoanalysts. As the Columbia clinic's admitting officer, she attained a reputation for astuteness as a diagnostician and evaluator of analysability. For fifteen years she lectured on psychoanalytic technique and led what have been called 'incomparable' case conferences. In New York and later in Toronto she was sought as a supervisor and training analyst. She was not a prolific writer (twelve publications and approximately fifteen unpublished papers and presentations). Yet through three seminal papers she had a minor influence as a theoretician on diagnosis and psychoanalytic technique. A careful review of her published and unpublished papers within an historical context confirms that her views were subtly prescient of current theories and practice. Indeed, in the light of psychoanalytic developments, her ideas remain fresh and relevant today. After twenty-five years of life as a psychoanalyst, wife, and mother, Ruth Easser died of cancer in 1975 at the age of fifty-three.

Ruth Easser belongs to that generation of North American women who became psychoanalysts after the Second World War and whose stories have yet to be documented. Some are still alive, and because their legacies are incomplete, their full significance cannot be evaluated. For many of those who have died, there is little in the way of a readily available record. There are several other reasons why Ruth Easser, like many influential analysts, remained essentially unknown outside her professional circle. Easser was primarily a clinician and teacher, not a major theoretician or writer, and her untimely death cut short her career in its prime. Yet, referred to as 'near perfect, almost iconic' by her colleague Arnold Cooper, Ruth Easser seems to epitomize the heart of the field. Prescient views, articulated by a person with an incisive mind, together with a clinical sensitivity and a thoughtful, dignified personal style of relating are indeed iconic attributes. Easser's integrity, humanity, and skill at passing knowledge from one mind to another made her an inspiring role model. Her need for and love of her work is illustrated in the following story as told by one of her supervisees. Until just days before she died, Easser continued to supervise and to meet with her students. She was obviously extremely ill, obviously dying, but her mind was very much alive. In response to a student's concern about the advisability of continuing supervision, she said quietly, and firmly, leaving no doubt, 'This is where I want to be. This is what I want to be doing. I wouldn't be here if I didn't.' Inevitably there are problems and pitfalls in using, as an example, a particular analyst to construct a portrait of life as a psychoanalyst. How to

Introduction

11

create a valid picture with which others can resonate became a principal question in this undertaking. Ruth Easser as the unsung psychoanalyst results from the convergence of three filters, that is, three interwoven viewpoints. The first comprises recollections of Ruth Easser by those who knew her personally and professionally. The second consists of the interviewees' own stories of what it is to be a psychoanalyst. The third is that of the author, who herself is a psychoanalyst and former analysand in a training analysis with Easser at the time of her death. The author filters the memories and stories, the facts of Ruth Easser's life, and Easser's papers and other documents. Indirectly the project is the author's own story of becoming and living life as a psychoanalyst. The most obvious pitfall is that of idealization. Ruth Easser was held in great esteem. Her death was a great loss, and this book is the author's response. Idealization enters into this image of the unsung analyst. This cannot be denied. Nor should it be. Ethel Person, also one of Easser's students, commented: 'I think that you adore her, I think she's worth adoring, I think her work is worth doing something about.' A positive, even idealized, transference is also a prime motivator: there is little reason to commemorate a person towards whom one feels negatively and much incentive to remember and understand a loved person. Idealization is tempered, nevertheless, by others' differing - and not always positive - experiences and memories of Ruth Easser, her time, and her milieu. Ruth Easser is representative of the other gifted, dedicated members of the profession whose formative contributions merit recognition. The commemoration of Easser and thereby other unacclaimed psychoanalysts achieves a secondary purpose. As Arnold Cooper suggests, 'it is important to remind today's psychoanalysts about the origin of ideas currently taken for granted,' and as Cooper, Kernberg, and Person state, 'to encourage the rising generation of psychoanalysts to pursue their studies and researches with the enthusiasm and vigour that will help psychoanalysis to continue to fulfil its promise for the relief and suffering and the understanding of man.'6 This book provides such encouragement. By reconstructing the influence of a little recognized psychoanalyst and teacher as an example, it shows the rewards, both intellectual and personal, that life as a psychoanalyst affords those who choose this profession. Encouragement is, in fact, needed today. Attention is accorded to critics, even vilifiers of psychoanalysis who consider Freud at best outmoded and at worst as having produced an unsubstantiated, even destructive theory and an expensive, lengthy, and ineffective mode of treatment. Psychoanalysis is in danger

12 The Unsung Psychoanalyst

of being rejected as a treatment option because of the success reported with short-term symptom-focused psychotherapies, or disregarded as irrelevant now that advances in neurobiology and neuroimaging have enhanced the invention and burgeoning use of powerful and often efficacious pharmacotherapies. Public trust of psychoanalysis has been diminished because a few members of this profession were found to have engaged in unethical practices. Moreover, the judicial system, third-party payers, and other such societal demands threaten to erode the confidentiality that is intrinsic to the psychoanalytic relationship and the privacy of the analytic situation. Psychoanalysis itself has from the beginning been considered "impossible" as attested to in Freud's oft-quoted comment: 'It almost looks as if analysis were the third of those 'impossible' professions in which one can be sure beforehand of achieving unsatisfying results. The other two, which have been known much longer, are education and government.'7 There are, indeed, pressing challenges and limitations to be faced by the psychoanalytic profession. The challenge for psychoanalysis, in the broadest sense, is to bring about a scientific renaissance so that its theory and technique are consistent with contemporary scientific and intellectual knowledge. In a more narrow sense, the profession must appreciate its own parameters. If psychoanalysis is to continue to be an effective instrument of treatment and research, it must be applied only to the right patient population.8 If psychoanalysis is to remain an innovative and influential theory of the mind, it must attempt to explain only that segment of the human experience and inner world as revealed by this particular method of investigation and accord appropriate consideration to knowledge in related fields. If psychoanalysis is to continue as a respected profession, its practitioners must work to maintain public trust. Psychoanalysis must strive for and claim no more and no less. The development and contributions of influential but little known psychoanalysts of earlier periods are relevant to being a psychoanalyst in today's climate. This book places the lessons of the prototypic unsung psychoanalyst before today's psychoanalysts and interested onlookers. The focus is both historical and contemporary: historical because much can be learned from a chronicle of little known aspects of a professional heritage; contemporary in that the complexity of being a psychoanalyst today is a central theme. All psychoanalysts bring a unique personal and intellectual background. They are taught, and they learn and grow within a particular professional environment, usually centred in their parent psychoanalytic institute, and within a phase of development in psychoanalysis.

Introduction

13

Ruth Eassefs formative years (1922-1946) were spent in Toronto, her early adult and professional years (1946-1970) in New York. She spent her last years in Toronto (1970-1975). Her psychoanalytic institutes were Columbia and Toronto. Her time was the first thirty years after the Second World War. These were also the first thirty years of the second half of the first century of psychoanalysis and psychoanalysts.

In the nearly thirty years since Easser's death, the psychoanalysts who were interviewed for this book, her contemporaries, living in her time and place, experienced and some contributed to significant developments in the field of psychoanalysis. In contributing to Easser's story, they recalled their own experiences of being psychoanalysts. Altogether they span the second fifty years of the profession; they are the bridge between Ruth Easser and the rising generation. No attempt is made to tell how to be a psychoanalyst or outline what kind of psychoanalyst one ought to be. Instead, using narratives of the life and work of Ruth Easser and others, this book offers a demonstration of what it is to live one's life as a member of this profession. A psychoanalyst's life moves from beginning, to becoming, to being, to integrating, and leaving a legacy. These are the phases of the professional life cycle of all psychoanalysts. Ruth Easser and those she influenced simply act as guides. In the background is the everyday life of a psychoanalyst. In the foreground are the moments of Easser's influence, of growth and development, experiences of insight, and learning within and among psychoanalysts as lived in memories. All of these are strung together on the serviceable thread of the history of psychoanalysis. Time and place both influence and are influenced by the development and contribution of individuals. In the field of psychoanalysis this is as true for today's practitioners as it was for Freud, for Ruth Easser, and for all the others. Time and place both determine arid are determined by the prevailing views, theoretical positions, new ideas and advances, controversies, and criticisms of psychoanalysis. Time and place both shift and are shifted by the problems that psychoanalytic patients present, in the philosophy and objectives of training programs, and the shape of the professional life of an analyst. Both historical and contemporary time and place frame this narrative about being a psychoanalyst, yesterday, today, and tomorrow. The rising generation of psychoanalysts and others interested in the field may find within this composite story relevant lessons to carry on their voyage into the second century of psychoanalysis.

1

Beginning: The Background

Our psyche is the essence of ourselves as human beings, and our personality the expression of ourselves as individuals. From the beginning we have tried to understand our life experiences, our thoughts, our feelings and passions, our behaviour, in our quest to fathom how our minds work. Psychoanalysis is one among our many groping efforts towards understanding this essence of ourselves. Psychoanalysis was born out of struggles to comprehend illness of the mind of which confused thoughts and painful emotions are not the only manifestations. Behavioural and bodily changes can also be expressions of mental illness, and they account for much misunderstanding of its causes. The pain distorts, often shatters, our capacity to function as human beings - to love, work, and play, to think, to feel, and to relate to others. Such distortion can unleash our capacity to harm and even destroy other people, as well as ourselves. The power of mental pain to incapacitate, even destroy lives makes all of us vulnerable because the inability to identify cause and meaning renders us fearful and helpless. Mental pain strikes at the very essence of our nature. Mental illness, until just over a century ago, was considered to be largely inherited, incomprehensible, and incurable. Treatment was at best palliative, at worst barbarically punitive, seldom curative. The theory of psychoanalysis proposed that the pain of mental illness has psychological causes and that we have an unconscious self wherein meaning can be found. The discovery of the psychoanalytic method, a process of understanding an individual's unconscious self, was a giant step forward in treating mental illness or at least the associated mental pain. Psychiatry shifted from a purely descriptive nihilistic approach to management to a recognition that symptoms and irrational behaviours can be both indications of and reactions to mental suffering. This new model of the mind heralded the recognition of interrelationships between mind and brain,

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brain and body, person and environment, and self and others, together with the study of the relative contributions of the biological, psychological, and sociocultural components to mental functioning. Of course, there are other psychological approaches to understanding the functioning of the mind as well as the neurosciences that elucidate the biological basis of thoughts and behaviour and the social sciences that place an individual's functioning in the larger context of family, group, and society. Psychoanalysis contributes particularly to the understanding of the psychological component of a biopsychosocial model of health and illness. The particular area of psychoanalytic expertise remains the exploration of the unconscious. Merton Gill aptly confirms this: 'No one really believes that any significant human behaviour is due solely to either internal or external factors' but 'the great discovery peculiar to psychoanalysis, the internal factor in the sense of unconscious fantasy, is the one that psychoanalysis must zealously protect.'1 Psychoanalysts have come to accept that 'the essence of Freud's work and thinking was that, with very few exceptions, everything was open to change, and that he never hesitated to alter his own views in the light of broader understanding of the human condition.'2 As Cooper, Kernberg, and Person write, 'Freud left to his inheritors - the current generation of analysts - the task of expanding, reformulating, and working out the inconsistencies of his ideas and developing newer ideas out of our own data and intellectual climate.'3 Beginning with the basic tenets of psychoanalysis that provide a common ground, contemporary psychoanalysis has developed from Freud's libido or drive theory, through ego psychology, theories of object relations, self-psychology, intersubjectivity, and emerging constructivism. These varying frames of reference are considered here as expansions and revisions of Freudian theory, as 'one psychoanalysis rather than many,' although as yet there is no overarching integrative psychoanalytic theory of the human psyche. Freud defined psychoanalysis as a general theory of the mind, a method of investigation of unconscious mental processes, and a specific type of treatment. Psychoanalysis is also a profession. As Arnold Cooper notes, psychoanalysis changed from an ideological organization best conceptualized as the psychoanalytic movement to a more typical professional organization dedicated to the scientific pursuit of knowledge in the field and to the advancement of psychoanalysis in society.4 Robert Michels, in agreement with Cooper, adds to Freud's tripartite definition two other components: psychoanalysis as an organized profession and as a powerful movement within society. Michels proposes that 'the interrelationships among these [five] components, such as the effect of the

16 The Unsung Psychoanalyst

structure of the profession on the method and the theory, or the effect of broad social attitudes on the utilization of the therapy, may have even greater impact than any of the five alone.'5 Michels maintains that as the nature of psychoanalysis as a profession unfolds over time, psychoanalysis and its practitioners are shaped and reshaped. Psychoanalysts investigate the mind's inner workings within their respective cultural and scientific milieux. They endeavour to illuminate why a person thinks, feels, and behaves in certain ways, how growth and development occur, why things go wrong in the inner world, and how mental pain can be alleviated. They work at developing methods of effecting self-understanding, change, and healing. Psychoanalysts are perpetual students because, even after a century of experience and despite progress in related scientific disciplines, very much about the psyche remains unknown. They continue to explore, discover, and search for a more comprehensive theory, more useful concepts, and more effective treatment techniques. They learn from their patients and their students. They are also teachers; they teach what they know about the mind. Their theory, therapeutic technique, and teaching continue to inform and be informed by their time and place. For the most part, psychoanalysts continue to work as clinicians. Training to become a psychoanalyst is training to become a particular type of therapist. The people who psychoanalysts treat using the psychoanalytic method are known as analysands. Analysands are ordinary people 'like you and me' who seek help from psychoanalysis. They are people whose inner world causes pain. They are people with emotional, and often physical symptoms and problems in living (often seriously debilitating even when not observable to others). Usually they do not understand the reasons for their pain. Nor are the causes always readily apparent or easily discernible by the usual diagnostic means. The psychoanalytic method provides a framework to facilitate an in-depth understanding of the inner workings of their minds, their unconscious, and of themselves as people. This is achieved through the analysand's intense relationship and purposeful communication with the analyst. It is a costly, time-consuming process, and it requires a high degree of mutual commitment and dedication; it is one of the most farreaching self-investments a person can make. Neville Symington maintains that although psychoanalytic history, theory, and technique can be communicated, the experience of psychoanalysis cannot be adequately described because: Psychoanalysis is an experience that occurs between two people. It's a deep experience and can only be very inadequately communicated to another

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person. It is as impossible to convey the sense of it to another person as it is to explain to an eight-year-old child what it is like to be in love. However, much of the world's literature is a record of the attempts to express the experience of being in love with all its attendant joys and agonies ... Psychoanalysis is a phenomenon which occurs at the centre of the individual. It is not a thing; it is a complex reality which is both intrapsychic and interpersonal, both individual and social.6

These working definitions of psychoanalysis, psychoanalysts, and analysands are the professional background for the story of the unsung psychoanalyst, of living one's life as a practising psychoanalyst. What is it of an analyst's early life that leads to psychoanalysis? How does one become a psychoanalyst? It is here that Ruth Easser's story as example begins. Barbara Ruth Easser was born in Toronto, Ontario, Canada, 23 March 1922. The first child of Sam Easser and Sarah Foster, she was also a middle child with a half-brother, Percy, nine years older, and a sister, Joan, eight years younger. She grew up in a comfortable working-to-middle-class area of Toronto, High Park, which at that time was largely a white Anglo-Saxon community, culturally and ethnically homogeneous. The Eassers were the only Jewish family on their street and most likely one of few in their immediate neighbourhood and schools. The family normally took two weeks' vacation (late July and early August) at a hotel, usually in Muskoka. Few Jewish families spent time in either place. Ruth was educated also in a non-Jewish milieu at the local schools, Keele Street Public School and Humberside Collegiate. She entered the University of Toronto in 1940 and received her medical degree in 1945, thereby becoming one of the very few Canadian Jewish women to graduate as physicians since the founding of this medical school in 1827. These bare bones of Ruth Easser's family background set the stage, the cultural and socioeconomic environment, within which she developed. Family demographics tell little about individual personalities and interactions, little about formative family relationships, values, and experiences and their interaction with a child's capacities, talents, and opportunities. Ruth's formative relationships of course began with her parents, Sam Easser and Sarah Foster.7 Sam Easser was born about 1887 near Vilna (capital of Lithuania and at that time part of the Russian Empire). He was the fourth child, in a sibline of six children. The family first lived with his father's in-laws and later rented land on another farm where their father worked for the landowner, kept his own cows, and offered self-taught skills such as watch repair. His oldest brother, destined bo be a Talmudic scholar, died in a drowning accident at age thirteen, leaving

18 The Unsung Psychoanalyst Sam, at age seven, the eldest son. A year later, the bereaved family moved into the city. In Vilna there was a large Jewish community, living in partially integrated areas with minimal strife between the Jews and Gentiles. (Lithuanian, Russian, and Polish Gentiles fought more among themselves.) Sam's father worked in a flour mill, and the family lived in a rented house with a stable; his enterprising mother kept a garden and cows. Sam was educated in a Jewish parochial school, the only schools open to Jews at the time. His love of learning had been stimulated much earlier by his father, who had had no opportunity to learn a trade but had been a student of the Talmud in a synagogue until he was married. The fact that he was a good learner facilitated his marriage to Sam's mother. The custom for Jewish families who wished to maintain their religion was to give a home to Talmudic students, allowing them to continue their studies for two years and eventually marry one of their daughters. Like other Jewish young men, his father was proud that both families came from lineages of rabbis, serious students, and missionaries - people considered intellectuals within the Jewish community. As was the tradition in intellectual Jewish families, Sam's father continued to value learning by reading and discussing with his sons. Sam, as well as being intelligent and a learner, was a hard-working, feisty young man. His work ethic and attitude to injustice had also been ingrained by his father, who, although sensitive for himself and his family to the degradation and injustices of the time, was fair in his dealings and never insulted others. Like his father (through lack of interest, and also lack of opportunity), Sam did not follow the traditional Jewish male religious professions. Rather, because of the family's financial need, at age twelve, Sam was apprenticed to a locksmith, an interest stimulated by an uncle in the Russian army who made locks for the czar. During his third year as an apprentice, at age fourteen, Sam was successfully involved in his first strike against the fourteen-hour workdays of the apprentices. This experience, along with his introduction to the social democratic movement in his work as a machinist, began his lifelong allegiance to fighting social injustices through socialist labour movements. Sam's socialist education continued into his late adolescence through discussions with coworkers, clandestine meetings, and reform activities to further workers' causes. Sam's awareness of culture and his appreciation of the theatre and music were awakened in the live theatres and concerts in the parks of Vilna. Having little money, he and his friends found imaginative ways to attend performances of Shakespeare and Gorki. In 1907, at age nineteen, Sam followed his sister and her husband to Canada. In this he had been encouraged by his father, who wanted his family to live in a free country and who recognized the political danger of his son's

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socialists activities. Sam's parents and other family members were brought over shortly after, joining the mass emigration of Eastern European Jews to North America. They settled in Toronto. Sam's parents opened a grocery store and Sam sought work in his trade. Immediately, Sam was faced with a dilemma. He had to be a member of a trade union to get a job; he had to have a job to be a member of a union! Being a feisty pragmatist, and determined to find work, he took a job as scab labour, but was taken into the union office where he explained his predicament. After that he was allowed to join the machinists union. Sam worked as a machinist until he retired and proudly remained a union man until he died. Most of his working life, from 1911 on, was spent in partnership with his brother-in-law; they owned the Allatt Machine and Tool Company. Sam ran the machine shop and Jim the office, while a third partner worked the store in front, which sold automotive parts. Sam was known as a strict but fair employer who expected to work for everything he owned and his workers to earn their money; he never had a strike in his shop and retained great sympathy for the union movement. Ruth's father believed in education, despite the fact that he had had little opportunity for formal education himself. He helped to put his youngest brother, David, through medical school. Although he remained a trade worker all his life, Sam was a self-educated, voracious reader. He was also a spellbinding speaker in Yiddish, passionately convincing, and fervently committed to his ideas, values, principles, and political causes - and known for his integrity. Having been raised in a non-religious and scholarly, socialist, free-thinking, working-class Jewish family, Sam did not believe in marriage, at least religious marriage. But he did believe in family. He married Anethel Sachs in 1910 and their son Percy was born in 1912. Anethel died in 1915, and in 1921 Sam married Sarah Foster whom he had known for a number of years, as his sister Becky was married to Sarah's brother Philip. Sarah was also from an Eastern European Jewish immigrant family. She was born in 1896, the fourth of eleven children, in a small town on the then Rumanian-Austrian border. Sarah's father, who was born in White Russia (Belarus), was uneducated formally and first worked as a water boy in her mother's wealthier family home. At seventeen, he married Sarah's mother, Rachel, the only daughter of this well-off family, and continued to work for his father-in-law. Rachel, born in a town situated in what was then Austria, went to the gymnasium with her brothers and became a linguist. The Feschter family (changed to Foster) were observant Orthodox Jews. When Sarah was very young, the family immigrated to Canada. They settled first in Montreal and then, because of the 1906 depression, moved to Toronto. In Canada, her father worked as a furrier and her mother as a court interpreter. Sarah's father

20 The Unsung Psychoanalyst died, at age fifty-one, of emphysema resulting from the damage he had done to his lungs to avoid going to war at age twenty-five. Rachel, a determined woman, supported and raised eleven 'strong-minded children.' Sarah spoke about her mother as a marvellous manager. The family did not have money but were well provided for; they never needed help. 'We may be poor but when you walk out of this house, you walk tall and you don't bend to anyone,' Rachel told her children. Similarly, Sarah never bent to anyone. Like her own mother, Sarah was a strong woman with a forceful personality. Although her family were Orthodox Jews, Sarah grew up in ethnically and religiously mixed neighbourhoods and had contact with French, English, Catholic, Protestant, and Jewish children. She received her primary education in Montreal at Catholic and Jewish parochial schools and, later, at secular schools in Toronto. Sarah was strikingly tall, attractive; outgoing; she was an enthusiastic woman who looked older than her years. At age twelve she began work in the garment industry to support her family. Active in the Toronto garment workers' strike (her picture appeared on the front page of the Toronto Telegram), she remained in this area in various capacities, as a seamstress, a salesperson, a demonstrator of industrial sewing machines, and as a manager of a dress shop until after her second child was born in 1929. As a vivacious young woman, Sarah's primary interest was her social life and her only club, the 'where you go, I go club.' In her late teens she was challenged on her lack of education and thereafter returned to night school. There her interest in social service was stimulated; realizing that there were people who needed help, she worked first as a volunteer and then as a paid 'on call' worker until 1965. Her socialist political and intellectual interests began when she met Sam Easser. Sam and Sarah first met at the wedding of his sister Becky and her oldest brother Philip when Sarah was eleven. A number of years later, they met again. Sam had broken his leg and Sarah went with his sister to visit him. 'We walked, we talked, Sam gave me Jack London's The Call of the Wild. I never read a trashy book again and I never had another boyfriend.' During their three-year courtship, Sam turned Sarah into a socialist 'through books, autobiographies, biographies, Jewish writings, socialist writings, and pamphlets.' Although she had been raised in an observant Orthodox family, she was an independent young woman with a mind of her own. She regarded her Jewish identity, as did Sam, as secular and cultural, rather than religious. She too was free-thinking, a woman ahead of her time. Aware of but disclaiming interest in the suffrage or women's rights movements, she commented, 'I always stood on my own feet and I think any woman who wants to can hold her own against anybody. All you have to remember is you are you.' Like Sam she did not believe in marriage. 'I didn't need a rabbi to tell me I could go to bed with a man I wanted.' But Sarah wanted children and she had a code; 'no one would point

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a finger at my children as being illegitimate.' Since, in 1921, there were no civil marriages in Canada, they went to the rabbi at Holy Blossom Synagogue, told him what they wanted, talked socialism for two hours, and having little money were married in a small private ceremony a few days afterwards. Sam gave her a diamond ring ten years later. Their marriage lasted over sixty years. Sarah immediately became a mother to Sam's nine-year-old son Percy. Ruth was born a year later when Sarah was twenty-six and Sam was thirty-five. When Ruth was eight years old, her younger sister Joan was born. Apparently Sarah had some difficulty with pregnancy and had lost at least one baby before Joan's birth. During Ruth's childhood her mother worked as a manager of a dress shop. Ruth was cared for by their housekeeper Mrs Cook (Cookie) and, frequently in the evenings, by her teenage brother Percy while her parents were involved in their political activities. After Joan was born, it seems Sarah did not work full-time but gradually became involved in her social service endeavours. As Percy noted, his father worked hard and brought home the pay but his mother was the one who helped build up a little extra money for the family. With the help of her brother Phil, who was in the mortgage business, Sarah started buying mortgages and made some investments which paid off. Ruth Easser's parents rejected the entrepreneurial, religious, Zionist values held by many in the Toronto Jewish community. Theirs was a social democratic, internationalist, non-Zionist, non-religious, Yiddish household which embraced the humanist, egalitarian views of a social democratic philosophy. These views found a political home in the Jewish Bund (Union) movement, a part of Sam's Vilna background. This pre-communist, Jewish socialist labour movement held that there could be no true socialism without democracy and that the only solution to the Jewish problem was to solve the problems of workers worldwide without regard to nationalism. In Eastern Europe, the Jewish working masses had played a significant role in the development of international socialism. Two dissident, revolutionary groups predominated. The Bund believed that the solution to the plight of the Jews in Russia and elsewhere would be found when socialism prevailed worldwide. Once the economic and social structure changed, anti-Semitism would disappear. In a better socialist world, Jews could retain their cultural identity, speak Yiddish, maintain customs and traditions, and keep Kosher if they wished. The Bund saw no reason to cling to what they regarded as misguided ideas of Jewish nationhood. The Labour Zionist group, by contrast, believed the Jewish problem had other, deeper roots. A more far-reaching and specific solution than righting the world economic wrongs or social disparity was needed. The Labour Zionists shared a socialist ideal but also advocated a Jewish national ideal based on the concept of Jewish independence and peoplehood. Both movements were

22 The Unsung Psychoanalyst secret and illegal in czarist Russia. They were also at odds with each other the harshest enemies of the Bundists were the Zionists and vice versa. In the old country, the Eassers were Bundists. In his youth, Sam had been actively involved in this socialist labour movement. His father had wisely advised him to emigrate, as he was in danger of being arrested for distributing illegal Bundist literature. In Toronto, Sam continued his involvement in Jewish social democratic, non-religious movements. He was involved in the formation of the Canadian socialist political party, the Co-operative Commonwealth Federation (CCF), forerunner to the present New Democratic Party (NDP) of Canada. Sam was a working man. His dedication, his passion, his commitment were to advance, first, the conditions of life for all workers and, second, the Jewish worker. A staunch union man and fair employer, he was a Bundist also in Toronto and was active in the Workman's Circle. Beyond these endeavours, Sam Easser had a more specific vision. It was to found the Toronto Labour Lyceum - similar to the Czechoslovak version of the gymnasium - an education and community centre for Jewish working men. For years, with Sam as president, the board of the Labour Lyceum struggled to complete his dream. There was never enough money, and often half of Sam's pay cheque went into paying the builder, much to Sarah's annoyance. The family was often rescued by groceries from his parents' store. Although Sam's vision was never quite realized, his steadfast efforts give a clear indication of the fibre of the man.8 As Mrs Sam Easser, Sarah became a socialist and a political activist. Although proud of her husband, and stimulated and challenged by his ideals, she carved out her own identity. Moderately active and not entirely comfortable in the women's division of the Workman's Circle in the 1920s, Sarah pursued political activities that included attending all kinds of socialist and labour meetings to hear Sam speak. In the 1930s, she became more directly involved in party activities. It was only after the Second World War that she reconnected with her Jewish roots. The Great Depression had a significant influence on Sam's and Sarah's socialist involvements and transformed the family environment within which Ruth was growing up. During the 1930s,, the interests of both of her parents extended beyond the Jewish community. They were very active in the High Park CCF. The party could not afford hotels for its leaders when they met in Toronto; they had to be billeted. Most of the Canadian socialist and labour leaders, at one point or another, stayed in or visited the Easser home. Such political notables as J.S. Woodsworth, his daughter Grace, and her husband Angus Maclnnis, as well as Agnes Macphail, Stanley Knowles, and John

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Mitchell participated in discussion, dined at the Easser table, and often stayed as the Eassers' guests. They rehearsed their speeches, talked of mutual concerns and interests, debated the political issues of the day, and honed party strategy. Sunday dinner, often with fifteen or sixteen at the table, was a family affair at the Eassers. Everybody was encouraged to take part. On one occasion Sarah commented to a noisy Joan, 'When adults are speaking, little children should listen.1 To this J.S. Woodsworth responded, saying, 'I am sorry, Mrs Easser, you are very wrong, never deny a child's comment.' As an adult, Ruth remembered and vividly recounted the heated discussions and the exciting ambiance her parents' political and social interests brought to the family. The Co-operative Commonwealth Youth Federation (CCYF) also met regularly at the house. Percy, as a young adult, was an active member. Because of the age and gender difference, Percy was protective of Ruth. He thought that the beer-drinking political meetings were not the right atmosphere for his younger sister. Ruth was dismayed; she wanted to be involved and never accepted the fact that she was not included as a participant just because she was a girl. Many of the people in that movement went on to become trade union leaders in the 1940s and 1950s. Percy became a lawyer and was very active politically before and after his war service. Sarah, like Sam, placed high value on education; she was active in the local Home and School Association but felt that her children also received an excellent education at home. 'My children benefited from meeting these fascinating people and political leaders. They had a socialist, Unitarian, political grounding that couldn't be beat.' Percy commented on Ruth's parents' efforts to support their children's education: 'My father, even though he was part owner of a machine company, was not a big earner. He managed on $55 or $60 a week which maybe in those days was good money; it put me through law school. Sarah was devoted to Ruth's education and would never say she couldn't afford it. When Ruth was studying in New York, Sarah put herself under financial pressure, using her own funds and her contacts with union representatives in the States to provide the hard-to-come-by U.S. funds. Our parents supported Joan through her university education as well.' When Ruth was in her last year of high school, the Easser family moved to Palmerston Boulevard, then an upper-middle-class, ethnically Jewish neighbourhood. The day they moved war was declared. Life changed radically. Her father's machine shop had many more contracts and was working on a twentyfour-hour basis. Sam developed ulcers, and Percy enlisted and went off to war for four years. The family changed from being one assimilated into the Canadian social democratic movement to a more traditional Jewish orientation. Sam

24 The Unsung Psychoanalyst had viewed the First World War as an imperialist war that the workers of the world should not have fought, and for years had been a pacifist. With the Second World War and the Jewish situation in Germany, Sam's pacifism collapsed, and he became more Jewish in his feelings and affiliations. Both parents worked very hard through the Jewish Labour Committee to bring refugees to Canada, particularly Jewish socialists from Poland and Germany. The Easser home became a different kind of household. People were still billeted but now it was a different flow of people. New York immigrants were coming up to Toronto to collect money for the Jewish Labour Committee to rescue Jews from Europe. Canadian immigration regulations required that jobs be available before non-Canadians could enter the country. Joan remembers their kitchen table at Palmerston where her mother would have all the right forms. The head of the Steelworkers Union and his assistant and the head of the Packinghouse Workers Union, all of whom had been early CCF or CCYF members, would come to the house and sign these forms whereby jobs were promised to Jewish refugees. These refugees would be taken from Toronto Union Station to the Labour Lyceum and then dispersed into housing provided by the Canadian Jewish Congress, the Jewish Labour Committee, and other Jewish organizations in Toronto. Ruth's mother was particularly involved in refugee assistance, while her father had to spend his time working at the shop. Few facts are known about Ruth's infancy and early childhood years except that she was healthy, well cared for, had the support of her extended family, and suffered no traumatic experiences personally. Ruth had not grown up in a Jewish neighbourhood or attended religious parochial schools. During the Second World War, when her parents' affiliations became more Jewish, she was in medical school, so she never established deep roots in the Jewish community. Apart from the influence of her family environment, the academic world seems to be where Ruth developed her unique abilities and talents. The family thought of her as bright but did not imagine she was as bright as she later proved to be. Nonetheless, Ruth's hard work and dedication to her studies were accepted and supported; she was always encouraged to achieve. For example, when Ruth was asked what she wanted to be, she said, 'a nurse,' to which her father replied, 'Why a nurse? Be independent, be a doctor.' Medicine and law were the two professions that allowed Jews independence. Medicine or law were natural directions for a bright student, if the family could afford it. The Easser's son and daughters were encouraged equally. Percy took law and Ruth medicine. There was no gender bias in the family: 'None whatsoever,' Joan commented. 'You did what you were capable of doing and she was capable of doing so she did it.' Several other influences within the

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extended family could also have contributed to Ruth's choice of medicine. Some of the people her father most admired were the Canadian women politicians, such as Grace Maclnnis, Dr Lorna Cotton, and Agnes Macphail. These role models were active, educated women, strongly independent, each with her own identity. There was also a doctor in the family, David, who was Sam's younger brother. He was very bright, and his education had been supported by his older siblings, especially Sam. Her uncle became one of the busiest general practitioners in town, and Ruth knew him well both as her uncle and family doctor; their relationship was close. Several of her cousins also studied medicine. The atmosphere in the Easser home and her parents' socialist-labour political activities instilled in Ruth central values of social responsibility, community involvement, and a commitment to improve the lives of others. Ideas and ideals were discussed, debated, developed, and used to reach goals. Change would be achieved through the skilful use of words and group effort. Ruth learned the power of language, words clearly articulated in well-rehearsed often spellbinding speeches, words used to influence minds and change individual behaviour. She learned the synergistic effect of people working together to help each other achieve goals and the primacy of practical help; people must have food, housing, work, and dignity before they can engage in dealing with problems of the mind. This is especially so when the causes of unmet basic needs are external and reality based. Psychotherapy is facilitating when emotional problems inhibit the ability to meet basic needs and individual functioning. Lessons about both the relative efficacy and limitations of practical assistance and psychotherapeutic help were first learned at home. Stanley Greben, former psychiatrist-in-chief at Mount Sinai Hospital and Ruth's colleague in Toronto, comments on her family's influence: There are a group of people here and in New York who, while they were secular, came from people who were strongly identified with being Jewish. Many became business people or professionals who were very giving. They gave up being communist, or being socialist, but they never gave up being interested in other people. She fits that stamp beautifully. Many of these people joked that their parents were communist, with a small 'c' and it wasn't a crime. Some of them are captains of industry now but they still carry that concern for the welfare of others. They learned that as children and while it isn't expressed in a religious way, it is expressed in a sociocultural way. They were one Jewish, two European historically, three socialist, often anti-religious, anti-Zionist. They were always highly

26 The Unsung Psychoanalyst intelligent, highly intellectual, and highly capable. This is the root of her humanism. Ruth's choice of medicine as a career and her years in medical school were giant steps towards autonomy and individuation. The fact that it was wartime accelerated her professional development because the six-year medical course was condensed to four and a half years after Ontario's Grade 13. Ruth completed her medical degree by the time she was twenty-three. To assist in the war effort, Ruth, along with many of her classmates, served in the reserve as an enlisted officer in the Canadian Women's Army Corps. Her army pay helped defray expenses and her uniform saved on clothes money. The rigours and responsibilities of medicine, and her army and later officer training, undoubtly accelerated her emancipation from home and her maturation as an adult. Although Ruth still lived at home through most of her university years, circumstances facilitated her increasing freedom from family, and her mother's rather intrusive, controlling ways. Both parents were heavily involved in their efforts to assist Jewish immigrants and their preoccupations freed Ruth to concentrate on her studies, which were considered of primary importance by the family. Two of Ruth's classmates, Ruth Stauffer and Agatha Tate, boarded with the Easser family. The three young women were very close. They studied together, supported each other, and provided a peer group for socializing. During her medical clerkship, Ruth lived at Toronto's Women's College Hospital, and this took her out of her parents' home even before graduating from medicine. Being Jewish and a woman, attributes which in 1945 did not facilitate a medical career in Toronto, she encountered problems when it came to securing an internship. She tried every teaching hospital and was hurt by the rejections, as there seemed no academic reason for them. Fortunately she obtained an internship in a good hospital outside Toronto and consequently spent a year at the Ottawa Civic Hospital in Canada's capital. She had relatives in Ottawa so that she was not alone, and being further from home she took another step towards independence. Unquestionably, early relational experiences, family dynamics, education, and cultural and social factors interacted synergistically with Ruth Easser's personal qualities to shape her character, interests, and life choices. It is certain that she was gifted with intelligence, had determination, and developed a capacity for hard work. It also appears that encouraging parents, a rich cultural and varied social environment, and opportunity facilitated her development towards young womanhood. These external aspects tell little of her inner life, her struggles, and solutions, or for that matter, what of her inner development

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led her to psychoanalysis and shaped her as the psychoanalyst she was to become. No pivotal events, major hardships, or losses emerged from Ruth's early history, although some family anecdotes suggest the roots of her inner life. To begin: Ruth Easser was a very private person; shy, reserved, internal, diffident about her personal self, yet interested in others, giving, engaging, in her public persona. 'Private person' is the descriptive phrase used by many of those interviewed - her sister, her best woman friend, her closest colleagues - and one o the reasons why it is difficult to know her. It is possible, however, to speculate about her inner life and motivations and how she got to be the psychoanalyst she was. Although a middle child, in essence, Ruth's childhood resembled that of an only child. Percy was nine years older and well into his teen years by the time she was in school. They attended different schools, and Ruth was in high school by the time Joan was of school age. Joan was too young to have specific memories of her until Ruth was in her late teens. She recalled that her mother claimed that 'when Ruth was in kindergarten she was called chatterbox and was frequently told to go behind the piano. That was a Ruth I never knew. The Ruth I knew was a teenager, very tall, very sensitive, a very studious older sister.' Her mother worked full-time until Joan was born, which coincided with Ruth's reaching school age, and her parents were out many evenings pursuing their socialist political interests. As an adult, Ruth was shy, yet very articulate. At home alone with her caretaker 'Cookie' she would have time to play by herself, be read to, and read (a capacity she developed at an early age), and to chatter away to herself or to whomever was around. Both her parents were talkative people (and her father especially had a capacity for languages). Time to herself, an early love of reading, and opportunity to absorb language contributed to both her private world and her articulateness. Perhaps her shyness began only when the strictness of the classroom at that time sent the 'chatterbox' behind the piano. Shy and private are characteristics often misinterpreted. For Ruth, her shyness seems to have resulted from an inhibition, and being a private person served other intrapsychic purposes which will be clarified as her story unfolds. Ruth's public and private self developed within and in response to her early relationships, especially with her parents. Sam Easser's integrity and vision had a profound influence on his daughter's character; in fact, integrity was the quality most emphasized when others described her. Sarah's influence on her daughter's unfolding as an autonomous woman was more complex and troubling. Sarah's strength, determination, and dominance contributed to Ruth's

28 The Unsung Psychoanalyst inner struggle to develop her sense of herself as a woman in her own right. Sarah's strengths lay in organizing, socializing, and fundraising, her weaknesses in the fact that she was opinionated, argumentative, and stubborn. Although well meaning, and at times facilitating, her tendency to organize others lives was especially difficult for Ruth. Little was gleaned from the siblings about the nature of Sarah's mothering. Percy provided a brief description: 'Ruth was Sarah's prize. She really accomplished a lot for Ruth by her devotion and doggedness in helping her to succeed. Ruth got along very well with her Dad, I don't recall any arguments she had with him [supporting the notion of less conflicted paternal identifications], although she might have had some with her mother, who tended to be hot tempered and a little stubborn. Sarah had arguments with everybody, with my father, too. A few times, she buzzed off, took the baby and left. She would get in a situation, would be angry, and wouldn't bend even with relatives. For example, she had a row with my uncle, Father's partner, and didn't talk to him or his wife for many years. Basically she was a kind, good-hearted person.' Joan commented that Vicariously, in many ways, Mother attempted to live through Ruth. It would not have been unusual if Mother joined Ruth and a friend to go to a movie. During her very sensitive teen years, she must have been in some doubt whether the friend was hers or her mother's. It was not until medical school that her classmates [Agatha Tate and Ruth Stauffer] who lived with us and were clearly her friends helped Ruth establish her separateness.' Yet when Ruth was a young adult, Sarah's dominance continued to intrude. Joan thought it was their mother's idea to buy the house on Palmerston; she thought it would be the ideal place for a doctor's office. She had visions of Ruth hanging her shingle at home when she became a doctor and looking after her in her later years. Agatha Tate remembering Ruth as a medical student writes: I do not remember any of us doing introspective thinking, wondering if we had chosen the right path or were fulfilling ourselves, as did the following generation. We had chosen to enter medicine and were in it, with our parents footing the bills. Our aim was to do as well as we could and to graduate. Lectures and labs filled out weekdays, often classes on Saturday mornings and studying in the evenings. We did not have much time for a social life. Ruth Stauffer (Stuffy) and I were very grateful to Mr And Mrs Easser and to Ruth for taking us into their home. There was always a pleasant welcoming atmosphere for us. Joan was a dear bubbly young girl. Percy must have been around at times but I don't remember him joining in with

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the family. I know that the Eassers did not follow Jewish traditions - Mrs Easser often served bacon and pork dishes. It was interesting to hear Mr Easser, after dinner, speak of his business, snippets of his life in Poland, union relations. We helped Mrs Easser when we could but she was in command of the household, doing things her way. She did not want to dry dishes - she stacked them on a chain board into a pile that you had to see to believe to dry on their own. The pile never collapsed. A few times Ruth S and I stuffed envelopes with invitations to tea at the Easser home for CCF gatherings. We helped serve at one affair when Mr David Lewis [later leader of the federal NDP] was the special guest. Ruth was a true friend, quiet in her manner, a winning smile, and sparkle in her eyes. I was not aware of her unhappy relationship with her mother. There were a number of Jewish classmates, and I did not feel any antagonism between them and the professors or with the rest of the class. I was unaware of Ruth's problems getting an internship. I can understand you asking about Ruth's interests, character, feelings as you are analysing her, but honestly, we did not discuss our thoughts and ideas about the future. We concentrated on the 'now' and successfully passing the year. When the Armed Forces decided they needed more medical personnel, the university agreed to accelerate the medical training. The students needed the money they made in summer jobs for tuition, so the army offered to enlist them as privates and to grant them privates' pay. We were not required to do any army service or to wear uniforms except for pay parade. We wore a narrow wine-coloured stripe on the jacket to show we were a little different. After internship we were required to attend officers' training school for six weeks. We graduated as lieutenants and within six weeks were given the rank of captain. By then it was September 1946. Our services were not needed and we were given the choice of retiring or continuing. It must have been then when Ruth went to New York to specialize.9 Although medical school, her live-in classmates, and an internship away from home provided a buffer between mother and daughter, Sarah's intrusion in her children's lives continued. Percy, an officer in the war from 1940 to 1944, sustained a wound in the foot. To have him released from the service, Sarah arranged that he be asked to run for office for the CCF. Just after V-E Day, he was released from active duty to enter Canadian politics. To celebrate his homecoming Sarah planned a party for family and members of the CCF. She called Ruth in Ottawa, where she was on call as an intern. She told Ruth to get

30 The Unsung Psychoanalyst on the same train as Percy and that she would phone the superintendent of the hospital to allow her to leave. 'Mother, you wouldn't dare!' 'Don't dare your old lady!' Ruth arrived home for the party. Sarah, sensitive to neighbours' losses (if not to her children's independence), took down the welcome sign. A young woman's struggle to become autonomous inevitably involves integration of maternal similarities with chosen differences. Pictures of Ruth's mother as a young woman reveal a striking resemblance to Ruth. Both were tall (near 6'), thin, dark haired, with high cheek bones and lovely faces. As her mother directed, Sarah walked tall in her own way. Ruth's struggle between stooping to her mother or walking tall her way seems central to her inner development and influential to her motivations underlying her life choices. Psychoanalysis became her way of walking tall. It is also possible to infer some of the external influences that led Ruth to choose psychoanalysis as her life's work. She came from a family interested in people and in working to help others, a family that encouraged education and the use of one's mind, to think for oneself, a family that held no gender bias with regard to independence and life goals. She was academically ambitious and goal oriented. A member of her family, her doctor uncle, whom her father had supported through medical school, set a family precedent and served as a model. During medical school she was encouraged by her mentors to consider psychiatry. The caption in her medical school yearbook reads: 'Interests - people and politics; after the war, psychiatry.'

Stanley Greben comments on Ruth's choice of her medical speciality: Some people who love medicine in the broader sense end up in psychiatry. That wasn't Ruth. The part of medicine which interested her was an intimate understanding of people. She was interested in medical matters, but was it as likely that she would be an internist as a psychiatrist? I would say no. People interested her, thinking about and understanding them. To diagnose someone as having a physical problem would not excite her as much as understanding a person's thinking. She never said this but I would guess that is what drew her into psychiatry. Analytic training wouldn't be automatic, but it was believed it provided the greatest understanding and the greatest depth. Anyone serious about psychiatry would want to go into analysis. That was the attitude then, but she would also be drawn to psychoanalysis because of the intellectual stimulation and depth it offered. Other areas of psychiatry would be considered superficial to someone of her intellect. She must have increasingly discovered that she could master learning and understanding about people. That was the highest goal in psychiatry, so she just kept going.

Beginning 31 Now there are newer challenges, but even today I wouldn't expect her to choose otherwise. Some people are excited by the chemistry of the brain, but that would not have excited her. She was more interested in the thinking and the soul of people, and her interest would not have changed.

Several of Ruth Easser's analytic colleagues recounted aspects of their motivations to become analysts. The reverberations in their stories add shading to Easser's experience and texture to the tapestry of beginning life as an analyst. It is 1910, and Sandor Rado, one of Freud's early disciples, in his oral history, comments that Ferenczi's Analysis of the Soul opened up the world of studies whose existence had been unknown to me. I became excited and ordered from the bookstore everything Freud had written ... I began to read Freud from cover to cover ... I realized that this was a method for study of the brain, because what people think, dream, and say, as well as how they behave, comes from the brain ... I decided overnight that this is what I wanted to do ... I went to see [Ferenczi] to announce that I would like to give up my political science studies in order to become a medical man and to specialize in psychiatry and psychoanalysis.10

It is 1952, and Arnold Cooper is among the candidates in the first-year class at Columbia: When I was a student at Columbia College at someone's suggestion I dutifully read through the Brill translation of Freud. Like so many others of my generation, I experienced a sense of instant revelation into myself and my adolescent miseries, into my friends, and into my world of politics and literature. This was a new way of seeing and understanding, an affirmation of my previously unvoiced conviction that more was going on than I was privy to. Things seemed clearer than they ever had before. I asked a friend of mine what one had to do to become a psychoanalyst and he said you have to go to medical school. At times I had thought of law, sociology, English literature, but never medical school. Shortly after graduation from medicine, I knew I needed an analysis for personal reasons, and although psychoanalysis still fascinated me, I was uncertain that anyone as neurotic as I felt myself to be could help other people. After a painful first experience with an orthodox, abstaining analyst and a second analysis with a responsive and talkative man, I decided that my initial instinct was correct. I took a psychiatry residency and applied to analytic school.11

32 The Unsung Psychoanalyst It is 1955, and Joseph Schachter begins at Columbia: I had been interested in analysis, from my PhD studies in Harvard's newly combined department of clinical and social psychology, cultural anthropology and sociology. Analysis was very highly thought of in Boston; academics were analysed because it was thought to be good for career advancement. I became interested in people and their emotional problems but then there was little chance for a psychologist to become a psychotherapist. It made sense to go to medical school and become a well-trained therapist rather than be limited as a psychologist. I went to medical school specifically to become a psychiatrist and an analyst. I was aware of my personal problems but deciding to become an analyst facilitated my getting treatment; 'apparently' for professional reasons. In 1966, eleven years later, four new candidates began in the same class. Their story illustrates not only an interest in people and curiosity about the workings of the human mind, but the influence of peers on career decisions and the value of mutual support. David Levine laughed when asked what made him choose psychoanalysis. 'That's a tough one.' From childhood Levine was motivated by an intellectual pursuit. Growing up next to the State Mental Hospital, I was taught to fear mental patients - my mother would say, 'Watch out.' I felt quite the opposite, I was intrigued. What made them different, why were they in this place? They were psychotic patients, not psychoanalytic patients, but I am sure that is what planted that seed. I wondered what was going on in their heads. They seemed to me people to be understood. How people work, how their minds work intrigued me through college. I was also trying to satisfy some frustrated need to be an artist or a writer or something. Once I decided on medicine and psychiatry, I couldn't imagine doing psychiatry without doing psychoanalytic training. It was like one choice. Sixty per cent in our residency class went on to psychoanalytic training; more than half to Columbia. Tom Anders was influenced by a life experience: My original direction in medicine had been pediatrics, I wasn't headed towards psychiatry. In the early 1960s I was drafted into the military, spent two years in the Air Force and practised pediatrics but found it unfulfilling. I befriended the psychiatrist on the base, the only one who could help with many of the problems. I was seeing depressed mothers taking out their

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depression on their kids and bringing them to medical care. Since I couldn't really help these people, I decided when I returned I would go into psychiatry. It was expected that residents would go into analytic training. There was a pressure; case supervisors would say things like: 'You would understand that better, if you were in analysis. To be a really good psychiatrist, you will have to get into analytic training.'

Daniel Stern said, All my medical school buddies were going to train as analysts and that made it easy for us. We had big discussions: Is it really worth it? Do we really want it? All that time and money? My reasons for wanting to go to analytic school were a little mundane. It was clear that the best clinicians were the analysts and they were the teachers in psychiatry at Columbia. I was never gung ho about analysis but during my residency, I was fascinated by development, by how people change in the sense of being transformed. This was highly mysterious and I was interested.

Anne Bernstein was also a member of the 1966 class: When I was chief resident at Mount Sinai, Dr Fedor who was at Columbia asked me, 'So when are you applying for analytic training? It is the thing for a good resident to do. I'll write a letter of recommendation for you for Columbia.' I had other analyst supervisors who talked about analysis but it was Fedor who said very directly whatever you are going to do in psychiatry, it will help you to know about psychoanalysis. I listened. I was a good girl. If I hadn't been I wouldn't have gotten far in those clays. Personally, I was the only child of professional parents, and you can write the rest - the driveness, the narcissistic entitlement, I was a special person, the good girl. Paul Lerner, a psychologist who trained at the Toronto institute in the class of 1973, comments: For many, especially those attracted to the helping professions, it was a progressive decision. For some perhaps, it was an intellectual decision, they read all of Freud at age fourteen. For others that was not the case. The question that can be asked is, Why the helping professions? For me, it was clearly that I had to fix things for everybody else beginning from the time of my mother's illness. That there is somebody or some interpersonal situation that we are trying to repair is true of most of us. Motivation to become an analyst goes beyond choosing a helping profession. In graduate school I

34 The Unsung Psychoanalyst had already chosen psychology but analytic training was the best way to be a good therapist. I wanted to feel competent and I needed the tools. What I lacked and sought in analytic training was a conceptual framework to understand the conscious and the unconscious.

Anna Freud, daughter and analytic heir of Freud, says of the motivations of the first psychoanalysts, 'We selected ourselves for the profession of becoming analysts, very much on the basis of one particular factor, a burning curiosity about how human beings function, what makes them function normally or what makes them suffer abnormally, and lastly what makes them develop from children to adults?'12 This 'burning curiosity,' this interest in people's minds suggests a ubiquitous motivation linking the first generation with Ruth Easser and those analysts with whom she interacted. The need to heal oneself by healing others inevitably underlies the psychoanalytic choice. Again Anna Freud comments, 'The socalled "neurotic" nature many of us have is commonly the source not only of our problems but of our personalities, our interests, our abilities; our passions as they become our achievements.'13 Without a wish to understand and heal one's own psyche, a person might never consider becoming a psychoanalyst. What needs healing is private to each analyst unless she or he chooses to reveal their personal motivations. It is precarious to speculate about the inner influences that impel individual psychoanalysts, including Ruth Easser, to seek the self-understanding essential for learning to assist others in understanding their inner worlds. In his book about D.W. Winnicott's life and work, Dodi Goldman cautions that 'an examination of the biographical roots of Winnicott's theorizing runs the risk of degenerating into a form of psycho-biography in which the objective significance of Winnicott's ideas becomes lost in the speculative search for motivations behind the ideas.' The association between Winnicott's theory and his biography is traced only 'to demonstrate the centrality of certain themes that are present in both his life and work.'14 Similarly, with Ruth Easser it is possible to discern recurring central themes in her life and work which contributed to her motivation to become an analyst. In particular, as gleaned from her personal history, from the reports of others, and from a close reading of her papers, the development of a sense of herself as an autonomous woman emerged as the primary underlying theme. The need to resolve this inner struggle, combined with her interest in people, her intellectual strength, determination, and integrity are the personal characteristics that shaped Easser's formation as a psychoanalyst.

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Personal motivations are not bound by time and place. Professional motivations do change over time. The first psychoanalysts were attracted by Freud's revolutionary ideas and the notion of pioneering in a new and promising field. The third generation, including Ruth Easser and her contemporaries, were motivated largely by career advancement - to be the best in psychiatry during those years, one became a psychoanalyst. Easser's comment to a friend, 'I always found it more difficult in medicine being a woman than being Jewish,' suggests that the relatively high proportion of Jews and the higher proportion of women in psychoanalysis than in most other medical specialities were facilitating factors. Psychoanalytic training requires intense involvement, first-hand experience through a personal analysis, and self-discipline within a defined framework: it is emotionally and intellectually demanding; it requires determination, persistence, and commitment. Prior success at facing difficult educational and personal experiences gives most applicants the ability and confidence to meet an additional rigorous challenge. From an internal perspective, however, the decision to apply for psychoanalytic training involves a particular kind of personal risk. Nathan Hale notes, in a study of applicants from one institute, that 'for those seeking analytic training, acceptance ... was the seal of personal worth and refusal "an almost catastrophic failure." Even the most qualified resident approached the Institute fearful that his secrets would be "discerned by the all-seeing eye of the Institute's interviewing analysts."'15 Psychoanalytic applicants will be assessed as persons. Inquiry will be made about their personality, life views, social and cultural values, relationships, emotional stability, judgment, capacity to handle life problems, and sense of responsibility. The essential assessment, however, is the capacity for insight into their inner world. Acceptance or rejection, therefore, looms large because it is experienced as ajudgment about oneself. Rejection as a person is the highly charged risk felt by applicants. This personal assessment does not stop once accepted but continues during training, as one's career develops, as professional advancement occurs. Why does self-knowledge remain important throughout an analytic career? Simply, the primary therapeutic tool is the self in relation to, in communication with, another. Ella Freeman Sharpe describes the analytic situation as the place where 'we can tell all we have never told another, all we have never told ourselves.'16 This involves the establishment of a relationship of great trust in the analyst's ability to understand and work with the vicissitudes of the unconscious - to tune one's own inner world to another's. Further, the work itself places special demands

36 The Unsung Psychoanalyst

on the psyche, involving the unconscious of both participants more intensely than in most human contacts. Psychoanalysts carry a heavy emotional responsibility. Becoming a psychoanalyst begins with a training program. As the profession developed in complexity, as its adherents increased in numbers and became more widespread geographically, more heterogeneous culturally and linguistically, the need for a standard method of training became apparent. Training institutes, in collaboration with psychoanalytic organizations, acquired the responsibility of selecting candidates, imparting knowledge, and maintaining standards and professional identity.17 Training institutes also carry heavy responsibility. Those who are accepted for training determine in the long run what the word 'psychoanalyst' will mean. Psychoanalysis is a powerful tool that, if misused, has the potential to harm. Analysands while in treatment are dependent and vulnerable. Those who train candidates are responsible for ensuring that graduates will be capable of using the psychoanalytic method effectively and, most importantly, will not do harm. As training programs became formalized, so too the selection criteria and procedures for acceptance into the institutes. The inevitable questions were posed: What is a good analyst? Who makes a good analyst? Can most interested persons be trained or is innate talent required? How is the trainable applicant recognized? What about the gifted applicant and, conversely, how can those who do not seem suited, or who would do harm or shame the profession be identified? As pertinent as these questions may be, answers are far from clear. Concomitant with the development of selection criteria and evaluation procedures, issues of objectivity and subjective bias of the evaluators (the human factor) arise as do problems and mistakes in judgment (human error). Lawrence Kolb underlines the significance of candidate selection: To entrust another with the great responsibility of seeking to modify one's personality through mutual study of the revelations of one's most intimate and deeply buried experiences properly presupposes that the personal integrity and human qualities of that individual are of the highest order. The range of emotions exposed in such a therapeutic effort and their expression in character formations, devious behaviour patterns, and unusual thoughts call for an empathic sympathy and understanding in the therapist of his fellows, and exquisite sensitivity to the various means of communicating their secret despair, as well as broad knowledge of the

Beginning 37 gamut of behaviour, changing as it does in various age spans, in differing ethnic groups and cultures.'18

Training committees attempt to utilize the most effective selection methods to attract high-calibre students. The traditional screening tools are: the application forms to confirm prerequisites, letters of reference, personal statements of motivation, and in some institutes, psychological testing to determine aptitude. Over the years, despite credential modifications, and minor revisions in the selection methods, the actual process has changed little. The individual interviews conducted by three experienced analysts, albeit subjective and controversial,19 are still regarded as the best assessment. Anna Freud urges interviewers to 'look not only into the future of the candidates but into the past of the psychoanalytic movement.' There, they will find that 'essential technical, clinical, and theoretical contributions to psychoanalysis have been made by individuals not only on the basis of different professional backgrounds, but in spite of, or prompted by, all sorts of personal characteristics, qualities and idiosyncrasies.'20 She encouraged that selection take place in 'a truly analytic atmosphere ... one in which the complexities of anyone's personality are evaluated carefully, thoughtfully., with due respect for a particular person's idiosyncratic talents and handicaps, both of which ought to be fitted into the context of an ongoing life, its everyday achievements.'21 Henriette Klein echoes Anna Freud: The most important ingredient in personality assessment may well be the assessor's intuition ... sizing people up is an essential human activity to which the analyst adds a particular kind of experience.'22 Richard Simons maintains that 'the ideal for selection and education of candidates should be one of discovering creative talent, nurturing professional maturity and the profession should be concerned with quality not with quantity.'23 Contemporary wisdom has little to add to these comments. Much depends on the fit between candidate and institute and what each is able to make of the opportunity provided. What is more difficult to determine is which applicants should be rejected. Again, Anna Freud comments that she was 'prepared to rule out the more severe psycho-pathologies and character disorders such as psychopathy, psychotic risks, depressive risks, perversions, and delinquent trends ... but to balance such a necessary skepticism'24 with an historical perspective. Despite being otherwise suitable, candidates with unresolvable envy, arrogance, and grandiosity would be rejected.

38 The Unsung Psychoanalyst It is September 1946 and a young Canadian woman leaves for New York to become a psychoanalyst. Ruth Easser is twenty-four, single, and Jewish. A new physician recently released from the Canadian Army Medical Corps, she is eagerly poised at a pivotal moment of life. She is about to begin her psychoanalytic training. Her choice of training institute is the newly formed, dissident Columbia University Psychoanalytic and Psychosomatic Clinic for Training and Research. Her choice will prove to be propitious. Her application form and letters to the admission's secretary give a glimpse of her experience and the practical arrangements she made. Easser had written to Columbia asking for information regarding the post-graduate course in psychiatry and subsequently applied simultaneously to the Psychoanalytic and Psychosomatic Clinic for Training and Research. One reference letter25 recommended her more for her personal qualities than her academic work which 'was above average but not brilliant. Her work [as an intern] of a junior nature was quite satisfactory. I feel confident in guaranteeing her personal integrity. She is a little diffident and possibly not overly endowed with initiative, but she gets along well with patients and is a very likeable, attractive person.' In April 1946, Ruth is asked to come to New York for personal interviews and psychological tests. Not yet released from the army, she requests postponement of this trip until May. Her letter is straightforward, although apologetic in having to ask for special consideration. The response from the Institute is accommodating. Although the admissions committee of the clinic notes that the results of personal interviews, the information received, and the Rorschach Test are satisfactory as to integrity of character, psychological aptitude, and scholastic achievement, by July, she has not yet heard whether she has been accepted to begin training in September. She risks asserting herself with the following letter: 'I am sorry to be bothering you again. As you know I am a Canadian and, in order to enter the United States I have to have the official acceptance of the college that I am to attend, also I must find a place to live that is approved by the college. As all this takes time I was wondering if the confirmation of my acceptance would be forthcoming in the near future. In case my application is not approved I would appreciate knowing as I am definitely being retired by the army in September and I am very interested in starting my post-graduate training this fall. Thank-you for all your kind attention and I trust that this is not too much trouble.' Once accepted and having to carefully plan her finances, in August, she writes again asking the cost of her personal analysis. She learns that her analysis would not be less than $3,000 by the time she is finished, a considerable sum in 1946. Her first year Ruth receives $1,000 bursary from Columbia but it

Beginning 39 is her mother who makes sure she has the financial resources needed. As Sarah later comments, 'I've got her books here, I call them my $25,000 books. Her three years cost me $21,000 and it was worth every cent.'

Little else is known about Ruth Easser's emotional experience of the selection process. The application experience of several applicants she interviewed sheds light on her attitudes towards and their experience of the selection process. Anne Bernstein recalls her admission interview: Ruth Easser was my first interviewer when I applied to Columbia. I arrived at her office early one morning. She came bustling through the waiting room with a thermos tucked under her arm and said she would be with me in just a few minutes. She opened the door, invited me in, opened her thermos, and offered me a cup of coffee. As the mother of two children with a third one on the way, I was amazed that she knew it was hard to go through medical education and raise a family. Of all the interviewers I had for medical school, for residency training, for candidacy, no one was as kind, courteous, and understanding of me. She did not start to attack or analyse, in fact, she said some very positive things, and then we talked. She seemed to feel that whatever the content or whatever the direction, she would get as much information as if she was attacking or challenging. I am sure she was listening with an analytic ear. Although she asked me meaningful questions, I never felt that I was a specimen under glass. Rather her manner made me feel willing to talk as freely as I was able about the benefit of an analysis and about my life. She made me comfortable for my other interviews.

Juanita Casselman's experience nine years earlier had been different: The interview I had with Ruth Easser was an unhappy experience. She was very tall, and I had a negative reaction because I had a tall half-sister which caused some difficulty in my family life. I experienced her as cool and distant. She sat far from me in a dimly lit room. She smoked and didn't offer me a cigarette. The questions she asked were pertinent to my life but I had the feeling that some of the issues were not separate from what was happening in her life. My husband and I were living separately because of work commitments. I was planning to come to New York for training, and he was remaining in Canada to work. We did not have children yet. Ruth seemed to go after this area of my life in a particularly strong way. I felt that the way I was dealing with these issues was looked on askance. I felt she thought I

40 The Unsung Psychoanalyst was a questionable candidate and that I might not have been accepted if the other interviews had not gone well. The positive side was that my interview with her had an impact on me. Her questions went to the core. My reaction crystalized certain issues and made an instant focus for my personal analysis.

By contrast, the Toronto institute where Ruth Easser subsequently taught had a different interviewing system. An applicant would initially have three interviews and if 'not rejected' would be asked to reapply after at least a year with a training analyst. Paul Lerner describes his progression: What made me fearful in my first interview was not the interviewer but a sense that I was being judged as to whether or not I was worthy to go ahead. I had a lot riding on it at the time. I felt if I wasn't accepted, I couldn't quite get to where I wanted to go. The second interviewer was good in that he used certain terms which I find myself using now. An interesting example, he was asking me about depressive experiences and I told him that I had been depressed after my mother died. Then he asked, 'Had I found depression to be a companion?' I said, 'No I hadn't,' but I thought that was the most tender way to ask a question about a painful experience. A year later, in the second set, my third interview was with Ruth Easser. By that time we knew each other well, we were writing a paper. I gave her some of my background and why I was applying, which she didn't know. My increased confidence and comfort said to me that the analysis was working. We were doing something good, there was a difference in what I was like in the first interviews and this later one.

These anecdotes of the interview experience illustrate the impact of the first meeting between candidates and their teachers, between aspirants and the psychoanalytic profession. Today, as in Ruth Easser's time, women and men, young and more mature, continue to become psychoanalysts. A choice of psychoanalytic training institutes is made. The training institutes select, from among the applicants, candidates for each class. Each hopes a good choice has been made. For the individual it is a pivotal, formative life choice. It is pivotal in the sense that it changes one's professional focus; formative in that it changes one's professional identity and involves risk-taking, because personal suitability is the sine qua non of acceptance or rejection for training. It is a major life commitment for the person. It is also a major commitment for the training institute and for the profession of psychoanalysis.

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Not all eligible, potentially good candidates are accepted for training. There are many reasons for rejection which have little to do with the suitability, motivation, or even determination of an applicant. For example, in any given year the number of applications can be greater than the optimal class size, the competition may be particularly stiff, or the applicant may not have the particular credentials desired by that institute. It is not uncommon for rejected but determined candidates to apply more than once, eventually be accepted, and prove to be good analysts. The initial rejection may have been because of a lack of readiness on the applicant's part. Or there may not be a good fit between the perspective of the institute and the applicant. A different selection committee in different circumstances and an increased readiness on the applicant's part can lead to a positive decision. Nevertheless, the nature of the selection process with its emphasis on personal attributes can leave the rejected applicant emotionally vulnerable. Rejection for psychoanalytic training is inevitably a blow to one's ego, to one's self-image. It is a narcissistic blow because of the emotional investment in the decision to apply for training. The degree to which this blow is felt varies according to the personal, professional, societal, and cultural value placed on psychoanalysis and psychoanalysts. Personal factors, such as a sense of inner security and firmly based identity, the nature of a relationship to authority and power, the degree to which psychoanalysts have been idealized, and the opportunity for and the prestige value of other viable options related to stage of life are especially critical in determining the applicant's capacity to accept rejection and integrate the experience. Most institutes require at least one year of analysis before a person is eligible to apply. Consequently, most rejected applicants are in a personal analysis when this occurs. The analyst's role is to analyse the applicant's experience. Ruth Easser helped one rejected analysand come to terms with the interviewer's authority, and even integrity to make what in the interviewer's opinion was the right decision. Easser accepted the analysand's passionate outburst, 'The government had the authority to send my father to war but I will never agree that was a good or fair decision,' and validated the analysand's awareness of the meaning of an authoritarian decision over which she had no control. It was an affectively learned lesson about the effect of authority on individual selfexpression. It was learned because the analyst continued to analyse unconscious implications and thereby freed the analysand to integrate a life disappointment and rejection. The ultimate integration of rejection depends on how the applicant

42 The Unsung Psychoanalyst

deals with the inevitable feelings of anger, hurt, loss, and diminished self-esteem. A number of adaptive choices are available to assist in positive integration. An applicant can apply again; the time and place and individual circumstances - the fit - may not have been right the first time around. There is also the obvious option of turning to other pursuits and using understanding gained from the analysis effacing a disappointing life experience. Less adaptive reactions would be angry, bitter attacks on psychoanalysis and/or prolonged loss of self-esteem, depression, withdrawal, or self-destructive behaviour. Although, initially, most rejected applicants experience some measure of these less adaptive reactions, they are usually relatively short-lived. Adaptation, over time, can be achieved through a variety of mitigating life experiences. One analyst was favourably impressed with the creative resiliency of rejected applicants he knew, despite initial anger, bitterness at the unfairness, and painful helplessness. Personal qualities are not easy to assess and are contingent on the judgment of the interviewers and their reports to training committees. There is little doubt that personal and institutional biases of interviewers and training committees can prejudice the selection process. Anecdotes abound about idiosyncratic interviews, imagined and real reasons for acceptance or rejection, and institutional attitudes. The tradition of maintaining confidentiality about reasons for rejection fosters a certain paranoia related to applying for psychoanalytic training. Committee discussion of the application material, comparing and rating applicants, and weighing the varying opinions of the interviewers helps mitigate the latent biases. Insufficient attention has been given by institutes to understanding the experience for unsuccessful applicants. Nor has there been much consideration given to whether or not feedback, opportunity for discussion, and supportive reassessment are feasible, wanted, or perhaps even vital to the rejected applicant. With such follow-up, institutes might learn more about their decision-making processes. Similarly, useful information might be gained from those few who drop out or are asked to leave the program. Just as rejection decisions can be mistaken, so too acceptance of some applicants can be wrong, with grave repercussions for the candidate (e.g., suicide or emotional breakdown), for his or her analysands (e.g., breach of ethics), and for the profession (e.g., most institutes have had the experience of a graduate turning against psychoanalysis and causing public shame and providing fuel for detractors of psychoanalysis) ,26 Successful applicants experience a rise in self-esteem at being found

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acceptable, accompanied by a sense of purpose, an eagerness to learn and develop. Initial elation is short-lived as the practicalities set in and the intense work of training begins. With her application to Columbia, Ruth Easser took the risk of acceptance or rejection. She was accepted. The risk was worth it. She now has the opportunity to pursue her plans, hopes, and dreams in this next step of her life. She has taken a pioneering step; the first of a number she will take as she proceeds. She has reached a pivotal point in her professional and personal development. This formative moment will shape her professional identity and to a large extent her personal life. Columbia selected Ruth Easser to be a candidate in the third class, a wise choice, the effects of which would span nearly thirty years. First impressions often presage the eventual fruitfulness of a mutual choice. Sarah Easser recounts27 a snippet of her daughter's application interview with Sandor Rado. After they finished the formal interview, Dr Rado turned to her and asked, 'What did your father do?' Ruth told him. Rado said, 'I knew you didn't get that education from a school.' Apparently he recognized what her mother described as the 'socialist, Unitarian, political grounding of Ruth's home education from which my children benefited,' and rapport was established. Ruth's 'way of thinking' seemed to fit with Rado's and Columbia's 'way of thinking' from the onset. From the beginning, there was an affinity between Ruth Easser and psychoanalysis at Columbia. One might even say that her application initiated a fateful encounter which became a good fit, a mutually formative and even passionate relationship. As will be seen, this was a relationship developed over time, a relationship that the psychoanalysts Easser influenced carry with them. That Ruth Easser decided to train in New York is not surprising. There was then no psychoanalytic institute in Canada. She had relatives in New York and other connections through her parents' political and union interests and assistance to Jewish immigrants. With her family, she had visited cousins in New York, so that she was not alone when she first arrived, and the city was not unfamiliar to her. What is unclear is why she chose to train at Columbia rather than the more established New York Psychoanalytic Institute. Apparently, she applied and was accepted at the Boston Psychoanalytic Institute, but it is not known if she applied to the New York Institute.

Founded in 1945, Columbia was the first psychoanalytic institute in the United States to be based in a university, within a faculty of medicine and a department of psychiatry. Its founders, Sandor Rado, George Daniels,

44 The Unsung Psychoanalyst

David Levy, and Abram Kardiner, were brilliant innovators passionately committed to a revolutionary mission. They were in protest against the perceived doctrinaire authoritarianism of psychoanalysis and were dedicated to academic freedom and scientific rigour and to interdisciplinary studies and research within psychoanalytic training. They were prescient, determined, on the cutting edge, and ahead of their time, attributes which likely appealed to Ruth Easser's pioneering spirit. Several of her colleagues describe why they chose Columbia. Arnold Cooper was accepted at both the New York and Columbia institutes. He chose Columbia for his training. Why? What appealed to him? I was told that Columbia would accept my ongoing analysis as a training analysis, while New York told me I would have to begin again with a different training analyst. It tells you something of my state of mind that I made no attempt to investigate what the differences were between the institutes. My interviewers at Columbia seemed interested in the fact that I had done physiology research and had published some papers, while my New York interviewers never broached the topic. I didn't know analysts or analytic candidates, except for one friend who was a candidate at the New York institute who told me the institutes are all the same and I might as well go where I didn't have to start a new analysis. I took his advice. I had no idea that Columbia was considered somewhat renegade, with a reputation of being tainted by culturalism and lacking real analytic vigour, and that Columbia was on a campaign to abolish the metapsychology that was dominant.28 Joseph Schachter, on the other hand, chose to apply to Columbia and not to New York: I applied to Columbia because I thought I would never survive in the New York institute. I saw it as a rigid and authoritarian place which valued compliance. Rado had already rejected libido theory, which delighted me because I had never felt comfortable with that. Columbia appealed to me as a much more biological kind of place. There were courses taught by geneticists and by anthropologists. Kardiner was there. It was a relatively new place with a lot of verve and enthusiasm. It was an intellectual environment with wonderful names teaching.

David Levine, prior to medical school, had been on his way to a doctoral degree in English Literature. 'By the time I trained in the late 1960s, Columbia had a well-established identity. Though not as presti-

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gious as the New York Psychoanalytic, the intellectual and medical ferment at Columbia attracted me.' Judith Schachter, speaking at Columbia's fiftieth anniversary, provides a glimpse into the formative influence of her psychoanalytic training: 'Columbia accepted me as a candidate more than forty years ago, and this changed my life. It, and perhaps specifically my personal analysis, supported by didactic work and excellent supervision transformed my psyche and my career.' The background of Ruth Easser's time and place in psychoanalysis and the nature and culture of her training at Columbia are as relevant to her development as is her personal background. The Columbia University Psychoanalytic and Psychosomatic Clinic for Training and Research, founded between 1944 and 1945, became her parent institute. The notion of a parent institute is pertinent because as Edith Kurzweil, the historian, states, 'even the best psychoanalysts, those who manage to cure their patients, inevitably function within the native philosophical assumptions, intellectual controversies, and fashions of their culture. And these ultimately affect not only the professional activities of the analysts but their larger intellectual concerns, such as human freedom, democracy, or war and peace.'29 Ethel Person, a former director of the Columbia centre, extends Kurzweil's claim: These differences are manifest even within the particular local culture of individual institutes ... The members of an institute have intricate connections and bonds with each other, and each of us is profoundly influenced by our institute's founders, theoreticians, and revered clinicians - some of whom we may not have known - and our idealizations of them. Idiosyncrasies of predilection, tone, emphasis, and sensibility are passed from one generation to the next by transference to analyst and institute.'30 The distinctive culture of Columbia, founded as a clinic and later raised to centre status within the university, was influenced by separate but related circumstances. Broader social circumstances were intimately connected with the prevailing New York psychoanalytic culture. What has been referred to as the New York psychoanalytic war began just prior to the Second World War. John Frosch provides an outline of the analytic schisms in New York: There were several major schisms in the New York area. The first related to [Karen] Horney's [1941] departure from the New York Psychoanalytic Society and Institute. There were multiple splits in this group which eventuated in a psychoanalytic facility at the New York Medical College, as well

46 The Unsung Psychoanalyst as the establishment of the William Alanson White Institute. Then there was Sandor Rado's 1944 defection, and the establishment of a psychoanalytic training facility at Columbia University, one at the Downstate Medical Center, and another at the New York University School of Medicine.31

These revolutionary breaks from the New York Psychoanalytic Institute laid the groundwork for the founding of the clinic at Columbia. George Goldman, Columbia's third director, describes the founders as outstanding psychoanalytic educators. Sandor Rado, previously a leader in psychoanalytic education at the Berlin and the New York Psychoanalytic institutes, 'brought his brilliant analytic mind, his exciting and stimulating quality as a teacher, a persisting doubt about the finality of any answer, and the insistence that all theory and therapeutic method must be capable of validation.' Abram Kardiner, in addition to his work as a psychoanalytic teacher, carried out many of his 'well-known psychoanalytic studies of culture and demonstrated how different cultural practices and child-rearing methods influence personality development.' David M. Levy produced 'original and significant contributions in the field of child development and child psychiatry. His work uniquely emphasized the application of experimental method to human and animal behaviour.' George E. Daniels had pioneered in the application of psychoanalytic knowledge to general hospital medicine, thereby stimulating modern interest in psychosomatic medicine through his teaching and research programs. Nolan D.C. Lewis, then chairman of the Department of Psychiatry, supported the development of this first university-affiliated institute and provided important organizational guidance and wisdom.32 Ethel Person says that, to understand Ruth Easser's psychoanalytic heritage, 'it is important that you know what kind of place Columbia was. Columbia was a place for dissidents. Columbia was born as a breakaway institute from the New York Psychoanalytic. Part of its tradition is to thumb its nose at the establishment. If there is an institutional crisis now it is that we have become part of the establishment. We still have a dissident mentality, which is "show me, don't tell me." That was there when Ruth was there, that was very much part of everybody who was trained or taught there. It is, "if you say so," don't tell me Freud said so and so. Freud was a great genius but don't quote any gods. There are no gods.' Recognizing that no institute is without flaws, Person notes that despite the clinic's dedication to academic freedom, the early years at Columbia were hardly free of dogmatism. Like revolutionaries everywhere, the founders of the Columbia clinic had a defensive zeal that sometimes

Beginning 47 brooked no differences of opinion. There are some ironic aspects to Rado's defection from the New York Psychoanalytic. He was its first educational director, having been recruited to establish the Berlin institute's tripartite system of education in New York, and in some ways he significantly helped to shape the very institute from which he subsequently fled. What with the opposition of the American Psychoanalytic Association to sanction a second training institute in New York (it was against their by-laws!), the prestige of the already existing New York Psychoanalytic, and the sometimes intimidating (but always towering) intelligence of Rado at Columbia, it is in some ways amazing that this second institute ever took hold and was finally able to do so within the auspices of the American Psychoanalytic Association. They were in the thick of the fray in what they called the 'Battle of the Frames of Reference.'33

Freud originally had envisioned colleges of psychoanalysis that would teach depth psychology, the biology of mental functioning, the science of sexuality, and the symptomatology of psychiatry, and that would also include other branches of knowledge such as the history of civilization, mythology, the psychology of religion, and the science of literature. He felt that institutes could become such colleges of psychoanalysis through closer affiliations with both universities and medical schools. The presence of qualified candidates from a wide range of disciplines would be the best guarantee for enriching this scholarly development of psychoanalytic education, practice, and research in the years ahead. The curriculum would encourage independent and critical examination of the data and superseding concepts rather than imitation of the master. There would be an atmosphere of open scientific exploration rather than indoctrination and a curriculum that included the most recent findings of developmental, neurobiological, and outcome research, as well as research on the psychoanalytic process and attention to the current theoretical controversies in the field. A review of the early calendars outlining the Columbia Training Program reveals that the founders attempted to incorporate most of these ideals. Rado believed that psychoanalysis was a part of medical science, that culture and society influenced the development of the individual, and that, as Lionel Ovesey notes, libido theory had outlived its usefulness. The founders held the opinion that [libido theory did not] take into account the role of society in human behaviour. It was a rigid framework that ultimately traced behaviour to inherent instinctual drives with fixed courses of development. The founders, in con-

48 The Unsung Psychoanalyst trast, believed that the bulk of human behaviour was adaptive and learned ... In order to redress this imbalance and expand the social dimension, the founders proposed that the libido theory be abandoned. They favoured an ego psychology that focussed on the adaptive functions of the ego as it interacted with the social environment. This was the origin of the term 'adaptational frame of reference' with which the center has always been associated.34

Arnold Cooper, a candidate several classes after Ruth Easser, describes the visionary atmosphere at Columbia during his student days: We came to realize there were multiple Dr Rados: a genuine fighter for academic freedom; an authoritarian Hungarian who couldn't bear to be contradicted; a devoted teacher who would do anything to help his students learn; a polemicist who was determined to bring analysis into the era of modern science; and an intuitive psychoanalyst who had an extraordinary feel for clinical material, especially dreams. Fuelling it all was the nuclear heat of his devotion to psychoanalysis and his conviction that we had only just begun: there was no end to what psychoanalysis could discover and contribute. Rado was determined that psychoanalysis should realize the potential Freud envisioned, and that smaller minds involved with orthodoxy and bureaucracy should not be allowed to stifle the psychoanalytic adventure. He felt no contradiction in speaking sequentially about Freud's unique genius and Freud's colossal error in emphasizing his metapsychology and libido economics rather than developing the full import of his second theory of anxiety and the role of affects. Alongside him, Kardiner was carrying on his work on trauma and his studies of culture, Daniels was helping to found modern psychosomatic medicine, and David Levy was laying out the program for child analytic observation for the decades to come. Furthermore, Nathan Ackerman was inventing family psychodynamics and therapy, Viola Bernard was breaking new ground in psychodynamic social psychiatry, and Henriette Klein was studying the psychoanalytic educational process. I think it is not a sentimental exaggeration to say that these people outlined the shape of psychoanalysis as we know it today. They were not only founders of our center they were also among a small group of figures who were the founders of modern psychoanalysis.35

Otto Kernberg suggests 'thirty methods to destroy the creativity of psychoanalytic candidates.'36 Among them are unquestioning accep-

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tance of the teaching of Freud, monolithic theoretical approaches, exclusion of candidates from the professional and scientific activities of the society, hierarchical faculty relations, discouragement of candidates' original contributions, lack of presentation of the clinical work of senior faculty, avoidance of controversial theory and technique, avoidance of interdisciplinary scientific inquiry, and the interrelationship with cultural and scientific boundaries of psychoanalysis. Columbia's curriculum was originally designed to avoid these pitfalls. Although the format, course content, and practice experience of the Columbia program have changed over the years, the questioning spirit of interdisciplinary scientific inquiry remains. As in all institutes the tripartite system of psychoanalytic education forms the base. Robert Michels comments: The traditional view of psychoanalytic education is that it consists of three components - a curriculum, supervision, and personal analysis. It is difficult to imagine an educational program without some curriculum - it would lead to psychoanalysts who knew nothing of Freud or of the ideas of other analysts. Similarly, psychoanalysis is a praxis, not a gnosis, a way of doing something rather than merely a system of ideas, and praxes are usually learned by modelling, training, supervision, and personal mentorship. The third component, personal analysis, is the most unique, but at the same time both the most essential and the most problematic.37

It was within the New York postwar psychoanalytic climate and the early years of the Columbia institute that Ruth Easser began her training and life journey as a psychoanalyst. When Ruth Easser entered the training program at Columbia, the Center for Psychoanalytic Training and Research was one year old. Lionel Ovesey, a member of the second group to graduate, remembers Ruth when she arrived as a student: She was a tall, gangly, shy but graceful young woman who gradually came out of herself. She was young, competent, and very bright. She was full of integrity. I don't know anyone who ever questioned her integrity. She was not beautiful but she had a certain kind of grace. I noticed that when I first met her. There was a deerlike quality about her. She was somewhat gangly, but she was well poised and she was striking in that sense.

The curriculum was dissident (in that Freud, although thoroughly taught, was presented from an historical and critical perspective) and

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innovative (in that Rado's adaptational theory was presented within the courses on psychodynamics and psychosomatics). Courses on technique included reconstructive technique (psychoanalysis proper) as well as briefer psychotherapy and psychosomatic methods of treatment. Although only those with a medical degree were eligible for training in the United States, and therefore at Columbia, seminars on scientific developments in related areas were conducted by faculty from various disciplines, and research was emphasized. Otto Kernberg, in his critique of contemporary psychoanalytic education, suggests that an innovative program would include in the curriculum research methodology and concern; the teaching of multiple psychoanalytic theories and clinical approaches, and of scientific developments at the boundary of psychoanalysis; and candidates' participation in making scientific contributions in the field. The curriculum of Ruth Easser's time could be judged innovative even by these contemporary criteria.38 The second component of Easser's training, supervision, comprised the conduct of three supervised five-times-a-week analyses, at least one with a male patient. In addition, supervision on two psychotherapy cases (one psychosomatic) was required. Control case analysands were assessed for their analysability before they were taken into analysis by candidates. Easser would have obtained her analysands from the Columbia clinic, and among her analytic supervisors were George Goldman and Nathaniel Ross. Ruth Moulton was supervisor for her psychosomatic cases. Goldman remembers: When I first saw Ruth, probably in 1947,1 didn't know anything about her. She was very young looking, very tall, thin, not especially attractive, not unattractive. She didn't seem to pay much attention to looks. She was not that ungainly but not especially graceful. She was one of the first people I supervised and she was probably of all the people I ever supervised in all those decades, the one I supervised the least. I gradually became more and more surprised that there was not much I could contribute. Here was this very young person who did not do anything to attract attention to her ability, her brilliance. Everything she did seemed to be good and going well. That was perhaps my first and last experience of supervising anyone like that. I became aware even while she was a candidate that this was a truly gifted person. She was not only gifted, but her sensitivity was not in the usual sense. It had to be sensitivity and at the same time an awareness of the emotions and conflicts behind what was happening then and there, behind the superficial. She was simply great at it. I can remember

Beginning 51 little of the clinical content. One thing I do remember was one of the phrases that her woman patient used which I had never heard before. I remember Ruth quoting her patient saying, tearfully, 'My snatch is broken.' I didn't know what snatch meant but Ruth knew right away. Ruth knew that her patient had a sexual encounter and got an infection. I was a little surprised, Ruth being very talented and brilliant, but being from Canada and a country girl (to a New Yorker), how would she know this particular phrase when I didn't? She had more awareness than she appeared to and a certain worldliness which I didn't associate with the figure she presented.

Goldman's own training experience gives a sense of his theoretical position as a supervisor: My psychoanalytic training started the same year the New York Psychoanalytic Institute was founded. I had been at Boston Psychopathic Hospital in psychiatry. A relative of mine knew the executive director of the New York Institute. He arranged for me to have an analysis with Sandor Rado, the director of education. From 1931 to 1935,1 was one of those caught between the orthodox training and inculcation which was standard in New York and Rado, the great expert of that tradition, but who turned out very differently. I attended Rado's lectures, which represented a gradual change in orientation. At one point he was critical of Franz Alexander, later he was closely allied with him. He began to question some of the things that were ascribed to Freud. My analysis was with this guy who was turning the whole psychoanalytic emphasis around. I was in an analytical fog for some years. During the Second World War, from 1942 to 1946,1 was in the army and came back in 1947. Shortly after I was at Columbia which was founded in 1945. I worked and taught with Kardiner who intellectually was one of the most lucid people I have ever known. He had a quality of being able to simplify a complex situation and pick out the essentials. Of course, it depended on what he picked out as being the essentials, but that quality made him an excellent teacher. Lionel Ovesey, analysed by him, was the only other person I have known who could take a complex situation and reduce it to the major aspects. This was my background; I was in tune with Rado's teaching.39

Nathaniel Ross, now deceased, was Easser's second supervisor. Goldman thought that Easser also would have had Rado or Kardiner as supervisors, as they were the mainstays at that time. They were liberal in their approach in contrast to others such as Ross, who, although cooperating

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with the Columbia program from the New York institute group, remained primarily orthodox. Ruth Moulton, seconded to Columbia from the William Alanson White Institute,40 in an assessment of Easser's psychotherapy work, writes: She did excellent work in the psychosomatic clinic. She had a good understanding of her patients and good rapport with their emotional problems. She needed help, as would be expected, in handling emotional outbursts and in pointing out significant things to drive home; but she did very superior work as compared to the other students, and had as good therapeutic results for the time she put in as one could possibly hope. She seemed to have a real feeling of how to help people and was a good therapist.

Joseph Schachter describes aspects of his training experience: I thought that Rado was a superb teacher, very engaging, charismatic, extremely bright, with a comprehensive view. His classes were important events. He taught what he called adaptational psychodynamics. His whole frame of reference was that of adaptation. Neurosis was a form of maladaptation which was an emergency discontrol. When people got anxious, they had to deal with the anxiety and that resulted in their developing ways of behaving which helped with the anxiety but were maladaptive. It fit so well into biological views of dealing with stress and just made a lot of sense to me. All our supervision, even of our hospital patients, was by analysts, which enhanced the residency program. We also had formal psychotherapy training in the analytic program. I had supervision of psychotherapy cases by the analytic supervisors as well as the analytic cases. I had two psychotherapy cases, one psychosomatic and one standard psychotherapy, and three analytic cases. They did that when Ruth Easser went through, but I don't think they are required now to do the psychotherapy cases. I don't know why they gave that up. Residencies are so limited in their psychodynamic training. Now psychiatrists come to analytic training with little training in psychotherapy or psychodynamics.

Alice Frankel, who trained in the mid-1950s, believes that the richest thing about analytic training was the simultaneous supervision, analysis, and classes. I found the overlapping immensely useful. I was thinking how training changes. Now at Columbia they have a preparatory year, which includes a year's analysis and introductory seminars but not courses.

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When I was there it was standard to start class work and the analysis simultaneously. We had to carry two psychotherapy cases and one psychosomatic case before we took on any analytic cases. They have long since dropped that. We had dynamic psychotherapy and psychoanalysis supervision as well as child and adolescent; it was a rich experience.

Norman Doidge's experience in the late-1980s is somewhat different, although seemingly as intense: 'I identified with some of the early psychoanalytic intellectuals at the turn of the century who had a deep interest in literature and philosophy and had read almost all of Freud. Columbia would be a place to complete that line of development. They did not want to make me do it their way but to channel creative energy.' Doidge's didactic experience was described as intense and rich with a good grounding in classical theory: 'Becoming a psychoanalyst without reading most of Freud was incomprehensible. Freud was read, taught, criticized, and appreciated historically as the founder of psychoanalysis. The reading load was intensive under Helen Meyers's leadership. A wide and inclusive reader, she reasoned out the various psychoanalytic approaches and how they interdigitate. There was simply too much going on at Columbia for one school of thought to take over. There was also the empirical side. One couldn't have people like Margaret Mahler or Daniel Stern and not develop a tradition of empirical studies of psychoanalysis.' Not all psychoanalysts who go through analytic training are destined to be full-time analysts, yet their analytic training influences the shape of their careers and, in turn, their work influences the shape of psychoanalytic theory. Daniel Stern's experience provides a case in point. His interest in infant emotional development began during his analytic training and psychiatric residency at Columbia: 'Larry Kolb was the chair of psychiatry, an extraordinary man, an analyst who was not very analytic but very wide thinking. He facilitated a lot of things, was entirely tolerant and supportive. He was analysed by Freda Fromm Reichman. He would have known Ruth, since ultimately he hired her. He did play a role in the Columbia program, since the psychoanalytic clinic, even though it is largely independent, is actually a sub-department of psychiatry.' Stern continues the description of decision-making about his career: Originally I went to Columbia because, after I had got out of my internship, I was at the NIH [National Institutes of Health] and had learned how to do fancy neurobiological and neurobiochemical research and was good at it. There was one lab in the world that could do it, and they wanted me to do

54 The Unsung Psychoanalyst that at Columbia. After a while, I said to Kolb, 'This is fascinating and I guess it would be good for my career if I stayed, but I don't really like doing it any more. I am not interested in the chemicals or animal behaviour. I would like to change into something else.' He said, 'Don't do that, look at the position you are in.' I said, 'I know, I just don't want to do it any more. I don't think I would be good at it over the long haul.' He said, 'Well if you really feel that way, What can I do to help?' I said, 'I'd like to get more into the developmental area.' So he said, 'There are films in the library of schizophrenic mothers feeding their babies.' I had a fellowship from him and he said, 'Why don't you go and look at them and see if you can find something to do with them.' He believed in people that way and he would have believed in Ruth and Stan. If he thought you would be good, he would let you do it even if he disagreed. That was very important to all of us. I dropped the other work and spent months and months watching those films. That was the real beginning, during my first year in analytic training. Then, the other thing the training did to push me further and deeper into the infant field was develop my profound dissatisfaction with all analytic formulations about early infancy psychodynamic development, which were not what it was really about. I believed in the analytic process, but not in the application of the theory to that period of life. I was encouraged to pursue my own interests during my analytic training. How do these two aspects of psychoanalytic training - the teaching of theory and supervision of control analyses - integrate with the candidate's personal analysis? Stanley Weiss recognizes that each part of the educational program - the training analysis, course work, and supervision - makes a specific contribution to the total learning experience of the candidate, and that each phase provides different kinds of learning experiences that contribute to professional development. The training analysis lays the foundation for the development of sensitive, empathic understanding, which is then linked with cognitive, explanatory understanding* taught during the second phase of the learning program. Both of these kinds of learning experiences are further developed and integrated into clinical skills that lead to therapeutic effectiveness and psychoanalytic scholarship. The basic goal of these educative experiences is the development of an analytic instrument or 'work ego,' in which the skills of introspection, empathy, and interpretation are highly developed.41

Although theory learned in the classroom provides a necessary knowl-

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edge base (the gnosis), most psychoanalysts consider the praxis (the supervisory component of their training) as the formative influence second only to their personal analysis. Identification with different supervisors' theoretical framework and technique varies for each candidate. Many identify with one more than another, although most candidates integrate the various lessons learned from all three. Candidates learn from supervisors not only how to conduct an analysis but how to supervise case material and teach others. How Ruth Easser integrated her lessons will be inferred later from her papers and from the accounts of those she supervised. The third component of training, a personal analysis, has always been considered the sine qua non of becoming a psychoanalyst. In the early days, it was the only training; those who wished to become analysts did so by having their own analyses. The essential reason for a personal analysis is simply that unless one is in touch with and understands one's own unconscious, the unconscious conflicts of another cannot be appreciated, let alone understood and helped. From the beginning there has been much discussion about the nature of a 'good enough' analysis for candidates; and this is a controversy that persists today.42 The goal of a candidate's personal analysis as described in the first issues of Columbia's curriculum is 'basic and indispensable preparation for psychoanalytic training. In this analysis the prospective student undertakes a penetrating psychological study of himself. He is expected to explore resolutely and thoroughly the unconscious reaches of his mind, trace his development back to the formative experiences of his childhood, and arrive at a better knowledge and more realistic appraisal of himself as an individual and as a product of a given period in culture. He is expected to overcome his personal difficulties and acquire a greater measure of self-direction, psychological and critical independence, and a more mature outlook on life.'43 It is of interest to compare Columbia's current description of the personal analysis requirement: In the earliest historical period of analytic training it was considered necessary for the prospective analyst to undergo a 'sample' of analysis in order to become acquainted with the unconscious and with mental mechanisms, interpretations, and insight. With increasing experience, the emphasis in the personal analysis has shifted from the didactic aspect of analysis to its therapeutic function. Its value goes beyond the aim of familiarizing the candidate with the course and conduct of the analytic process. The candidate

56 The Unsung Psychoanalyst undertakes a therapeutic analysis and emerges from this personal analytic experience with new self-understanding. The candidate comes to appreciate the content and inner pressure of his or her own unconscious conflicts and learns, in the most realistic and meaningful way, the relationship between early experience, character, and symptom formation. The candidate develops an awareness of the ways in which his or her perceptions or responses may be distorted and becomes better prepared to function fully and more empathically in the analytic situation. Responsiveness to the complex communications, needs, and fears of patients becomes richer and more resonant as areas of personal vulnerability are understood and mastered. The candidate's capacity to use personal feelings and fantasies in the service of the patient's analysis is enhanced. From personal experience, the candidate encounters the fundamental necessity for a thorough working through of the forces that interfere with change. The personal analysis fosters the maturing process of the candidate as a psychoanalytically trained therapist.44

Speaking about training analyses, Robert Michels expands: First, there are the goals of every personal analysis - to relieve symptoms and suffering, resolve maladaptive conflicts, enhance freedom and creativity, and foster continued self-analysis. Second, there is the understanding and experiential learning that stems from having participated in the analytic process as a patient. Transference, resistance, insight, working through and acting out mean more when one has personally lived them. Third, becoming an analyst and the supervisory experience stimulate themes in the candidate's mental life that, if analysed, can enhance analytic training and functioning and, if not analysed, may lead to anti-analytic enactments. Fourth, psychoanalysis is a profession, and psychoanalysts are not solo practitioners but members of that profession. Their ethics, standards, and clinical practice reflect group norms, not simply personal choices. The candidate's analysis is central to professional socialization, the initiation rite that is essential to becoming a member of the group.45

In the early days, as Henriette Klein describes, 'candidates are required to begin their personal analysis immediately upon being admitted to the training program ... If the candidate has been in treatment with someone who is a training analyst elsewhere, he may be permitted to continue the analysis for a period. The candidate who has been in treatment with a non-training analyst is reassigned at once. Early in training each student will be assigned to a staff analyst.'46 Candidates are still required to be analysed by a training analyst; most institutes do not assign analysts,

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thereby allowing the candidates to make their own choice. One year of analysis is usually required prior to application. The analysis is the most costly part of training.' When Ruth Easser applied, she inquired whether or not as a war veteran, having completed her officers' training, the cost of analysis could be covered. She received the following information: 'The analysis is not underwritten by Columbia University ... and students were unable to get this expense from the Veterans Administration because the University was unwilling to state that it was an actual part of the curriculum. This is because nominally the analysis should be completed before you start the course, and we are simply making exceptions for the convenience of veterans.'47 An analysis required for training is a personal analysis. It cannot be an academic exercise if a candidate's emotional conflicts are to be resolved so as not to interfere with analysing another. In no other profession is 'know thyself such an imperative: 'We believe along with Freud, that analysts should be analysed, and it is hard to imagine someone who recognizes the power and benefits of analysis and embarks on a career of providing them to others but does not want to experience them personally.'48 Not only is a personal analysis indispensable, it is the most private component of training. From sketchy facts of Ruth Easser's training analysis, it is possible to glean something about the influence of her analyst and her analysis on her own development. Ruth Easser's analyst was Fanny von Hann-Kende. It seems that they began their analytic work together in 1946 and ended when she finished her training in 1949. Their relationship continued as colleagues. Easser maintained a concerned attachment during Hann-Kende's illness with cancer until her death three years later, in 1952. Hann-Kende's obituary in the New York Times (15 April 1952) provides some facts about her life. Born in Budapest in 1891, she was educated at the Royal Hungarian University and became a physician in 1914 at age twenty-three. Hann-Kende was assistant professor in pathology at the university from 1914 to 1920, during which time she was also chief pathologist in several Budapest hospitals. At the age of twenty-nine she married Bela Kende, a noted Budapest physician: they had one daughter. During the First World War, she became interested in psychotherapy. From 1927 to 1929, she received psychiatric and psychoanalytic training in Vienna, where she worked at the Wagner-Jauregg Clinic. Returning to Budapest, Hann-Kende became a member of a group of psychoanalysts headed by Sandor Ferenczi who founded the Budapest Psychoanalytic Institute. There she developed a new method of abbreviated psychoanalytic therapy. From 1932 to 1936, she was a lecturer in the Hungarian Psychoanalyt-

58 The Unsung Psychoanalyst

ical Institute, and for the next two years she was an instructor (a training analyst). Early in 1938, Hann-Kende came to the United States as a lecturer at the invitation of the New York Psychoanalytic Institute (and with the support of Sandor Rado whom she had known in Budapest), becoming an instructor in 1948. She became an American citizen in 1944. In 1948, she was made an associate in psychiatry at Columbia and an associate attending at the university's Psychoanalytic Clinic for Training and Research. Fanny von Hann-Kende died of colon cancer three days short of her sixty-first birthday. The early Columbia analysts, such as Lionel Ovesey, Henriette Klein, Aaron Karush, and Bluma Swerdloff (a social work colleague on the Columbia Clinic Admitting Service), knew Hann-Kende and shared their impressions of the impact she may have had on Ruth Easser. Ovesey describes Hann-Kende as a person that others felt good about, honourable, and straight. She was highly regarded by the candidates and staff. It makes sense that Ruth was analysed by her. On committees with her, Hann-Kende tried to hold on to some of the older views that Rado was so strongly against. Although there was tension between them, Rado had great regard and respect for her. She didn't talk much in our meetings because it didn't go well with Rado. She kept from saying things which would upset him if she didn't have to. HannKende was patient but she wouldn't duck things. Ruth was also like that on committees.

Aaron Karush thinks Hann-Kende's relationship to the Columbia Psychoanalytic Clinic was not always very clear, as she was seconded from the New York Psychoanalytic Institute. Although more classical, she was open-minded about new ideas in psychoanalysis. Henriette Klein comments that Hann-Kende 'seemed more orthodox and not in the Rado vein like the rest of us were. Yet, she accepted the differences without making a hue and cry. She wasn't stimulating the way Rado, Kardiner, or Levy were, but she was attractive, demure, polite, tactful.' Klein thinks that she went her own way in analysis but was very conscientious and would stick with a patient until she was satisfied that the major work had been accomplished. Bluma Swerdloff describes Hann-Kende as a beautiful woman with red hair and fine features [there was a picture of her in Swerdloff s office]. Ruth was very fond of her. Fanny was a friend of Rado's and he was happy to have her come to teach when Columbia began,

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even though, his objective was to train people and replace the classical psychoanalysts by Radovian analysts. They got along well, he respected her. Ruth was influenced by her attachment to her classical analyst and by Radovian ideas but being very bright she was able to integrate the two.

These impressions of Fanny von Hann-Kende allow only the most tentative speculations about the effect of Ruth Easser's analyst on her personal and professional identity. One association does not seem farfetched. Hann-Kende was consistently described as a woman feminine in manner and beautiful in appearance. Yet she was not a shy, passive, non-assertive woman, as attested to by her archival correspondence with the New York Psychoanalytic Institute. In her letters she did not seem afraid to assert her needs and persist until they were met. She, too, had been analysed by a woman, Helena Deutsch. Perhaps for both HannKende and Easser the identification with their female analysts facilitated the development of their womanhood. This seems true for Ruth Easser. She was not by objective standards a physically beautiful woman, yet as many have observed, when she spoke, when she smiled, when she entered a room, her presence was felt. She was by nature shy, but this did not interfere with the eventual development of her ability to effectively assert herself. Her comfort with her well-integrated feminine and assertive self became more evident as she developed professionally. Surely, Easser's analysis with a feminine, assertive, and analytically skilled woman had a mutative influence on her personal and professional development. This mutative power of analysis, the capacity to change a person's inner and outer life, explains why the personal analysis is the core component of training. Not only does it assist the candidate in developing personal potential, but it is the most convincing evidence of the ability of an analysis, and the person of the analyst, to have a significant impact on the course of one's development and life. This conviction gained through experience is essential if one is to persist in helping others through the slow, difficult work of self-understanding gained in a relationship with another person. Beginning life as a psychoanalyst for Ruth Easser and the others exemplified here involved choosing, being chosen, and training to become a psychoanalyst. The influence of personal background, time and place, of their parent institute, predecessors, teachers, supervisors, analysts, and training experience is evident in this phase of learning. The analyst's individual voice is yet to be fully discovered.

2

Becoming

By its nature, psychoanalysis cannot be learned or practised in isolation. Psychoanalysis involves relational attachments: attachments in the mind and attachments in external reality. Attachments imply external and internal needs, physical and emotional needs; knowledge of self and of others, similarities and distinction of self from others; communication; boundaries, boundaries to be maintained, boundaries to be crossed. Some attachments remain stable, while others do not; some flourish, some are just there, some are stifled, some destroyed, others are lost. Many develop in complexity and depth, others are superficial and merely functional. Psychoanalytic attachments are both professional and personal and uniquely shape the psychoanalyst. Despite these truisms about the symbiosis between psychoanalysis and attachments there has been an uneasy association between psychoanalytic theory and theories of relationship. John Bowlby, a British psychoanalyst (1907-1990) and father of attachment theory, writes: Early formulations of psychoanalytic theory were strongly influenced by the physiology of the day ... cast in terms of the individual organism, its energies, and drives, with only marginal reference to relationships. Yet, by contrast, the principal feature of the innovative technique that Freud introduced is to focus attention on the relationship patients make with their therapist. From the start, therefore, there was a yawning gulf between the phenomena with which the therapist was confronted, and the theory that had been advanced to account for them'.1

This 'yawning gulf has narrowed more recently. Suffice it to say that there has been a growing recognition that psychoanalytic theory must

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include a theory of relationship. Although there have been major developments in psychoanalytic understanding of relationships in general, it is the increased understanding of the analytic relationship and the nature of the attachment between analyst and analysand that are relevant here. The essence of this change has been a shift from emphasis on the mind of one person (intrapsychic) to a concentration on the interaction between the minds of two people (intersubjective). The intrapsychic and intersubjective models of the mind, though distinct, are not mutually exclusive. Jessica Benjamin notes both this non-exclusivity and the necessity of sustaining a kind of paradoxical tension in theory and practice.2 This tension is, indeed, inevitable with respect to becoming a psychoanalyst. Analysts must constantly attend to the minds of their analysands, to their own minds, and to the two minds in relation to one another. The psychoanalyst's work is to hold this tension within a common space while moving back and forth between the mind of self and other. During training, in personal analysis and in analysing control cases, the candidate's focus is more on the intrapsychic, on understanding the nature and power of the unconscious. In the Becoming Phase of an analyst's development, the focus expands to the interpersonal aspects of attachment as expressed within the analytic relationship.3 Ruth Easser's views about the nature of the analytic attachment are communicated indirectly in a paper which evolved from her participation in a study group at Toronto's Mount Sinai Hospital. This paper resulting from the group discussion was published after she died, by Stanley Greben (a Toronto colleague) and Stanley Lesser (Easser's husband), and it states: Psychotherapy depends for its effectiveness upon the human influence of one person on another. Objectivity is useful in helping the two persons to achieve a not too distorted view of the patient's reality. But objectivity alone cannot lead to change. When good results have been achieved, there have always been highly subjective feelings shared by the two participants in the therapeutic relationship; both therapist and patient must recognize that liking, respecting, caring, concern, mutuality, and even magical expectations have occurred. Without these, we would have to say that an appropriate emotional climate had not existed. Neither patient nor therapist should be allowed to hide behind a non-recognition of the therapist's humanness.4

To paraphrase the British psychoanalyst D.W. Winnicott, there is no

62 The Unsung Psychoanalyst

such thing as a baby without a mother; there is also no such thing as an analysand without an analyst and vice versa. There is no such thing as an analytic relationship without two actively, although differently, involved participants. As Theodore Shapiro submits, 'psychoanalysis still retains an intrapsychic focus as much as it has become interpersonal in its observational stance. This does not undo our zeal to understand how people talk to, interact, even help each other.'5 Current emphasis on analytic intersubjectivity grapples with the problem of, as Benjamin puts it, 'how we relate to the fact of the other's interdependent consciousness, a mind that is fundamentally like our own but unfathomably different and outside our control.'6 The tension between intrapsychic and interpersonal reflects forces within the individual, resulting in a synergism between attachment and autonomy, between self and other. Analysts and analysands have the same basic attachment needs. To paraphrase Michael Ignatieff, these needs are what humans require to be human, to realize the full extent of human potential. Many of these basic needs, such as security, love, respect, honour, dignity, and solidarity can be filled only in relationship with family, friends, lovers, and colleagues, which provide mutual emotional, social, physical, and sexual satisfaction. Other needs, such as, self-expression, validation, stimulation, and respect, are partly met through relationships but also through intellectual, cultural, artistic, and recreational pursuits, and especially through work. Still other needs have to do with individuality, independence, autonomy, and a sense of oneself separate from others. These are the needs for privacy, solitude, differentiation, and self-realization met through periods of being unattached, through being with oneself. The need for connectedness and for separateness, seemingly antithetical, are intertwined. People who are secure in their attachments, comfortable being with, separating from, and returning to others, are more likely to be self-reliant, to be creatively and contentedly alone. Winnicott explains, 'I am trying to justify the paradox that the capacity to be alone is based on the experience of being alone in the presence of someone, and that without a sufficiency of this experience the capacity to be alone cannot develop.'8 Arnold Modell expands on the paradoxical nature of the self: The self derives its sense of coherence and continuity from within, yet at the same time depends on the appraisals of others, who can either support or disrupt the self s continuity. The self is paradoxical: it is an enduring structure and at the same time nearly coterminus with an ever-changing consciousness. Furthermore, the private self supports a relative self-suffi-

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ciency, whereas from another perspective the self is not at all autonomous but can be seen as vulnerable in its dependence upon others for a sense of coherence and continuity.9

To meet the analysand's needs within the therapeutic relationship the primary tool of the analyst is words. As Ruth Easser succinctly states, 'psychoanalysis by necessity, has had as its base line, in fact as its principal armamentarium, words. To permit other than highly symbolic communication within the psychoanalytic situation is to defeat the purpose and often to arouse a degree of anxiety in the patient that precludes further work.'10 This symbolic communication, however, is not always through verbalized words. Through behaviour and modes of relating, a great deal is communicated non-verbally by both the analyst and analysand. The analyst's work is to translate, to give meaning to verbal and non-verbal communications, and to facilitate the analysand in finding 'the words to say it.' Finding the words is not all there is to it because the timing and way in which words are said convey both cognitive and emotional meaning and attempt to reach the conscious and unconscious mind and thereby establish an affective connection. The analytic relationship is established for the benefit of the analysand and, in this sense, is not reciprocal. This lack of reciprocity and the fact that words are the major way in which the needs of the analysand are met has implications for the becoming analyst. First, since words are the primary tool, this tool requires continual refinement and sharpening if the analyst is to meet the analysand's needs. The much appreciated supervisor is one who helps to hone this tool, who, as Ruth Easser did, teaches how to use words by modelling. One of her supervisees, George Boujoff, recalls: She [Easser] taught the capacity to express complex psychoanalytic ideas in clear language. The beauty of that is this. In training we begin by expressing our thinking in complex psychoanalytic terms. By expressing herself in clear language, Ruth permitted me to translate what I saw in my patients into meaningful human terms. She taught by translating. One sensed how she was with patients by the way she supervised. There was a humaneness and gentleness about her. She encouraged activeness, by encouraging me to use my observations. Her approach enhanced my abilities to make connections and to use my thinking by translating with the patient. She felt that the patient was there to be helped and to be talked to.

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Perhaps in no other field is the understanding of the interplay between attachment and autonomy so essential. Analysts and analysands as two people have the same basic needs for both. Yet, for each, the respective nature and purpose of the professional attachment differ considerably. Anthony Storr realizes that 'the capacity to be alone thus becomes linked with self-discovery and self-realization; with becoming aware of one's deepest needs, feelings, and impulses.'11 'Aloneness' in the presence of the analyst facilitates putting the analysand in touch with his or her inner world. The analyst's capacity to be 'alone' in the presence of the analysand facilitates the introspection necessary for the creative and empathic understanding of die other. The therapeutic work of psychoanalysis takes place through an attachment formed between the analyst and the analysand. Each brings to this new relationship his or her past and present needs and desires, mental representations of self and others, and characteristic ways of relating. The manner in which internal and external attachment needs, both past and present, are expressed within the therapeutic relationship is largely unique to each analytic pair. Although the psychoanalytic relationship provides the framework within which healing occurs, its ultimate fate is to be transformed into an 'internalized working model' for the analysand. This new working model will contain a more robust capacity both for togetherness and separateness. Just as the tension is held between intrapsychic and interpersonal, the analyst holds firm the relational and autonomous tension until the analysand does so independently. Through the phenomenon of transference the analysand begins, largely unconsciously, to form a relationship with the analyst that resembles significant past and present relationships. Inevitably, perceptions of one's self and significant others come into play and are experienced and enacted in the analytic relationship. The experience of die relationship is coloured by these expectations of how self and others ought to be. Attempts are unconsciously made to evoke expected reactions from the analyst. At the same time, the analysand seeks a better relationship - better in the sense that he or she hopes that basic human needs and highly individual desires will be attended to. Unfulfilled desires and unmet needs, past and present, along with conflicted feelings in achieving gratification constitute the stuff of the transference. It is through the understanding of how these needs are expressed in the relational patterns evoked in the transference that therapeutic change occurs for the analysand. The analyst, too, has unique internal working models of relationships,

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along with attachment needs. For psychoanalysts, their own emotional and physical needs, especially unmet needs, are often aroused through the closeness of the analytic relationship, the richness, extensiveness, depth, and intimacy of the communication. These personal needs are awakened in a particularly intense way through the phenomenon of countertransference. The analyst tries not to impose personal needs on the analysand; countertransference reactions become a tool of understanding the other. Christopher Bellas offers this succinct comment: 'Analysands recreate their infantile life in the transference in such a determined and unconsciously accomplished way that the analyst is compelled to relive elements of this infantile history through his countertransference. Patients may enact fragments of a parent inviting us unconsciously to learn through experience how it felt to be the child of such a parent.' Bellas submits that 'the analyst must find a way to selectively express some of his subjective states of mind, even when he does not know what it means.' And 'in order to find the patient we must look for him within ourselves.'12 Ruth Easser, in a continuous case seminar taught Douglas Frayn, another supervisee, how to utilize his countertransference reactions to translate the non-verbal dialogue that occurred with a virtually silent analysand. The young man, whose father had died when he was three, entered analysis because he would become extremely anxious and experience fits of vomiting when in an intimate situation with a woman. Frayn describes his work with this analysand: Every now and then he would break the silence to tell me a dream or part of a dream he was actually having on the couch. His pulse, I could count his carotid pulsations, would be slowed down to about sixty-eight. He seemed quite at ease and would fall asleep. That was daunting enough. Later, when silent, he had borborygmy. His stomach would start to rumble and mine would start to rumble. We'd rumble back and forth and he'd say, 'Was that your stomach or was that my stomach?' Sometimes, I didn't know if it was mine or his, a very primitive way of communicating. This activated my first interest in intersubjectivity, in empathy, and the more primitive form of it. This is where I found Ruth of help. I don't know whether or what I might have done without her. This basic kind of interaction, at a gut level, was his way of communicating. I would say, 'Could you put that into words?' And he would go off to sleep. If he were awake, there would be stomach rumblings and occasional dreams which he would tell me. If asleep, he would wake in time to leave; I never had to wake him.

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Ruth Easser encouraged Frayn to persist despite the difficultly in understanding the meaning of his patient's silence and non-verbal communications. She taught that the analyst does not have control over the analysand's use of the analytic relationship, and might not be able to explain theoretically or know what is effective. Interestingly, Frayn's patient's performance outside was amazingly good, even though he seemed to be almost psychotic, relating at a primitive archaic level within the analysis. In the seminar Ruth helped us manage this kind of archaic transference. She was very supportive, saying that under the circumstances things are going well. She encouraged us to speculate as to what was going on, to explore our own fantasies and effect on the patient. She encouraged me to fantasize and to write my thinking and associations during the silent times. This man had been left with a domineering mother who didn't let him say anything but would tell him what to do. Ruth said, 'He is going to need this time just to be with you. That is fine. It is encouraging that he dreams on the couch and reports them to you.' He was not excluding me totally, he gave me fragments of dreams. He left his mother while in analysis but without telling me. He developed a relationship with a woman also with little discussion.

Personal analysis and supervision develop the psychoanalyst's awareness of personal needs and patterns of relating and the capacity to distinguish these from the patterns by which the analysand tries to shape the relationship. Training also provides a theoretical and technical framework within which to understand, interpret, and utilize, for the good of the patient, the transference and countertransference phenomena that emerge within the analytic relationship. The particular paradigm and techniques in which an analyst is trained are not the issue here. The point is that analyst and analysand are reciprocally involved in an interactional process in which they continuously affect each other both consciously and unconsciously. The psychoanalyst of today, regardless of theoretical orientation, no longer seeks to be a blank screen on which the analysand projects but rather acknowledges and utilizes the potent participant role. In Martin Gill's words, 'analysts from quite different operational positions, have provided rich data to demonstrate that both parties are caught up in a communicative field of incredible sensitivity and subtlety, with transferential-countertransferential shading constantly at play in enormous affective intensities.'13

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Analytic attachments are also to ideas, to theoretical models of the mind which along with personal internal models of relationships influence the analyst's method of relating and working. Although theory can provide a framework within which the analyst thinks and communicates, as Neville Symington points out, adherence to theory can cloud the psychoanalyst's reverie or free-floating attention so essential to the necessary openness to the analysand's pain and suffering. Analysts need a way of thinking to relate to 'the different levels of communication between analyst and patient, and so cut across any superficial theory structure.'14 No one analytic model or theory has a monopoly when it comes to explaining or teaching a psychoanalyst effective use of self as a person. The capacity to utilize awareness of the impact of the analyst and analysand on each other cuts across differing theoretical orientations. Analysts need a theory, a way of thinking, but those who are clinically effective select their particular frame of reference from across the spectrum of psychoanalytic theories. They are effective neither because of nor in spite of their framework but more likely because they are not rigid followers of any one theory. They are effective because they are aware of the analysand's unique needs and open to finding the best way to help. The effective analyst neither impetuously embraces new ideas nor defensively clings to what is taught. The effective analyst is an attentive listener, keen observer, and bender of his particular framework to respond therapeutically to the needs of the analysand. The effective analyst is the involved analyst. It is frequently observed that what Freud wrote about technique and what he did in relation to his patients was quite different.15 He was more interactionally involved with his patients than he acknowledged formally, perhaps even to himself. His descriptions of therapeutic neutrality and the elevation of this concept by loyal followers to a technical obligation led to misunderstanding and a discrepancy between what analysts report and what actually occurs within accepted boundaries of the analytic frame. Gradually, psychoanalysts have come to acknowledge their subjective involvement and caring for their analysands. The analyst as a totally neutral observer and interpreter, with the analysand as recipient of purely 'objective' interpretations, is a relationship no longer held as ideal or even possible. John Bowlby, in commenting on his therapeutic abilities found himself obliged to admit: T am not strong on intuition ... perhaps my saving graces have been that I am a good listener and not too dogmatic about the theory ... I often shudder to think how inept I have been as a therapist ... Clearly the best therapy is done

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by a therapist who is naturally intuitive and also guided by the appropriate theory.'16 If the analyst's primary skill is the relational use of one's self to pa knowledge from one mind to another, it follows that the capacity to distinguish self and other boundaries is critical to becoming a psychoanalyst. Boundary distinction between the analyst and analysand defines the different role of each within the analytic relationship. Moreover, an analyst's capacity to differentiate personal needs from needs of the analysand is essential. The abstinence rule, quite properly accepted by the profession, is that physical, sexual, or material needs of both participants must be gratified outside and the analysand's needs interpreted within the analytic situation. Distinguishing and separating emotional needs is a more complex issue. This is how Joan Fleming describes the analyst's work: The analyst's work with a patient becomes deeply and intensely work with himself, work in which he experiences emotionally strong infantile strivings and their frustration, with full knowledge of the strives and full acceptance of their frustration. In other words, the analyst's work requires living in two worlds - past and present, real and unreal, of himself and someone else simultaneously. He must identify with another person with no loss of reality contact or of his own identity. He must be able to live another person's life by empathic understanding and at the same time maintain himself in a situation of deprivation and frustration. From this experience he is expected to feel pleasure and to perform creative work. R. Fleiss (1942) and Freud (1947) comment on this seemingly impossible task demanded by analysis. Their refuge is found in the temporary character of these ego operations; i.e., analysing is work and as such the ego is required to work in this way only during working hours! Only a mature ego capable of sublimation, with a strong sense of reality and developed insight, can manage such ajob.17

Basically, the psychoanalyst must gratify personal and professional attachment needs outside the therapeutic relationship. The needs vicariously satisfied through the analytic relationship, apart from earning a living, derive from the satisfaction of the analytic work itself. Great novels, poetry, opera, theatre, and film capture the heights and depths, the variety and vicissitudes of people's lives; the psychoanalyst hears firsthand and partakes of the most intimate emotional aspects of the lives of others. Just as people are greatly enriched by entering the lives of the

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others portrayed by the written, spoken, or sung word, psychoanalysts are greatly enriched by entering the lives of their analysands. Ella Freeman Sharpe captures that aspect of the analytic endeavour which make the deprivations of the work possible: Leaving now the deep unconscious gratifications that our work can give, gratifications that must be genuine sublimations, apart from the obvious one of earning an income, I will name a possible final one. Its roots are in the unconscious and they too are obvious. While our task lies primarily with the unconscious mind of the patient, I personally find the enrichment of my ego through the experiences of other people not the least of my satisfactions. From the limited confines of an individual life, limited in time and space and environment, I experience a rich variety of living through my work. I contact all sorts and kinds of living, all imaginable circumstances, human tragedy and human comedy, humour and dourness, the pathos of the defeated, and the incredible endurances and victories that some souls achieve over human fate. Perhaps what makes me most glad that I chose to be a psycho-analyst is the rich variety of every type of human experience that has become part of me, which never would have been mine either to experience or to understand in a single mortal life, but for my work.18

Richard Simons also questions what it is that allows analysts to function and endure: '[For most of us] the answers ... lie somewhere in the two or three simple and great images which first gained access to our hearts.'19 That Ruth Easser serves as one of these great images, an internalized model, was clearly articulated by one of her supervisees, Robert Michels: 'I was in love with her and have never stopped being in love with her. I was consciously enamoured with her mind. She was brilliant and able to illustrate and teach her way of thinking and to serve as a model for it and for her sensitivity.' This preamble about attachment and autonomy, about relationship and separateness, about intrapsychic, interpersonal, and intersubjective, about self and other, about boundaries serves to underline the quintessential human elements of becoming an analyst. These are the elements that comprised Ruth Easser's way of thinking and working. What of Ruth Easser's personal life as she becomes an analyst? When Ruth Easser completed her training she was single, though soon to be married to psychiatrist and psychoanalyst Stanley Lesser, who graduated from the

70 The Unsung Psychoanalyst Columbia institute a year after she did. There was a question of coming back to Canada after studying in the United States but Ruth had met Stan and was content to make a life of their own in New York. Ruth and Stanley met through a fellow candidate, Janet Kennedy, in Ruth's second year (1947). The three of them were good friends. Kennedy says, They met quickly, were together quickly and were well mated. He was very intelligent.' Stanley Lesser (2 November 1919-2 August 1986) was the middle child of three, having a sister, Mildred, a year and a half older, and brother, Gershon, three years younger. Mildred, now widowed, married an admiral and lived in Washington. Gershon, an internist, was first married to a psychologist also named Ruth. He subsequently divorced and remarried, but he remained in New York with his family. Stan, who had been sickly as a child, grew up in Brooklyn. His father died when Stan was eleven. A physician, he had contacted tuberculosis during the 1918 influenza epidemic. He recovered and was a vigorous man until he died, suddenly, of a heart attack. Stan's mother, Anna, was an only daughter with six or seven brothers from a comfortable family. She went back to teachers college after her physician husband died and became a principal of a school. Anna died at age ninety-one, mentally competent, of a stroke. Stanley was in the army/air force (1941-1945), as a captain in the medical corps but did not go overseas. He was always interested in psychiatry, neurology, and psychoanalytic training, which he pursued after the war (19471950); he trained as both an adult and child psychoanalyst. Stanley died of lung cancer in 1986, a few months before his mother, who felt 'it should have been me.' The ups and downs of their three-year courtship were shared with her closest woman friend Dena Wechter. 'I used to see Ruth fairly often. It was up and down with Stanley. Although he had grown up in a secular Jewish family in Brooklyn, he was living in an apartment near his widowed mother in the familyowned residential hotel on West 87th Street. His mother, a charming woman, was supposed to have been this very good teacher, a really interesting, talented lady, who dressed in black, did a lot of travelling on her own, in the form of classes in different parts of the world. She was well read, well versed, well dressed, always had money and did not quite understand lack of money. His mother doted on Stanley and when living in the hotel would come and lay out his clothes for him. Ruth was a strong woman, this was something she couldn't abide.' 'Ruth came from quite a different of type of family.' Dena explains further: 'Her family were not wealthy but they were hard workers and provided a good education for their children. Ruth's mother was an overwhelming kind of person. I would say, without anything mean about it, she was not as intelligent as

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the father, not as well read. She was shrewd and a very good business woman. Her father was very intelligent. His family looked down on Ruth's mother's family. Mrs Rubin, her father's sister, was a matriarchal aunt who considered herself a Russian intellectual of that era. The Rubin family were also involved at that time in Toronto's arts and music, a part of the large Jewish intellectual community, rather than the working-class community. Whereas Ruth's mother came from a not particularly cultured middle-class family, her father's family ate, drank, and slept culture.' Ruth, as Joan notes, 'was the only one in her family to marry a Jew and probably the one who had the least background in the Jewish community. Ruth was, however, comfortable with mixed marriages, as she had introduced Percy to his non-Jewish wife, Lorna, who had been her best friend in high school.' Joan married Gordon Milling, the research director ot the Ontario Federation of Labour and subsequently of the United Steel Workers of America. Obviously the Easser family values, their cultural, political, social, and intellectual interests rather than religious considerations, influenced their selection of spouses. Ruth and Stan were well matched intellectually and culturally, were equally well educated in the same profession, and had expectations of a prosperous work future together. Stanley was well liked by her family. Percy comments: 'We first met Stan when he and Ruth drove to Toronto from New York before they were married. I remember Ruth saying that when she met Stan she noticed he needed soles on his shoes. He was a very bright fellow, very kind and our family were very fond of him.' There seemed to be a consensus that Stan was reluctant to marry. Dena remarks, They might not have married had she not set a deadline because Stan was so reluctant. These were the periods when she was beside herself with uncertainty. She decided with the help of her analysis to take a stand. Stan was casual about these things. Probably, they had some struggles after but no one ever knew.' Henriette Klein confirms that Stan 'was reluctant to marry; he wouldn't have married her (not that he was looking for anyone else) if she hadn't called the shot. I remember how he was dragging it out. Yet, he didn't regret marrying her, rather he regretted not having married her earlier.' Ruth and Stanley had a big engagement party that his mother held in the family hotel in the West 80s near Riverside Drive. They were married in New York in June 1950, with both families and a few friends in attendance, and a small reception at the Ritz followed. Childless for the first three years of their marriage, Ruth and Stan were socially active, enjoying a box at the Metropolitan Opera, which they shared with friends and colleagues, including Janet Kennedy and her husband. Her sister Joan notes that 'the Ruth who came back from New York was far more sophisticated, articulate in every way than

72 The Unsung Psychoanalyst the Ruth who left for New York. She didn't change in her modesty; she always credited me with more knowledge in art and literature than I had. In New York, a far richer environment than Toronto, she blossomed. She had time for art galleries, and museums, she read. Stan was also a voracious reader, reading all the books at the drug store counter while he was having breakfast. Sunday was their day. They would have breakfast on the lower east side and then gallery hop. She hadn't time for that when she lived here. Her whole sense of style developed in New York; here she had been dominated by Mother who chose what she wore because she paid for it and let you know it. There, Ruth developed her own style, tailored but feminine; she loved beautiful clothes.' A friend recounts Ruth telling her that she loved to get into a taxi and say, Take me to Tiffany's, please.' Comments persist about the dominance and control of Ruth's mother and the opportunity for emancipation and autonomy allowed by Ruth's move to New York. Yet, it is important to note that for Ruth independence did not mean alienation from her family or a rejection of her mother. Ruth faced her internal struggle to become her own woman while maintaining an active and involved 'real' relationship with her mother as well as with her father, siblings, and extended family in Toronto. She and Stanley and eventually their children were involved with the extended family on both sides. Ruth and Stan settled in an apartment in the east 70s, ten blocks from Stanley's brother, Gershon, who comments: 'Stan was a good big brother, our two families were very close through the years. Within a few years they bought a country house in Connecticut. They also travelled during this time. And they were trying to make a family.' Their friend Dena lived with them for a while. Dena describes how that came about: In late 1952, I was ready to go on my own. Stanley and Ruth were going to Mexico. They had a maid who was a follower of Father Devine, one of the evangelists. People who followed him turned their money over to him; they were not to receive gifts or take vacation. Ruth and Stan didn't like the fact she would be in their apartment by herself. So they said, 'Why didn't I take their place for six weeks?' - which I did. It was very nice, a seven-room apartment, and I didn't have to pay. The maid was there and the only thing I could give her was something for her work. They were due back and I was starting to look for an apartment and couldn't find any I could afford. Lo and behold they came back four or five days earlier because Ruth was having trouble with her back. She had trouble with her back many times; she was so tall and thin at that time. When they came I was already packed. At the back of their apartment there were two maid

Becoming 73 rooms which they offered to me. It even had its own entrance and I rarely saw them. If they invited me for dinner, they would leave me a note or I would sometimes see them on Sunday, I'd go out and bring goodies back and we'd have brunch, smoked salmon, etc., things they liked. In April I found an apartment for May. Ruth told me that they were expecting to adopt a child in July. So we had a big party celebrating the coming of their first daughter and my going into my own apartment. Then they let me know I was not in their way, so, 'Why didn't I stay with them?' Both Ruth and Stanley wanted children, but Ruth had some difficulty becoming pregnant. Janet Kennedy was privy to Ruth's wish to have children. 'It was very important; like everything else for her it was something which could and should be done. Ruth said, 'I can't seem to get pregnant, there were just no takes. In those days, you could test for sperm, but there were no infertility clinics. They wanted to adopt and asked, 'Can you help?' I could and did and was happy about it.' Their first adopted daughter arrived in 1953 and a second daughter in 1956. Kennedy's comments also shed light on Stan and Ruth as individuals and as a couple: There were a number of pioneering steps she took not knowing she was the first, that wouldn't have been her. There were times I was asked to be on TV and she'd say 'I think you enjoy it, that must be fun.' She never was one to say, 'Oh, I'm going to be the first at this or that,' that was not her way. She wasn't a shrinking violet but I found her a very easy person to be with, we could just be ourselves all the time. I knew how she dressed, what she liked. Of course, she was tall and thin and liked rather tailored clothes which looked well on her. We used to talk about clothes and girl things - where you get your hair done, etc. But it was deeper than that. It was me she came to when they wanted to adopt. Yet there was a whole inside of Ruth that none of us ever saw. She always presented as calm with a great deal of equanimity. So much about her never showed. Stan was somewhat more open. Stan couldn't have cared for himself, he was always like that, he could have different socks on, forget his tie, any number of things but he was a good friend. They were good together, they filled in the spaces. They worked well together, they would discuss things with me and my husband. They didn't fight; they could disagree but it was collaboration. They did much for each other and together thought they could do everything. Perhaps that is why we didn't get really close, there was little time. I really loved them.

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What of Ruth Easser's early development as a psychoanalyst? Since only a few facts are known the usual process of becoming an analyst will be described and her development viewed primarily through the eyes of those for whom she has remained an enduring attachment. First, a few words about the rite of passage into the profession. The initial step, of course, is completion of training requirements and acceptance for graduation by the institute. Requirements and length of time to completion vary somewhat among institutes and 'readiness to graduate' is determined on an individual basis for each candidate. A positive vote by the members for acceptance for membership in the local and national societies completes the formal process of initiation. Membership in the International Psychoanalytical Association is automatic by virtue of the national society being an IPA component society and by paying fees. A further issue arises around the questions: Who is a bona fide psychoanalyst? How are the name and practice of psychoanalysis legitimized? In fact, in most jurisdictions there is no control over who calls herself or himself a psychoanalyst or who 'practises' psychoanalysis. That is, there is no legal registration of the name nor is the practice licensed, although the majority of psychoanalysts also have formal professional qualifications as psychiatrists, psychologists, social workers, or nurses. Irrespective of other professional affiliations, psychoanalytic identity is instilled during training and maintained through identification with the practice of psychoanalysis, with colleagues similarly engaged, and with professional associations, but depends on the development of a solid sense of oneself working as a psychoanalyst. Belonging and freedom are the underpinnings for the development of a psychoanalytic identity. Entering the profession through the rites of passage, a sense of freedom is experienced: freedom from meeting the requirements of the institute and from being constantly assessed, freedom to decide where and how life as a psychoanalyst will be lived. A sense of oneself as a psychoanalyst comes not only from the freedom to practise but also through new and different collegial attachments. These postgraduation attachments involve relational transitions. Because analytic classes are small, affiliations tend to continue with classmates as fellow analysts, with mentors, and even with training analysts and supervisors as colleagues. Because the work is understood by few non-analysts and more importantly, it is highly confidential, psychoanalysts need each other to develop an autonomous sense of self as analysts. A sense of belonging to the profession develops initially in the parent institute. Since most graduates are still involved with their control cases

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and have begun an analytic practice, many continue to practise where they trained. Some who commute from other cities for the formal parts of training conduct their control analysis where they live and continue their practice there. Some, having moved to train elsewhere, return home. Most graduates, even those who relocate on graduation or a number of years later, maintain some identification with their parent institute. As members of their local society, their new identity as psychoanalysts is reinforced. In scientific meetings, study groups, national conferences, and international congresses they continue to learn and develop together. Strong, mutually supportive, and productive attachments are formed which often persist throughout one's career. This does not mean that analytic classes, institutes, or societies are cosy, homogeneous groups; far from it. It means that these affiliations provide an essential forum for support, stimulating discussion, and inevitably, challenging controversy. At the same time, the small size, the 'inbreeding,' and the 'intolerance of diversity' in psychoanalytic groups can generate at the least, a sense of isolation, at worst, destructive competition, even schisms. Kenneth Eisold20 maintains that psychoanalytic institutes, as well as other psychoanalytic organizations, historically have been prone to schisms. He identifies three anxieties arising from the isolation of the work: the contradiction between the analyst's need to belong to a particular theoretical school and the need to be receptive to clinical material; the contradiction between membership in a psychoanalytic society and loyalties to the dyads (i.e., former analysts or supervisors) within which psychoanalytic training takes place; and, participation in the culture of psychoanalysis which sets itself apart from the social world. Institutional fragility results when institutional organizations fail to provide containment for such anxieties, that is, when they fail to tolerate diversity. Intolerance of diversity, at the extreme - schism - is seen as a social defence against anxiety associated with the practice of psychoanalysis. Most psychoanalysts would agree that it takes at least five years of immersion in the work to experience oneself fully as a psychoanalyst, establish a practice, make the necessary attachment transitions, and be an active member of the profession. Four years after receiving her licence to practice medicine, Ruth Easser qualified as a psychiatrist and a psychoanalyst. She graduated with a certificate in psychoanalytic medicine from Columbia University in 1949 and established a private practice in New York the same year. In those days, setting up a psychoanalytic practice was relatively straightforward. In the words of one of her contemporaries, 'There was a plethora of patients, fees were low and the living was easy.'

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Initially, as did many New Yorkers, Ruth Easser had her private office in her apartment. Subsequently, she and Stanley had their offices in their apartment, separate from their living quarters. After the children arrived, their offices were more self-contained in a nearby apartment. Private practice provided the bulk of Easser's income. Although she had academic (as faculty) and eventually administrative appointments (as clinical staff) in both psychiatry and psychoanalysis, these provided only small stipends. As Arnold Cooper laughingly notes, 'being on faculty at Columbia Psychoanalytic just meant you had a title and you went to teach there. No perks came with it, no money, no office space, no secretarial or support staff. You were given the privilege of giving time for nothing.' Ruth Easser had this privilege from the beginning, as the first woman graduate to be invited to join the staff of Columbia's Psychoanalytic Clinic as lecturer and research assistant. Nevertheless, giving time for nothing or very little has subtle rewards. The analyst who combines private practice with work in a clinic, teaching, and supervision has a different experience from one in private practice only. A psychoanalyst on faculty is not alone because there is the stimulating and energizing effect of working with colleagues in an academic setting, teaching candidates and gaining experience with of a varied group of patients. Psychoanalysts 'become' by establishing and maintaining a psychoanalytic practice. A psychoanalytic candidate graduates to become an independent psychoanalyst and, hopefully, a lifelong student. Ella Freeman Sharpe notes the ongoing nature of the process of becoming a psychoanalyst: The acquisition of practical technique can only be achieved slowly; indeed, one can say that technique is never 'learnt.' The best technicians are those who remain students, growing more sensitive and alert as experience increases, more subtle and easier in their handling of cases. If this takes place, stereotypy of manner, of procedure, of 'outlook' and 'in look,' will be avoided. A new patient will present a new field for discovery, rather than an opportunity for application of acquired knowledge, or a repetition of a crystallized technique ... Acquiring a finer technique will depend upon preserving the student attitude towards experience, flexibility of mind and ability to profit through recognition of failure.21

New psychoanalysts are eager to establish a practice, acquire patients, and gain experience. Usually they are still involved with at least one or

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two control cases, and continuing supervision and/or consultation eases the transition. Having conducted one analysis for at least three or four years and begun two others, the new psychoanalyst already has familiarity with the nature, commitment, and intensity of the attachment that forms with an analysand. Whereas candidates must be given permission to begin analysis of their control cases under supervision, the new analyst's freedom to treat patients independently evokes both exhilaration and trepidation. Exhilaration comes from the freedom itself, from the sense of achievement, new identity, and hard-won credentials, from the chance to put into practice newly acquired skills, from the freedom to select patients, and shape one's practice and professional life. Trepidation comes from the responsibility and commitment from the trust involved in the work of analysis, as well as from the fear that one may not be good enough, especially in comparison with more knowledgeable and experienced psychoanalysts. Moreover, personal analysts and supervisors are still idealized to some extent. Trepidation comes also from the isolation of the work and the lack of consensual validation. Most importantly, after graduation, the new psychoanalyst faces the daunting task of developing an individual identity. Identifications with and separations from the parent institute, supervisors, analysts, mentors, and classmates require integration. Through clinical work, idealizations, identifications, and differences are transformed into an analytic self. Motivation to treat analysands independently, to put knowledge and skills into practice, to gain experience, and to become an analyst in every respect is rarely a problem for the new member of the profession. Building a psychoanalytic practice presents some hurdles, such as acquiring appropriate patients. Not everyone with emotional problems can be helped by psychoanalysis. Others who could benefit might also be helped by less-intensive psychotherapy or other treatments. Not all potential analysands can afford the time, energy, and cost. The new psychoanalyst needs good diagnostic skills, grounding in psychotherapy, and an appreciation of the advantages and disadvantages of other forms of treatment, as well as of the necessity for different treatment approaches for different problems and needs. Ruth Easser grasped this notion early in her career and used her experience to articulate her ideas in her unpublished 1962 paper called 'Indications and Contra-indications for Reconstructive Analytic Treatment.' Easser knew that psychoanalysis was not the treatment of choice for many people or for many types of emotional problems. She knew that

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analysands had to be selected carefully, taking into consideration not only their diagnoses and life circumstances, but also their level of adaptation. She understood this so well that, as John Rainer, a Columbia analyst, comments: 'Ruth Easser's paper on "Indications for Reconstructive Treatment," though never published was handed out in mimeographed form to all the candidates at the Center as the bible for analysability. This was the paper we used in the admissions unit as the criteria when interviewing patients to determine suitability for analysis.' Easser writes: In general, we can expect that neurotic conflict will manifest itself more grossly in those areas that demand more intimacy of relationship. Thus, we anticipate lesser adaptation and more evidence of anxiety, rage, guilt, inhibition, etc. in the familial and sexual areas. Functioning, in this context, includes pleasurable gratification, affective transactions, accuracy in the evaluation of self-performance, as well as realistic accomplishment and social esteem. Severe difficulty in vocational functioning and lack of any satisfactions within the social sphere would tend to signal greater pathology than would similar maladaptations in the familial and sexual spheres. One practical rule in evaluating the current balance of function can be found in the content of the presenting problems and in the therapeutic expectancies as verbalized by the patient. The more delineated and organized the complaint, the more specific the area of desired relief, the more insight into the self-role as a participant in the declared difficulty, the better the prognosis. For example: 'I love my husband but find I don't have much sexual feeling in that I make efforts to avoid intercourse.' Or, 'My job would be okay if I could take criticism more easily without fearing that I either will be fired or that I will get into intense arguments with my superior.' Or, 'If only I didn't get so anxious when my child misbehaves and fights me back if I try to discipline him. I find that I get tearful and unsure of myself In contrast, we would assume greater prognostic caution when the presenting complaints are diffuse and unrelated to specific relationships and functional activities. For example: 'On the one hand I feel that society is one great manifestation of hypocrisy and I feel superior to it. On the other hand, I am afraid of society and people. I find myself hating people or at least the things they do. I am inflexible, afraid of change, afraid of the world, afraid to even look in the mirror. My life seems more hopeless and empty every day. I don't know who I am. I want to find out what I really want and where I should go.'

Becoming 79 The problem becomes more complex as we analyse more closely the total balance of adaptation; the residue of integrated behaviour and health in the face of the symptomatology. Beyond the specific symptomatology, the total balance of adaptation must be considered. In the presence of neurotic conflicts and their concomitant affects of anxiety, rage, and guilt, the individual reactivity is viewed in terms of the degree of regression, the retention of pleasure, the ability to retain relatedness, and the limiting of projection and depressive mechanisms.

Easser illustrates this with the example of two patients who showed high levels of anxiety and discomfort, emotional discontrol and severe sexual conflicts. Socially they were both dramatic, emotive and popular. They both demonstrated externally successful achievements. Mrs A requested therapy to overcome her sexual inhibitions and to understand her over-reactive rages. Miss B, while requesting help to overcome her vocational block, which had led to depression and regression, was preconsciously aware of her lack of definition of such basic questions as 'Who am I, what do I want, and where should I go?' Symptomatic manifestations must be viewed in terms not only of their content but also in terms of their invasiveness into the rest of the personality, restriction of functioning, duration and amount of secondary gain.

Easser's recommendations remain useful and relevant. It is unfortunate for today's analyst that this paper was never published. The consulting room is of particular importance to the image the psychoanalyst presents and to establishing the analysand's sense of confidence and comfort. The analyst wants to convey an image of solidity, capability, and ability to help; the analysand wants to feel confident that help is available from a competent professional. As Batya Gur explains, from the viewpoint of a non-analyst writer, 'yes, the rooms are quite similar. But the work is quite similar too; the analytic patient always lies on a couch, so you need a couch and a chair behind it. Every analyst does psychotherapy too, so they all have two armchairs. Most patients cry sometimes, so you need a box of tissues.'22 The psychoanalyst also needs a desk or table for writing and a cupboard of files. The differences in the personality of psychoanalysts are expressed in the colour schemes, the quality of the furniture, and the pictures and objets d'art in the room. Ruth Easser's private office in Toronto was spacious and bright, warm, and pleasantly understated feminine. In New York she worked in a num-

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her of private offices, most likely with the same ambiance. She also worked in small, dark, and somewhat dingy clinic offices or in bright sterile hospital offices. Easser was attuned to the impact of her office on individual analysands. For example, in writing about treatment of narcissistic character problems, she described a dramatic incident which occurred when her analysand 'noticed, as he entered my office, that I had hung a new painting on the wall which depicted a mother holding a small girl in her arms. He took his usual position on the couch and in a choked voice stated, "You pulled one on me this time," and remained lying on the couch in a rigid and quite obviously enraged position, not a muscle twitched and so the hour passed. That was the entire session.' Easser realized her space has for each analysand particular meaning with diagnostic and treatment implications. Her attentiveness to her patient's reaction to her picture was used to illustrate her understanding of a patient's rage and helplessness when the intimacy of the analytic relationship awakens the emotional pain of previously defended against awareness of lack of maternal empathy or absence of maternal bonding. Although the office itself will have a different impact on different analysands, the personal manner, and the communicating style of the psychoanalyst supersedes the physical surroundings. Ruth Easser developed her own way of interviewing, interacting, communicating, and being with a person. From the beginning, she was highly sensitive to the importance of the specific psychoanalytic encounter, the interaction, and mode of communication, as well as the separation and the crossing of psychic boundaries. Easser was intricately, creatively, and humanely involved with each person she encountered clinically, as can be seen from Arnold Cooper's description of watching her interview patients: Ruth's personal style was very pleasant, a little bit crisp and dignified within her own space. She was not overflowing with outgoing warmth. At least that was my experience of her. It was interesting to see that when she did an interview her manner changed dramatically. Her voice became softer, she leaned forward to the patient with a motherly attitude about her that I didn't ordinarily see. There was an extraordinary change when she was talking to a patient. She was a wonderful interviewer, elicited the material easily, and was not at all abrasive. The patient was at ease and trusted her. I used to debate with myself which was the real Ruth. The change in her made me start thinking about who we are when we are talking to patients. How different are we from our other selves?

Cooper notes that Easser's personal manner was not overly warm, and

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one of her supervisees also commented on the incongruity between her warmth in the consulting room and her manner outside it: Sometimes I would be in the waiting room, still putting my coat on or notes together. She would come out to see her next patient and just stand there. She never said anything. We talked about that as part of planning a standard manner. She felt there had to be a sameness that was comfortable. So if I said, 'Hello' or 'Good morning,' to my patients that was fine but that had to be consistent and become my standard. A departure could mean that I was sensing something which if understood could give me information about the patient or myself.

In Toronto, Easser's and Lesser's office was on two levels with the waiting room upstairs and her office below. An analysand recalled that ordinarily Easser came at least part-way up the stairs to the waiting room and that would be the signal to go down for the session. Her standard non-verbal greeting was not experienced as impersonal. In fact, her silent greeting was a mutual recognition that they knew each other and did not need to say names. Although this was her private office, not calling out a name in a public waiting room is also respect for the confidentiality of a patient's identity. When Easser became ill and couldn't come upstairs she called to a patient when she was ready. A woman analysand recalls that in the first session after she was married, Easser called her by her married name instead of her maiden name. This departure from her standard communicated information both about Easser and her awareness of her analysand as a person. Easser was ill and could not manage stairs, and yet she recognized the analysand's new marital status. Verbally or non-verbally Easser communicated individualized awareness of the other person and gave straightforward information about herself. Easser taught clear and open communication with the analysand. Anne Bernstein, one of Easser's supervisees, explains: 'She was a master at listening very close up, and of not wondering but asking what was going on. If you didn't get an answer, you didn't get one; if you got an answer, you had to try to understand it. You couldn't force the patient to tell you what they could not tell you but you could learn something about what was going on rather than try to guess what it meant.' Psychoanalytic theory assists in establishing the analyst's internal working model of the mind. Easser modelled and encouraged the development of emotional attentiveness in her supervisees. 'In retrospect,' says Robert Michels,

82 The Unsung Psychoanalyst I never felt her as predominately a theoretician or somebody who had a strong conceptual structure that was guiding her so much as someone who was exquisitely attentive to the clinical material and was constantly studying and understanding the patient. She emphasized the importance of attending to where the patient's emotional investment was at any point in the material. That was always her central guide. She was so exquisitely attentive to the way and the reason why the patient was relating whatever it was within the context of the transference setting within which the analytic work was done. This is something that has become more powerful in our writing since but was clear in Ruth's thinking from the very beginning.

Richard Simons is correct in stating that 'we need and utilize multiple models of the mind and multiple theoretical perspectives to help us understand the wide range of talents, conflict, and deficits our patients bring to us.'23 Psychoanalysts need theory as a frame of reference to guide their technique. When candidates first learn theory and technique, they tend to swallow it in gulps. Gradually, as theory is put into practice, the process of making it part of one's analytic self begins. Gradually, theory and technique are selected to suit the analyst's personality and style, to develop a natural and effective way of working. Ruth Easser's ways of thinking (theory) and working (technique) seemed to be seamlessly integrated. New psychoanalysts, for the most part, assume some combination of the theoretical and technical position of their institute and their analysts, supervisors, and mentors. The primary framework within which Ruth Easser was formally trained is described by her senior colleague Aaron Karush: 'Ruth was very much involved in the Columbia, Radovian view of analysis. She was also a bridge to the more classical view. Of course, with her classical analyst [Hann-Kende], she rode both horses well. Everyone liked working with her and profited from it. She was a very bright person. She grasped the essence of what we were trying to accomplish very quickly and introduced her own notions in a very helpful way.' Arnold Cooper adds that 'most of us at Columbia shifted to object relations thinking. All of that was there in Rado's way of thinking from the start and has now become mainstream. All of us benefited from being at Columbia in that what others struggled a great deal to come to we drank in as mother's milk.' Ruth Easser's theoretical position at the time she graduated is perhaps best illustrated through a discussion of her first published papers (see Appendix 1). Easser was a co-author, with Kelly, Daniels, Poe, and Mun-

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roe, of a study entitled, 'Psychological Correlations with Secondary Amenorrhea.' Easser wrote a second paper, at that time and called it 'A Case of Amenorrhea Showing Psychohormonal Inter-relationships.' In the latter paper Easser reveals that her psychoanalytic framework includes a scientific vision with a humanistic core. Although the term 'biopsychosocial' did not come into use until much later, this three-pronged approach was the foundation driving the work of the Columbia institute and consequently Ruth's training: The interrelationships among the biological, psychological, and socio-cultural factors contributing to the physical and psychological manifestations of illness are all to be taken into account. An understanding and therapeutic use of Rado's concept of 'adaptive functioning' is evident. Easser's diagnostic astuteness is demonstrated in her paper, clearly presented as a case description, without use of a technical language, but within a coherent theoretical framework. Easser's psychodynamic formulation brings alive a young woman's inner and outer world, her past and current life experiences, her emotional and physical condition, and her adaptive functioning. Therapeutic modesty and caution, based on diagnostic understanding, are also part of Easser's view. She is the involved realistic therapist, acknowledging 'the danger of symptomatic relief without consideration of the total personality.' She recognizes the intricacies of mind-body, hormonal-emotional balance and notes that it may be 'dangerous to some patients' ego integration to use hormone therapy or psychiatric therapy without exercising great caution.' She also cautions about the limitations that life circumstances and premature termination of therapy place on outcome. She cautions that psychotherapy and psychoanalysis have their limitations and that therapeutic fervour can be harmful. Clearly, Easser recognizes that symptoms alone do not reveal the underlying psychic organization. Symptoms can be adaptive and protective against further breakdown or painful, unbearable awareness. This theme is more fully developed later in her papers on 'Hysterical Personality and Narcissistic Character Disorder.' Besides the freedom to develop a 'way of thinking' as one becomes a psychoanalyst, another sense of freedom is experienced: freedom to decide whether to continue supervision and/or personal analysis; freedom to select and even change supervisors and analyst; freedom to strike out on one's own without supervision. Supervision now becomes consultation, and personal analysis is no longer confused with analysis required for training. Theory and technique suited to personal style, and 'a way of working' which is natural and effective develop.

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Candidates frequently identify with the supervisors who encouraged their unique potential. Each of Ruth Easser's three supervisors represents a different school of thought: George Goldman is probably the closest to the Radovian way of thinking; Nathaniel Ross from the New York institute, although connected with Columbia, is a classical psychoanalyst; and Ruth Moulton from the William Alanson White Institute has an interpersonal perspective. How Ruth Eassser integrated what she learned in supervision has to be gleaned from those who as supervisors continue to use what she taught. George Boujoff, a supervisee in the early 1970s reflects: She seemed atheoretical. She knew the theory, but the ease with which she expressed the ideas made her seem as if she were not theoretical. Being trained in the United States, her natural bent was toward ego psychology but it was much more than that. She was not rigid. There were elements of interpersonal psychology in her thinking. She was highly respectful of the contributions of Karen Horney and Harry Stack Sullivan and very much aware of the contributions of object relations which seemed to fit her as a person more than the seemingly cold, abstract theoretical concepts of ego psychology.

The nature of Easser's efforts to integrate her idealizations, her identifications, and her differences into an analytic self is not easily detected. If the struggles of others to become psychoanalysts are any indication, this was likely not a simple or straightforward process. Arnold Cooper, who also trained at Columbia in the early days, describes his 'great uncertainty' during his years as a candidate and for many years afterwards: My first reaction to the teachings of Rado, Kardiner, Ovesey, and others at Columbia had been rather contemptuous, believing them to be excessively simplistic, since I had no difficulty understanding what they were saying. That couldn't be psychoanalysis. Rado's use of everyday language in psychoanalysis was distressing to me. Words such as pride, hope, welfare emotions, and self-assertion rather than aggression, led me to think I was back in literature or sociology rather than in the science of psychoanalysis. Although it made sense to me, how could family and couples therapy be a part of an analytic curriculum since real analysts didn't do that? In contrast, the language of ego psychology held a fascination for me because it seemed as if it might be science. I found it difficult to understand, and it seemed to be the way all psychoanalysts spoke - except for those relative

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outsiders in my institute. At the same time libido economics seemed clearly a dead end and the language of instinct theory seemed hopelessly outdated biologically. I reflected the uncertainty of my entire institute, as we wavered back and forth between trying to enjoy the comfort of being part of the mainstream as it was reflected in the American Psychoanalytic Association or sustaining our courage to continue the battle that Rado, Kardiner, Daniels, Karush and Ovesey had begun. In their view they were fighting to restore psychoanalysis to the more important findings of Freud concerning the core of psychic life in the struggle to find an emotionally acceptable adaptation to one's conflicts within the constraints of biology, culture, and one's individual experience of one's care-taking persons; their interest in present functioning superseded their interest in the infantile past. For many years I vacillated back and forth between feeling that I was not a real analyst because I could not comfortably adapt to mainstream ego psychology, and rather angrily feeling that the excitement of psychoanalysis was being strangled by the hold of the so-called classical analysts.24

Non-doctrinaire, open, and growth-promoting supervisors and mentors help becoming psychoanalysts acquire the ability to develop their own way of using theory. They assist the analyst in integrating what is learned in classes with what is experienced in their own analyses and with their patients. Doctrinaire and rigid supervisors, on the other hand, can do a great deal of harm. Instead of promoting creative and independent thinking, and a way of working that allows the new psychoanalyst to utilize individual strengths, hesitancy and prolonged dependency are promoted. Otto Kernberg underlines the integrative role of the supervisor 'both to identify with overall institute educational objectives, and yet preserve a sufficient degree of autonomy so that philosophical differences they may have with how various issues are taught may be shared candidly with the candidate.'25 That Ruth Easser was helped to develop her way of thinking and working, and how she helped others to do so, are as important now for psychoanalytic educators and young analysts struggling to develop their own way of thinking as it was for her then. George Goldman, in his supervision, fostered her unique gifts: 'She paid much more attention to the patient than the theory ... her sensitivity and clinical feel came across right away. It was apparently a gift and so good that I had a good time going along with it and seeing her case progress.' Easser, in turn, was a growth-promoting supervisor. George Boujoff, her supervisee, had the sense that she was open to his ideas and the development of his position:

86 The Unsung Psychoanalyst We worked well together and respected one another's position. She never imposed anything on me as a supervisor. I could not help but be respectful of her position because she was so clear in her thinking ... though she was tolerant of other ideas, she couldn't be pushed around intellectually. She was clear about her beliefs but wouldn't depreciate others' beliefs. She was open to differences of opinion. I would say, I am not sure I perceive the material in the way that you do. She would say, that is all right, that doesn't make it invalid, it means you have a different mental set, maybe you're seeing things that I don't see, after all you are there and I am not.

Anne Bernstein, another supervisee, acknowledges, 'I learned from her, and everyone I have supervised knows Ruth Easser's name because I tell them that I had her as a supervisor and she taught me to extract what could be learned from each particular case.' Reviewing his notes, one of her first supervisees, Joseph Schacter, comments: What was so striking was that Ruth formulated the kind of problems that are currently being formulated. She based her understanding on an interaction conception of the analytic process which was not at all prevalent forty years ago. Her supervision is absolutely appropriate today. It is as if she read all the intersubjectivists and the social constructivists and knew the importance of what was going on between the analyst and the patient. This was so different from what was being taught then with emphasis on neutrality and abstinence and the analyst outside the process. Ahead of her time, her view foresaw where concepts of the analytic process and technique were bound to go.

Supervisory influence is intertwined with the equally powerful influence of one's own analyst. Bluma Swerdloff believes that Hann-Kende was a model for Easser, in that she seemed to combine 'her Radovian training with her more orthodox analyst's approach.' Others commented that Easser also couched her ideas in language that was acceptable both to the Columbia Radovians and the mainstream, so that early on she bridged Columbia psychoanalysis with the outside psychoanalytic and psychiatric world. Although greatly influenced by them, Easser was not bound by her formal beginnings. Her flexibility, her openness to new ideas, and her way of thinking were soundly based on observation and experience in her work as a psychoanalyst. At Columbia, she acquired what Ethel Person has

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referred to as a 'high calibre of critical intelligence' prevalent among Columbia graduates. It was at Columbia that she became a member of the staff and faculty, allowing her to remain academically involved as she established her private practice. It was at Columbia that she received the support and stimulation of colleagues and students; it was there that her gifts and creativity unfolded. Arnold Cooper comments, 'Ruth was fun to work with. She was full of personality. She had ideas, she took them seriously and put them forward, even strongly. If you disagreed with her, you had to be prepared to wage a serious discussion: why one way, why not another. She was not hesitant about defending her views.' Upon graduation Easser became an active and contributing member of the Association for Psychoanalytic Medicine. Again Cooper comments, 'Ruth was one of the main members of the Columbia society. We were a closely knit society, not that we were that intimate but we didn't fight with each other. We got along unusually well. The fight was with the outside world. Within, it was quite friendly and we respected and liked each other.' In speaking of the experiences that helped sustain his analytic enthusiasm, Cooper notes, 'Central, of course, were the sheer excitement and interest of Freud's ideas in his writings and in the writing of a few other innovators, my continuing analytic work with a large variety of patients, and the powerful friendships with some of my teachers, colleagues, and students.' Remaining strongly attached to her parent institute and society throughout her career Easser enjoyed 'these universal experiences of psychoanalysts.' Her later active involvement in the Toronto Institute of Psychoanalysis and Toronto Psychoanalytic Society did not diminish the importance of these first attachments. She was also involved in the department of psychiatry both at Columbia University and at the University of Toronto. Anne Bernstein believes that 'Easser remained a physician in an era when most medical analysts were merely analysts. Not long after my supervision, when I suggested a continuing education course in psychopharmacology for analysts, the idea was laughed away. Now that is the current thinking. She was in advance of her generation and some of her early supervisees were in advance of my generation in interweaving medicine and psychoanalysis.' Ruth Easser was active in the American Psychoanalytic Association. As Helen Meyers points out, she was the only Columbia analyst that the American association appointed to committees in the early days. Others were more militant. Easser was 'solid, not battling, very definite but quietly so. Whereas others had axes to grind, she had a way of sounding that came across as a thoughtful, serious person. She was accepted on the important

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committee for certification, and that was special to people at Columbia. She provided a model of the notion that one could think about psychoanalysis in the new [Radovian] way and not turn people off. If this thinking was presented in a quiet way then people listened.' With this link to the American association Easser forged attachments with colleagues in the wider analytic world and provided a bridge for Columbia as well as an example of constructive participation in analytic organizations.26 Easser's mutually constructive relationship with Columbia seems in contradiction to Eisold's position (1998) that analysts' allegiances are to 'schools of thought' and to their analysts and supervisors, not their institutes. Easser's allegiance to all four seems to have been well integrated. Kenneth Eisold speculates on why Easser and Columbia formed a mutually productive attachment: When an institute is getting off the ground, it needs everyone so there is not that sense of personal ambition at the expense of other people. Personal ambition is then something that can be serviceable. There is a need for a role to be played and a willingness to play it. It is not at the expense of someone else because there is too much work that needs to be done. Being in on the ground floor meant that she must have been needed. At that phase of the life of an institute, when a good person chooses to go with them, that person is doubly valued. It is not only that the person becomes a good analyst but it is a vote for the new institute amidst all the conflict and bitterness with the outside world. It is an endorsement for their position, a sign of strength. The new institute will succeed if people like that choose to go with it.

Easser needed Columbia, and Columbia needed her. This bird's-eye view of Ruth Easser's attachments, transitions, and development during her early years of practice leads to consideration of an important aspect of the psychoanalytic relationship. Winnicott addressed the question of how the analyst behaves while working: 'First, there is the technique of psycho-analysis as it has gradually developed, and which students learn. The material presented by the patient is to be understood and to be interpreted. And, second, there is the setting in which this work is carried through ... A good deal more could be said, but the whole thing adds up to the fact that the analyst behaves himself or herself, and behaves without too much cost simply because of being a relatively mature person.'2 Paradoxically, the symbolic crossing and often melding of boundaries is intrinsic to the work of psychoanalysis. Gabbard

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and Lester comment on the interplay between inner (intrapsychic) and outer (interpersonal) boundaries in the analytic process itself. They hold that a certain fluidity in outer (interpersonal) boundaries in the analyst (indicating the ability to communicate affectively with the other) is necessary for the therapeutic process. Empathy might thus be understood as implying relatively permeable interpersonal boundaries on the part of the analyst. This proposition, however, does not extend to the analyst's inner boundaries. For the proper conduct of the analysis, a cohesion and stability of inner boundaries in the analyst seems to promote an optimal analystanalysand exchange. Heinz Kohut ... made this distinction when he remarked, The good analyst... will have a personality that is characterized by central firmness and peripheral looseness.'28

Ruth Easser's capacity to be the humane analyst while maintaining boundaries was articulated by colleague Daniel Silver, who continued with some of her analysands after she died: 'She looked an even greater clinician in my eyes when I heard what went on with her as an analyst. Ruth was an analyst and a human being and she could combine the two. She didn't have to step out of the bounds of analysis to be really human. She didn't have to have coffee with you or take you home or go to your home, and yet there could be this tremendous human feeling back and forth. She was always the analyst but so human and so practical without the nonsense.' Paul Lerner underlines this human-professional quality: The boundaries were incredibly clear; we had a friendship before I began training, but that didn't change the work we did in supervision. She was able to use her own experience, her own struggles, her own idiosyncrasies. She taught me a lot about women that only a woman could know. For example, my patient, an obsessional woman was organized on the surface. Ruth said, 'If you look in her drawers there would be a real mess.' Sure enough, under the surface there was a real mess. She used her own experience in very accurate and subtle ways. She taught theory and technique in her language: simple, straightforward, and understanding. In her office, she could be remarkably professional and tough. As a friend, I saw a different side. Once we went for a walk before she gave a paper on womanhood; she was nervous and vulnerable and charming. She related as a woman who could be vulnerable and dependent; it made me feel good to give support.

90 The Unsung Psychoanalyst There was a little girl quality which showed through on a personal basis. She could also be excited about new experiences which she also expressed. I valued the experience of seeing both her professional and personal side. She also talked about a woman's relationship with her housekeeper and the need to interpret the struggle a woman has depending on someone else to care for her home and not always the way she would like. She suggested, a simple, 'She is your maid, show her how you would like it done rather than doing it yourself in frustration.'

Neither the physical nor psychological needs of the analyst, nor yet the physical or sexual needs of the analysand, may be directly gratified within the psychoanalytic relationship. This is imperative if the analysand's goal of being able to live an autonomous, more fulfilled, less emotionally encumbered life is to be achieved. Analysis is a means to this end, not a substitute for it. That the analyst's own sexual, social, and emotional needs be met outside the analytic relationship is crucial for the protection of both parties. The analysand - the person who needs help with emotional problems - must be able to trust that the analyst is there to meet that need. No psychoanalyst can undo often traumatic histories or make up for painful deprivations. The analyst has to bear the emotional strain of the intense analytic relationship and contain the arousal of the wishes, needs, devices, and desires without exploiting or retraumatizing the patient. Professional belonging and a fulfilling personal life in the face of inevitable challenges are important if the analyst is to maintain ethical standards and clinical efficacy. Professional belonging has been insightfully described in a contemporary murder mystery, Sunday Morning Murder, set in a psychoanalytic institute: 'And when a man spends hour upon hour with people in whose company he has to efface his own needs, allowing them to level unrealistic accusations against him, or to love him for qualities he has never possessed, he begins to feel a powerful need to be in the company of his colleagues, to exchange experiences, to learn, to feel secure, to obtain encouragement and support, even to hear objective criticism: to feel a sense of belonging to a framework, a tradition backing his work.'29 The need for personal fulfilment has been captured by Ella Freeman Sharpe's thoughts on life as a psychoanalyst: 'While it is inevitable and rightly so, that psycho-analysis should be one major satisfying and absorbing interest of a psycho-analyst's life, if good work is to be done, it should contribute to the fuller life of the analyst ... It is for the greater

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happiness and efficiency of the psycho-analyst if his life includes other interests, healthy libidinal satisfaction and friendships that do not involve psychoanalytic interests.'30 Personal integrity and awareness of one's own needs and unconscious conflicts through personal analysis, following the dictum 'physician heal thyself,' are the basis of therapeutically ethical behaviour. A satisfying personal life assists the psychoanalyst in maintaining self and other boundaries. An environment conducive to crossing intrapsychic boundaries for the good of the patient then develops. Boundary keeping, boundary crossing, and boundary violations are complex notions. Boundary keeping distinguishes between self and other. Boundary crossing involves the self with the other. Paraphrasing from Gabbard and Lester, boundary violations in the narrow sense are potentially harmful crossings or transgressions. Relatively harmless and often useful boundary crossings are distinguishable from serious and harmful boundary violations. Sexual transgressions are violations, whereas some non-sexual boundaries may be ethically crossed. Boundary crossings are currently understood as transference-countertransference enactments. The roots of the word 'enactment' are understood in James McLaughlin's terms as the notion of playing a part or simulating as well as persuading or influencing someone else in the interpersonal field. Enactment is broadly defined as 'all behaviours of both parties in the analytic relationship, even verbal, in consequence of the intensification of the action intent of our words created by the constraints and regressive push induced by the analytic rules and frame.' It is noted that 'the analyst is "sucked into" the patient's world through an ongoing series of enactments that dislodge the analyst from the traditional posture of quiet, reflective listening.'31 How does the analyst maintain boundaries so as to avoid actual or surreptitious gratification of personal needs, sexual or non-sexual? Sharpe maintains that 'sexual curiosity is as much a motive drive in the work of a psycho-analyst as it is in the work of doctors, nurses, scientific investigators, historians, novelists, and artists ... Curiosity becomes adult and benevolent, because the psycho-analyst is not engaged upon a surreptitious gratification of his own immature sexuality.'32 The physical needs for affection, touching, holding, and for sexual involvement that are aroused in the analytic dyad can present an intense and contentious challenge to analytic boundaries. This is well recognized. The psychoanalyst's response to, for example, an an'alysand's strong need to be held, must remain at the verbal level. It should convey the attitude, 'I recognize your need to be held, especially in this or that situation. I can best

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help you by holding you with my words so that you can bear your loss, your loneliness, and/or will be able to understand what in you makes it difficult to allow another person to meet these needs.' This attitude, expressed in appropriate words, can be useful in the face of the arousal of real needs in the analytic situation. In the experience of one analysand, touching or not touching was something Ruth Easser handled with ease. The analysand came in excited and before moving to die couch, held out her hand to show her new engagement ring. Easser looked at the ring, seeming to mirror the analysand's pleasure and admiration for a beautiful piece of jewellery and the joy it represented. Did she hold her analysand's hand to look? The analysand's memory is that she did. But whether she did or not, the analysand felt held in a moment of shared happiness. Anne Bernstein recalls from her supervision with Easser: We didn't talk directly about ethical issues but in her matter-of-fact way, she taught straightforward ways of handling boundary problems. For example, when the patient she supervised wondered from the couch what I would do if, when he got up, he grabbed me and kissed me, I told him that it was a choice of a kiss or an analysis. He could fantasize, he could say anything he wanted, but if he wanted an analysis, we could not physically touch. It was simple and straightforward language. I didn't spend a lot of time exploring that issue, that was the boundary. Traditional technique might be to continue to interpret rather than address the boundary threat directly. A lot of things can be listened to and analysed for a long time, yet nothing really happens: 'When something fractures the analytic situation, it is not going to be put back together if the analyst yields to an attack on the analytic frame within which the work proceeds. This patient who wanted to kiss me was very aggressive, he wanted to disrupt the process.'

When the boundary threat is addressed directly, the underlying conflict (in this example, the conflict was about aggressive rather than sexual impulses) becomes apparent and can be interpreted productively. Social needs can be handled similarly. 'You can have many friends, but you can only have one analyst' was another of Easser's useful interventions. The analysand's need for friendship, for advice in other areas of expertise, and for special favours or assistance are other boundary issues to be dealt with. Crossings of these non-sexual boundaries are also potentially destructive of the psychoanalytic work. Again Bernstein recounts an unusual but nonetheless good example of such an issue:

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This patient came in, calculated how many thousands of dollars his analysis would cost for a year and went to give me a check for the whole amount. I said, 'I bill at the end of each month.' This gave Ruth an opportunity to teach just how narcissistic and grandiose this man was. She used the smallest things so effectively. I learned not only about his money conflicts but also about the impact that his seductive and controlling use of it [money] had on my feelings and behaviour as the analyst.

Ruth Easser's straightforward way of handling boundary issues could seem superficial. Yet, simple statements such as, 'You can have many friends/lovers but only one analyst,' or 'You have to choose between a kiss and analysis and you are here for analysis,' or 'I bill at the end of each month,' or a sharing of joy, can be therapeutically powerful. The analysand who is testing boundaries is reassured that impulses are not in danger of being acted on but can be understood. The analyst is able to focus on the analytic task without having to deal with anxiety-provoking behaviour which could lead to boundary violations rather than therapeutically useful boundary crossings. Sharing of joyful moments and happy events in an analysand's life gives pleasure to the analyst as well. Robert Michels explains that, in supervision, Easser had a way of teaching useful analytic 'tidbits.' He recalled all sorts of'pearls' she taught which he finds himself continuing to use. She helped him formulate clinical principles that way. For example, Easser taught that the analysand is less likely to act out during the first summer break than the second break, when firmly involved in the transference, so that interruptions and enactments of their meaning tend to be more dramatic. 'That's a kind of Ruth maxim.' The emotional needs of the analysand are addressed through words, through understanding, through non-verbal messages of caring and interest, and by the consistent presence and availability of the analyst. What of the analyst's emotional needs, especially in the areas of selfesteem, validation, admiration, and affection, as well as the need for power, dominance, and potency, the need to be listened to, to tell about oneself, or the need for empathy, compassion, and self-understanding? Engaging in analytic work indirectly satisfies some of these needs. For example, analysands' attendance at sessions is validating at a number of levels. At the least, it is reassuring that one has work to do. An analyst may feel gratification when positive change occurs in an analysand's life. Even when an analysand spontaneously expresses empathy, having intuitively sensed something of what the analyst is currently experiencing, the analyst may feel gratified. At a deeper emotional level, to accomplish the

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work of analysis, the self of the analyst becomes intertwined with the self of the analysand. When these intertwined selves re-emerge as separate individuals, as they must, it is not only the self of the analysand that has changed and developed, but also the self of the analyst. Thomas Ogden notes, 'It is only through the recognition by another who is recognized as a separate (and yet interdependent) person that one becomes increasingly (self-reflectively) human.'33 Psychoanalysts learn how to handle the stress and strains of real human needs which emerge within the transference and countertransference. They learn that deriving satisfaction, even enjoyment, from the work itself allows for both maintenance and purposeful crossing of boundaries between self and other. Psychoanalysts' need for their patients does not imply a violation of boundaries. John Klauber recognizes: Patient and analyst need one another. The patient comes to the analyst because of internal conflicts that prevent him from enjoying life, and he begins to use the analyst not only to resolve them, but increasingly as a receptacle for his pent-up feeling. But the analyst also needs the patient in order to crystallize and communicate his own thoughts, including some of his inmost thoughts on intimate human problems which can only grow organically in the context of this relationship. They cannot be shared and experienced in the same immediate way with a colleague, or even with a husband or wife.34

This legitimization of the gratification derived from the analysand's contribution to the enrichment of the psychoanalyst's inner world assists boundary maintenance by increasing the rewards of analytic work. Often patients feel they are the needy dependent ones; analysts' timely acknowledgment of satisfaction in their work can be useful in distinguishing between real and neurotic dependency. The importance of personal relationships and outside interests to reduce the internal strain of analytic work and augment its rewards is vividly captured by Ella Freeman Sharper One must at times exchange listening for looking - seeing films, works of art, architecture, landscape. One must also at times exchange sitting for walking, riding, driving. Above all, to counterbalance the constant intake by the ears in analysis, or by the eyes in reading, the analyst needs to create, to write or paint or find a way of producing something to balance this intensive absorption of materials. Mutual conversations and discussion bal-

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ance one-sided analytic relationships. There are no substitutes for living, challenging, robust friendships on equal terms. These are two different things and the analyst needs both.35

What of gender issues among analysts? Both men and women become psychoanalysts. Both find intellectual and emotional satisfaction in their work. Both want relationships, and both need autonomy but the ways in which these needs are expressed and satisfied differ somewhat by gender. Current cultural and psychological understanding holds that women find their identity primarily through intimate relationships (the self-inrelationship) and men primarily through autonomy and achievement (the self-in-work or accomplishment). These varying expressions of basic relational needs are by no means mutually exclusive (men also need and seek attachment, women also need and seek autonomy and achievement) but the felt need and the emphasis seem to differ. Even in the current cultural climate of feminism and men's increased recognition of emotional and affectional needs, this gender difference seems to persist. In a unique way, the practice of psychoanalysis provides the opportunity to meet these differing gender needs and simultaneously allows for the crossing of gender-need boundaries. Psychoanalysis is a liberated profession, in that from the beginning women have been accepted into the profession, their intellectual contributions have been valued, and they represent a substantial proportion of its members. In this respect, the profession was ahead of its time. For both men and women, needs for attachment and achievement as autonomous persons are met partially and indirectly in psychoanalytic work. Partially because, as already noted, it is imperative for both analyst and analysand that personal fulfilment happens outside the consulting room, in other relationships and experiences. Indirectly, because psychoanalysis takes place within an emotional relationship. Psychoanalysts inevitably become emotionally attached to their patients with whom they are so intensely involved. For Ruth Easser this emotional relationship comprises a honed, integrated use of intellect (through words) and empathy. In discussing the difference between a real relationship (in which the feelings, perceptions, opinions, and sensitivities of each person must be attended to) and the psychoanalytic relationship (which allows total verbal licence for the patient with a non-judgmental neutrality on the part of the analyst) Easser maintains that 'patients in psychoanalysis know a great deal about us, gleaned from our responsiveness to them, both verbal and non-verbal.' She quotes Hans W. Loewald's 'excellent definition of the

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use of words in psychoanalysis: 'the words by which the meaning is expressed are recognizable to the patient as expressions of what he experiences. They organize for him what was previously less organized and then give him the distance from himself which enables him to understand ... A higher stage of organization, of both himself and his environment, is thus reached, by way of the organizing understanding which the analyst provides.' Easser believes that this description of the psychoanalytic relationship draws together the manner by which words communicate, clarify, and transmit therapeutic empathy.36 If women find themselves largely through relationships, then making and maintaining connections and giving and receiving nurture are central concerns in their professional and personal lives. Forming an intimate attachment through marriage or with a significant other and child-bearing and mothering are important considerations and inevitably figure prominently in a woman's planning of her work life. This is not to say that all women psychoanalysts should have a partner or want to or should have children or want to; it is to say that these choices must be addressed. A resolution, in either direction, traditionally presents dilemmas and, not infrequently, difficult trade-offs in a woman psychoanalyst's life. Those who do not have a partner by choice or circumstance need to face personal loneliness; they are also free to devote themselves more fully to their work. The need to balance work with other interests is greater so as to avoid work becoming life. Those who have an intimate relationship but without children, by choice or otherwise, may meet their need for attachment in their personal lives but less so their need to nurture. Women psychoanalysts who have all three marriage, family, and an active professional life - may well experience fulfilment in their work and personal lives but not without tremendous expenditures of effort. As satisfying as this may be, it is not without exacting a cost. One of Ruth Easser's analyst-friends, describes her as wanting 'to do everything. She wanted to teach, to see patients, to do supervision, to take the children to school, to pick them up, have them go to art classes or ballet, run the house, care for the country house always busy.' Ruth Easser chose to be a married psychoanalyst with children.37 It is clear that this ambitious lifestyle was vitally important to her. What is less clear is how these personal choices affected her work as a psychoanalyst. One candidate recounted a vignette which reflected how Easser's positive bias towards her chosen lifestyle seeped into her work. This

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analysand married while in analysis and felt not only support for her wish for marriage and children, but also that the effective analysis of her defensive, successful, independent lifestyle freed her to pursue actively her dream of finding a partner with whom she could make a family. A glimpse of an inhibiting bias of Easser's is revealed when she questions why a patient, an adopted daughter, would want to contact her birth mother when she has experienced twenty-five years of good adoptive mothering. It was only after Easser died that her own adopted daughter sought information about her birth mother. As with most psychoanalysts, at certain times in life, in certain circumstances, and around certain topics, Easser also found it difficult to separate personal issues from work. For a further example, two candidates interviewed ten years apart were possibly affected by her personal circumstances. The first one's interview occurred just after the birth of Easser's first child, who had been difficult to conceive. The candidate had put off having children and felt that 'Ruth looked askance at the way I was dealing with this area of my life.' The second candidate, interviewed ten years later, when Easser's last child was of latency age, felt supported as a woman with children who was applying to train as a psychoanalyst. Just as some expressed needs and satisfactions as an analyst are somewhat gender specific, so too are some risks, conflicts, and problems. Women's need to nurture is well gratified in psychoanalytic work but their need to be nurtured less so. Men may satisfactorily gratify their need for autonomy but find it more difficult to meet achievement and power needs within the psychoanalytic work. Men, too, face personal-professional choices in establishing a practice and lifestyle as psychoanalysts but of a somewhat different sort. In as much as men seek identity and fulfilment through achievement and frequently power, these needs are only indirectly met through psychoanalytic work. The marriage-children question is less of a conflict for men than for women because, traditionally, men have been able to have both work and a family if they so choose. What is more of a problem for male psychoanalysts is that the analyst's life within the consulting room requires relative passivity and does not provide direct opportunity for an overt sense of achievement and the exercise of power. These needs can be met in other areas of professional life, academically, administratively, or through leadership in psychoanalytic organizations, or in outside activities such as business ventures or other areas of interest. For women, psychoanalysis, like teaching, medicine, or other helping

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professions, provides ample opportunity to satisfy sublimated maternal needs. The risk is that if these needs are frustrated in personal life, relationships with analysands may substitute too directly for intimate relationships and/or children. The psychoanalyst may inadvertently foster excessive dependency or seek vicarious satisfaction through the lives of analysands. For men, psychoanalysis provides a culturally acceptable way of experiencing their feelings, including the wish to nurture that many male occupations deny. It gratifies the need to be involved in an emotionally close relationship, to see something of oneself in another. Yet the need for differentiation from another is also accommodated. In fact, for both men and women, the opportunity to develop one's sense of autonomy, one's distinctive separateness from another person, is implicit in the necessity of distinguishing one's own needs from those of the analysand. A sense of achievement is experienced by doing work that one has been trained for and wants to do, especially when one understands the underlying motivation for choosing this particular work. Again, indirectly and not always, this satisfaction in doing one's chosen work is increased with the realization that the effort can make a profound difference in another person's life, as well as facilitate one's inner growth. Thomas Ogden expresses the analyst's need for patients, colleagues, and personal relationships with these words: 'Human beings have a need as deep as hunger and thirst to establish intersubjective constructions (including projective identifications) in order to find an exit from unending, futile wanderings in their own internal object world. It is in part for this reason that consultation with colleagues and supervisors even [our own] analysts post-analysis - is so important in our work.'38 Although psychoanalysis cannot be learned or practised in isolation, the creativity of analytic work is a solitary endeavour. A psychoanalyst works alone. 'The capacity to be alone [is] linked with self-discovery and self-realization; with becoming aware of one's deepest needs, feelings and impulses.'39 The capacity to create is as relevant as the capacity to relate. Psychoanalytic creativity occurs within the analyst's musings about the needs, feelings, and impulses of self and other, within reveries about their intersubjectivity. The psychoanalyst works both within and outside her or his own solitude: 'The capacity to create provides an irreplaceable opportunity for personal development in isolation ... The artist or philosopher [analyst] is able to mature primarily on his own. His passage through life is defined by the changing nature and increasing maturity of his work, rather than by his relations with others.'40 Just as a dynamic

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tension exists between interpersonal and intrapsychic, so too a tension exists between practising psychoanalysis in a relationship and the creative work in solitude. This emphasis on the solitude of psychoanalytic work seems in contradiction to the importance placed on attachment in becoming an analyst. It is naive to intimate that an effective psychoanalyst has a prescribed ability to relate or a prescribed capacity for creative solitude. Psychoanalysts have varying degrees of both and strive to find an individual working balance. Arnold Cooper, in giving 'some account of his efforts to achieve some peace of mind as a working psychoanalyst,' clearly articulates the analyst's internal struggle: 'I never had difficulty over the question of whether I was a psychoanalyst, because if I wasn't an analyst then I wasn't anything, but I have had tremendous problems over whether I was the right kind of psychoanalyst or a good enough psychoanalyst.'41 Ruth Easser from the beginning of her career strove to be a 'good enough analyst' and was intensely involved in her work. She met her personal needs for attachment through marriage and children, through friendship, through a passionate interest in the arts, and through a keenness for living life fully. Little, however, is known about the joys and struggles of her intimate relationships, nor were the minutiae of her personal life revealed by interviewees. Michels comments, 'I knew vaguely about her personal life, but that was never a focus of our discussion. She was reserved and loathe to distract from the supervisory task with anything that could intrude on it.' Nevertheless, several facets of her personal-professional boundaries were culled from the few known facts, from observations and comments. There was consensus among those who knew her that her marriage was fulfilling, that her children's well-being was a primary concern, and that her friendships were valued. As a psychoanalyst, Easser was known for her integrity and for her capacity to be the humane analyst while maintaining the requisite boundaries. The strength of an analyst's capacity to work effectively within the psychoanalytic relationship while satisfying needs outside can be sorely tested when personal attachments are not satisfying, when problems that threaten the well-being of self or close others develop, when human frailties or narcissistic characteristics press to the fore. During Ruth Easser's first five years of practice there is little evidence of pressing difficulties in her personal life. From all accounts she was energetically and enthusiastically engaged both privately and professionally. Although she experienced some difficulty in becoming pregnant,

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she and her husband, having decided on adoption, welcomed their first child three years after marriage. Her brother comments, 'There was not so much tragedy in Ruth's life until she became sick.' Nevertheless, as her life as a psychoanalyst unfolded, painful family events and eventually lifethreatening illness sorely tested Easser's personal and professional boundaries. How she maintained her psychoanalytic effectiveness, and her integrity, will emerge as her career develops.

3 Being

Beginning involves choosing, being chosen, and training to become a psychoanalyst. Becoming involves doing the work of psychoanalysis through attachments, that is, through professional and personal relationships which form the basis for being a psychoanalyst. Being involves the gradual unfurling of a psychoanalyst's way of thinking and working. In Beginning, hopes, dreams, and efforts to achieve the status of psychoanalyst are realized. In Becoming, the psychoanalyst as therapist emerges. Having passed through the striving of beginning and the elation and trepidation of becoming, the next challenge is to settle into Being a psychoanalyst, into carving out a career, a professional identity, and over time, expressing one's unique potential. Time and place affect the basic shape of a career; age at entry, years in practice, and gender exert additional influence. Of course, individual talents, predilections, and images of self-as-analyst converge with opportunity at various stages. Anthony Storr in The School for Genius discusses the phases of development of an artist's life: 'Bernard Berenson defined genius as the "capacity for productive reaction against one's training," and as an artist becomes more confident, he gains the courage to dispense with whatever aspects of the past are irrelevant to himself, and enters upon his second period, in which both his mastery and his individuality are clearly manifest.'1 Much the same could be said of the Being phase of a psychoanalyst's life. The shape of Ruth Easser's professional life was the kind to which many psychoanalysts aspire. Her career touched on most areas (clinical practice, teaching, training analyst, writer, and active member in psychoanalytic societies) potentially open to but not often achieved by many analysts. In her personal life

102 The Unsung Psychoanalyst she integrated career, marriage, and family. She is neither an ideal nor typical of what being a psychoanalyst is or should be. In fact, in some ways her career was atypical. Ruth Easser was young to qualify as an analyst. She was especially gifted and identified as such very early on. She rose to the top at the beginning of her career. She was fortunate to be in a facilitating psychoanalytic institute and a member of a university department supportive of psychoanalysis. Her career unfolded during a period of history when it was feasible to do a number of things at the same time - to have an analytic practice, to teach, to become a training analyst, and to be involved in psychoanalytic scholarly pursuits, as well as contribute to psychoanalytic organizations and academic psychiatry. Her papers, although few, track not only her clinical and teaching skills, but also the growth of her creativity and scholarship. Easser's career ended over twentyfive years ago, yet the issues she touched on in her written record remain central. She died in mid-life, and it is possible to see what she accomplished during her compressed professional life and therefore to assess the quality and prescience of her contribution. It is also possible to take a rough measure of the extent of her influence, since many of those who followed in her footsteps are among today's senior members of the profession. Typical or atypical, Ruth Easser's and most other analysts' careers have much in common. She faced many of the same issues as do those whose careers take different shapes.

A 'typical' career does not exist; analytic careers have many variations. Some analysts are in full-time private practice, spending their working day treating their patients. Others combine an analytic practice with activities related to their first profession or pursue an academic career or other work in their area of expertise. Yet, they are all trained psychoanalysts who have in common psychoanalytic knowledge and skills, a way of understanding human beings. Arnold Cooper believes that the identity of the analyst 'stems from the solidity of his analytic education and its pervasive influence on his professional life, rather than from a single uniform activity or belief. It would be folly to attempt to define psychoanalysis on the basis of a technique or practice. Techniques change over time and the essence of psychoanalysis lies in the nature of its inquiry and its views of man, not in its technical procedures.'2 As a psychoanalytic career unfolds, the focus is on the vicissitudes of the roles of psychoanalyst, teacher, collaborator, clinical scientist, and writer. These roles in various combinations constitute the lives and identities of psychoanalysts. Each of these roles as played out in Ruth Easser's life will be examined through excerpts from her papers and her students' com-

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ments. On the assumption that a psychoanalyst's primary role is therapeutic, this Being Phase begins with the role of psychoanalyst. Many analysts devote their entire professional lives to psychoanalytic practice. As they strive to become effective clinicians, they learn from experience. They grow and mature as they reflect on the hundreds of hours spent in intense involvement with each of their analysands. They may enter a second personal analysis for further self-understanding. They often consult with senior colleagues about difficult cases, to increase their clinical knowledge or to improve their technical skills, or share clinical experience in small groups of peers. They attend scientific meetings and special courses to keep up-to-date. They may or may not be actively involved in psychoanalytic organizations, serving on committees or in administratve positions. Their contributions remain unrecorded, unless they present papers to professional or scientific societies or as published articles. Many will not become training analysts for a variety of reasons, most commonly lack of time and interest or lack of opportunity. They spend their working lives quietly keeping the confidences of those who consult them. They derive sustenance from their private pursuits, their collegial and personal relationships, and their outside interests. These are the anonymous troops of the profession. Several stories involving Ruth Easser illustrate the lives of psychoanalysts who spent the major portion of their professional lives in private practice and a minor portion teaching or supervising in psychiatry. At a time when the use of medication during an analysis was controversial, a colleague who occasionally consulted Easser on difficult cases admired her open and no-nonsense approach to medication: 'If a person in analysis needs medication then it should be used.' This colleague also admired her gutsy sensitivity. She once commented after a heated discussion with a prominent colleague at a society meeting, 'I could have gone for his jugular but felt he couldn't take it.' This colleague recognized that behind Easser's reserve was an incisive and assertive mind. Although this analyst presented and published only two brief articles. Easser admired his creative ideas and 'envied his eloquent delivery and elocution.' He had served as president of his society but was unable to achieve psychoanalyst status, probably because of political controversy within the institute, and he subsequently withdrew from the society into his private practice and sustaining love of music. A second colleague, one of Easser's supervisees for whom private pratice and family were the primary commitments, asked, with amusement, if he would be included as an interviewee for this book because it would be 'the only psychoana-

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lytic publication where my name would be in print.' Professionally, although he taught in psychiatry, and chaired the ethics committee of his analytic society, any psychoanalytic writing ambition he may have had remains unrealized. Whether concentrating on a practice or combining this with other work, it was much easier to have a full psychoanalytic caseload in Easser's time than it is today. The reasons for this have been written about extensively in the professional literature.3 The following is a brief summary of these changes. During the 1940s, 1950s, and at least the early 1960s, psychoanalysis was the dominant form of psychotherapy in North America. It was valued above other therapies by people who sought psychological treatment and by referring physicians, non-analytic psychiatrists, and others in the helping professions. This was before extensive pharmacotherapy, brief psychotherapies, and cognitive-behavioural approaches entered the therapeutic mainstream, and before it became clear that some conditions are better treated by drugs and/or other forms of psychotherapy. It was also before third-party payment became commonplace, with all the restrictions on the length and type of therapy that prepaid insurance plans now impose. Bright young psychoanalysts were then actively recruited by academic departments of psychiatry (many of which had psychoanalysts as chairmen) because the conduct of dynamic psychotherapy under supervision was a core component of psychiatric residency training. Psychoanalysts with academic appointments taught courses in psychoanalysis, psychiatry, and other university departments (e.g., social work, psychology, and philosophy). Hypotheses derived from psychoanalysis offered promising leads to the understanding of psychosomatic and psychotic disorders, as well as the psychoneuroses. In addition, there were fewer psychoanalysts and many potential patients. Although it was easier to maintain a full psychoanalytic practice then, there is no reason to believe that the rewards and problems of practising analysis year after year are different today. Ruth Easser must have asked herself, as Arnold Cooper asked himself, whether she was the right kind of analyst and a good enough analyst. In the search for an answer, as Michels points out, most analysts are 'concerned with the clinical process, the patient, the analyst, their experiences, and what transpires between them.' Ruth Easser's constant attention to the clinical data as they unfolded taught Michels that being a psychoanalyst is based in clinical work. Like most analysts, Easser shows an ongoing interest in improving the efficacy of psychoanalysis. In her work on the hysterical personality, she recognizes that 'repeated inconsistency in the ability of the method to reverse the course of the hysteri-

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cal symptoms has led to uncertainty, discouragement, disinterest,'4 and she uses her clinical mind to further her understanding and treatment of people with these symptoms. In a later paper,5 she notes that 'until recently, a large group of patients generally diagnosed as suffering from a narcissistic personality disorder have been excluded as subjects for satisfactory analytic treatment. Much of the core structure and dynamics of this disorder have been poorly understood and, as a result, in most cases have remained inaccessible to the ususal psychoanalytic techniques.' Again, using clinical examples, she endeavours 'to clarify the disorder from both the theoretical and technical points of view, reflecting a constant desire in psychoanalysis to extend the boundaries of psychoanalytic technique and theory.'6 A psychoanalysis begins simply with an agreement. The practical arrangements set the frame. Within a context of a realistic therapeutic optimism, the psychoanalyst works towards, but cannot assure cure. It is the analysand who uses the analyst to change, to grow. As an integral part of the process, yet separate from the analysand's motivation and capacity to use the analysis, the analyst facilitates growth and change. Ruth Easser comments on the analytic attitude in her paper 'Cure in Psychoanalysis': The theory of psychoanalysis is based on the assumption that all adult neuroses have their roots in childhood conflicts. Thus, when we undertake to treat an adult patient, we are undertaking the treatment, and if possible, the cure of a disease process of many years' duration. Obviously we cannot undo the past and start over. In fact, those patients who are most insistent upon our actually changing their bitter past, by this very insistence doom the analysis. What we do attempt, assisted by the patient with his more mature psychic equipment and experience, is to review the past as it impinges upon the present, adding the dimension of a new joint perspective. The goal encompasses the ability of the patient to free himself from his old ties and their present-day derivatives, allowing for the formation of new modes by which he may regard both his environment and himself.7

Evelyne Schwaber addresses the difficulty of maintaining the analytic attitude: As analysts, we may agree with certain basic tenets: we should not impose our truths, whether or not theory-laden; we should maintain the focus on the patient's inner reality, not on how he or she lives in the world - out there; we should be prepared to be surprised, to learn something that hadn't occurred to us; we should look for multiple cues in the clinical data,

106 The Unsung Psychoanalyst pay attention to affect and state as may be expressed within the moment, and listen for subtleties that may convey something about how we are being experienced in the transference ... Despite our best intentions, we seem to have a fundamental disinclination to maintaining these positions.8

She suggests a reason for this disinclination is that it is difficult to recognize and explore, from the patient's point of view, the impact on the patient of the analyst's own perceptions, feelings, and agendas. Underlying this difficulty of maintaining the analytic attitude is the quintessentially human struggle between creative and destructive urges. Analyst and analysand consciously wish to be successful and fear failure. For both, the humbling disappointment of therapeutic zeal comes with the realization that a person can achieve self-understanding and a considerable degree of personality integration yet not be rid of undesirable parts of the self. Psychoanalytic understanding does not completely safeguard against eruption of destructive impulses or passionate affects. It is what one does with these impulses and affects, not that one still has them, that matters. Psychoanalysts need to be prepared to deal with intense passion of all kinds in themselves and their patients and to recognize that they also contribute to patients' perceptions and feelings. Helen Meyers felt her effectiveness as a psychoanalyst increased because Ruth Easser taught the importance of analysing rage and aggression, especially when these feelings relate to the analyst. Meyers, a candidate in late 1950s, recalls: I thought her judgment of the patient was hard but she was right. I didn't realize all the rage and anger that one had to be direct about. Now I wouldn't think it was hard at all. She was pioneering. Other teachers didn't talk about anger but about frustrated libidinal desires. Hers was a different approach. Others didn't talk about aggression, and she talked a good deal about aggression. She was quiet but innovative. She got it from Rado, but it was hard to learn from Rado because of his bombastic character. From Ruth, it didn't sound bombastic, so I learned. Ruth was talking about rage and aggression at Columbia much before the understanding of early aggression came to the forefront in American psychoanalysis. In retrospect there were a lot of pioneering things that she did quietly. She didn't say, 'Hey, I've come up with this new idea.' She just said it.

Rage and anger are not the only intense emotions psychoanalysts encounter. Strong feelings of love and hate are often directed towards

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the analyst. Erotic feelings and sexual wishes are expressed, as are cries for human compassion. That multiple and varied unconscious fantasies drive such emotions evoked in the transference does not dilute the strength of the affect. For example, faced with an acute need for solace in the presence of obvious suffering, the psychoanalyst can only facilitate the analysand's attempts to integrate the experience. One of Easser's analysands, in deep distress over a devastating loss, screamed out, 'Why don't you say something?' Her response was, 'Real pain cannot be talked away.' That response not only validated the intensity of the experience but facilitated mourning and the understanding of the meaning of the loss to the analysand. Indeed, this validation allowed the analysis to proceed. When a psychoanalyst validates expression of affect, the patient is helped to endure intense feelings, and the painful experience becomes available for analysis. Another of her patients from time to time would enter the session dressed in a state of disarray, refuse to lie on the couch and would express the desire to crouch in the corner of the room. Yet, if the analyst would encounter this behaviour with the comment that she certainly seemed most upset and to feel that her anxiety was getting out of hand but that it could only be understood if they both knew what it was about, she would be able to assume the analytic position on the couch and communicate the events and feelings that had evoked so great a response. These events were usually associated with some feelings she had attributed to the analyst.9

Easser realizes that this careful attention to the analysand's affect requires that the analyst give equal attention to her own feeling state. In discussing the narcissistic patient, Easser says that 'with no other type of patient does the analyst experience quite the same sensation - of being constantly viewed under a magnifying glass. Every breath, every shift, every comment is scrutinized and responded to by the patient as evidence to weigh before allowing the relationship to continue.'10 Easser recognizes that an analyst accepts this often critical, even attacking, scrutiny until a moment arises within the relationship to use it therapeutically. When a patient overreacts and misinterprets a behaviour or utterance of the analyst, it is possible to challenge the presumed lack of empathic capacity. Easser refers to, as an example, a female patient who flew into a rage and attacked her for excusing herself momentarily to assist a new patient to find the waiting room. The gist of the attack was that leaving was clear evidence that Easser was uninterested in her patient's

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feelings and communications, displaying indifference in blatant and cruel fashion. Easser commented that, considering the patient's intense alertness to her attitude, she wondered if the patient truly needed this action of hers to determine her level of attention and interest. The patient was startled by Easser's comment, pondered it, and then admitted she had been aware that her analyst was attending and that her comments implied interest but nevertheless found it difficult to trust and did not want to depend. A period of meaningful communication that followed was accompanied by anxiety. This patient did not lack empathic capacity but fended off its emergence to avoid anticipated disappointment if she permitted a trusting relationship.11 Ruth Easser had a capacity to deal effectively with passionate feelings. Many psychoanalysts have a similar capacity. It is part of being good at the work. Her skill demonstrates a subtle but important aspect of effective psychoanalysis. She did not attribute affect simply to transference, nor confront it directly nor give premature reassurance. Rather she accepted the analysand's feelings as real and understandable in terms of the present and past situation. She gives the following example: A young woman, after the disclosure of her urge to touch me, had the following association. She recalled a similar desire toward her previous analyst and her feeling that his attempt to reassure her, rather than to understand her feelings as an affectionate gesture had been in her mind, his fear of her impulse to touch. She felt that he had misread her discomfiture as emanating from anxiety rather than to understand her feelings as an affectionate reaching. Similarly, her associations led toward experiences with her mother whom she said 'went crazy' whenever the patient attempted to reach out and to demonstrate affection ... This led to a memory of a repetitive childhood dream which she thought had its origins at a time when she slept in a crib. The dream was of a large lion crouched under her dresser. In the dream, she would call for her father who, instead of picking her up, would respond by throwing the lion out of the window - he would attend to her anxiety but not to the underlying dominant affect. Interestingly, she finally returned to a positive memory of her mother soothing her in the crib when she was ill, but she stressed, 'I had to be sick.'12

This vignette illustrates what Daniel Stern learned: Ruth Easser was the first person in the analytic school who got across to us the idea of working with what was really going on between the therapist

Being 109 and the patient. She would constantly ask things like: What do they really want? What are they feeling? What are the pragmatics of this? It was very different than what we had had before. She focused us not on what the symbolic connections were but on down-to-earth meaning: What does the patient want right now? She got us to see that at a time when it was remarkably hard to get students to even address that question. That is what I most appreciated from her. Finally, and maybe for the first time, someone had put psychoanalysis back into what I already knew what life was truly about. So in that sense, she was both liberating and pushed us forward. That was the best thing she gave.

Robert Caper comments that 'analysis as an activity must necessarily exclude too many of the elements that are vital in any ordinary, natural human relationship. Its power stems from its intense, exclusive focus on the passions of the unconscious. This exclusive intensity produces what Bion called the sense of isolation within an intimate relationship that prevails when each party is aware of his own responsibilities and limits in the analysis.'13 Easser's position includes a focus on the passions of the unconscious, but warns against the 'danger of reifying the constructs of the structural theory [ego, id, and superego] and in particular the constructs of the ego and self representations,' because Easser realizes that 'by doing so we lose the vital dynamic human being within.' The nature of the psychoanalytic relationship does not include many of the elements of ordinary relationships, for example, 'in the motherchild situation the mother is expected by her responsiveness to guide or inhibit the actions, reactions and responses of her child. These guidance or inhibitory rules, most appropriate for mothering, are not viewed as useful psychoanalytic modalities.'14 Yet, as Stern clearly articulates, Easser did not lose the human being within. Indeed, understanding what a person wants from another at a given moment is clearly connecting with the human being within. Ethel Person also comments on Easser's compassionate view of human nature: Ruth understood that what happened to people in life did not always have to do with what other people call mental health. She had enormous tolerance. She once said in a class that so-and-so had married a person with schizophrenia and it was a satisfactory marriage. That was shocking to the students, but also enlightened, because she realized that there are many different values and ways of adapting to life. Much of what happens depends on fate rather than on some preconceived idea of mental health.

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The humanness of this connection is confined to the consulting room in that the psychoanalytic relationship does not extend beyond it in any real way. Easser's silence with her analysand in pain over loss could be read as traditional abstinence from giving immediate solace; however, her comment, 'Real pain cannot be talked away,' gave the solace of understanding. The work of psychoanalysis decreases emotional isolation for both participants. The analysand gains a fuller, less conflicted sense of self and other. The analyst derives satisfaction from working effectively. In offering to undertake an analysis, the psychoanalyst asks not only whether psychoanalysis is the treatment of choice, she also considers the effect of this commitment on her practice and personal life. Psychoanalysts' thoughts about each of these issues are translated into purposeful decisions that are conveyed to the analysand in words and manner. The psychoanalyst assesses a potential analysand's conscious and unconscious motives, needs, and capacities derived from a complex, multilayered story. Easser's straightforward manner made it easy for people to tell their stories. She never used jargon and never talked theory. She would ask non-leading, non-threatening questions to draw a person out: 'What are your living arrangements? Have you ever been in love? How do you think you got to be that way?' From their supervision, Joseph and Judy Schachter remember her 'refreshing view of assessing what was going on with the patient. She would say, "you learn most about family structure by finding out who takes out the garbage and who does the dishes." Her comments and questions, although few in number, would evoke new thought, new feelings, a different view of oneself. Easser would engage clearly, honestly, and individually with each patient, leaving little doubt of what she was able to offer.' A woman analysand's description of her first meeting illustrates the importance of initial impressions. Previously, this person had met with several analysts: Then I saw Ruth Easser. We had trouble finding a mutual time and she finally said, 'Would you mind having your interview at the Center?' and I said, 'Sure.' I walked into that long main corridor at one end. She was coming out of the office at the extreme other end. She walked toward me and I toward her. As we got closer, she smiled and reached her hand out to shake hands and I said [to myself], She's it.' We had not exchanged a word but she came across as someone I wanted to connect with: human, dignified, wonderful.

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It is not only the analyst who asks, 'Can I work with this person?' The analysand, too, experiences a rapport that says 'I can tell this person what is on my mind.' Not all who were interviewed by Ruth Easser felt this affinity. Some found her manner cool and aloof, others had negative, even anxious reactions to a severity in her physical appearance. One potential male candidate spoke about his 'mythical dreamlike experience of being interviewed by a tall, long-legged, dark woman dressed in black, a metaphor which became a central theme in my analysis having more to do with my inner world than her pleasant, searching, but not at all off-putting manner.' A woman candidate 'turned Easser down as an analyst because she felt Easser was too young and inexperienced: I was young and wanted a man rather than a woman analyst - the ridiculous notions of those days. I wasn't an analyst yet, I didn't know why I chose a man. I probably would have been better off with her.' Analysts have to be prepared to be turned down. The woman analysand who fit so well with Easser described her interviews with two other analysts. The first appealed to her very much and he offered to work with her but did not have time for a year and she did not want to wait. The second, a senior, much-sought-after analyst with 'slicked back hair and a thin moustache' she found off-putting: 'I waded across a thick carpet in which I could have sprained my ankle, in an office that looked like a caricature of a Central Park South fashionable analyst's office. What finally finished me was his meticulous explanation of his fee schedule. I thought, I cannot work with somebody whose mind works like this.' A psychoanalyst has to be minutely attentive and observant in the initial interview. One analysand felt immediately understood but did not realize she was not communicating her feelings. Easser observed and remembered. Months later, she used her observation when it would be useful to her patient. Her comment, 'You didn't let me know that you felt understood' helped this analysand be less defensively restricted in expressing feelings and perceptions. She also knew that patients learn much about the psychoanalyst from the first meeting; that besides transferences they continue to have multiple conscious, reality-based reactions which need to be articulated and examined. This attention to subtle detail and well-timed use of observation is a skill that psychoanalysts hone through experience. Behind Easser's ease of manner was a mind that was evaluating what would best meet this person's needs. In her 1962 paper, 'Indications and Centra-indications for Reconstructive Analytic Treatment,'15 she

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emphasizes the necessity of evaluating total adaptive balance in terms of integration, identification, and potential transference manifestations throughout the life cycle, as well as the person's current integration. She notes that 'emotionally healthy' is best defined if contrasted with what is maladaptive. She is practical in her assessment without losing sight of the essential ingredients of the psychoanalytic process and the ultimate goals of psychoanalysis. For Easser the main ingredients are the childhood conflicts which result in distorted images, emotionally conflicted relationships, and neurotic attitudes towards the members of the original family group. For her, the analytic process changes these distortions, as they arise within the transference, that is, as they are expressed towards the analyst in words, feelings, and behaviour. The goal towards, which the analytic dyad strives is for the analysand to become a separate and different individual, neither an extension of the parents, nor a positive or negative print of the same. Second, part of the ego differentiation is an awareness and a sense of responsibility for one's own affects, actions, and motivations neither rationalizing, projecting upon others, nor introjecting as a part of one's self, actions and feelings of others. Third, the above shifts subsume a synthesis and integration of various aspects of the personality. This would not permit a divorcement of the head, the wit, the intellect, from the body, nor the body with its passions, its tensions and its needs from the head, i.e., the rational self.

Ruth Easser reflected on these issues, as all psychoanalysts must. She seems to have been able to find meaningful words to communicate her thoughts clearly, so that a choice could be made and a person's autonomy, self-esteem, sense of responsibility, and independence could be maintained even while in the dependent position of analysand. Her way of thinking and communicating about people's relationships, their adaptation to life, and their need for help was clear. It had been instilled by her training, developed in early clinical work, sharpened through research on amenorrhea and work with colleagues in developing Columbia's Adaptive Balance Profile,16 and honed by her extensive experience on the assessment service of Columbia's psychoanalytic clinic. This way of thinking was, of course, not unique to Ruth Easser or Columbia but was developed in her multiple and spirited interchanges with her colleagues at Columbia and later with other leading psychoanalysts such as Therese Benedek, Hilda Bruch, Joan Fleming, Annie Reich, and Robert Waelder. Not only did she admire their thinking and incor-

Being 113 porate some of it into hers, but she received respect in return. Similarly, hers was a way of thinking that those who were influenced by her took in and found to be useful, as they developed in their own roles as healers. The decision having been made to offer a psychoanalysis, with a conviction that this method of treatment can help, the psychoanalyst tries to ensure that a person's acceptance is a free choice. Accounts of how Easser and her analysands reached a working agreement are available only from candidates. A male candidate reports that he 'felt very good he had been assigned to her by the institute's training committee because her reputation amongst colleagues and peers was that she was really one of the better analysts, more rigorous, more intellectually committed to psychoanalysis than some.' Women candidates who had a choice reported that initially they felt understood and a sense that change in themselves and in their lives was not only possible but would happen. The agreement they reached was simple, and the mutually acceptable, practical arrangements were clear. They would begin on a certain date, meet at certain times, and the fee would be so much. Candidates are a skewed group of analysands; they seek analysis for training as well as personal reasons. Was Easser different in her approach with a non-candidate? There is little reason to believe so. Since no accounts of Easser's initial interviews with non-candidates are available, it seems useful to consider the experience of the novelist Marie Cardinal, who having told her story is offered psychoanalysis by a 'classical French analyst.' In her memoir, The Words to Say It,17 she writes: My whole body relaxed. I felt profound gratitude towards this little man. Perhaps there was a path between myself and another. If only it were true. If only I could talk to someone who would really listen to me! He continued: 'I think I can help you. If you agree, we can begin an analysis together starting tomorrow. You would come three times a week for three forty-five-minute sessions. But, should you agree to come here, it is my duty to warn you, on the one hand, of the risk that psychoanalysis may turn your whole life upside down, and, on the other hand, that you will have to stop taking all medications right now ... Finally, you must know that an analysis lasts at least three years and that it will be expensive.' His manner of speaking was serious and I felt he wanted me to listen to him and to think about what he was saying. For the first time in a long time someone was addressing me as if I were a normal person. And for the first time in a long time I was behaving like a person capable of assuming responsibilities. Then I understood that little by little they had taken all

114 The Unsung Psychoanalyst these responsibilities away from me. I was no longer a nothing. I began to think about this situation and about what he had just said. How could my life turned upside down be worse than it was? As for the money that was more difficult; I didn't have any. I lived on the money my husband earned and what my parents gave me. 'I have no money, Doctor.' 'You will earn it. You will have to pay for your sessions with the money you have earned yourself. It is better that way.' 'But I can't go out, I can't work.' 'You'll manage. I can wait three months, six months until you find a position. We can arrange something. What I want is for you to know that you will have to pay me and that it will be expensive. The sessions you miss will be paid for the same as the others. If it doesn't cost you one way or another, you won't take the analysis seriously. This is common knowledge.' His tone of voice was dry enough, as though he was someone involved in a business transaction. Not any commiseration in his voice, nothing of the doctor or the father. I didn't know that in agreeing to begin immediately, he was taking three more hours a week out of his own life which was already invaded by his patients. He made no allusion to the additional fatigue or to the fact that he was making an exception because he saw how ill I was. Not a word of it; on the contrary. On the face of it, it was a simple bargain. He was taking a risk, he was allowing me to choose. And yet, he knew that but for him, there were only two solutions for me: the psychiatric hospital or suicide. 'I agree, Doctor. I don't know how I can manage to pay you, but I agree.' 'Very well, we'll begin tomorrow.'

Cardinal felt understood, felt hope and a sense that change in herself - in her life - was not only possible but would happen. The agreemen she and her analyst reached was simple, and clear; they would begin on a certain date, meet at certain times, and the fee would be so much. She was also clear that their agreement meant much effort and commitment for both. Each psychoanalytic pair finds a way of engaging for the vital work ahead. It is the psychoanalyst's task to individualize this engagement to meet the analysand's specific needs. The analysand then uses the analyst, verbally, in whatever way is emotionally necessary. The agreement provides the underpinnings; away of working provides the supportive base for the analyst. The work is the creative translation of the anayst's understanding, and of the analysand's communications. The challenge is to maintain, over time, a fresh view towards each analysand;

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to remain optimistic about the healing capacity of psychoanalysis in the face of inevitable setbacks and failures. At the same time as attention and communications are focused on the analysand, self-discipline is required to be self-aware, to maintain the therapeutic contract, to be available to work together session after session. These are the unrelenting responsibilities of being a psychoanalyst. Such expectations can be revitalizing or depleting; every analysis brings something of both. Cooper has discussed the problem of maintaining therapeutic effectiveness throughout a professional lifetime. He feels that psychoanalysts are subject to paradoxical emotional and characterological demands, uncompensated for by the usual gratifications of other healing professions. Burnout syndromes can occur in a setting of great emotional intensity that demand high degrees of affective awareness and control, empathy, and tolerance of uncertainty. Cooper suggests that prevention of burnout is possible by noting self-observable markers, seeking consultation or supervision, and/or returning to personal analysis.18 There is, however, no easy formula for the analyst to remain vital, creative, and replenished by the work, to avoid the risk of depletion and burnout. Whether adhering to the so-called classical or a contemporary framework, each psychoanalyst has the freedom to fashion theory and technique into a personal style of working. Doing psychoanalysis is a creative endeavour. Each analysis is unique - the person, the problems, the process; each session has individual meaning to the analyst and the analysand. The routine daily activity, moving from patient to patient on an hourly basis, the inevitable uncertainty, the enlightening surprises, the emotional energy, and the urgency provide a vibrant rhythm to the day. The psychoanalyst's work includes listening, remembering, contemplating, and translating thoughts about communications into hypotheses, monitoring and linking one's own thoughts and feelings with those of the analysands, putting thoughts into words, and interpreting. The rhythm of the psychoanalytic work is stimulating and satisfying. Its consistency provides the reassurance of a solid structure of steady work and can offset the emotional drain. Anthony Storr, in commenting on the uniqueness of the psychoanalytic encounter, recognizes that no ordinary social meeting allows detailed study of the way in which one party reacts to the other. In no other situation in life can one count on a devoted listener who is prepared to give so much time and skilled attention to the problems of a single individual without asking for any reciprocal

116 The Unsung Psychoanalyst return, other than professional remuneration. The patient may never have encountered anyone in his life who has paid him such attention or even been prepared to listen to his problems. It is not surprising that the analyst becomes important to him.19

What of the analysand's importance to the analyst? Symington, in discussing the psychoanalytic experience from the analyst's viewpoint says: Patients will challenge the analyst to grow emotionally. If the analyst does not want this, or if he reaches middle age and thinks to himself that he will gently settle down, then analysis is at an end for him. Emotional development does not happen smoothly, but by great upheavals that are extremely disturbing; Bion said that during one of these upheavals you do not know whether you are breaking up or breaking down. However, there is no possibility of being a satisfactory analyst if you do not desire your own emotional development.20

Not only is the role of healer, although exacting, usually experienced as personally enriching and rewarding - it is also a privilege to know intimately another person's thoughts and feelings. As Judith Krantowitz puts it, 'the character of the analyst is likely to remain relatively stable despite being buffeted by the intensity of patient difficulties.' But no analyst is immune to either positive or negative impact. Krantowitz points out that the extent and nature of the impact for better or worse 'depends on many factors, such as the particular stage of the analyst's life, the nature and extent of supports and satisfactions outside work with patients, other past and current experiences with patients, and the particular match between the analyst and the patient.'21 Ruth Easser recognizes the potential for a positive or negative impact of the analysand on the analyst. She taught her supervisees, Joseph and Judy Schachter, to optimize their emotional participation so as to minimize negative impact, that is, to use their own feeling reactions as a guide to those of the analysand. Judy Schachter gives an example of her confusion with 'a patient who was involved in complicated real estate undertakings which I didn't understand and I made some assumptions. Ruth would say, "You don't have to know the answers. You should ask the questions. It is perfectly OK to say you don't understand this or that and to pursue it until you do understand." She supported the supervisee's not knowing, and being comfortable in asking. She got across the

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idea that the other person was quite separate, with different thoughts and knowledge, with separate feelings.'Joseph Schacter agrees that he too learned the importance of the psychoanalyst's use of the self and his emotional responses. He thinks that Easser's was an early grasp of the notion of countertransference and that the analyst's feelings can be valuable guides to understanding the patient. The Schachters learned to be both comfortable in not understanding and to have confidence in the usefulness of their feelings. Easser was 'the only one of our supervisors who taught that.' Comfort with and confidence in one's feelings are more than the psychoanalyst's technical use of countertransference reactions. In fact, awareness and acceptance come before therapeutically creative use can be made of such reactions. Judy Schachter learned that when she feels irritated with a patient, it is important not to be self-critical for that feeling. Although this is now a well-accepted part of psychoanalytic practice it was not in the 1950s. She felt free to admit all sorts of feeling in supervision: Ruth would say, 'Isn't the patient making you feel this or that?' or ask, 'Aren't you feeling this way about the patient?' She made the whole idea of countertransference real. She helped me realize that I was not absolutely neutral, bland, and white bread acceptable. Nor was I the world's worst animal to have those terrible feelings. She helped me feel comfortable with a range of feelings, although some were very specific. I remember a quite powerful and anxious response to a patient describing a childhood incident of driving his tricycle off the porch and suffering a finger amputation, an act with symbolic meaning. It was my problem, stimulated by the patient's material. We came to understand that when that patient entered analysis, he had described a series of quite horrific actions taken against women as a way of distancing, warning, and scaring me. It was a transference response to test me to see if I could tolerate his hostility towards women. She was very supportive, and allowed me to describe how I felt about a patient who did these things to women. He presented himself as dangerous, and a kind of psychopath, who did not want to pay bad debts or meet obligations. She was not judgmental about my reaction or about the patient; that was an important part of supervision with her.

Was Easser changed by her work? The retrospective observations of colleagues and what can be gathered from her papers suggest that she

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was. Aaron Karush, at Ruth Easser's memorial service, eulogized her growth: We grew up together as psychoanalysts in the same psychoanalytic family. Over the years I and others grew to love and depend more and more upon this quiet, steadfast friend and teacher, this firm but compassionate psychoanalyst. We soon learned the apparent shyness of her early years reflected a natural modesty and deep wisdom from which we all gained. When we were impulsive, she quietly redirected; when we were confused, she clarified; when we became unstable, she brought harmony. One of Ruth's unique talents was her ability to be firm in her views, never compromising her ideals, but without self-righteousness or arrogance.

Although sincere, this glowing description of Easser's growth gives little indication of the struggles and gradual steps towards inner change through psychoanalytic work. The case examples that Easser uses in her papers illustrate a deepening of her understanding of the analysand and of her own role in the psychoanalytic process. In her early papers, the case descriptions are more formal, less interactional, more of the doctor, less of the personanalyst. In a 1962 paper,22 Easser describes a patient, 'who relinquished the repression and denial of her feminine and sexual interest, stating originally when these interests would arise that "People are bothering me," changing to an awareness and an acceptance of her interest in clothes and pleasurable sexual and bodily desires. Further, this patient could respond to a criticism by her lover that she was so avidly in pursuit of her own pleasure that she was showing very little concern for him. This remark did not lead, as before, to either anger or depression but rather to an interest, introspection and finally to an acknowledgement of the truth of this statement.' Easser does not comment on what role the psychoanalyst had in bringing about this change. By the 1970s, Easser's papers are replete with examples of the analyst's participation in the analytic process. She tells of a young man who, after a year and a half of analysis, was forced to undergo a serious surgical operation. He had attacked me frequently for my seeming lack of appreciation of the intimate mutual adoration and concern which he and his mother felt. He insisted that my lack of appreciation must stem from my jealousy and my desire to destroy his attachment to his mother so that I could bind him to me. Since he lived in a city some distance from his fam-

Being 119 ily, I had questioned whether he had informed his family of his impending operation. This question evoked anger and he attacked me, declaring that I was inferring that he was inadequate and immature. He informed me that he was quite capable of handling the operation alone. Nonetheless, I had requested that he call me during his hospitalization to inform me as to his progress. Since he delegated a nurse to call me, I subsequently called him and received the usual curt, abrupt response. When he returned to analysis, I commented upon his indirect communication and once more asked whether he allowed his family to enter his life at this time. He then informed me, with great sorrow, that he had contacted his mother and had requested her to be present but that she had declined. He confessed that he had felt that her excuses had been patently shallow. It was painfully clear to him that his mother preferred not to be involved in his life and did not wish to be placed in a situation in which she would be expected to respond to his feelings.23

This attention to the psychoanalytic interaction furthered the analysis and demonstrates Easser's clinically based conviction that the most effective intervention is made when what happens between the analyst and analysand can be linked with internalized and real relationships. For Easser the psychoanalyst is a full participant in an interactive relationship. There are also practical issues that affect an analyst's effectiveness and growth in the role of therapist. These are maintaining a practice and referral sources, making a living, and third-party involvement in payment. The challenge of maintaining a consistently steady practice arises as some analysands complete their analysis or drop out of treatment. The analyst is left with hours to fill and loss of income for what can sometimes be a significant period of time. Problems arise around keeping a waiting list, or feelings about letting one's colleagues know about a need for patients, and around filling one's time with non-analytic psychotherapy patients. It can be difficult to maintain full analytic hours. Psychoanalysts frequently assess people for whom analysis is not the treatment of choice or who, only after some psychotherapy, are able to work into analysis. Precious psychoanalytic time may remain empty until a suitable case comes along. Sometimes the analyst takes a chance and uses these hours for psychotherapy with persons for whom analysis might eventually be indicated. Psychoanalysis is a specialized form of treatment for a circumscribed group of people; innovative ways are needed to match analyst and analysand throughout a career. Developing a steady referral source is dealt with early in a practice but

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must be maintained on an ongoing basis. This is much easier for medical than for non-medical psychoanalysts. This is especially true where medical insurance covers the treatment or a large part of it. Organizing the business aspects of the work of psychoanalysis is necessary to make a good living, as it is in all professions. Unlike many other professional's psychoanalysts' incomes do not significantly increase with experience, especially after a level of practice income is achieved. Many patients in need of psychoanalysis cannot afford full fees. It is possible to treat only a limited number of patients at a time - there are only so many hours in which optimal work of such emotional involvement can be done. Insurance coverage is limited. Unless a psychoanalytic practice is restricted to wealthy people, fees cannot be increased greatly, and they frequently may need to be adjusted downward if people with lower incomes who could benefit from psychoanalysis are to be treated. The psychoanalyst has to set a reasonable fee both for himself and for the patient. Easser once commented to a friend: 'I never felt that what I had to say was worth a hundred dollars an hour,' when she was charging seventy; this was then the going rate, although others, some less senior, with a greater sense of entitlement were charging a hundred or more. Granted, as a woman married to another professional, one might think she could afford to be somewhat less concerned about her earnings. True or not, she would not have appreciated this statement. It would have jarred her sense of herself as an independent woman. A sense of worth about compensation for work and opportunity to increase income is of interest to both men and women psychoanalysts. A male analyst may be the primary and perhaps sole supporter of the family. So, too, a women analyst can be her own sole support or the primary breadwinner. Today, it is the rare psychoanalyst who earns a living through a full analytic practice. Many psychoanalysts, men and women, supplement their analytic income with other work whether psychotherapy, consulting, or other professional activities. A reasonable financial expectation is of help when setting a fee standard. If earning large sums of money, rather than merely making a good living, is important to a psychoanalyst, this will add extra stress to the work. Such an analyst is driven to compete for the wealthier patients, by urges to move to where the 'grass is greener,' to keep a number of prospective analysands on a waiting list for a lengthy period of time, by competitive feelings towards colleagues, or by aggrieved sentiments when referrals are not forthcoming. The judicious psychoanalyst who yearns 'to make money' will attempt to do so outside his or her analytic practice. For at least the past thirty-five years, the analytic fee no longer involves

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only the analyst and therapist. Frequently, third-party payers are now involved. Without third-party assistance, psychoanalysis would be available to few patients, and psychoanalysts' incomes would fall well below those of comparable professionals. Cherished autonomy has been eroded by inevitable intrusions. Money, time, and freedom from scrutiny are no longer privileges. Confidentiality is being threatened. These are issues of concern to the profession, not just to the individual psychoanalyst.24 Aside from this third-party involvement the analytic fee remains a vital part of treatment. Money has both real and symbolic meaning to both analyst and analysand. Even for the psychoanalyst whose aim is simply to make a decent living, concerns about being paid on time, or being paid at all, about earning enough, and about feeling the work is valued are, understandably, prevalent. Analysands, of course, also have reactions to the necessarily high cost of psychoanalysis. It is expensive even when the fee is lowered to what a person can reasonably afford because of the number of sessions and length of time that the method requires. Paying for psychoanalysis is inevitably a sacrifice but it should not be an incapacitating hardship. Necessities of life come before psychoanalysis and this must be taken into consideration when recommending psychoanalysis to someone unlikely to be able to afford it. It happens not infrequently, especially among candidates and young psychoanalysts who are eager to begin a case, that a very low fee is set to make the analysis possible. This can backfire. The psychoanalyst can, despite herself or himself, resent working for a lower fee, and this can adversely affect the treatment. The analysand can undervalue a 'cheap' psychoanalysis or sense the psychoanalyst's resentment. The wealthier patients, who can afford to pay, can arouse other problematic feelings. In an eagerness to engage such a person, the psychoanalyst can be overly accommodating. The analysand may sense the analyst's need and use this in a manipulative way. The practical implications of the fee are further complicated by the interplay of the unconscious meaning of money to both analyst and analysand. One of Ruth Easser's supervisees reported that her 'enormously wealthy and famous' analysand wanted to pay the full amount of his analysis on day one. The meaning of this enactment continued to play out: 'He always paid me some part of his bill, more or less, usually more, and we were forever caught up in the analysis as to why he couldn't manage to hold on to his bill or figure it out and to pay the exact amount. A great deal of the analysis hinged on the power struggle in the transference, exhibited in his behaviour and stimulating countertransference feelings. Insight was gained into the meaning of money to him and to me.'

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The structure necessary to conducting a psychoanalytic practice places constraints on the analyst's flexibility with the family. The rigid time commitment, the long hours, and especially the strict confidentiality contribute to these constraints. Often spouses and children do not understand just what analyst Mom or Dad or spouse does at work and may feel that more time and attentive involvement is given to patients than to them. Feelings of resentment, jealousy, and neglect are not uncommon among family members. The regularity and predictability of a practice, which provides patients with a secure 'facilitating environment,' can also lead to emotional drain. After hours of listening, one's head is full of words, thoughts, and feelings, stimulated by continuous communication and involvement in the mental world of others. After a day's work, the psychoanalyst needs to tune out, to clear one's head. Often spouses can accommodate and wait for their time, but this is more difficult for children, especially for those whose mothers are analysts. 'Mom to Earth, Mom to Earth' is a phrase adaptive kids learn to use effectively. It is not easy to shift gears to listen to one's children, to take a more active, direct role, and to enter a reciprocal interaction. A number of psychoanalysts, especially women, practise in their homes. This has advantages and disadvantages. Children can feel secure in knowing a parent is nearby and doing a kind of work that 'helps other people.' Yet this nearby parent, attending to patients, is not readily available. A senior psychoanalyst recounted his young child's response to the question, 'What do you want to be when you grow up?' 'I want to be a psychiatric patient so I can see my daddy.' Being a psychoanalyst does not necessarily make one a better parent. Psychoanalysts vary in their parenting capacity as much as people who do other work. Psychoanalysts are supposedly more aware of the emotional needs of children, an awareness that can facilitate good enough parenting or increase guilt over parenting failures. Like other working parents, psychoanalysts require the essential help of trustworthy family members, nannies, and housekeepers, who can be counted on with the children. One of Ruth Easser's close friends recounted a vignette of Easser's difficulties as a working parent. One of her children had done something naughty and she took the television away for a significant period. Later, she found to her horror that the maid had let the children watch pornographic movies. She confided to her friend that she realized she was being too strict with the children, as a way of compensating for feeling out of touch with their daily activities. She struggled to be the involved psychoanalyst, to teach, see patients, do supervision, and to be the involved mother.

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As another woman psychoanalyst, Patricia White,25 asserts: 'There is always the feeling of being pulled between the two important worlds, the professional and the personal, with commitments to each that can be allconsuming.' White remembers discussing with a male colleague the problems of finding time to research and write, but also the pleasure in doing so, once one could get going on a paper. He agreed enthusiastically and shared his method, 'Yes, I just sit down at my desk and tell my wife, 'Just put my dinner right here."' To which she could only reply, '"But, in my family, I'm the one who brings the dinner." Oh! He hadn't thought of that.' She continues her reflection: So there's always a balancing act, or to express it in more theoretical language, a super-ego ideal conflict. One should read more, write more, present more papers, attend more conferences. Of course. But one should also have a life, be present for daily living, which is surely what we seek for our patients. It has been important to me that my pursuit of training and practice of psychoanalysis should not interfere with our normal family life. I did not want my professional pursuit to be a liability for those I felt most committed to - my husband and children. I wanted it to do no harm. I think that is a peculiarly female concern. Nevertheless, the enormity of commitment to my patients and to the Institute was also at the forefront. Ours is not work that one dabbles in as a secondary concern. This double commitment is not, for the most part, as conflicted for the male analyst. But for us as women, it is.

This conflict is less intense for men because of what White refers to as a 'subtle form of sexism in analytic societies and institutes. This is manifested in the unquestioning acceptance of the male work ethic. Male analysts work very long hours, often also attend several meetings a week and are willing to schedule weekend events. They are able to do so because their wives at home look after the household, the children, the extended family. No one questions this way of working.'26 As in other professional and work situations, women psychoanalysts with families attempt to balance both - while men can concentrate more easily on work. Interestingly, among those male psychoanalysts interviewed for this book, not one commented on his struggles to attempt such a balance or on what he thought about how Ruth Easser did it or her attitude towards being a psychoanalyst with family. By contrast, every woman interviewee volunteered comments about her own experience and what she knew or sensed of Easser's attitude. Not only was Ruth Easser a woman analyst with a family but she was

124 The Unsung Psychoanalyst also married to a physician-psychoanalyst. In many dual-analyst families the woman was responsible for both home and practice. This was the case in the Easser-Lesser household, although only tiny glimpses into the division of labour and gender attitudes in that family are available. A colleague comments, She was a kind of super woman. While being fully involved in her practice, teaching, and the analytic society, she looked after the children, the household bills, their office billings, she even looked after Stan. Even though he was known to be disorganized about day-to-day matters, he was very nurturing, soft, and gentle. If you saw him interview a child, he was marvellous, like a teddy bear. He was a good person, well liked, very bright, with many interests, in music, in the opera, in nature. He was warm and caring with Ruth, they shared much in their lives together but not the practicalities of life. Comments from friends shed some light on the nature of Ruth's role in the family. Dena recalls: When I say Ruth was not demonstrative, although I loved her dearly, I never saw her being warm, cuddly with the children. She was reserved but an extremely fair mother. When she said she would do something, she would do it. After each child arrived, Ruth went back to work and they had a nurse for a number of months. Beginning with their oldest daughter I would stay with one, then two, then three, then four children when Ruth and Stan went on vacation. They had two other aunts here but I was nearly their aunt and their first sleep-overs were at my house. When they were growing up, Ruth applied too much psychoanalysis to some of the actions of the girls perhaps not always acting first as the mother. She was the disciplinarian. Stanley had a habit. He could sit and read and the house could fall apart. Another friend recalls Ruth telling the funny story. 'Stan was in the back talking to their across-the-hall neighbour, Richard Rogers. He is smoking his cigarettes, oblivious to the fact that Ruth is upstairs trying to put out the fire the kids had set in the waste basket. Stan was like that, oblivious even to himself. He could have different socks on, forget his tie. He was like a kid himself and that's why he was a good child psychiatrist. But he was a good friend.' Dena, as 'a member of the family,' talks about summer vacations at their country house.

Being 125 Ruth would really relax there; it was two months away from work. I learned a long time ago, whoever owned the house was in charge, I would just help her. That reminds me her ex-sister-in-law resented the fact I was so close to Ruth. She used to say, 'Well, you can entertain, you have Dena with you all the time.' We really didn't do that much. She might read. Some time would be spent with the kids, or we would just sit around or visit with a few guests. Meals were simple, whatever she made, she made well but she wasn't a gourmet cook. She might have developed but she never had the time. Her interests were elsewhere. As noted previously, Stanley's mother thought there wasn't anybody good enough for her son, but 'Ruth was not deterred by this. Although not overly demonstrative, Ruth was concerned about his mother. She would remind Stanley to call his mother and she would invite her more than his sister or sister-in-law. Ruth was the one who had his mother's welfare at heart. One time, Ruth and Stan went food shopping when Stan's mother was visiting. She was upset that her son was carrying packages; he was a doctor. To which, Ruth said, "I am a doctor too."' Autonomy and respect for her womanhood were issues with her mother-in-law as well as her mother, both strong women. That a psychoanalyst has attempted to mature psychologically and to understand his or her own inner workings through a personal analysis is no guarantee of satisfactory personal and family relationships. Psychoanalysts are only spouses and parents at home. They face the same successes and failures, pleasures and disappointments, even tragedies as other parents and spouses. In fact, psychoanalytic knowledge and intense involvement in relationships with patients place unique stresses and strains on these roles. It is painful to be aware of a child's struggles, or a child's serious problems. One candidate was taken aback and yet never forgot Easser's effective comment: 'You are speaking about your son as if he were a patient.' Psychoanalysts carry a double burden; a heightened awareness of emotional problems and a realization of their contribution to a loved one's pain. Psychoanalysts also experience helplessness, in that they cannot force a child or spouse to accept obviously needed help. 'Don't analyse me and don't tell me I need help' are phrases often used by family members. The understandable defensive thought 'not my child' can blind psychoanalysts to problems related to family dynamics. Parent-analysts may help others' children more readily than their own. Several psychoanalysts told stories of treatment their children received from Stanley Lesser, a child psychoanalyst whom they

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trusted and respected. They felt fortunate that they had this collegial contact and support within the psychoanalytic family. The work of psychoanalysis and family life impinge on each other. They also inform one another. As Easser comments: 'What keeps one going is that after every massive regression, reinterpreted again as the welling up of intolerable anxiety and tension, the individual who emerges is a more intact, less shallow and more substantial human being than the one before the last go-round. In many ways it is like weathering the storms of parenthood which is worth the tumult, if maturity results.'27Theana-alyst-parent comes to realize that growth takes place in spurts and starts with backtracking, side-stepping, and then leaps ahead. Patience and belief in the growth process are learned through experience. To know this from one's work assists in the parenting role and vice versa. There is no doubt that Ruth Easser had her personal and familial struggles. Yet, it appears that these problems intruded little into the lives of others, whether students, analysands, or colleagues. One colleague remarks: 'I am sure Ruth at times had worries but if she was depressed she never showed it. That was an aspect about her that I felt was dissimilar from some other analysts. I wondered if she had best friends whom she might tell. If her life was troubled, nothing showed on the outside. If it affected her work in any way, you couldn't see it. She was remarkable in that respect, you couldn't tell what she was going through personally.' One of her supervisees feels that Easser 'was loath to distract from the task by anything that would intrude upon it. I was consciously enamoured of her but I didn't know her that well. She was reserved, she was right with you but there was a privacy. When I learned of some of her personal troubles later, I realized they had never intruded into the space with me. Her capacity to turn to the other person was remarkable.' Another colleaguefriend remembers: 'We went to visit Ruth and Stan in their country home with our children who were comparable in age with theirs. In that setting, she was very caring, collegial, and hospitable. They came to visit us in our home and the two families travelled together to a psychoanalytic congress. We shared struggles we had in raising children but we didn't know much about her personal life. Then at Ruth's funeral I learned about a woman friend whom Ruth would talk to on walks together. So there was at least a close friend in whom she confided but she was very careful about boundaries.' Certainly, Easser's analysands experienced her as being focused intently on their concerns. Although they felt her to be emotionally present and open, aspects of her personal life simply did not enter the psychoanalytic space or interfere with her healing capacity.

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Psychoanalysts are not immune to problems in their marriages. It is doubtful whether their marriages are better or worse than marriages of people in other kinds of work. Some thrive, many survive, others do not. Increased self-knowledge can result in marital breakdown with the recognition that choices made by a less mature self were based on the neurotic needs of that time. In fact, reduced neurotic symptoms and improved capacity for intimacy can strengthen the relationship. One senior psychoanalyst comments: 'Analysis never breaks up a sound marriage.' Dena comments on the Easser-Lesser marriage: 'What's interesting is the last conversation I had with Ruth, in Toronto, and I don't know whatever made me say this to her but I said, "Would you have married Stan if he came around now?" She said, "I would have married him but I might not have had children with him."' Stanley's brother comments: 'Stanley said he never regretted what he did, he regretted what he didn't do. It was hard on both of them to raise children, they were so suited to and absorbed in their work and each other.' Social relationships can be more complicated for psychoanalysts than for many other professionals. Friends and acquaintances tend to react in one of two ways. They cluster around wanting informal psychoanalytic insight, or they steer clear, leery that the analyst might see into them. Awareness of unconscious feelings and motivations in oneself and others can rob one of common adaptive illusions, and although they cannot read others' minds, psychoanalysts have to take care to separate work from social life. Some psychoanalysts tend to socialize with each other. Advantages to this include supportive understanding of the depth and rewards of the work, as well as the stresses and strains. Psychoanalysts working in small towns or ethnic communities may not have this advantage and can feel restricted and isolated. For them, the greater chance of meeting analysands socially or in business adds further stress. Disadvantages can come from the arousal of feelings of competition and jealousy and can result in hurtful critical backbiting, as well, as a restriction of social experience. Too much 'bread on bread' deprives one of the stimulation of being with people engaged in other types of life. Socializing with other psychoanalysts raises confidentiality problems, especially for training analysts, who treat candidates-colleagues, and the more senior analysts, who often treat colleagues and their families or others within the helping professions. It can also lead to two-tier socializing, for example, candidates with candidates, young psychoanalysts with each other, training analysts with peers, and senior non-training analysts with their colleagues. Some psychoanalysts may feel left out of the higher echelons

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or the 'in-group' but others have little interest in being included and perhaps experience more freedom to move about inside and outside psychoanalytic circles. They realize that, although they find support in sharing common work interests, as individuals with unique interests, they have little else in common. This is not to say that psychoanalysts do not enjoy each other's company. In fact, when close personal friendships develop, they feel fortunate that the small but worldwide psychoanalytic family has brought them together with congenial people they might otherwise not meet. Was there a professional downside to Ruth Easser's reserve? The overall impression is that her carefully kept boundaries contributed to her psychoanalytic efficacy. Although she had close professional relationships with colleagues, they and students felt a loss of opportunity to know her better personally. Had she not left New York, had she not died prematurely, and once her preoccupation with family lessened as the children grew, more personal relationships with colleagues and former students might have developed. Socializing with former New York candidate analysands would have been less likely. One analysand says that 'by mutual agreement, we didn't socialize. I was at one big party they gave. When I married after my analysis, Ruth and Stan sent me a wedding present. If I hadn't had a working relationship with Stan, this probably wouldn't have happened. Another time, I invited Ruth and Stanley and mutual friends to a dinner party. We all enjoyed it, but the question of whether we would become socially involved never came up.' Another analysand reflects: There's a piece of her I resent and this is my problem. I was rather passive about asking her who she really was, what her life was really like, what kind of a mother she was, what kind of a wife she was. I am not generally a passive person. I was passive in the sense that I assumed she wouldn't answer those kinds of questions. Instead of asking them anyway, and taking them where they might lead, I pretended I wasn't interested. Part of my fantasies have to do with her being formidable, perhaps cold and distant. Was she that way with her kids and her husband and her life? It would have been better if I had challenged my fantasies.

Perhaps Easser's attention to boundaries and the care she took in not allowing her personal life to intrude into the psychoanalytic space colluded with this analysand's inhibited curiosity. Psychoanalysts need to wonder about an analysand's lack of curiosity about them as people.

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Otherwise, inhibitions persist, and a certain distance continues. When this analysand learned of a similarity in their backgrounds, he comments: 'It would have helped if I had known. It would have been nice for me to be able to bond with her in that regard. I had not asked anyone about her, let alone asked her.' Psychoanalysts' relative anonymity about their personal lives is both a protection and a burden. It is a protection in that it allows the analyst to attend more freely to the other person. It also allows for privacy. It reduces the strain of intense emotional involvement on a daily basis with a number of patients. It maintains a personal inner space within which to do the work of analysis - that solitude required for creativity. Keeping one's personal life private provides a haven to which one can retreat and leave work behind. Within that haven one needs close supportive relationships. Although Easser did have such relationships within her personal life, she seemed to absorb a great deal of anxiety, both her own and that of others. Her sensitivity and skill in alleviating the anxiety of others is described by a younger analyst who met her when applying for a position: 'To say I was totally intimidated wasn't far from the truth. I remember her asking things in such a way that I couldn't help but give the right answer. She asked about things that obviously I should have known, and in a way that jogged my memory to talk about it. I came off much better in the discussion mostly due to her kind understanding and sharing. She treated me like a colleague although she was already an analyst of stature.' This same analyst adds: 'She was giving to me personally. I had a lot of misgivings about things and felt I could talk to her. On one of our last visits, she was really jaundiced but she would smile and ask about my kids, about me. She had difficulties in her own life, and her tragic illness, it wasn't easy.' One wonders about the price of being the psychoanalytic healer. This is not to say that a psychoanalyst should not strive to develop the capacity to turn to the other person but to underline the reality that psychoanalysts are not immune to being affected emotionally by their work and need personal nurturance to bear the intensity. To be sure, through psychoanalysis one may relinquish one's neurotic problems only to be faced with the common human problems of life. Psychoanalysts are only too often reminded of their human problems. For example, psychoanalysts can be aware that they work better with certain types of analysands but unwittingly become committed to a 'difficult-forme to treat-or-to-like person.' Self-knowledge does not prevent characteristic reactions from recurring regularly. One interviewee shares this sober-

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ing awareness: 'I went through Ruth's supervisory comments and selected a number which were particularly striking. It was a disturbing experience because I realized that I am still struggling with a number of the problems in treatment now that I struggled with when Ruth supervised me years ago.' The effort to be self-aware, to contain and utilize individual reactions therapeutically, to maintain a private working space and sustaining relationships is a constant for the psychoanalyst as therapist-healer. What of the psychoanalyst as teacher? Psychoanalysts pass their knowledge from one generation to the next in four ways: as personal analysts of candidates, as control case supervisors, as seminar leaders, and of course, through their presentations and writing. Those psychoanalysts who contribute to the literature leave a permanent legacy that speaks for itself. Many effective teachers, however, who have written little and are not widely known outside their own institutes, have a profound influence on the development, attitudes, and practice of their students and colleagues. Traditionally, training analysts hold special status within psychoanalytic organizations. In charge of psychoanalytic training, they administer the institutes. They are the formally identified teachers with multiple teaching responsibilities as analysts, supervisors, mentors, and lecturers who exert a primary influence on candidates. Training analysts and non-training analysts alike teach as seminar leaders in the institutes and provide supervisory consultation for psychoanalysts and other psychotherapists who are not candidates. Ruth Easser became a training analyst at age thirty-two, five years after she graduated. She was appointed by a simple letter from the director of the Columbia clinic, Sandor Rado: 'It gives me great pleasure to inform you that you are authorized as of this date [20 October 1954] to undertake the personal analysis of students and to supervise their prescribed reconstructive therapeutic work. This decision was made by unanimous consent at the Faculty Meeting, Oct. 19.' The process for selecting training analysts at the time was fairly informal. Rado and the executive committee of the institute would decide. In fact, as one contemporary notes, 'there were "few surprises." After four years in class even candidates seemed to agree as to who were the gifted ones, who were not and who would advance in the institute. What they said in class made it evident to others that they had a grasp of analysis.' It seems that the appropriateness of Ruth Easser's appointment as a training analyst was obvious to her superiors and colleagues. It was at a time when the Columbia institute was eager to have its own graduates as train-

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ing analysts. That is, those who had been trained in the Columbia [Radovian] way of thinking. Previously, they had been dependent on analysts trained elsewhere and especially on analysts seconded from the New York Psychoanalytic Institute. Also, just after the war the increase in the number of candidates was proportionately greater than the number of training analysts available to train them, and most institutes were in need of training analysts. Once appointed, a training analyst can begin to analyse and supervise candidates. Again, Easser had the help of a facilitating institute. For practical purposes, at the time, Columbia candidates were assigned training analysts. Assignments were made by the director, in consultation with the chairman of the committee on student selection procedures. They considered the number of candidates per training analyst, estimated the candidate's needs and compatibility, and indicated that 'if there are any problems, let us know.' A similar practice was in place for appointing supervisors. The fee for supervision and analysis of candidates was set by the institute and could not be supplemented. Equalizing the number of candidates per analyst and supervisor also avoided a clustering around 'idealized' or seemingly more powerful training analysts. These policies were facilitating in that new training analysts were formally introduced to candidates and did not have to wait until they were 'discovered.' Today, assigning psychoanalysts is regarded as paternalistic, and candidates are free to choose their own analyst. Otto Kernberg questions, however, the current practice in most institutes of free choice of supervisors: The extent to which candidates should be free to select their supervisors is an open question. Probably a mixture of personal selection and assignment may help candidates to avoid "blind spots."'28 Institutes have to balance the development of training analysts through facilitating their experience in analysing and supervising candidates and promoting free choice. Both practices can be problematic and neither fully resolves what Kenneth Eisold refers to as the 'psychological power of the pair.' He notes that overbounded analytic systems become 'rigid, confining, and authoritarian because the primary allegiances of its members are to the psychoanalytic pairs of which they are part, and to the lineages, the interlocking chains of pairs, of which they are descendants.'29 The most important yet controversial teaching role of the training analyst is the analysis of candidates. Controversial because an analysis by a training analyst does not guarantee a candidate a better analysis. Important because the first responsibility is to conduct a personal analysis - the sine qua non of training.30 The primary obligation is to the candidate as

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analysand. Obligations to the institute are secondary. The candidate learns through the experience of being analysed; teaching is indirect through modelling and identification. Although in the past some institutes required that candidates' analysts report to the training committee on progress in the analysis, most institutes today have a non-reporting policy.31 That is, what goes on between the analyst and the candidate remains confidential and is not part of the student's progress report because the primary obligation is to the analysand. Training analysts also have accountability to the institute and the profession.32 They struggle with concerns about candidates whose problems, of the sort which could interfere with doing psychoanalytic work, become evident during the personal analysis. During Easser's time at Columbia, the function of the personal analysis was not to train the student in psychoanalytic technique, nor to judge the competence of the analysand's theoretical or clinical performance. It was hoped, however, that there would be a high concordance between the student's performance in training and progress in analysis. An analyst would state his judgment of the candidate in general terms of suitability. If an analyst found a trainee 'unsuitable' during analysis, except in rare cases, the analyst would discuss the issues with the analysand, to allow voluntary withdrawal from the program. Even this degree of 'reporting' gave way to full confidentiality so that training analysts now excuse themselves from committee discussion of their candidates' progress and suitability for the field. Training analysis is now a completely private matter between analyst and candidate, in most institutes. This does not erase the analyst's responsibility to consider widi the candidate personal issues which could interfere with becoming a competent and ethical analyst. Given the vested interests of both parties, on rare occasions, this can be a veritable minefield.33 With respect to confidentiality, there is a double standard for analyst and analysand. Outside the analysis, analysts cannot reveal their opinions or even the doubts they have about a candidate's ability to practise analysis, whereas analysands can be as outspoken as they care to be with regard to their analysts. The reputations of psychoanalysts are affected by word of mouth, candidate to candidate. There is strong consensus that, although it is a requirement for training, the primary purpose of a candidate's 'personal' analysis is therapeutic. The challenge for the training analyst is not to confuse the therapist's role with the teaching role. Ruth Easser held the position that a training analysis above all is personal and therapeutic. In an unpublished paper,34 she writes, 'As our requirements of a trained analyst presume the necessity for a full thera-

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peutic analysis in every candidate, we have complicated our task no end.' The dual purpose of a training analysis can be used creatively to achieve this task. In Easser's view, every candidate enters psychoanalysis fully aware of his or her divided goals and usually with knowledge of the therapist's two-fold role. With rare exceptions the candidate has garnered at least minimal available information about the analyst from other analysands, other candidates, and colleagues. The candidate already has a preconceived intellectual notion of how a 'good' analysand should behave. Many a candidate, in the need to form a 'good transference neurosis' finds it necessary to deny extra-analytic sources of knowledge and may further use this denial in the service of resistance to the formation of a true transference. This extra-analytic knowledge of the analyst can, of course, be suppressed and withheld or can be dwelled upon to obfuscate other transference phenomena. Since the desire to obtain a noncontaminated transference may be of equal importance to the analyst, the analyst, too, does not want this analysis contaminated with reality. The patient may be permitted to continue the denial of this aspect of reality and a peculiar collusion can develop. As with any patient, that which is real in the outside life of the analysand has to be sorted out from the unreal in transference but here again, the task is more difficult. In the real situation, for example, the institute milieu, the analysand often feels the need to protect, defend, support, and even flatter his or her analyst. This is not an unusual reaction during a state of regression but it requires of the analyst a greater abstinence from such narcissistic gratification than is the case with a patient who lives and works in a completely separate environment. It is tempting to the training analyst to have loyal disciples and to lead a coterie of them, but the judicious training analyst will avoid cultivating this. To understand the effects of candidates' inevitable extra-analytic contacts with their analysts on the course of analysis, Easser reviews her experience. She proposes that analysands' reactions to such contacts may be diagnostically grouped according to character structure and linked with the nature of their transference. She maintains that responses to extraanalytic contacts can be used effectively to further analysis of character problems. Certainly, resolving neuroses, alleviating symptoms, and facilitating emotional growth and self-understanding are goals of all analyses. It is, however, the character of the candidate that most determines the integrity of the analyst he or she will become. The dilemmas that the training analyst faces (dual role, knowledge of the analyst and analysis, extra-analytic contacts) have changed little since Easser's paper.

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Although training analysts almost never simultaneously assume the role of supervisors, they frequently teach their candidate-analysands in classes and seminars. This is a theoretically questionable but often unavoidable practice. There are some institutes that arrange courses so that those training analysts who are analysing candidates in a particular class are not teaching that class. Most institutes do not have a sufficient number of training analysts to separate the roles of personal analyst and teacher for all candidates. Since Ruth Easser taught 'special technique' at Columbia for twenty years, a number of her analysands were in her seminars. She utilized her classroom observations of her analysands for therapeutic purposes. One analysand comments on the impact of her extra-analytic contact: There are two incidents that I remember about her as a teacher. One, I was trying to get pregnant. I had such irregular periods and never knew when I was ovulating. I walked into class one day having just got my period when I hoped I was pregnant. Later that afternoon, I had my analytic session. I came in and lay on the couch and said, 'Well I got my period.' She said, 'I know.' 'How did you know?' 'When you came into class today you looked very depressed.' I was astonished that it showed, I had thought it would be utterly invisible and that became something for my analysis. I sometimes think of her observing quality because I have a young woman patient who is having a ghastly fertility problem. I can tell when her period comes when she walks into the office to the couch. It is then I remember that episode and use it in my understanding of my patient. The second time was when she was teaching and I looked at her and thought, if I didn't know she couldn't have children (I knew she had adopted children), I'd swear she was pregnant. She was.

These two experiences illustrate the mutually keen observation of the analyst and candidate. This same psychoanalyst gave an even more subtle example of a candidate's intuitive awareness of personal aspects of the analyst despite best efforts to maintain personal anonymity. As a break approached, the candidate unwittingly blurted out her imagined reason for the analyst's time off: 'You're going to adopt a baby.' Easser expressed understandable surprise at how she could know this and at the same time validated the analysand's accurate intuitive observation. Although careful to keep her personal life separate, she did not main-

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tain a false anonymity at the expense of an analysand's capacity to be in tune with, know, and have valid perceptions of her. She used her own observations and the analysand's observations of her to further the analysis. The training analyst's role as an object of identification is exemplified in this vignette. The author, herself an analysand of Easser's, during an interview with a fellow analysand asks, 'I am curious about how you felt about her as a woman with whom you could identify.' The other responds, Til tell you one aspect of her that I have identified with because I haven't had a patient who in one way or another fails to touch on it. I obviously picked up not her pattern of speech, but her voice. She had a very quiet voice and I talk to patients that way. I don't have a strikingly quiet voice generally, as you can hear. But some patients will ask me to speak up. Some of them talk about a soft velvety quality to my voice and that's clearly an identification with her. She had a calm presence and warmth in her voice. I experienced her as womanly, welcoming, and warm with a steady sense of solidity and strength; not macho, just somebody solid.'

The author then comments that she experienced Easser as having a rocking quality, a kind of soothing, secure quality; a sense she was there, would go with her, and it would be safe. The interviewee was sitting in the rocking chair she uses at work. She rocked as she talked, unaware of this identification with her analyst's rocking quality. Both agreed that her soothing quality was not a 'there, there' but a sense that she was walking beside you, supportive and challenging. Clearly, these companion analysands, were re-experiencing affectively internalized aspects of their analyses with Ruth Easser, as well as describing aspects of her as a woman and a psychoanalyst. This interviewee also comments poignantly on Ruth Easser's physical appearance. T always liked her looks and thought she was a handsome woman. She had those wonderful cheek bones and high arching eyebrows. There wasn't any question about her femaleness without being cutesy, that was not her personal style. I remember thinking, I wish when she was an adolescent she had felt better about her height because she had acquired that too tall adolescent slouch. Her posture was unfortunate which always saddened me because if she had stood up and held her head high and said I'm over 6 feet and I'm proud of it, she would have knocked them all dead. She had long since acquired a body posture that

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didn't include that.' Ruth Easser walked tall as a psychoanalyst, but remnants of her early struggle with pride in her womanly stature remained. Access to information about the psychoanalyst outside the consulting room is complicating also for the analyst. Scrutiny by the analysand can feel like intrusion unless a high degree of comfort and acceptance with oneself, 'warts and all,' is achieved. Feelings of competition, envy, pain, and sadness can be stirred up by analysands who may be more talented, have an easier time of it in training, have happier personal lives, or as in Ruth Easser's case, be able to become pregnant with less difficulty and to have healthier babies. Helen Meyers recalls with admiration that Ruth Easser analysed a pregnant candidate while she herself was struggling with pregnancy: 'For women analysts who can't have children or have a defective child and who have pregnant patients, it is a horror. How good a woman you have to be to deal with this.' How Ruth Easser dealt with this challenge can be gathered from her pregnant analysand. The candidate remembers with appreciation the sensitive listening to her joy over the birth of her beautiful healthy child. Only much later did she realize that at this time Easser was struggling with the congenital deafness of her firstborn child. There are rewards particular to analysing candidates. The self-reflection, triggered in the psychoanalytic interaction, promotes the analyst's own personal understanding and growth. When analyst and analysand hold similar interests, values, goals, and experiences professionally this positive impact is intensified. It is edifying for the training analyst to watch candidates grow in skill and understanding of the work and realize their successes partially are the result of their joint analytic work. Just as parents relive their younger years as their children grow, psychoanalysts rework the struggles and satisfactions of learning their profession. Generativity renews commitment and conviction. One's sense of self as a psychoanalyst is replenished. There are also pitfalls to analysing someone in the same profession. The psychoanalyst's need for recognition, even praise, can be more acutely aroused with a candidate than with other analysands for whom there is less opportunity for awareness of the analyst's personal life and less overlap in their professional lives. What psychoanalyst does not want to be thought of as 'excellent,' perhaps better than colleagues? Candidates are in a good position to compare analysts. Colleagues are also in a position to contrast the progress or lack of it by candidates in analysis with different training analysts. Successes and failures can be experienced more acutely with the risk of being the object of competitive envy or jealous criticism.

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Not only are there the complications and rewards of the dual role of analyst and role model, as already discussed, there are also peer issues related to the status accorded to the training analyst. In most North American psychoanalytic institutes, only training analysts can analyse candidates and supervise their control cases. Although this system gives the institute a way of monitoring the quality of the training program and the progress of candidates, it also contributes to issues of elitism and competitiveness and can foster splits between the institute and other society members. Many society members feel that the training analysts have the advantage of a readymade practice because candidates must go to them for analysis and supervision. Within institutes, training analysts can compete with each other for candidates. Or candidates can be prone to seeking out those who seem to hold the reins of power in the institute or appear most popular. However, myths of 'readymade' practices for training analysts and having power are usually just that, myths. Candidates are not that numerous and the issue of power is illusory. Most often, though, where the culture of the institute is democratic and facilitating, quality prevails; training analysts are able to get on with their work and with experience can grow and develop as educators of the next generation. Members of the training committee work together to develop good programs and assist each other when problems arise in their work as analysts, supervisors, and teachers. Each class provides a new learning experience for the institute members, as well as for the society members who, although they do not analyse or supervise candidates, do teach them in seminars or work with them on committees or in other society activities. Non-training analysts also exert much influence on the development of a candidate's professional identity. Columbia was a facilitating institute for Ruth Easser as training analyst and she, in turn, facilitated other candidates. As one analysand comments, 'I know she was very much valued as a supervisor because I remember thinking one of the problems of having her as an analyst was that I couldn't have her as a supervisor.' One of Easser's supervisees notes that Easser facilitated her becoming a training analyst earlier than might have happened otherwise. Another analyst who never became a training analyst feels that had Easser been there at the time the outcome might have been different, in that she might have mitigated a supposed institute bias against women with children. A Toronto colleague speaks of the influence of both Easser and her husband and attributed it to their sense of fairness: 'When it came to voting, they carried a lot of weight. One analyst gave a paper to become a Toronto training analyst. It was a tie vote; one ballot was questionable. They felt that if it was questionable on his side he

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should be given the benefit of the doubt. The decision was in his favour, which allowed him to present another paper and there was no doubt in the second vote.' Supervision of candidates' control cases is the second teaching role of the training analyst. Candidates are required to analyse three cases each under the supervision of a different supervisor. Consequently, candidates have the opportunity to learn from analysts with varying viewpoints, and more members of the training committee than just one are involved in their education. A supervisor is a clinical teacher. Joan Fleming, a Chicago training analyst and an early thinker about the supervisory process, recognized the complexity of this 'creative growth-promoting work that involves both treating and learning.'Just as the analyst indirectly teaches the candidate, the supervisor indirectly treats the supervisee's analysand while teaching the candidate to analyse. The supervisor evaluates a candidate's learning patterns and competence, together with the patient's progress. Fleming describes supervision as an interactive process of communication in which a supervisor and his student enter into an active teaching-learning experience where, without doubt, information is exchanged, mistakes corrected, old habits reshaped, and new skills established; but there is a more creative aspect of the teaching-learning relationship that needs to be cultivated. There is an expanded level of teaching that goes beyond demonstrations which can be imitated or advice which can be followed. What is missing in much supervision is the active engagement of the student by the supervisor in the exercise of the synthesizing and integrative ego functions that make empathic understanding and interpretative interaction possible.

In Fleming's terms, successful supervision necessitates putting observations and interpretations into words that an analytic student can understand. It becomes a mutual learning experience when both supervisor and candidate struggle to find words to answer the reciprocal questions: 'How did you arrive at that interpretation?' and 'Why did you make that intervention?' Active creative supervision increases the candidate's capacity to question, to tolerate uncertainty, and to comprehend the need for an expanding, spiralling evolution of psychoanalytic theory. The supervisor learns as well.35 Easser's approach was interactive. 'Let's see what we can learn from this clinical material, this article, this idea; does it apply here?' A supervi-

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see recalls how she and Easser worked together to understand the narcissistic personality of her patient just as new developments in psychoanalytic theory began to shed understanding on the clinical management of such cases: Easser had just read Heinz Kohut's [the analyst who developed 'self psychology'] first widely available published paper. She was waiting for me with the article and said, take it and read it, I think we have some beginning of trying to understand your patient. She said, it might be a different kind of psychology, but I think there are some good ideas about what is involved in narcissistic character. We had to understand how vulnerable this successful but grandiose man was to narcissistic injury and to think about mirroring, self-object issues. We didn't know much about that but we recognized his exquisite sensitivity. This recognition is what kept him in treatment.

Betty Joseph, a much-sought-after contemporary supervisor, teaches candidates 'to listen with their ears and guts without becoming self-consciously preoccupied with what goes on in themselves or their associations. The physical and emotional ear must be turned to the patient primarily and to the self only as a resonating instrument.'36 Her view has much in common with Ruth Easser's way of supervising. Easser supervised candidates over two decades, from 1955 to 1975. For the first fifteen years she supervised Columbia candidates and during the last five Toronto candidates. Seven supervisees from different periods, through the mid-1950s to the mid-1970s speak about their experiences. These former supervisees illustrate important aspects of Easser's development as a supervisor over the years. When read chronologically they reveal the integration of her maturing psychoanalytic thinking with her teaching method. Moreover, students challenged Easser to focus on their individual learning needs and thereby contributed to her growth, as well as their own. Evident to all her supervisees was Easser's exquisite attentiveness to the precise details of the clinical transaction, not only to what was happening at that moment within the patient but also within the analyst in relation to the patient. Easser saw the therapeutic relationship as dynamic, with the therapist as central guide of the patient's emotional investment within the transference. Easser would analyse the smallest interaction for its intrapsychic meaning without denying the here-and-now reality of the event. She encouraged small interpretations, in plain language, free of

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psychoanalytic jargon. She taught students to work from observation and not preconceived notions of mental health, and thus encouraged openness to new and diverse ideas. Furthermore, she did not hesitate to confront students with their mistakes or to face their criticism of her. Easser engendered respect and thereby taught respect for patients as people, for what psychoanalysis can and cannot do, and for the powerful reverberations of the psychoanalyst's only tools - the use of one's self and one's words. Joseph Schachter, beginning in 1955, was supervised on three analytic cases. From his notes he was able to provide evidence that certain basic principles were integral to Easser's supervisory approach from the beginning. His first case was that of an emotionally isolated, passive young man who was struggling with his sexual orientation. On those occasions when the candidate-analyst was overly supportive, Easser said explicitly: 'You see this man as a boy.' This simple statement contains, in a nutshell, the multiple lessons that are essential when a candidate is learning to conduct an analysis. These are: the core conflict of an analysis can be articulated in simple language that is specific to the analysand; a line of interpretation needs to be consistent with the central theme; and the conflict and a way of helping through understanding can be found in the interaction between analyst and analysand. A patient can free associate, report all kinds of dreams, and the analyst can make theoretically correct interpretations - but the analysis goes nowhere without emotional engagement. Easser emphasizes that it was less important to comment on the content of what the patient said than on the patient's feelings as expressed in the transference. Often the patient's transferential feelings can be deduced from the analyst's countertransference. This man was angry with his father for failing to treat him as an adult and to respect his knowledge. Repeating his central conflict in the analysis, the patient unconsciously induced the candidate-analyst to treat him as a little boy, as his father continued to do. Easser's supervision went right to the core of the problem. Technically, she taught that humour ('poking some fun at his intellectual defences without belittling him') could be used to encourage the patient's expression of feeling. Silence, rather than explanations of dynamics or 'busy' interpretations, can be used to generate an optimal level of motivating anxiety. Interpretative comments have to be specific to the person's core conflict as expressed in his life. Schachter's second case provided a more difficult learning experience. Putting a functioning housewife and mother on the couch unexpectedly precipitated an almost immediate breakdown. Easser had raised the pos-

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sibility that a schizophrenic process could be going on (the sexual confusion of her dreams was consistent with a diagnosis of schizophrenia). She cautioned Schachter to be very careful. When the woman decompensated further and had to be hospitalized, it was devastating for the candidate to have to stop the analysis in favour of more suitable methods of treatment. Schachter learned the importance of accurate assessment, that psychoanalysis can be destabilizing when it is not the appropriate treatment, that it must be used cautiously, and that mistakes can be made. The supervisor's limitations are also underlined. Although an astute diagnostician, Easser could not protect the candidate from this experience. She could only help him understand what had happened rather than blame himself for a 'psychosis looking for a place to happen.' Schachter's third case was that of a less fragile woman, in her twenties who presented with an off-putting manner and unappealing appearance. This patient's life was a mess, replete with relationship problems in her personal and work life. She longed to be cared for and wanted. Yet her sense of deprivation resulting from emotional neglect was expressed as anger with others. Her inappropriate - seductive - behaviour drove people away. Although difficult, her problems proved analysable. This analysand wanted the analyst to like her and help her. Yet she acted as a bad-mannered, vulgar, and unattractive person. Easser encouraged Schachter to analyse this woman's discrepant behaviour towards him as an expression of her fear of positive relationships with others, including the analyst. She helped him call attention to the patient's apparent naivete about the impact of her behaviour. It seemed that her fear of being accepted was greater than her fear of being rejected. Eventually, the unconscious meaning of her behaviour became clearer. To prove that her mother was not a bad mother, she made everybody else reject her as her mother did: Then her mother was no worse than anybody else. Understanding the psychodynamics of a person's behaviour is an important step, but timing of interpretation also has to be learned. Easser advised that it would be better not to pursue the theme of the patient's disappointment with her mother before a long vacation which was about to occur. If the patient had to deal with not getting what she wan ted from her mother and with losing the analyst at the same time, her losses would compound, and at this time further delving into these painful feelings could lead to a depression. Psychoanalysts, like other people, act in ways that are not always within their conscious control. They make mistakes. Schachter once forgot an appointment with this patient. He tried to cover it up rather than admit he forgot. Easser felt it would have been better if he had

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been straightforward and had admitted his mistake. She would not hide behind analytic neutrality, and advised that admitting a mistake allows the patient to explore feelings about that and about the analyst. Psychoanalysis, like supervision, is a mutual endeavour. Schachter learned that, if an analysis is to have an impact, the patient has to work at it. It is better to leave much of the formulations or interpretations up to the patient. For example, if a patient presents a dream and then does not attempt to do anything with it, the analyst could say: 'Are you waiting for me to make an interpretation of your dream; I wonder why you don't think of seeing what you can make of it?' Roger MacKinnon, who was supervised by Ruth Easser shortly after Joseph Schachter's supervision, described Easser as a young bright supervisor, very smart, direct, a rigorous, incisive thinker, sometimes with a sharp edge. Previously, Rado, whom he had experienced as a European authoritarian intellectual professor, had been his supervisor. MacKinnon felt a great relief to have a supervisor who was open, who interacted with him, and who was skilled in teaching a complex concept in simplified and understandable terms. He remembers two supervisory experiences which had an emotional impact on him and his development as a psychoanalyst. Easser told MacKinnon a story about a patient of hers who had medical symptoms. He recalled that 'she analysed her patient's resistance and fears of going to see a medical specialist as the patient's wishes to be rescued by her. The patient still did not go to the specialist. Finally, Easser said to the patient, "We are not going to have any more sessions until you have found out what is wrong with you physically." Then she said to me, in a dramatic way, 'That was the end of the analysis!" She thought that the patient's health and life had to come first. In thirty-five years of doing analysis, there were many times when I did something "heroic" for the overall well-being of the patient. The permission to do that was obviously communicated through that story. By today's standards, this non-analytic intervention would not ruin the analysis. It is called an action interpretation for someone for whom words have lost their meaning and only actions count. It is now considered possible to analyse the patient's responses to that strong gesture of rescue.' MacKinnon contends that Easser did not realize the impact that story had on an impressionable young trainee. He reflects: Educators often tell stories to students but often fail to consider their influence. Psychoanalysts often think this isn't a patient, so it is acceptable to relate an experience without considering its meaning or why this student is

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being told this story at this time. Easser's story would have been even more useful to me if she had discussed the meaning of that departure from what was then standard technique as well as why and what was her evidence that this intervention would preclude more analysis taking place. Did she continue to intervene like that with other patients? Did this particular patient stop psychoanalysis or was she referred to someone else? That was a discussion that candidates did not feel safe in having with supervisors in those days. They questioned little and tended to be guarded in what they told supervisors.

Easser would have welcomed MacKinnon's questions even though she had not offered an explanation. She did not hesitate to confront students with their problems or to face their criticism of her. Towards the end of MacKinnon's supervision Easser addressed a difficulty she had with his readiness to graduate. She listened to his disagreement with her views, discussed their misunderstanding within their interaction, thought about his perspective, and changed her mind. Through this experience he felt he learned how to deal with students in difficulty and to accept negative reactions without retaliating. Not only can candidates be satisfied students, admiring of their supervisors. Supervisors, too, are stimulated and derive satisfaction from their relationship with candidates. Such was the relationship that Ruth Easser had with Robert Michels in the mid-1960s. Their work together was enhanced by a mutual admiration, a meeting of like minds. Helen Meyers remembers that Ruth Easser deeply admired Robert Michels. At one of the Auden House meetings Easser had been sitting and talking to Michels. 'When Bob left, she said, "God, he's got a beautiful mind."' Meyers goes on to reflect on the affinity this supervisory pair enjoyed: 'Bob is very clear and he is very, very bright. Mainly he's a very incisive thinker, he expresses himself well. She liked to hear him talk and think out loud. She wasn't as quick as Bob, as verbally challenging or as cleverly funny. But she could appreciate him as he thought very much in her line of thinking. His clarity was something she had and that she could appreciate in him. It is inconceivable that she could appreciate him that much without him appreciating her.' Indeed, Robert Michels does appreciate her. As Michels explains, supervision was enjoyable because of Ruth Easser's clinical focus and way of teaching useful analytical 'tidbits.' She taught him 'all sorts of pearls' which he finds himself continuing to use. He feels she helped him formulate clinical principles that way. She also taught the relationship

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between diagnosis and technique. Michels has a vivid memory of the patients Easser supervised. They were 'male hysterics and she taught an in-depth understanding of hysterical emotionality.' Seemingly atheoretical, Easser's central guide was 'exquisite attentiveness to the way and the reason why the patient was relating in the context of the transference and countertransference within which the analytic work was done. This theme has become more powerful in analytic writing since then but was clear in her thinking from the beginning.' By the late 1960s, when Anne Bernstein was one of her supervisees, Easser had expanded her way of thinking and working to include the analysis of patients not previously considered analysable, and Bernstein learned how to handle narcissistic injury - a relatively new analytic concept at that time. They worked at understanding how terribly sensitive her patient was to such injury in the psychoanalytic situation. Bernstein began to understand that the patient felt misunderstood, rebuffed, and rejected in even very small ways. Easser told her, 'You have to go back and talk about this because otherwise he is going to build this up and you're going to be the recipient of the negativity that this man feels and eventually he will leave treatment.' According to Bernstein: She understood this process even when people weren't yet talking in those terms. Others would say that is interesting, but it is not classical analysis. Once during a session on an especially warm day, I twisted my hair and put it up. When my patient got up off the couch and looked at me he became enraged. He hated women who tied their hair up; his mother did her hair like that. Easser pointed out that I could have come to the session in a Batman suit. If it didn't happen to key into one of his invested areas, it didn't matter. It didn't matter so much that he would manage to walk across my feet without noticing as though I was a piece of the carpet. Both his hypersensitivity (to perceived injury) and lack of sensitivity (to his effect on others' feelings) had to be analysed. So behaviours that I might have ignored because it didn't seem purposeful became major instruments of understanding.

George Boujoff was supervised by Ruth Easser almost twenty years after she had supervised Joseph Schachter. Whereas Schachter gleaned the basic principles of analysis from his case supervision notes, Boujoff speaks of how, in addition to basic principles, he learned from Easser a particular conceptualization of the psychoanalytic process. Consistent with Schachter's observation and that of intervening supervisees, Bou-

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joff identifies her prime focus as being on what was happening between the patient and the analyst. As Schachter comments, she had foreseen in the 1950s that conceptualizations of the psychoanalytic process were bound to shift from the intrapsychic one-person focus that was then standard to an interpersonal-interactional two-person emphasis. By the 1970s object relations theory had come to the fore. Boujoff feels Easser helped him 'understand the patient-analyst interaction in terms of real, or wished for, or absent object relationships, the relationships that were, should have been, or might or could have been.' She broadened his capacity to observe clinical material from the perspective of both analyst and analysand, to think about his observations, and utilize them actively by linking the patient's current behaviour vis-a-vis the analyst with past relationships. Whereas Boujoff s first supervisor 'insisted I be virtually mute for a year, Easser encouraged me to speak to the material, to use it to translate knowledge for the patient. In other words, to bring theory to life by connecting it to the material, not talking theory but rather using it in relationship terms.' In contrast to the then-traditional stance of the relatively silent analyst, who leaves the transference alone if it does not seem to constitute a resistance, Boujoff feels Easser made the transference a living thing by actively making connections between the present and the past. She also helped Boujoff become more comfortable with countertransference, particularly to attribute his reactions and feelings not only to himself but to consider what the patient is doing to generate those feelings in him. Easser's tolerance taught him empathy for himself and to utilize whatever was going on within himself to help analysands understand themselves. Although Easser made a clear distinction between what the supervisee had to deal with in his personal analysis and in the supervision, she would not hesitate to suggest that a candidate's reaction had more to do with the candidate than with the patient. She said this in such a way that the candidate was not offended. As a result, Boujoff holds the opinion that it is legitimate to say to a candidate: 'You know I think some of your reaction to your patient is coming from you and maybe you need to look at that. We don't have to get into what is behind your reaction but it could be helpful if you did in your own analysis.' It is also legitimate for a training analyst to say to an analysand, 'I think you have got some problems about this vis-a-vis patients,' and maybe to say to the training committee, 'This candidate has some difficulty in this area.' Boujoff realizes that analysts differ about the extent to which there is a crossover between supervisory and analyst roles. He also feels that he learned from Easser

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that training analysts make judgments about how they are going to function within an institute milieu. Easser would not hesitate to comment either to supervisees or to analysands that personal issues were affecting their work. She did adhere, however, to the non-reporting policy for training analysts in regard to their candidate-analysands even when she disagreed with decisions made by the training committee. Easser influenced Boujoff in another specific way. Boujoff chose Easser as a supervisor because he wanted to learn about 'emotional life from a woman's perspective.' He explains: Men have a way of seeing things in defensive terms such as 'getting perspective,' meaning control, denial, minimization, adaptation, and so on. She made me aware of the tendency of the male analyst to employ those defences to stifle patients or to get them to adapt to a situation, rather than to express themselves and understand their feelings. She helped me to accept a patient's discomfort. Some male analysts are extremely uncomfortable with affects. That I work comfortably with different affects is due in no small measure to her influence. She didn't try to talk people out of how they were feeling but to understand their feelings in relation to their development.

Easser's explanation of 'emergency affect' - an expression of intense feeling by which it is so flagrantly obvious that a person is firing off a cannon to keep himself from feeling helpless - remains meaningful and useful to Boujoff these many years later. Both training and non-training analysts teach as seminar leaders. What is their impact on candidates' formation as psychoanalysts? Candidates appreciated Easser as a seminar leader because she came to class prepared and was focused, clear, and articulate in her presentation. Douglas Frayn met Easser for the first time in a continuous case seminar that she was conducting. When she came into the room, she had a lovely smile which put me at ease. She was a formidable-looking woman with imposing height. At first glance she was not an attractive woman but after working with her for a time, she was beautiful. That was her presence. She had a charm about her a quality that only certain women, no men, have. There was something delightfully feminine about her. Yet she could manage a group of competitive men with no ambiguity as to who was leader. She made it very clear. She never seemed to get flustered, nor did she have to play the tough person. Yet you knew that what she said she meant. There was never a problem as with some other instruc-

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tors. There was a fair amount of rebellion in our class. She had no problem with that because she conveyed that she knew what she was doing. She was very fair.

Frayn compared her to Clifford Scott, a leading Montreal analyst — and founder of psychoanalysis in Canada upon his return from twenty-five years at the Maudsley Hospital in England - who was curious about what candidates thought: 'People like Ruth and Scottie learned from us. It is helpful to a student to see a teacher learning as you learn.' Frayn's experience with Ruth Easser in the classroom was primarily as the leader of his continuous case presentation of a mostly silent analysand (previously mentioned) who often communicated through borborygmi (stomach rumbling). Candidates also receive individual supervision for the same case they present in class. Frayn found his supervisors differently supportive and helpful: 'Ruth had an imaginative process which encouraged me to explore my own fantasies. Elly [Elliot Markson] was helpful around practical issues. For example, technical parameters should not be used to accommodate a patient's different lifestyle. Both of them listened very well. Both were open to innovative ways of working with a patient who didn't talk.' Whether as personal analyst of candidates, supervisor, seminar leader, or consultant, Ruth Easser allowed students to experience her according to their individual developmental needs. Two of her well-known students, Robert Michels (an outstanding medical and psychoanalytic educator) and Daniel Stern (a leading researcher into the preverbal interpersonal world of mothers and infants), illustrate this quality. Michels's experience with Easser was intellectual: 'I was in love with her mind. Her mind was brilliant; she was able to illustrate and model both her way of thinking and her sensitivity.' Stern had a visual learning experience: 'I fell in love with her face. Very simply, it was the way she walked into the room, sat down, and looked at us. She was very authentic.' Stern's visual image integrates Easser's personal self with her professional self as the teacher: 'Ruth was a strange creature, so birdlike, tall, thin. I thought she was beautiful. I was always fascinated by looking at her. In class she showed herself as a person like everyone else. She had a peculiar ability to be a woman, not hold it back or push it. She was a bit timid but with us, it didn't get in her way. I can see her; I know exactly which classroom it was. I can see her wearing a sort of rust-coloured suit. I have no idea if she ever really did. The colour wasn't too strong but it wasn't so faded out that I still knew it was red. She commanded the utmost respect.'

148 The Unsung Psychoanalyst Stern continues, Both she and Dr Lesser were less intrusive and aggressive than most of the other teachers. Many of the teachers can be very threatening at that point in your career. Some try to interpret as well as evaluate. Ruth and Stan were not threatening in that way. They were considered very special, both individually and as a couple. They had a certain amount of magic in our minds. They were like stars in the firmament. For me, she was part of a spirit of having the freedom to challenge what were then the prevailing views. Like Ovesey, the other best example, she was one of the free-thinking group, part of the intellectual enterprise to see things in a different light, to turn them this way and that. Ruth and Ovesey were the two who were really doing that in an important way. That was probably the best thing at Columbia. She was part of that. When I think of Ruth Easser, I don't think of any of her papers. I don't think of what she taught. I think of her attitude towards psychoanalysis, of her spirit. I see her face.

Psychoanalysis is primarily a solitary clinical endeavour. However, as well as practising analysis and teaching, psychoanalysts are also collaborators. Psychoanalysts often plan courses and teach and write together. Although many articles in psychoanalytic journals are single authored, in contrast to papers in the general psychiatric, psychological, and biological literature, psychoanalysts do form scholarly collaborative relationships. There are notable psychoanalytic soloists but most are not without partners or a 'corps' in the background. Collaborations within the profession for scientific purposes may take the shape of pairs, small groups, or larger teams for more extensive projects. One well-known pair, Jacob Arlow and Charles Brenner (their names often are said together automatically) has recently written: 'Collaboration with peers and with teachers on theoretical and technical problems in psychoanalysis has had a decisive influence on our development and thinking as psychoanalysts. Collaboration has been a sustaining and continuing dimension of our careers.' They note that this was collaboration in the true sense in that they would be hard pressed to say which idea was whose and that along with mutual respect they brought different talents, perspectives, and temperaments to their joint work.38 Other past examples of psychoanalysts working together, evident in the literature, include the team of Heinz Hartmann, Rudolph Lowenstein, and Ernst Kris, and the productive groups around Anna Freud and Melanie Klein. More recently the respective teams of John Bowlby, Daniel Stern, and

Being 149 Peter Fonagy have made major contributions to psychoanalytic theory in the areas of infant development and attachment. Throughout her career, to varying degrees, Ruth Easser worked collaboratively with other creative thinkers, giving and receiving stimulation and support. She began with the secure base of her sound theoretical and technical training. She continued to enjoy the support of the Columbia institute and society. A public record of the kind of stimulation, challenge, and support she would have received as a member of Columbia's Psychoanalytic Society, the Association for Psychoanalytic Medicine, is contained in their Bulletin. Summaries of members' scientific presentations, thinking, discussions, and debates about psychoanalytic issues and developments are documented from the beginning. Further documentation of the intellectual atmosphere at Columbia during Easser's time is contained in two books, one commemorating the tenth and the other the twentieth anniversary of the psychoanalytic centre, and in a third book for the fortieth anniversary which discusses subsequent developments. Easser was an active, even influential contributor as a presenter, panel member, discussant, and as a member of the audience whose comments are recorded. Ruth Easser's early articles involved collaboration in the usual formal sense of a group of people working together on a research project on the psychological correlates of amenorrhea. Her next collaborative work and joint publications, which took place during the late 1950s and early 1960s, include The Evaluation of Ego Strength: A Profile of Adaptive Balance' and The Adaptive Balance Profile and Prediction of Early Treatment Behaviour.' This work was not published in a psychoanalytic journal but in the Journal of Nervous and Mental Disease. Psychoanalytic journals were not yet considering 'research' articles as psychoanalytic scholarship, no matter how much they were based on psychoanalytic concepts. There were few psychotherapy journals in the 1950s and 1960s, and empirical psychotherapy research, just beginning, would not take off for another ten to fifteen years. Other reasons why Columbia analysts were not being published in psychoanalytic journals had to do with the war of the 'frames of reference' and the fact that they were regarded as being on the fringes of the psychoanalytic establishment. Lionel Ovesey was one of the first revolutionary Columbia-trained analysts, and he notes that, because relations with the American Psychoanalytic Association were not good, 'they were set on making me a second class citizen. They would not publish our papers. Rado sent a paper in and they refused it. Everything I published in those days was done outside the American or international psychoan-

150 The Unsung Psychoanalyst alytic journals. I taught analysis, I knew how to practise analysis, but I was also interested in the shorter term therapies, the marital therapies, family therapy and behavioral therapy. If you hear anything about me from classical people, most of them would say I was not a real psychoanalyts.' The orthodox psychoanalytic world was highly critical of his now classic book Homosexuality and Pseudohomosexualitf9eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee formulated his theory within the framework of Rado's adaptational theory rather than that of ego psychology and the work of Heinz Hartmann, David Rapaport, and similar others.ee Columbia's fight with the mainstream psychoanalytic world made it more difficult for die early graduates to publish or to make their ideas known widiin the profession. Several of Easser's colleagues feel that some Columbia psychoanalysts chose to write on controversial issues, to present 'shocking' views in argumentative styles. Did they avoid die mainstream journals and reject die establishment perhaps before they could be rejected? Identification and allegiance to Rado also played a role. Rado's and Ovesey's style was not Rudi Easser's style. She was not argumentative or confrontational. Although she bore the stigma of being from a nonestablishment institute, her nature was not rebellious, nor did she stress being in or out of the mainstream. This early ostracization of the Columbia group had two effects: productive collaboration within the group and inhibition in psychoanalytic publishing. As with many analysts, the reasons Ruth Easser did not publish earlier and more often were both professional and personal. Arnold Cooper describes the professional institutional contribution to this paucity of publications: No one at Columbia was way out psychoanalytically except for Sandor Rado. By the time we started the Ego Strength project with Karush, the people at Columbia were taking a fairly standard ego psychological structural point of view. Jacob Arlow chastised us for using libido theory too much. I think one of the errors of Columbia was that many of us lacked the courage to really follow through with what were Rado's insights. His insights emerged later as aspects of self psychology or were incorporated in Sandler's work. Joseph Sandier was a professor with us in the 1950s and arrived independelty at what Rado had arrived at earlier. The interest in attachment and differentiation, in safety and adaptive defences was also Radovian. Rado was a pioneer but he was so angry with the analytic movement and analysts that to stay an analyst one had to separate from him which handicapped Columbia as a prioneer institute. It started out to be a good thing, after all we had great leaders, but we failed to develop, we let others come through with the

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discoveries. Ruth participated in that willingness to hold back a bit to be part of the analytic group rather than putting forward too forcefully the ideas of Rado and Kardiner. She was accepted, her work was acceptable within standard analysis whereas Lionel's was not. She moved towards the mainstream.

Psychoanalysts can also be clinical scientists and writers. Eric Kan del, the Nobel laureate neuroscientist, considers psychoanalysis 'the most coherent and intellectually satisfying view of the mind,41 and that during its first half century, 'psychoanalysis revolutionized our understanding of mental life. Although psychoanalytic thinking continued to progress, there have been relatively few brilliant new insights, with the possible exception of certain advances in child development.' John Bowlby's work on attachment theory, Mary Ainsworth's studies on infant attachment patterns, and Mary Main's development of the concept of internal working models in adults, as well as the work of Daniel Stern on affective development in infants and maternal attunement, and Peter Fonagy's research on affect regulation, mentalization, and self-development are current examples. Kandel argues that 'psychoanalysis has not evolved scientifically. Specifically, it has not developed objective methods for testing the exciting ideas it had formulated earlier.'42 That psychoanalysis lags behind in research methods does not in itself negate it as a scientific discipline engaged in cross-fertilization with related disciplines. Olds and Cooper address this consideration: Psychoanalysis, from its very beginnings has greatly valued what we could learn from and what we could contribute to other areas of knowledge and discovery. Creative ideas often come from such cross-fertilization, and it is inherent in the nature of science to be refreshed by discoveries from other disciplines. In the past our mutural interactions with anthropology, literature, linguistics, sociology and history, as some examples, have enriched both disciplines. Currently, advances in neuroscience and cognitive sciences have aroused new interest in the exciting possibility of developing the study of mind-brain relationships and interactions. Freud himself was an early pioneer in biological interdisciplinary study, and we are reminded that he gave up this line of inquiry in part, at least, because neuroscience had not reached the point where such a project could be fruitful.43

Furthermore, Olds and Cooper recognize that 'most analysts today would accept that psychoanalysis is a particular branch of psychology, focused

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on psychic conflict, unconscious mental functioning, and aspects of development, with a special emphasis on object relations, affects and mental representations.' Most analysts agree that psychoanalysis is not a science in the sense of the natural and biological sciences with an experimental method of investigation that legitimizes it as such. In the early years, psychoanalysts could and did make useful and original contributions to our understanding of the mind by virtue of the method of listening to patients, or by testing in observational studies, ideas that emerge from the psychoanalytic situation. Nevertheless, as a research tool psychoanalysis has exhausted much of its original investigative power in the view of many scientists, including some psychoanalysts. Yet many believe that psychoanalytic scholarship can continue to be fertile. Psychoanalysts' primary contribution to the 'science of the mind' has been through a particular kind of scholarship most often based on single or several case studies. Their data are clinical experience; their methodology consists of intense listening to the minutiate of what a person says to understand its unconscious as well as conscious meaning, of attempting to understand the intricacies of the person's inner world. They conceptualize its meaning to build a particular theory of the mind. Kandel is of the view that 'one hundred years after its introduction, there is little new in the way of theory that can be learned by merely listening carefully to patients. We must at least acknowledge that at this point in the modern study of mind, clinical observations of individual patients, in a context like the psychoanalytic situation that is so susceptible to observer bias, is not a sufficient basis for a science of mind. Traditionally, psychoanalysis has been far better at generating ideas than at testing them.'44 It was, indeed, the generation of ideas that made psychoanalysis such a vibrant if ambivalently regarded contributor to scientific thought in the late 1940s, throughout the 1950s, and into the 1960s. During this period the development of neuroscience was hampered by huge methodological and technical gaps: neurologists could do little but clarify syndromes, neuroradiology was in its infancy, endrocine studies were promising but the neurohormones were not well understood, and only electroencephalography promised to shed light on the brain-mind interactions. Psychoanalytic hypotheses derived from clinical observation and the psychoanalytic promise of an overarching theory of mind provided hope that a variety of medical illnesses and pathophysiological processes might now be understood. Conditions as diverse as high blood pressure, peptic ulcer, hyperthyroidism, rheumatoid arthritis, and even cancer were thought by some to be responses to unresolved mental conflicts

Being 153 and mediated by unconscious processes which psychoanalyst might elucidate. Psychosomatic medicine was a major focus in Columbia's department of psychiatry. It was in this climate that Ruth Easser's scholarship as a clinical scientist began. Indeed, Columbia's program was offered by the Psychoanalytic and Psychosomatic Clinic for Training and Research. Careful reading of Easser's work reveals that she developed her own synthesis of what she observed. She articulated her conceptualizations primarily in her teaching but also in her papers. Easser was, in the best sense of the term, a clinical scientist. As such, she worked neither as an empirical investigator, nor at the level of theory building but as a bender of theoretical and technical paradigms, to advance psychoanalytic understanding and therapeutic effectiveness. The written legacy of Easser begins in 1954 with two papers on psychological correlations with secondary amenorrhea, both published in Psychosomatic Medicine. In a nutshell, these papers contain the framework within which Ruth Easser's way of thinking evolved. Psychoanalysis for her is firmly grounded in a biopsychosocial model of development, a multidisciplinary approach, and an attitude of scientific inquiry. Easser's first co-authored paper45 is a report of a research project conducted under the leadership of George Daniels with colleagues from the departments of psychiatry and of obstetrics and gynaecology and the Sloane Endocrine Clinic, Columbia University. Daniels, a founder of the Columbia Psychoanalytic, and a psychoanalytic pioneer in psychosomatic medicine, was one of Easser's mentors. Their research reflects the scientific view of the time — the understanding of the mind-body relationship of James Cannon and Hans Selye, Adolf Meyer, and Sandor Rado. Daniels and his team were cognizant of the advances occurring in die study of physiology and psychology, and they attempt to link psychoanalytic understanding with changes in neurohormonal status and the autonomic nervous system. When many psychoanalytic writers veered away from careful observation to make sometimes wild speculations about the unconscious origins and symbolic meaning of psychosomatic symptoms, this Columbia group attempted to be systematic and objective. Their cautious conclusions are based on comparisons with normal and psychiatric groups, laboratory data, and careful clinical observation of the interaction between the physical and the psychological, the latter as revealed in the psychotherapeutic process. The mindset of this research team forms the background for Easser's case study illustrating psycho-hormonal interrelationships between

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amenorrhea and psychotherapeutic progress. Easser places the problem of amenorrhea in the context of normal emotional reactions to menararche and menses, as well as distortions of these attitudes, and raises questions about the relationship between emotional attitudes and hormonal levels. Her psychodynamic formulation in clear, non-technical language brings alive a young woman's inner and outer world, her sociocultural life experience and attitudes, her emotional and physical condition, and her current functioning, as well as the influence of familial and other relationships on the development of her sense of herself as a woman. Easser notes that during therapy as the young woman's emotional conflicts progressed towards mature femininity and sexuality, with a concomitant increase in hormonal levels and a return of her menses, her ego integration became threatened. Easser asks whether the therapeutic relationship and the changes in the patient's adaptive functioning may not have influenced the rise in hormonal levels. Conversely, the hormonal rise occurring spontaneously may, in turn, have affected the emotional balance of the patient. She recognizes the danger to some patients' ego integration to use hormone therapy or psychotherapy without exercising great caution. Moreover, symptoms can be adaptive and protective against further breakdown. Therapeutic technique needs to be tailored to a person's level of psychological development as well as the realities of a person's situation. The theme that psychotherapy and psychoanalysis have their limitations and that therapeutic fervour can be harmful is developed in Easser's later papers. Most importantly in this paper Easser recognizes that symptoms do not necessarily reveal underlying ego organization. This theme is well developed in her later papers on hysterical personality. Between 1948 and 1953, while a psychiatric consultant for obstetrics and gynaecology at the Columbia Presbyterian Hospital and the Sloane Endocrine Clinic, Ruth Easser participated not only in research on amenorrhea but also worked (with Henriette Klein) on studies of habitual abortion, hyperemesis in pregnancy, the effect of the unconscious meaning of pregnancy on its course, and subsequent attitudes to the mother role. Although her early papers are not published in psychoanalytic journals, Easser's psychoanalytic career was furthered by work with experienced psychoanalytic researchers such as George Daniels, and she had the opportunity to work collaboratively with medical researchers in areas other than psychiatry and psychoanalysis. She did publish in the first few years after graduating, and she learned the importance of making empirical data clinically meaningful. This reinforcement of her

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approach at this early stage of her career laid the groundwork for her period of productive creativity which began about eight years later. A second opportunity for collaborative psychoanalytic research presented itself in the early 1960s. This was the 'adaptive balance' project. From it came Ruth Easser's next two papers, ten years after her first publications. The first was published in the Journal of Nervous and Mental Disease46 and the second in Columbia's twentieth-anniversary book.47 Begun in 1959, the project studied change in adaptation among clinic patients treated by psychoanalysis and psychoanalytic psychotherapy. The research and resulting publications are the collaborative work of Aaron Karush, Ruth Easser, Arnold Cooper, and Bluma Swerdloff. George Goldman, at Columbia's twentieth-anniversary symposium, described these researchers as young Columbia analysts who wanted to find their own way and establish their own identity influenced but independent from Columbia's founders. Their first publication reports on the development of a psychotherapy outcome research scale, called the Adaptive Balance Profile. The second paper utilizes this scale in an attempt to predict early treatment behaviour on the basis of personality profiles. The work rests on several basic assumptions: that successful psychological adaptation is a reflection of ego strength; that ego strength is an important determinant of behaviour in treatment and of treatment outcome; and that intuitive assessment of ego strength commonly employed by psychoanalysts can be reliably objectified and standardized. On the basis of clinical data, Easser and her colleagues contructed a personality profile organized along a series of nine 'adaptive balances.' Each dimension reflects 'a critical aspect of the multifaceted quality which is called ego strength.' The nine dimensions of adaptive balance are dependency, general pleasure, frustration, affect, defences, emergency emotion, guilt, pathology, and social integration. This collaborative research experience contributed to the development of improved clinical technique on the part of all participants, including Ruth Easser. In this connection, Arnold Cooper comments: 'We all learned by working on this project; it sharpened our ideas as to what clinical data are important to collect in the initial assessment. Considering people in relationships and their adaptations is more interesting than diagnosis of pathology and outcomes.' Cooper reminisces about his collaboration with Easser and the eventual fate of this work: 'Ruth was part of the team of researchers who worked on the adaptational scale. The ego strength scale was Aaron Karush's project. The core team included me, Ruth, and Bluma Swerd-

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loff. There were others including Stanley Lesser who helped to interview subjects. Aaron was the true intellectual leader and major force in the project. He had some scientific background and knew about scale construction. I also had some scientific training. I don't recall what Ruth's scientific background was but she was a full participant.' Cooper raises two issues that commonly interfere with and restrict psychoanalysts' scientific work: 'What happened was that the scales we developed were good scales, even today. It was a workable idea. Our subject numbers were not bad. We were approved for a National Institute of Mental Health grant but were unfunded. The project had reached a level of complexity that a statistician and computer time were needed. I was beginning to be less interested since it was very time consuming without some kind of support - I had young kinds and so on. I'm not sure what happened to Aaron and Ruth but the project just seemed to stop. No one had the energy to do more interviews.' Today, many psychoanalysts lack either the research expertise, the consultants, and/or the financial and technical resources or a facilitating institutional setting required to engage in increasingly sophisticated mind-body investigations. The demands of personal and family life combined with the emotional and intellectual energy required for the practice of analysis continue to make it difficult for analysts/clinicians to be researchers as well. The fate of Columbia's adaptive balance study is not dissimilar to what had happened to the psychoanalytic 'science of the mind' by the 1960s. Kandel explains that 'as the limitations of psychoanalysis as a system of rigorous, self-critical thought became apparent, rather than confronting these limitations in a systematic, questioning, experimental manner, and perhaps rejoining biology in searching for newer ways of exploring the brain, psychoanalytic psychiatry spent most of the decades of its dominance - the period from 1950 to 1980 - on the defensive. Although there were individual exceptions, as a group, psychoanalysts devalued experimental inquiry.'48 Columbia analysts were among the exceptions. The Adaptive Balance Profile is important for several reasons. First, the profile is an early attempt to construct a useful, valid, and reliable scale that could move clinical evaluation beyond die intuitive conclusions of individual psychoanalysts and provide 'objective' predictors of patient behaviour. In this way it anticipated the development of subsequent scales by psychoanalytic researchers such as Louis Gottschalk, Lester Luborsky, David Malan, Mardi Horowitz, and others. Second, it served as a springboard for the Columbia Records Project, led by John Weber which is one of the largest

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studies of the outcome of psychoanalytic treatment and factors associated with outcome.49 Third, it is an exception to the tendency among many psychoanalysts to denigrate research and the biopsychosocial model as irrelevant to psychoanalysis. Although the initial group did not continue their work on this scale, this early collaborative experience integrating adaptational theory with ego psychology exerted considerable influence on the evolution of Easser's way of thinking and working. In four unpublished papers written between 1962 and 1968,50 Easser addresses issues pertinent to clinical practice, thereby engaging in what might best be described as clinical scholarship. Written during what would have been the height of her teaching at Columbia, these papers communicate her ideas about psychoanalytic issues, and they are of continuing relevance. Over the years her thinking in these areas has proved useful to other psychoanalytic teachers. Judith Schachter uses the 1962 paper 'Indications and Centra-indications for Reconstructive Analytic Treatment' to teach analysability. She explains its usefulness to her: This is a rich paper because the criteria for analyzability are attached to people's lives, their behavior and their use of affect. In it Ruth says that if the patient's perception of the family of origin has not changed during the analysis, then the patient hasn't made any structural changes. This fits in with Arnold Modell, who later considered neurosis an impairment in the ability to revise experience in the light of greater ego strength and knowledge of the world.51 When a person is able to revise then he or she does not remain neurotic but is able to move on. That is what Ruth considers a successful analysis. She also says those with a Proustian memory really can't be analysed. I agree that if a person has this marvellously composed memory which includes the smells and the minute details of the experience, this is very hard to handle because it's so complete, there is little need to shift anything.

Eassers's views are also akin to those of her contemporary Ernst Kris, who writes of the defensive use of personal history when it becomes a 'personal myth which, as all living myth, extends from the past into the present.'52 One of Easser's other roles provides an additional stimulus for this and three other clinical papers.53 As director of patient admissions at the Columbia Clinic, Easser's impact as a teacher, supervisor, and clinician increased. The Schachters' point out that patients would be interviewed by the psychiatric residents who were often also psychoanalytic candidates. At the time, Columbia referred to psychoanalysis as reconstructive

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therapy and psychotherapy as reparative treatment. According to Joseph Schachter, 'Ruth would read all the assessment interviews, with supervisor notes, and decide which patients were suitable for psychoanalysis, under what conditions. In a sense, she was secondary supervisor. Studies have been done that suggest that the person who reads the reports gets a better view of the patient than the interviewer. She got the range of psychopathology and an overview of who did well and who didn't in analysis.' Easser also honed her skills in determining the treatment of choice for each patient based on an 'adaptive balance' assessment. Presented on a panel at the William Alanson White Institute, Easser's 1962 paper 'Cure' is an extension of the 'Indications' paper which made the point that the criteria to determine if psychoanalysis is indicated should include the goals of the therapy. These goals 'encompass the ability of the patient to free himself from his old ties and their present-day derivatives, allowing for the formation of new modes by which he may regard both his environment and himself.' Her recognition of the ongoing importance of the analytic relationship is underlined when she quotes a patient, who said, towards the close of analysis, 'I see that I must go it alone but at least I am doing it with the knowledge that how I do and how I feel does matter to someone.' The analysand both leaves his analyst and takes her with him. (These papers were discussed previously in relation to Easser's views on the role of psychoanalyst as therapist.) In the other two unpublished papers, Easser gives thought to issues which until then had received little attention in the literature. The first, 'Special Forms of Resistance: Extra-analytic Contacts' (1965), is related to her teaching and her views on aspects of the personal analysis of candidates. The clinical principles that she derives from her case material are also applicable to non-candidate analysands, although there are usually fewer opportunities for extra-analytic contact. (Originally presented as part of a panel at an American Psychoanalytic Association meeting, this paper was previously discussed here in relation to her views on the personal analysis of candidates.) As a member of a panel at the Association for Psychoanalytic Medicine (April 1968) Easser in her clinical paper, 'Fate of the Transference Neurosis at Termination,' gives special attention to the woman psychoanalyst. Her thinking on this subject was stimulated by her students. She notes that, with increasing frequency, candidates asked whether differences in the course of treatment could be anticipated if the analyst were a man or a woman. Easser's ideas on the effect of the gender of the analyst on the therapeutic relationship, course, and outcome were ahead of

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her time. She proposes that the gender of the analyst does influence the nature, progression, and specific content of the transference, but since the same conflicts need resolution, gender usually does not play an important role in the outcome, except in a few situations (e.g., an adolescent girl immobilized by sexual fantasies about her young male analyst) . She presages that a fruitful area of study would be the effect of same gender analyst on the analysand's self-image. Fifteen years after qualifying as a psychoanalyst, and ten years after becoming a training analyst through her work on the hysterical personality, Ruth Easser proved herself to be an original thinker, clinical scholar, and paradigm bender with her first paper published in a psychoanalytic journal. It is the astute clinical mind that discerns the key features of a previously misunderstood major clinical entity. 'Hysterical Personality: A Re-evaluation' (1965) is a fine example of creative psychoanalytic thinking. What raises her to the level of paradigm bender is her capacity to conceptualize from clinical data to theory and thereby extend psychoanalytic knowledge into previously unexplored areas. Utilizing material from the analysis of six female patients who all fell within the diagnosis of hysterical personality, as it was then used, Easser and Lesser differentiate this group from a larger patient group who use hysterical mechanisms, but diagnostically, should not be classified as hysterics. This latter group was referred to as 'hysteroid.' Simply stated, this paper argues that symptoms alone do not reveal the underlying personality structure. Although superficially both groups present with similar symptoms, it is the ego organization and integration that differentiates the level of disturbance between the hysteric and the hysteroid. Their coining of the term 'hysteroid' and description of a hysterical continuum contributes to diagnostic understanding in at least two ways. As Lazare (1971)54 notes in The Hysterical Character in Psychoanalytic Theory' that the Easser and Lesser paper is the first of three seminal papers - the other two were by Kernberg (1967) and Zetzel (1968) - that furthered the understanding of hysteria.55 This classic paper heralded developments in psychoanalysis which during the next three decades widened its application from a therapy for neurosis to a therapy for character and personality disorders. Furthermore, Easser's and Lesser's description of the hysteroid's affective style and severity of disturbance presaged the current conceptions of borderline personality disorder. As Millan notes, 'this group of patients exhibits the outward behaviors of the classical hysterical (histrionic) personality, but unquestionably, constitute a more deeply disturbed variant.'56 Their description of the affective symptoms portrays 'the affinity of the hysteroid to both an affective style and a borderline

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severity.'57 Their description is akin to Otto Kernberg's description of the 'infantile personality, a character type he judged structurally at the "lower level" (borderline) of organization.' Kernberg considers the Easser and Lesser paper to be an important contribution to the early development of the borderline construct and Zetzel's 'as if personality.58 When placed in historical context, the 'Hysterical Personality' paper broadened the bounds of psychoanalytic understanding of character development and pathology by carefully demonstrating that diagnoses of hysteria, hysterical character, or hysterical personality are more complex and heterogeneous than had originally been considered. The second Easser-Lesser 1966 paper, Transference Resistance in Hysterical Character Neurosis: Technical Considerations' (1966), is less well known because it is published in a volume celebrating the Columbia Center's twentieth anniversary. The paper presents an application of the diagnostic insights detailed in the first 'Hysterical Personality' article to the treatment situation. It examines further the problem of diagnosis and outlines technical considerations. Joan Fleming comments on the authors' contribution to the development of psychoanalytic technique based on clinical experience. 'The paper "Transference Resistance,"' she says, gives us valuable information not simply in the description of the phenomena of hysterical reactions, but more especially in the picture of the authors' thinking as they formulated a problem and proceeded to try to solve it. Their method of approach follows a model for the use of psychoanalytic data in clinical investigation. Starting from clinical observations which raise questions not answered by established theory, they proceeded to hypothetical answers which can be checked by further clinical observations confirming or modifying what is already known ... The way in which the hysteric's repetition of his childhood fantasy serves as: a resistance to a therapeutic alliance, a stimulus for countertransference in the analyst, and a protection of infantile narcissism is beautifully elaborated ... Their [the authors']contribution is their sharp focus on the secondary defences which present the most intense resistance and reinforce the more primary repression and inhibition. They have elaborated the problem of diagnosis, interpretation, and working through this transference resistance which achieved defensive gratification behind the denial of competition as an adult... [There is] clarity in their exposition of this difficult resistance and they call attention to the subtle ways in which the character defences of the hysteric and the narcissistic counter-reactions of the analyst tend to support each other in this particular solution to the oedipal conflict.59

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In other words, Transference Resistance' anticipates the current technical emphasis on the affective relational modes of the analysand as expressed in the interaction with the analyst. Easser and Lesser were among the first to articulate that patients with hysterical and borderline personality disorders exhibit behaviours which themselves are defences against confronting the pain of their primary deeply unconscious fears. The analyst cannot help them confront and deal with these conflicts and their pain without first interpreting the meaning of the behaviours exhibited in the analyst-analysand relationship itself. Clinical observation and experience are the sources of the quintessential data on which psychoanalytic theory develops, which then leads to improvement in clinical technique and increases efficacy. These two Easser and Lesser papers influenced subsequent work on hysterical, borderline, and narcissistic personality disorders and on technique for interpreting character defences and secondary defences; they continue to be applicable in current psychoanalytic theory and therapy. A third paper by Lesser and Easser, 'The Marital Life of the Hysterical Woman' (1969), utilizing their understanding of hysterical personality, suggests clinical applications for physicians, obstetricians, and other front-line therapists who frequently encounter hysterical symptoms in their practices. These three papers are the sort of contribution that most psychoanalysts who are primarily clinicians would like to make. Only a few manage to do so. There is, of course, a vast psychoanalytic clinical literature. Some of the major theory builders of the field are also gifted clinicians. Others are not theory builders but sometimes make insightful contributions to this literature. Easser was neither a theory builder, nor did she write many papers; some were prepared for presentation rather than publication, a few others were written as if they were sketches for a final draft. Three of her published papers (two on hysterical personality and one on empathetic inhibition and narcissistic character) can be considered substantially prescient of subsequent developments in analytic theory and technique. Why do so few clinically gifted psychoanalysts make original contributions which herald a leap forward in the field and why was Ruth Easser able to do so? Certainly, the capacity to conceptualize from clinical data is a necessary prerequisite, as are the abilities to think, write and articulate in an organized and clear manner. These capacities were among Easser's gifts but other factors must have enabled her to make a seminal contribution. Timing is one of these factors. Timing is not just being at the right

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place at the right time but having a sense of timing, and having a finger on the pulse of time and place at the level both of the individual analysand and of the state of the discipline. A leap forward begins with a sense of internal time and place with respect to one's analysands, oneself as an analyst, and the moment-to-moment space occupied by both, and then having the ability to place these within the context of other similar experiences, all within the framework of what is currently known, as well as what is confusing or what is unknown within the field. To use the contemporary concept of attunement,60 the analyst as clinical theorist needs a sort of maternal sensitivity. The in-tune mother senses the emotional and external place of the infant. She intuitively moves into this space at the moment of communication and of necessity. A mother's premature movement is startling, and off-putting. The infant may respond with aggressive, sometimes angry rejection or with disinterested withdrawal. Belated movement increases frustration or provokes a sense of a separateness, a disconnection from a secure base. A well-timed movement by action, word, sound, or look allows the child to develop creatively. There are many psychoanalysts, exquisitely in tune with their analysands, whose movements (interpretations, actions, and other communications) are well timed - but they do not write. Others are both in tune and write but what they write only confirms or perhaps elaborates what is already known. The contributions of others may be too startling, too out of touch with the current climate as to be indigestible, or they may be argumentative in an 'out to pick a fight' tone. The work of some may be ahead of their time and will only be revisited later, as in the case of W. Ronald D. Fairbairn and more recently Sandor Ferenczi. Easser's colleague Lionel Ovesey is an example of a Columbia analyst whose psychoanalytic research into gender issues, although ahead of his time, generated controversy and often initial negative reactions. Only later, as Ethel Person points out in her tribute to his work, has it been realized that many of Ovesey's ideas have stood the test of time. Person comments: 'Nonetheless, when a thinker comes up with one important, original idea, he is generally guaranteed a place in intellectual history, and in studying homosexual imagery in heterosexual men, Lionel had come upon a major organizing insight' - that homosexual imagery in heterosexual men can symbolize power and self- esteem issues more than sexual issues.61 Moments of creativity are stimulated by multiple factors. Timing' and a convergence of insight, skill, and opportunity are suggested here in a consideration of Ruth Easser's seminal papers. In addition, perhaps two

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other factors play an essential role in her inspired creativity: the support and stimulation of an intimate collaboration and the inner intensity of her last few years. But what of Ruth Easser's personal life during this phase? The Being Phase of Ruth Easser's life spanned fifteen years, from 1955 to 1970. During the ten years between the amenorrhea papers (1954) and the adaptive balance work (1964), she wrote a series of unpublished papers for lectures, panel presentations, or responses to papers of others. Why was this work with rather innovative and forward-looking ideas not developed and prepared for publication? As with most other psychoanalysts, especially women, personal life intervened and absorbed her. These were her years of maternity and family development. Ruth and Stanley began their family with the adoption of their first child, a little girl, in 1953, and a second daughter, in 1956. Three years later, Ruth became pregnant for the first time, at the age of thirty-seven, and she gave birth to their first son. Her friend Dena recalls, 'She had a very hard delivery; they took a long time to get the baby to cry. He was a beautiful baby but they felt something was wrong and didn't really know what. At first, although he had started to talk, they thought he was autistic because if he did something, he would continue to do it. At about three and half they took him to Baltimore where there were the best testing facilities at that time and found he was profoundly hard of hearing. They were relieved but a new problem arose because Ruth spent a lot of time with him to develop his speech. The girls' noses were out of joint. Stanley didn't spend nearly as much time working with their son as Ruth did.' In 1962, at age forty, she found .she was pregnant again which, Dena remembers, 'didn't make her happy at that time.' Apparently, their second son's birth was unevenful, he was a healthy baby and only later did he develop some perceptual problems due to poor eyesight. 'She was concerned as to whether or not she could manage it all. There were the three other children, one with a handicap, there was more work, she was becoming better known. She had to be the mother and the wife and the therapist. She was involved with Columbia, in some of the politics there, and then there were the papers. It really was a hectic schedule, and she wanted to be involved in everything. Then they had an active social life. They had tickets to the theatre and the series for the Metropolitan Opera.'

These were also Ruth Easser's years of development as a training analyst and teacher. There are only so many hours and a limited number of areas in which one's efforts can be spent. Easser's academic work was to

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a large extent voluntary, part-time, and secondary to her practice and family. This is not much different from the situation of many young especially women - psychoanalysts today. It is very difficult to combine psychoanalytic scholarship with an active analytic practice and family life. It is even more difficult nowadays to have an active academic career as well. The difficulties of being an academic psychoanalyst differ for men and women. Women can more easily tailor a practice to family requirements but the price they pay is a slower road to advancement, both in academic departments of psychiatry and in psychoanalytic societies. Men, of course, also find it difficult to excel both as psychoanalysts and as academicians for several reasons: psychoanalysis is less valued in academic psychiatry today and the competition for research grants, the shift in emphasis from psychological to biological research, and the need to publish make it very hard to take the considerable time required for analytic training, as well as the financial risk of having a predominately analytic practice. To a certain extent Easser tried to be both clinician and academic but these roles, combined with the demands of family life and Columbia's institutional reticence about publishing, constituted obstacles to her writing for publication. Something more was required to release her creative capacities. Personally, she was shy, and it took time and a special kind of support before she was comfortable in publicly exposing her ideas. This support came from her primary 'live-in' collaborator, her husband Stanley Lesser. That theirs was a lively, intense, intellectual, and emotional relationship was evident to both friends and colleagues. Both were highly intelligent but with quite different ways of approaching and expressing ideas. It seems that he was her inspiration, she, his articulator. That Stan brought her out as a woman and as a creative person was commented on by Ethel Person: 'Stan was a lovely, warm, adorable man. He was more off the wall, easier to know. Ruth was the more intellectually profound. She often articulated ideas for Stan. Yet he was more gregarious, he was the outside for Ruth. This was not an accidental marriage. I think he brought something to her that liberated her.' Interestingly, Arnold Cooper had a somewhat different view of them as individuals in that he 'thought of Stanley as the real brains, but that was my bias. He mumbled and fumbled but he was extremely bright. My assumption was that he provided the intellectual stimulus and Ruth the organization, although she had ideas as well. Ruth was enormously good humoured but I did not see her as having a sense of humour. I could not imagine her making a joke; Stanley was making jokes all the time. So Stan had a quality that

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seemed to me to be more original than hers.' He agrees that 'they seemed to have a wonderful marriage.' That theirs was a creative and synergistic working collaboration became evident with the presentation and publication of their jointly authored paper, 'Hysterical Personality: A Re-evaluation' (previously discussed) . Easser presented the paper at a meeting of the Columbia association. 'It was an important paper,' says Arnold Cooper. 'I was surprised when she presented it. What surprised me was that I had no idea Ruth was thinking along those lines, that she had that kind of an ability to develop an idea. I knew she was bright, very perceptive, able to conceptualize and all that but I hadn't thought of her as an analytic thinker until after that paper.' Helen Meyers comments, 'This was a very daring paper. We accepted it right away; we thought it was great. Years later, when Otto Kernberg came to Columbia and discovered it, he thought it was fantastic because it made so much sense. Ruth was very sensible. Even though her language was different than the classical, she was so clear. She and this paper were accepted because she was sensible and clear, not combative.' Yet there was no doubt in anyone's mind that in Easser's presentation she was speaking for Stanley as well and that he was as much a contributor to these innovative ideas. Nor was there any doubt in her mind about what he gave her professionally. She responded to a colleague's 'thank you' for her helpful advice on a case with, 'It is wonderful to have a live-in consultant.' Ruth Easser's and Stan Lesser's working style was described by their long-time friend Dena Wechter. 'The three of them would get together for a weekend to write. Ruth or Stan would give an idea, they would discuss, argue, change their minds. Then one would begin a sentence, the other would finish it, or they might even voice a thought simultaneously. Then they would say, "This is it," and I [Dena] would type. Surely, this kind of stimulation from a husband, a colleague, a friend, or muse,' the inspiration leading to an unleashing of ideas, must have been an essential ingredient in her creativity. Presumably, this is what allowed her to write a seminal contribution. Ruth Easser grew in confidence, and her ideas took inspired shape with her husband's 'special' support. She seemed also to have had an additional quality which probably facilitated the publication of their paper in the Psychoanalytic Quarterly, and led to Easser being noticed, included, and eventually influential within psychoanalytic circles beyond Columbia. Her capacity to articulate ideas clearly, that she demonstrated she was a 'psychoanalytic thinker' helped, but she also had an ability to

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form bridges, to facilitate productive cooperation. She had, moreover, an innate political sense and lack of political ambition, yet considerable influence within the profession. According to Ethel Person, she was a very good politician, she didn't have trouble with anyone. I'm not sure if she was political or if she was so political that she was apolitical. Having this kind of political sense did not mean that she was politically ambitious. This was not within her nature or plans. She was on the cutting edge. She was a woman but also she had a special career in psychoanalysis with some of the most pivotal people, and she dissipated a certain kind of influence. When I trained, she was one of the few senior, truly influential women. Ruth was not actively political. She observed the political scene and wended her way through it. Critics of psychoanalysis observe that many analysts are on the make politically. For them psychoanalysis is a narcissistic venue. Ruth was utterly devoid of that kind of narcissistic investment which is almost unique. Someone of her stature and intellect could have written her own ticket. Yet she seemed to be without larger political ambitions. She was interested in psychoanalysis; she loved analysis, she loved her work.

Ruth Easser valued opportunities to make contributions to psychoanalytic education and professional organization. Her capacity to form bridges afforded her the opportunity to be one of the first Columbia graduates acceptable to the American Psychoanalytic Association. She participated on the Board of Professional Standards (1960-70) and the membership (1964—70) and program (1970-5) committees. Easser was most likely the first Columbia graduate to be a member of the 'Board,' then chaired by Joan Fleming, as she replaced Henriette Klein, who although affiliated with Columbia was not a graduate of that institute. The publication of the 'Hysterical Personality' papers perhaps also contributed to Easser becoming a participant in another kind of collaborative experience which meant a great deal to her. She was invited to be a member of the prestigious Center for Advanced Psychoanalytic Studies (CAPS), in which she was active from 1966 to 1975.62 Officially the CAPS Advisory Board extends invitations to psychoanalysts with continuing involvement in clinical psychoanalytic practice who are also active in psychoanalytic education or research. The underlying reasons why particular psychoanalysts are selected are never disclosed. It is interesting though that Easser was noticed just after the publication of this paper. She was the second Columbia graduate - Aaron Karush being the first to be invited, and she was the only woman in the fifth group to be

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formed. Freed of administrative and political considerations, CAPS affords the opportunity for open exchange of clinical experience and evolving conceptual views with peers outside the local psychoanalytic community. Fellow participants valued her consistent and committed participation in their group. During an interview with CAPS group five, Kenneth Calder and Roy Whitman remembered her fondly. They described her as bright, articulate, and with more confidence in her opinions than some other members of the group. 'Maybe we were a little reluctant to speak out and maybe a number of us had not yet formulated our ideas. She seemed to have done so. She would let you know what she thought. She was not aggressive or abrasive but happy to discuss.' Edward Joseph, a fellow member of the same CAPS group and representative of the American Psychoanalytic Association, eulogized Ruth Easser with these words: Now let me speak of this Princeton experience, since it was here that I really got to know Ruth. The CAPS set-up is such as to get to know an individual extremely well. It is a group that meets in Princeton twice a year for a threeday weekend with no definite commitment to administrative or even scientific decision-making but rather to the exchange of clinical, theoretical, and scientific points of view amongst a group of psychoanalysts from all around the country. There is ample time for scientific discussion, but equally ample time to sit around in an informal setting, freed of all responsibilities, to exchange points of view and to explore each other's thinking. By one of the quirks of organization, Ruth was the only woman in our group. At the risk of sounding chauvinistic, which I do not mean, Ruth fit in perfectly to our group. She did this through the point of view that she presented and, most particularly, through the warmth and strength of her personality. She was a font of knowledge in many areas, with a wealth of clinical experience, wide reading, and most of all, an ability to integrate this knowledge and experience into useful concepts. In the rather wide-ranging discussions that were often held, Ruth not only could hold her own, but add to the topics under consideration. When she agreed with what was being said, she could give an additional dimension to the matter under consideration. When she disagreed, she could present her evidence and arguments logically, cogently, and in a way that also served to further the discussion and consideration of the topic. In the more informal times spent together, the warmth of Ruth as a person was the dominant feature. It was in these contacts that the love of her field - the depth of her devotion to psychoanalysis - came out most clearly. She travelled much in the service of her work and gave much of herself in her lecturing and teaching. In these same informal

168 The Unsung Psychoanalyst contacts, her depth of devotion to her family was also a prominent feature. Whatever else Ruth was - psychoanalyst, educator, scientist, clinician - she was most of all a devoted member of the family with an interest in her husband and children that transcended everything else.

There is another aspect of Easser's work that deserves mention. She did not use the authority which ensued from her creative achievements or collaborative opportunities in a self-serving way. Rather she encouraged younger psychoanalysts to use their talents and interests creatively to move ahead and contribute professionally. For example, when Judy Schachter was a candidate, Easser as supervisor and mentor encouraged her and a fellow candidate to write a paper. They won a prize for the best paper presented by a candidate and later had it published. Judy felt that if she had stayed in New York she would have written more with Ruth as 'Ethel Person did with Lionel Ovesey.' Additionally, Easser did not hesitate to use her influence on a colleague's behalf. Ruth Moulton recalls that Columbia had qualms about making her a supervisor and full member of of its institute because she belonged to a different psychoanalytic organization not affiliated with the American Psychoanalytic Association: 'Ruth apparently got me in because she stood up and said, "Look you may not like the William Alanson White Institute but Ruth Moulton knows what she is talking about. She taught me my first lessons about transference and showed me how it worked. You can't say she is not a good analyst." Daniel Silver said she would give a person the "benefit of the doubt."' Roland Forrester also commented that Easser was able to hold back, choosing when and how to assert influence. She would not assert herself in a destructive way. The decade of the 1960s was the height of the Being Phase of Ruth Easser's career. During this time, her scholarly work emerged from her collaborative research (two papers), her teaching (four papers), prepared discussions of colleagues' papers (six presentations), and with the support and stimulation of her colleague-husband. Indeed it was the collaborative relationship with Stanley Lesser that apparently released Easser's creative thinking for their first two seminal papers on hysteria. Ten years is an unusually short time for this phase of an analytic career. In Easser's case this phase would have certainly continued through the more usual three to four decades had two life events not intervened: These events were relocation to Toronto in 1970 and her subsequent fatal illness.

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The relocation from New York to Toronto was in some respects a professional setback. In 1969, George Goldman was about to retire as Director of the Columbia Psychoanalytic Clinic. In most colleagues' minds Ruth Easser would have been a logical successor and strong contender for the position. Had the family not decided already to leave New York, Easser might well have achieved this professional advancement. Instead, she withdrew from the competition and made one of her final contributions as staff-faculty in her parent institute as chair of the committee for selection of the new director. Goldman, who had appointed her, was grateful she had accepted this 'crucial assignment' and said so in a letter to her, dated 29 October 1969. In Toronto Ruth Easser and Stanley Lesser would have to start over, establish a practice, work to be accepted as members of the newly established Toronto Psychoanalytic Institute, and carve roles for themselves as training analysts. Furthermore, they were separating from a now wellestablished institute, experienced colleagues whom they had been with for a long time, and the stimulation of working in New York, the oldest and most vibrant psychoanalytic centre in North America. On the other hand, a quieter lifestyle for their latency aged boys and teenaged girls, and the stimulation of participating in the development of a new institute might have contributed to her next productive period. Freedom from her heavy responsibilities at Columbia possibly allowed her more time for scholarly work. Indeed, the next five years of Easser's life were extremely productive and creative. Between 1970 and 1975, as sole author, she produced her third seminal paper, 'Empathetic Inhibition and Psychoanalytic Technique,' published in the Psychoanalytic Quarterly, made four related presentations on narcissism and affect development,63 and published a discussion in the International Journal of PsychoAnalysis^ in addition, she collaborated with her husband in preparing for publication their work on the perceptually handicapped,65 presented a psychoanalytic perspective on two contemporary social issues,66 and in her two final papers articulated her views on womanhood.67 Anthony Storr poignantly observes: 'Man is the only creature who can see his own death coming; and, when he does, it concentrates his mind wonderfully. He prepares for death by freeing himself from mundane goals and attachments, and turns instead to the cultivation of his own interior garden.'68 It is superficial to intimate that at the time of relocation Ruth Easser had any conscious awareness that these years would be the final phase of her career and her life. Relocation alone could not

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have heralded a shift from being the psychoanalyst to a precipitation of the Integration Phase of her career. Would Ruth Easser have been more or less productive in the remaining years of her life had she stayed in New York? It is no more possible to answer this question than it is to know what further psychoanalytic contributions she would have made had she had more time.

4

Integration

Integration in a psychoanalyst's life involves, among other things, merging one's work with one's sense of self. It means living with contradiction, inconsistency, and incongruity; working with ambiguity, dilemmas, and puzzles. Alignment of work with self is prerequisite for maintaining effectiveness, work satisfaction, and ultimately, integration. Anthony Storr believes that 'work especially of a creative kind which changes, progresses, and deepens over the years can provide the integrating factor within the personality.'1 Integration of one's work with one's sense of self is a process that takes place over time. Several variations of this theme emerge as being of particular relevance for psychoanalysts. These variations are not new; they exist from the moment one begins to practise analysis. They have to do with melding the personal and professional aspects of life, with resolving the incongruities of attachment and autonomy, with harmonizing the similarities and differences in self and others. These variations embody a dynamic tension striving for optimal balance throughout the life of a psychoanalyst. Just as there is no such thing as a complete analysis, no analyst completely achieves this optimal balance. Just as the goal of each analysis is to better the analysand's life, so too does the analyst strive towards increasing personal and professional work satisfaction. The ultimate paradox which analysts spend their lives trying to resolve is to make 'the impossible profession,' fulfilling and possible. So far, Ruth Easser, her work, and the words of those who knew her have provided a personalized example of a psychoanalyst's life. Just as the paradoxes of being a psychoanalyst are never fully resolved, the perils of constructing a prototypical image of a psychoanalyst are never completely avoided. Just as 'the good enough analyst' persists, so too the good enough example continues towards integration.

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The stimulation and support of Ruth Easser's intimate collaborative relationship with Stanley Lesser released her creative potential. During the last five years of her life (1970-5) her contributions increased. Opportunity and possibly a heightened internal urgency inspired further seminal work on the understanding of empathy and narcissism. These and other contributions of this phase reveal the effect of her training, her twenty years' experience, and a deep love for her work. Stanley Lesser's remarks at her memorial gathering at Columbia attest to the integration of these influences on Ruth Easser's creativity: You all know of Ruth's devotion to the Columbia Psychoanalytic Clinic. Perhaps less well known was her conviction that her work at the clinic with its attendant collegiality with so many creative minds and warm friends permitted her to mature both scientifically and personally; a kind of second birth. Later her research endeavour first with George Daniels, then with Aaron Karush, Arnold Cooper, and Bluma Swerdloff as well as her didactic activities with the always challenging candidates honed her understanding of both theoretical and clinical psychoanalysis. These pursuits she continued with an even greater efflorescence until our vacation, six weeks before she died. Her alertness and empathy continued to the end of her life. Spared suffering, she died untimely, but as she wished it: with her boots on.

When the Easser and Lesser family relocated to Toronto, Easser was not consciously aware of moving into the Integration Phase of her life as a psychoanalyst. At forty-eight, in the prime of her professional life, she energetically carved out space for herself in Toronto's psychoanalytic world. In her private practice she took on analysands and supervisees, consulted in the analytically oriented department of psychiatry at the Mount Sinai Hospital and at the University of Toronto, taught in the newly established Toronto Institute of Psychoanalysis, and was an active participant in the Toronto Psychoanalytic Society. She maintained contact with Columbia and colleagues in New York. It is only in hindsight that themes of integration can be found in the events of this phase of her life and read into her papers written during these years. In a remarkably uncanny way, Ruth Easser addresses the themes suggested here as pertinent to the integration process in psychoanalysts' lives. Her thoughts, as expressed in her final papers, shed light on one psychoanalyst's attempts to resolve the dynamic tension between the personal and professional, attachment and autonomy, self and others. Psychoanalysts struggle with disappointments, personal problems, and

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tragedies in their lives - as does everyone else. Personal problems can have a constructive or destructive effect on an analyst's efficacy and productivity. The stresses of life frequently impinge on a psychoanalyst's work. The problem may be physical such as a handicap or an illness or emotional in nature such as depression, burnout, or an episodic breakdown. One's work can be affected by problems in the family such as an ill spouse or a handicapped child, aging parents, or a financial difficulty; life events such as marriage, pregnancy, or relocation; or life traumas such as divorce, the illness or death of a spouse or child, aging, and finally, one's own incapacitating illness or death. Many areas of pain in psychoanalysts' lives, their adaptation to human difficulty, and the effect on their work are only beginning to be explored.2 The birth to Stanley Lesser and Ruth Easser of a child with special needs provides an example of the constructive professional sequelae which can result when a psychoanalyst faces family trauma. When Ruth Easser was thirty-seven, in 1959, her first son was born, and he had a profound hearing deficit. How the family dealt with this personal trauma is not the issue here. What is relevant is that Easser and Lesser, as parents of a deaf child, drew on their experience, their psychoanalytic knowledge, and the stimulation of the work of colleagues to write three papers in the early 1970s on the psychoanalytic understanding of deafness.3 Within the context of what was known at the time, and in the light of subsequent understanding of the inner world of the deaf, these papers continue to challenge today's psychoanalysts to pursue further understanding of the psychological aspects of perceptual handicaps. Ruth Easser and Stanley Lesser were motivated by their child's problem to contribute to the psychoanalytic understanding of perceptual handicaps, and a stimulating institutional structure was available to them. Beginning in 1967 they collaborated with Aaron Karush in a research work group. Their project was described as an attempt to study perceptual styles, defence organization, and ego development by comparing deaf, blind, and economically deprived preschoolers. Since 1955, Columbia psychoanalysts John Rainer and Kenneth Altshuler, both candidates when Easser taught at Columbia, had been involved in research examing both the diagnosis and treatment of the deaf. At the January 1963 scientific meeting of the Association for Psychoanalytic Medicine, Kenneth Altshuler spoke on 'Personality Traits and Depressive Symptoms in the Deaf.'4 Easser is reported to have mentioned 'several clinical examples of blind patients denying their handicaps. She wondered if the deaf were similar in this respect,' Although she couched

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her question in clinical 'impersonal' terms, at that time her son would have been four years old. She had experienced the painful process of discovering her son's handicap and the early years of mothering a child who is profoundly hard of hearing. Easser had just heard a report on emotional problems of children afflicted by deafness. She must have wondered what lay ahead for her son. Altshuler's response to Easser's query seems to have planted ideas later developed in her papers. Altschuler informed those present that 'the ten-year-old children studied were aware of their handicap and self-conscious because of it' but that he 'did not know at what age such awareness began' and that 'the congenital and early deaf tended to be open and trusting'; they also discouraged study of themselves, 'because of fears of being stigmatized as well as possible denial mechanisms.' The work in this area of Easser and Lesser illustrates the interaction of a personally motivating experience with institutional stimulus. Themes central in Easser's other writings reverberate, as she and Lesser consider the psychological development and emotional problems of perceptually handicapped people. They confront the assumption by some psychoanalysts that perceptual and cognitive distortions - faulty ego development - resulting in symptom, personality, and character formations are the result of internal fantasy and conflict and can be understood in psychodynamic terms alone. This assumption, they say, does not hold for a person 'confined to living within the shell of an incomplete perceptual environment' which in turn affects 'good enough mothering' and the nurturing environment. Easser and Lesser consider the interaction of three factors: 'biological equipment, the ego and the environment' as being essential to the understanding of psychological development, adaptation, illness, and well-being. Since people do not begin life all with the same perceptive apparatus and cognitive capacities, adequate evaluation must include the different developmental and experiential tracks especially in those with faulty biological equipment. Diagnostic accuracy and appropriate therapeutic techniques follow when these differences are recognized. Similarity, unconscious fantasy and inner conflict when placed within this framework can be better understood. In their only other collaborative papers, on hysterical personality, Easser and Lesser conceptualized the notion that symptoms of hysteria do not necessarily reveal underlying psychic organization; the same symptoms in different people do not have the same causes or reflect the same degree of ego development; the symptoms are determined by multiple factors but causes can be prioritized; and the significance of overt symp-

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toms is determined by the underlying causes and psychic structure. Similarly, they write in these papers: 'That which looks alike is not always the same.' What is considered pathological in a perceptually intact person may be adaptive in a person who is perceptually handicapped. For example, neurotic symptoms are not always an expression of psychic conflict. Rather, in a deaf child, such symptoms are more often modes of adaptation to the frustration of not being able to communicate experiences, needs, wishes, and intense feelings. That which looks alike is not always the same, also recalls Easser's work on 'adaptive functioning.' Again, her empathy comes through in her understanding not only of the locked-in inner world of the deaf person but also of a maternal struggle to communicate with a deaf child. Ruth Easser, as a psychoanalyst, placed importance on the mode of expressing feelings and the words used to communicate needs and establish relationships. Throughout she struggled to understand affect development. She thought that exaggerated, inappropriate expression of affect or denial of feelings could be either or both adaptive and defensive. Adaptively, this is a way of dealing with disturbing cognitive or affective awareness. It is also a defence against painful acknowledgment of deprivation, deficit, or trauma. Easser maintained that people who are frightened often employ 'emergency' emotions of anxiety and rage; people who do not receive affectionate nurturing are impaired in their use of 'welfare' emotions such as empathy, mutuality, and tenderness; inappropriate feelings are often expressed by people who cannot make sense of their experience; and people who deny emotions are inhibited rather than lacking in feeling. She believed that a person lacking in empathy suffers not from an absence of a capacity for empathy, but rather from an inhibited capacity for empathy. Furthermore, she held that individuals with a deficit in biological equipment do not necessarily lack a capacity for relationships. Rather, their developmental and early relational experiences are different because of their faulty equipment. These papers emphasize the need to use many means to help a deaf child communicate. Self-development was never far from Ruth Easser's thinking. She recognized that a perceptually handicapped child's sense of self often lags or becomes impaired. Faulty physical, for example, visual or sound, equipment cannot adequately receive or communicate self and other perceptions and experiences. There are differences in the self- development of a child who is unable to experience his or her verbal self or that of the other person. A deaf child's primary problem is one of language, of making cognitive sense of visual and emotional experiences, and communi-

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eating inner perceptions of self and others. Compensatory ways of communicating feelings, needs, and experience have to be learned. It is the development of a communicating - rather than specifically verbal self which influences the child's emotional and relational well-being. Easser and Lesser stress the centrality of parents, especially the mother, in providing the earliest intervention to assist the impaired child's development. During the first year, the deaf child is usually able to achieve normal emotional development. This arises from his almost unhampered ability to form a strong and stable attachment to his mother and to develop the nucleus of his body ego. They speculate, hopefully but somewhat inaccurately, that development during the first year was similar to that of the hearing child. Jane Silver points out: The mother is unaware of her infant's auditory deprivation; therefore, she does not realize, when she leaves her baby alone in a room or at night to sleep, that the infant does not hear her or other family members in the home. For the deaf infant, seeing the mother or seeing other people means not being alone. When no one is visibly present for the deaf infant, there is isolation and the feeling of abandonment until someone can be seen again. The normal infant continues to hear on some level while sleeping; the deaf infant sleeps in total isolation of the hearing world.5

This does not mean that the deaf child cannot develop close attachments. However, this capacity for emotional connectedness, which Oliver Sacks observed so vividly among signers, is stimulated and develops differently than in the hearing child. In Seeing Voices, Sacks shows that communication, whether verbal or sign, and attachment are inextricably entwined: One has only to watch two people signing to see that signing has a playful quality, a style, quite different from that of speech. Signers tend to improvise, to play with signs, to bring all their humour, their imaginativeness, their personality, into their signing, so that signing is not just the manipulation of symbols according to grammatical rules, but irreducibly, the voice of the signer - a voice given a special force, because it utters itself, so immediately, with the body. One can have or imagine disembodied speech, but one cannot have disembodied Sign. The body and soul of the signer, his unique human identity, are continually expressed in the act of signing.6

Language communication becomes essential in the latter half of the

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second year of life. This coincides with the time when parents need to utilize language to facilitate the child's organization of thought, affect, and inner controls, and when major problems in the deaf child's development may accelerate. The mother of a deaf child must struggle to find pathways to communicate, help, and relate to her child. Ruth Easser, as the mother, taught her child to communicate. She was aware of the impact such time and effort has on the mother and on the dynamics of the family. As the mother she recognized the importance of clear communication in the child's development of a sense of self and other. Easser once told this story to a supervisee: She was with her family in a restaurant. One of the other women guests happened to walk into the men's washroom by mistake. She quickly emerged, embarrassed and red in the face. Her son asked in his way, 'Why is that lady's face red, Mommy?' She explained carefully, 'Her face is red because she made a mistake by going into the men's washroom. She is embarrassed, and sometimes when people are embarrassed their faces go red.' Her son responded, 'You mean a red face is what embarrassed is?' 'Yes,' she agreed, 'that is how we show embarrassed.'

As a psychoanalyst, Easser was particularly sensitive to the importance of naming and expressing affects and of affect communication to the analysand's sense of self. Bearing and raising a deaf child could only have honed her sensitivity to naming and expressing feelings verbally and visually. Ruth Easser is remembered for her expressive face. One wonders how much of her ability to communicate with her face, especially her eyes, developed from her close attachment to and teaching of her deaf child. Recall that Daniel Stern, who was taught by Easser made the comment: 'I fell in love with her face and never tired of watching her.' This is an apt and wonderful comment from a person who went on to study the development of a child's sense of self through mother-child facial expression. Stern recognizes the double-edged sword of language in that ways of being with another are increased while it also 'makes some parts of our experience less sharable with ourselves and with others. It drives a wedge between two simultaneous forms of interpersonal experience: as it is lived and as it is verbally represented.' Furthermore, he notes that 'just as the being-with experiences of intersubjective relatedness require the sense of two subjectivities in alignment- a sharing of inner experience of state - so too, at this new level of verbal relatedness, the infant and

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mother create a being-with experience using verbal symbols - a sharing of mutually created meanings about personal experience.' In his book Mapping the Mind, Fred Levin observes that the acquisition of language seems to affect psychological development in a decisive way. In his opinion, the answer to why language is central to development 'lies in appreciating how "abstractability" becomes possible as a mental function. The key to our learning how to abstract lies in training the brain to make connections between a number of processes: On one hand, the verbal and the non-verbal must be brought together. This happens only through exposure to the naming experience, which is how parents share feelings with their offspring. Words are given to experience.'8 It is evident from even a cursory survey of the psychoanalytic literature that the inner world of the deaf person has been virtually unexplored by psychoanalysts - to the impoverishment of both deaf people and psychoanalysis. This is not surprising, given that the primary tool of a psychoanalyst is the verbal use of words to establish a relationship and impart therapeutic understanding, even to interpret non-verbal messages. The sign language of the deaf has not been explored as an alternative psychoanalytic tool. Some forms of psychotherapy are undertaken using American Sign Language (ASL), while others use signed English.9 No report of an analysis using sign language of a person congenitally or prelingually deaf has been found. Furthermore, a deaf person has yet to be trained as a psychoanalyst. Initially, this might only be possible by training a hearing person born of deaf parents who learned to sign and speak simultaneously in childhood. That person could then train a deaf person as a psychoanalyst. What of the implications of a 'visual' language for psychoanalysis? Psychoanalysis is focused on the inner workings of the human mind; it is concerned with what goes wrong and what goes right in our thoughts, feelings, perceptions, behaviour, relationships, self-expression, and very personhood. This knowledge has been gained and imparted through the use of our ears and our mouths, and through word interpretation of thoughts, feelings, and non-verbal body language. Fred Levin, forcefully argues against psychoanalysis taking a narrow linguistic approach which appears to ignore the non-verbal realm and for a 'total language' approach with attention to both verbal and non-verbal communication. He recognizes that verbal communication is not superior to non-verbal communication any more than a spoken language is superior to the sign language of the deaf community. Given that language acquisition whether spoken or signed is critical to psychological development and

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that non-verbal communication is essential to learning language, the world of the deaf and sign language offer a rich, unexplored area to investigate. As Oliver Sacks notes, the existence of this unique alternative mode of language has wide-ranging implications for those in the hearing world as well. He suggests how much psychoanalysts could learn about 'total' communication from a signing psychoanalyst and analysand: Much of what is distinctly human in us - our capacities for language, for thought, for communication, and culture - do not develop automatically in us, are not just biological functions, but are equally, social and historical in origin ... they are a gift - the most wonderful of gifts - from one generation to another ... The existence of a visual language, Sign ... shows us that the brain is rich in potentials we would scarcely have guessed of, shows us the almost unlimited resource of the human organism when it is faced with the new and must adapt.10

In a letter to the author, written in December 1994, Oliver Sacks agrees that psychoanalysts have yet to mine this rich field of endeavour: As an analysand myself one of my own first ponderings was whether there had ever been anything much in the way of psychoanalytic approaches to the deaf - approaches which would necessitate a fluently signing analyst. My impression was that there had not been a deep analysis using Sign - tho' I was not in a position to cull the literature minutely ... I cannot judge how much the linguistic differences between Speech and Sign extend into cognitive differences, and emotional and personality differences too - I think this is an open question of real importance - and that a signing analysis could give information and insight obtainable no other way.

Psychoanalysis has much to learn about non-verbal communication, although in the last few decades inroads have been made. Daniel Stern explains how he realized the importance of non-verbal communication in infant development and why he went on to make major contributions in this area: When I was seven or so, I remember watching an adult try to deal with an infant of one or two years. At that moment it seemed to me so obvious what the infant was all about, but the adult seemed not to understand it at all. It occurred to me that I was at a pivotal age. I knew the infant's language but

180 The Unsung Psychoanalyst also knew the adult's. I was still bilingual and wondered if that facility had to be lost as I grew older. This early incident has a history of its own. As an infant, I spent considerable time in the hospital, and in order to know what was going on, I became a watcher, a reader of the nonverbal. I never did grow out of it.10

Psychoanalysts, too, need to develop their bilingualism. Having personal problems, even of a severe nature, does not mean that the analyst cannot and will not function well as an analyst. Functioning and efficacy have more to do with the analyst's vigilance over countertransference reactions and enactments than that he or sbe struggles with personal problems. The Easser and Lesser collaborative efforts to understand a life trauma they personally experienced - she as mother of a deaf child and he as a father and a child analyst - exemplify how such work blends personal and professional aspects of psychoanalysts' lives and can contribute to analytic efficacy, both their own and others. Life events and personal choices, like personal problems, need to be integrated with one's professional life. Relocation is one event which can disrupt the flow of a psychoanalyst's work. At the beginning of an analysis a commitment is made to be there while an analysand takes whatever time is needed to grow. This commitment allows the necessary mutual attachment to develop, the work to proceed at the analysand's pace, and to last 'as long as it takes.' Ideally, ending is based on the analysand's readiness to separate, to carry on independently, having achieved significant gains. Less ideally, an analysis is terminated when no further progress seems possible. At irregular intervals a psychoanalyst commits at least two to five years of professional life to each analysand. Because analysands do not begin and end at the same time, stability of location is required over a considerable period to maintain a practice. Certain life choices, for example, career advancement, can limit a psychoanalyst's ability to commit to a full analytic practice. One of Easser's students, Tom Anders, explains: 'After I graduated, I stayed in New York for a few years and then moved from place to place up the academic ladder. I maintained analytic patients in New York but when I left, I couldn't sustain an analytic practice. I have always done long-term psychotherapy and have a psychoanalytic identity. I say I am a general psychiatrist trained as an analyst and committed to work with the unconscious and psychodynamic conflict.' Analysands sometimes unilaterally decide to end their analyses for their own reasons. Psychoanalysts rarely impose a unilateral termination

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or begin an analysis with a time limit. Rarely, that is, except in certain life circumstances. Psychoanalysts with fully established practices can be forced to relocate. Historically, the exodus from Central Europe and Russia in the 1930s and 1940s was a major dislocation and relocation of both analysts and their analysands. This, of course, was a time of exceptional political upheaval. Outside circumstances forced the breaking of the psychoanalytic contract. Often there was no free choice or time for careful decision-making. Analysts moved to stay alive. Although some took their patients with them or were followed by fleeing analysands, the obligation to consider the professional contract was overridden by catastrophic events. The reality of survival of self and loved ones superseded. Psychoanalysts also can decide to relocate in times of peace and stability. The difference is that there is no outside social force dictating the move. A choice is made for reasons that reflect the personal needs and life design of the analyst with the result that the commitment 'to see it through' until the analysand's readiness for separation unfolds is not always maintained. Relocation of an analytic practice is one of the more heart-wrenching decisions a psychoanalyst makes. Eugene Kaplan and colleagues explain that 'moving is so painful that most analysts "put it out of their minds."'11 It is 'painful' because moving can be a blow to the ideal self-image of the committed and dependable healer. Additionally, it is not easy to give up an established practice and a hard-earned reputation. Separation from the essence of one's work - analysands - arouses strong feelings, for example, feelings of loss of one's practice, of contact with patients with whom one has been intensely involved, guilt about pleasurable anticipation of the move, and anxiety about leaving as well as about analysands' rage at being left. Forrester describes the intensity of such rage in an analysand during a planned 'last session' of a successful analysis: Although she had expressed appreciation for her analysis which had lasted several years, and although an expression of this appreciation was the thank-you gift, the dreams showed something else, that she had at the same time feelings of rage towards me, had criticized me savagely and cruelly, blamed me for the sessions stopping, and feared for my life and safety. That is, suppose her destructive wishes towards me were realized, as in one dream she made me into an old and decrepit man close to death. She also wondered whether it was not I who was rejecting her and whether, in fact, I liked her at all. Perhaps I was even relieved to say good-bye to her. Thus, in

182 The Unsung Psychoanalyst the last session, strong negative feelings emerged which were immediately related to the impending separation.12

If such feelings are frequently aroused at planned termination an increase in an analyst's anxiety about provoking strong reactions - of not only rage but depression, withdrawal, denial of feelings, or regressed behaviour - in a number of analysands simultaneously is to be expected. Indeed, such reactions need to be anticipated if analysands are to be helped with the psychoanalyst's decision to leave and, symbolically, with the inevitability of separations throughout life. Little wonder so few psychoanalysts move from an established practice, and none do so without trepidation. The experience and consequences of relocation are, unfortunately, infrequently communicated to others going through the same experience. Analysts rarely choose to relocate simply for the sake of practising in a different place. Mostly there are strong personal reasons. Although commitment to analysands is the essence of being a psychoanalyst, sometimes commitment to one's personal life takes priority. Work is not all of life. This underlines the reality that psychoanalysts are people who happen to be psychoanalysts. It emphasizes their human limitations and can be used to assist analysands to accept their own and their analysts' limits - an inevitable task of every analysis. Ruth Easser talked with a colleague about leaving New York. He recalled her view during that conversation: 'A personal decision is based on your needs. It is less likely to be based on your analysands' needs. An analyst cannot tell patients that he cares so much when the reality is that, for some special reason, for you or your family or your career, you move on. She never pretended that she could give more than she could. She was a neutral analyst in the best sense and yet warm and open.' Ruth Easser and Stanley Lesser moved in 1970 from New York to Toronto at a time when they were at the peak of their careers. They left behind them analysands, candidates, colleagues, friends, and professional commitments. They gave up well-established practices, academic positions, influence, and prestige within the by then well-established Columbia institute and the New York psychoanalytic community for a fledgling, provincial, tightly controlled, and inexperienced psychoanalytic society and institute. They left the excitement and stimulation of cosmopolitan New York for scaled-down (in comparison with New York) more staid Toronto. Why did they do that? As Ethel Person puts it: 'Ruth was deeply committed to her children. That is why she moved. It was tough to raise kids in New York. She was

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willing to put aside whatever her connections and ambitions were in order to go to a city that she felt was more habitable. She was prescient because New York is certainly not habitable for children.' Helen Meyers agrees: 'They moved there because they felt the New York environment with the drug scene, the social pressures, and the lack of safety was too difficult for their children. They thought that in Canada, the children would face fewer of these social problems. They had no other reason to leave.' Their move to Toronto was disconcerting to analysands, students, and colleagues of both Easser and Lesser. Those left behind struggled between understanding 'for their children' and a sense of abandonment. As one colleague puts it: We felt odd about it. We didn't want her moving. I know the people in analysis were terribly unhappy, they were very angry, as they didn't get much notice. I know it less about Ruth than about Stan. There were a couple of candidates in analysis with him who were furious. They felt very abandoned. I don't know if Ruth handled it better with patients; Stan didn't handle it well. Maybe you can't handle that kind of thing well. They were very angry with him and I assume they were angry at her. It was as though they abandoned these analytic children for their children and the competition was very strong. Maybe, she was going home where she thought she could get more family support. People here felt abandoned but people always feel abandoned. That shouldn't stand in the way of what was important for her and her family. One of her analysands at the time of the move says now: Ruth was leaving New York for Toronto when my four-year analysis ended. I don't know if my analysis would have ended where it did if they had not moved. I was glad that she thought it was finished enough so I could graduate from the institute and not have to start with someone else. Columbia was progressive in that regard. I probably was viewed as bright and healthy, so get him out and get it over with. I actually don't think my analysis was finished. Subsequently, I re-entered psychotherapy so my experience with Easser set the tone to use professional help when in need. One former supervisee says: 'I worked with Easser in the mid-sixties. I used to call her in Toronto afterwards, if I had any sticky wickets. She seemed glad to do this, to maintain the connection.'

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Maintaining a connection is important not only to those left behind but also to the relocating psychoanalyst. It is also difficult to do. Ruth Easser continued to teach periodically at Columbia until she resigned in 1971. She wrote to George Goldman in June 1971: 'It is with regret that I find it necessary to resign any active participation in the administration and teaching of the Columbia University Psychoanalytic Clinic. As you well know, my sentiments and interests will always be deeply involved. Although I have found that commuting is beyond my present capabilities, if at any time I can be of assistance, I hope that you will always feel free to call upon me.' For her, leaving was not without some struggle between her personal and her professional self. Again, as her parent institute, Columbia supported her decision to separate while maintaining a connection. Lawrence Kolb, professor of psychiatry, wrote in July 1971, 'I'm sure you must know how much I admired your work but you may not know how deeply I appreciated all your efforts on behalf of this department over the years. You left a very distinguished record of accomplishment with us and I know a group of colleagues who will miss your inspiring competence as well. On the other hand, having visited Toronto and having had some opportunity to note what was going on there, I am certain you have found a wonderful new place to continue your interests.' Aaron Karush, the new director at Columbia (Easser chaired the committee that selected him) wrote (also in July 1971), 'I wonder if you would object if I continued listing your name as "Collaborating Staff - at least for another year or two -just in case you get homesick for us and can make some time available for an occasional seminar or clinical conference.' She responded immediately, saying, 'It was nice to hear that the umbilical tie does not have to be fully broken; I would certainly be glad to participate on the Collaborating Staff.' The notion of 'parent institute' is meaningful, at least it was for Ruth Easser. One wonders if relocation was more difficult for her husband, Stanley Lesser, a native New Yorker. There is no evidence for this. Together Easser and Lesser became involved professionally in Toronto. Together they made a conscious decision 'for the children,' giving precedence to the personal over the professional. What is important here is how Easser integrated her personal choice to relocate with her professional life. Relocation involves not only separating from analytic attachments but establishing new ones as well. It means re-establishing a practice, building referral sources and support systems, developing collegial and organizational relationships, and acquiring institutional appointments. The reception that new psychoanalysts receive is most likely determined by

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the needs of the host community, the extent of resources, and the openness to different ideas. Differences in psychoanalytic experience and status facilitate or inhibit the establishment of the analyst in the new community. Often there is the honeymoon period of the infusion of fresh ideas and expertise. Inevitably there is a probation period for the newcomer regardless of level of experience. Invariably the pyschoanalyst and the new community grapple with feelings and reactions as the outsider becomes an insider. When Easser and Lesser arrived, Toronto had a small psychoanalytic community. It consisted of a study group which had been meeting for fifteen years by then; a psychoanalytic society, which was just five years old; and a fledgling institute, founded in 1969, with its first class of candidates beginning their second year. Although Toronto's relationship with psychoanalysis dated back to the days of Ernest Jones's three-year tenure early in the twentieth century at the University of Toronto, the department of psychiatry had a largely biological orientation until the arrival of its first psychoanalyst chairman, Robin Hunter (in 1966),13 and its second, Frederick Lowy (in 1974). By the late 1960s there was a large enough group of analysts in Toronto to organize formally. Easser and Lesser were welcomed jointly by the university and the department of psychiatry at the Mount Sinai Hospital which at the time was headed by psychoanalyst Stanley Greben. Both Easser and Lesser had academic appointments and were able to establish active practices, and being physicians their psychoanalytic and psychiatric work were covered by Ontario's medical insurance (OHIP). Ruth Easser was especially welcomed as that made her the only woman training analyst in Toronto. In one area, however, they experienced difficulty in re-establishing their professional life. Surprisingly, although admitted as training analysts, they were ambivalently received by the Toronto institute, which was tightly controlled by a small group of comparatively inexperienced training analysts. Candidates, patients, and colleagues were all eager to work with the newcomers, to learn from their way of thinking. Influence within the institute was acquired more slowly. Their years of experience and 'different' training posed somewhat of a threat to some members of the new institute's founding group. But many candidates and analysts within the Toronto Psychoanalytic Society began to learn from them and benefited from their experience and ideas. Undoubtedly, Easser and Lesser had some professional frustrations and misgivings about their move. There were also challenges and satisfactions. There is little doubt, however, that they derived gratification

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from contributing to the development of psychoanalysis in Toronto, as they had in New York. Teaching and practice were important to them in both places. It is generally thought that their positive influence on the institute would have been more significant had Easser not died and had Lesser not returned to his hometown of New York soon after her death. Hilda Bruch was Ruth Easser's friend and colleague. It is interesting to compare how their different relocation experiences were integrated into their professional lives. Bruch decided to leave the turmoil in Europe and that meant separating from her family and her fiance because they could not believe what was happening in Germany. Her survival took precedence over her attachments to her loved ones. She left to save her own life and to become a pediatrician. Bruch's losses and other life events precipitated a depression which led her to psychiatry and psychoanalysis. She never married, nor had children of her own. Her energy was consumed by her work with children and by her contributions to the understanding of eating disorders. She claimed that she happened on working with eating disorders. Perhaps her introduction to this area was by chance. Fate and external life events may have determined the outside shape of her life. But her inner world had more to do with the nature of her professional contribution. Only a woman who understood the necessity of self-deprivation for survival and intense hunger for what has been deprived could understand those who hunger and deprive themselves out of emotional necessity. Bruch sublimated her personal pain to help those with a symbolically similar suffering. Her maternal energy fed her analytic children. In her tribute delivered at the first Ruth Easser Memorial Lecture, Bruch spoke movingly about Easser's sensitivity to her own children's needs and her dedication to her work. She understood Easser's efforts to integrate both. Bruch's long life and concentration on her work made her the 'sung analyst.' Easser's foreshortened time and dual commitment left her largely 'unsung.' In 1973 and 1974, in collaboration with several colleagues, Ruth Easser wrote two papers.14 Both focus on psychoanalytic views of sociocultural issues. These papers are of relevance because they illustrate that personal interests as well as personal problems can motivate a psychoanalyst to make a contribution in areas beyond the consulting room. They also demonstrate another aspect of Ruth Easser's development and use of her analytic self. One of her Toronto colleagues, Daniel Silver, puts it this way: Before she came to Toronto she was doing consultation on obstetrics. She would talk about working with patients on the ward, conceptualizing their

Integration 187 problems psychodynamically, and helping them without a long analysis. This is an analyst speaking, not a short-term psychotherapist using all the euphemisms. She would simply treat these patients on the ward with students trailing after her. This was in New York where she was probably the most soughtafter supervisor. In Toronto, the word got around how good she was and the residents wanted her. She would teach consultation-liaison as part of their regular work; she used her consultations to teach. She used herself a lot. She taught in supervision, didn't interpret, didn't wait, wasn't silent, certainly wasn't intrusive or over-talkative. She had the art of teaching. The paper, 'A Hospital Staff Copes with Abortion,' with Sarah McCall (1973) derived from her consultation work. Undoubtly, her paper, 'The Effect of Changes in Lifestyle of Contemporary Youth on Psychiatry: Diagnosis and Psychotherapy,' with Paul Lerner and Stanley Lesser, was influenced by her experience of living in New York during the social upheavals of the 1960s - the decade of alienated youth and student activism - and the impact this had on her teenaged daughters. At the Mount Sinai Hospital, as a member of a study group, Easser used her experience to teach indirectly. Again, Silver describes her involvement: She was modest, she'd listen. You'd almost have to coax her to speak. She had a great deal of courage without being demeaning or derogatory. If someone was bullshitting she'd name it; she had no compunction, no matter who it was. Being in this group with her and Stan, an extraordinarily bright man with a lot of experience, although underrated because he was not as clear in articulating his ideas, was one of the most important personal growth experiences I had. At the larger psychoanalytic meetings, she participated in a similar way. She came forward, with plain talk, straightforward, simple, kind, very kind. Several people who are training analysts today presented papers which were not up to standards she was used to. The criticism she offered was constructive even if the papers were a mess; she would say this is the first time, remarking on all the work that had gone into it, pointing out the good parts, what could have been done or might be a way of improving it. The implication was, it was an honest job. It was in Toronto that opportunity and possibly a heightened internal urgency led Ruth Easser to make her second seminal contribution. Her paper, 'Empathetic Inhibition and Psychoanalytic Technique' was initi-

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ated by the invitation to be the first Columbia graduate to give the Sandor Rado Lecture. In September of 1972, Daniel Shapiro wrote: In this year in which Rado's contribution to psychoanalytic theory and psychoanalytic education at Columbia are being reappraised, the Committee on Visiting Lectures is particularly eager that a psychoanalyst of your stature who was trained by Dr Rado be given the opportunity afforded by the Rado Lecture to exemplify the quality of independent psychoanalytic thinking based on careful observation that he transmitted to the early generation of graduates trained by him at the clinic ... We know you would honour yourself and Dr Rado in giving the lecture named after him in whatever area you might select.

Here was the opportunity that stimulated Easser's creative thinking. What Columbia graduate could turn down such an honour, despite the rather intimidating challenge this implied? She did not, but accepted with her characteristic modesty: 'My first thought would be to present a paper closely utilizing clinical material which would integrate psychoanalytic theory and application to the problem of the narcissistic character.' Her suggestion again shows she has her finger on the pulse of psychoanalysis. She is aware of the effect of the contemporary cultural and intellectual climate on psychoanalytic developments. The early 1970s is that time in modern history frequently referred to as the age of narcissism. Psychoanalytic attention turned to the concept of the self and self-organization and to the treatment of a group of people suffering from 'narcissistic personality disorder' for whom psychoanalysis previously had been considered ineffective. This was the beginning of a fourth significant shift of emphasis in the seventy-five years of evolution of psychoanalytic theory. Easser notes: Historically, psychoanalytic theory and practice has never been a static body of knowledge. We are all familiar with the changing emphasis which has been stressed by the theoreticians and therapists of this science as it has evolved. The shift has been from: (1) concentration on the identification of the instincts and their vicissitudes during growth and development, to (2) focus on defining the characteristics, synthesis and functions of the ego, with specific reference to its defence organization, to (3) the significance and origin of object relatedness, and most recently, to (4) awarding special attention to the concept of self and the self-organization. More

Integration 189 attention is being paid to that aspect of self which conjoins the soma and the psyche, the affective organization of the individual. Each evolutionary phase has been motivated by a sense of frustration with our clinical results and by our desire to extend the boundaries of our therapeutic efficacy.15

As with her work on hysterical personality, this work on narcissistic personality continues her efforts to extend the efficacy boundaries. Easser's Sandor Rado Lecture was given on 22 March 1973 (her fiftyfirst birthday) just over two years before she died. Her creativity in this area might have been stimulated simply by the invitation. It is not unusual for opportunities of 'having to produce' to activate the creative process. It is also possible that a preconscious awareness of the limited time she had left generated an internal urgency to undertake her second creative leap. Her colon cancer was not diagnosed until February 1974. She might or might not have 'known' earlier, at some level of awareness, that she had a life-threatening illness. This is only speculation. What is not speculation is that she took preliminary steps to arrive at her paper for the Rado Lecture and continued to develop her ideas in this area after its publication. Her six papers pertaining to narcissism and empathy written between 1972 and 197516 document the evolution of her independent thinking. They provide an absorbing illustration of the development of an experienced psychoanalyst's original contribution. Independent thinking and original contributions are not simply the product of a single mind. What makes for originality is the integration of various influences which stimulate one's ideas. Beginning with her preliminary paper, 'Some Observations on the Treatment of Narcissistic Character,' it is possible to trace the integration of four factors that influenced Ruth Easser's ideas: the teaching of Sandor Rado, her astute clinical observations, her capacity to conceptualize from her observations and build on her previous work on hysterical personality, and the cross-fertilization of the then few psychoanalysts working in this new area of focus. In his teaching, Rado paid constant attention to the affective transactions between patient and analyst. The lessons Ruth Easser learned from her first psychoanalytic teacher contribute to her understanding of narcissistic personality. From her clinical observations, she identifies a group of patients who are not failures in life but are extreme failures in living. She observes that these people seem to function successfully vocationally and socially but receive little gratification from their accomplishments. They enter a series of disappointing relationships and experience frequent bouts of despair and depression. Because they lack awareness

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of their participation in their failures, they collect injustices. The intimacy of the psychoanalytic relationship, although desired, is also feared and mobilizes powerful emergency affects of anxiety and rage. Once psychoanalytic technique is attempted, a massive regression can occur with a mounting panic and a totally unrealistic and paranoid outburst of feelings directed towards the person of the analyst. Accompanying this outbreak is a flurry of action, either away from analysis directly or in the outside world in conjunction with analysis. Many of these patients were in treatment before Easser was aware of the growing body of literature dealing with this group. In this way Easser demonstrates that astute clinicians grasp the meaning of patients' interaction and modify their understanding and adjust their technique accordingly, often before these developments are articulated in the literature. Busy clinicians rarely have time to conceptualize and communicate the valuable insights that they gain through experience. Rare are the Winnicotts of this profession, whose clinical insights, conceptualizations, and writing are so integrated that they flow spontaneously from each other. Ruth Easser was not a Winnicott but she did have the capacity to conceptualize theory from clinical material. Her ability was not unlike that of another discerning clinician, Annie Reich,17 whose keen observation allowed her to conceptualize from clinical observation and thereby contribute to developments in theory and technique. Prior to presenting her own ideas Easser had referred to Annie Reich's 1960 paper, 'Pathological Forms of Self-Esteem Regulation.'18 An affinity in the thinking of these two clinicians is apparent. Both observe marked fluctuations in self-esteem and advance understanding of its meaning. Easser also recognizes her indebtedness to two others currently working in the area, 'for their contributions in abstracting and organizing some of the common determinants that underlie narcissistic character disorders.' Otto Kern berg was working on the understanding of the borderline and narcissistic personalities, and his 1970 paper, 'Factors in the Psychoanalytic Treatment of Narcissistic Personalities,' utilizes the Easser-Lesser paper on hysterical personality. Heinz Kohut, in his book The Analysis of the Self, which was published in 1971, was beginning to offer hope for the treatment of disorders of the self. Ruth Easser's reference to the work of her contemporaries illustrates the cross-fertilization necessary for the development of psychoanalytic thinking. Although the profession needs a Kernberg and a Kohut to articulate and disseminate major conceptual advances, patients need astute analysts - a Reich and an Easser - who are observant, learn from their patients, are flexible enough to find more efficacious ways of working, and sometimes find

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the time to communicate their ideas in small papers that become classic gems. The final published version of Easser's Rado Lecture, entitled 'Empathetic Inhibition and Psychoanalytic Technique,' extends the boundaries in at least three areas of psychoanalytic thinking: ego functions and defence organization, object relatedness, and the concept of the self and self-organization, especially the affective organization of the soma and psyche. Certainly, Easser's papers written between 1972 and 1974 advance the diagnostic understanding and the technical considerations for the treatment of narcissistic personality. What is less evident is her contribution to the psychoanalytic understanding of empathy empathy in the analyst and empathy in the analysand. Empathy19 as a concept is common to every form of psychotherapy and all psychoanalytic paradigms. It is the therapeutic tool which not only promotes emotional connection but also protects emotional differentiation. Empathy is a means of conveying affective attachment and autonomy. A capacity for empathy is a prerequisite for object relatedness. A capacity for empathy in both the analyst and analysand is essential for the therapeutic relationship. Empathy can therefore be considered the royal road to the interchange of perception, thought, and feeling between self and other which leads to therapeutic change. Empathy is defined by Ruth Easser as 'the ability to sample others' affects, and through this sampling to perceive them and be able to respond in resonance to them' and 'as the capacity to appreciate others' emotional response and the response of others to one's own feelings.' Like Rado and those investigators she referred to, Easser recognizes in these narcissistic patients disturbances in the development of a self-concept, the resultant fluctuations in self-esteem, and the lack of or tenuous nature of their object relations. She thinks these patients share a remarkable lack of self-perception. As well, they seem to lack a capacity for empathic awareness of the feelings of others; they seem unaware that others may react to them with hurt, with affection, or with pain. Unaware of the effect of their insensitivity to others, they show little guilt in reaction to their behaviour; rather, they readily resort to reactions of righteous rage or deep despair and a sense of hopelessness. Easser addresses the seeming absence of empathy and the potential for development of an innate empathic capacity: Most investigators have stressed that this empathic capacity appears to be absent in this group of individuals. I disagree.20 These patients, rather than lacking the capacity to develop empathy, cannot permit themselves

192 The Unsung Psychoanalyst empathic responses. This seeming lack of affect performs the function of a defense against emerging anxiety, anxiety which is subjectively reacted to as a traumatic state. It seems more valid and useful to view this lack of perceptiveness or empathy with the emotionality of others, and the flight away from this emotionality as a defense against a painful tension state.

Easser realizes that there has been an early failure of empathy: The difference in my hypothesis stems from the dynamic conception that it is the confusion resulting from the contrast between the child's apperception and the mother's input which leads the child to inhibit his own apperception and to fail to develop, as an extension of this inhibition, an empathetic responsiveness. The therapeutic attitude and the therapeutic technique are quite different whether one considers that the empathic capacity has been crippled, as have many investigators, or if one can assume the potential empathic capacity is present but inhibited and defensively blocked.

Easser maintained that the inhibition of empathic capacity as a defence against the shattering experience of helplessness and diffuse anxiety had two major developmental sources: The first, the parent who seems incapable herself of accurately reading and responding empathically to her child's needs and, second, the child who suffers a severe failure in his own body - an accident, a handicap, or a chronic illness - for which the mother is incapable of offering adequate compensation.21 Whatever the source, there is a dichotomy experienced by the child. A confusion ensues. Does one believe what one is told, what one perceives, or what one wishes to perceive? The reality testing of emotional resonance breaks down.

Ruth Easser's views on empathy, developed in these papers written in the last few years of her life, illustrate the degree to which she integrates her personal capacity for empathy, and her respect for the individual as being worthy of and capable of empathy, with her analytic role. That she considers the inability to express empathy an inhibition rather than a defect is indeed a most empathic insight. In addressing the technical considerations required to undo this inhibition, she emphasizes the importance of the psychoanalytic relationship; the challenge to this defensive lack of empathy must be made within the analytic situation itself. She rec-

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ognizes the anxiety and pain which lie behind a cold, often aggressively critical, off-putting manner exhibited by some analysands towards other persons, including the analyst. This insight could have come only from someone whose own empathic capacity was well developed and who highly valued the individuality and potential of each person. Easser realizes that the psychoanalyst has to be aware of the overwhelming tension underlying inhibited empathy and comment on its painfulness before a patient can begin to feel understood within the analytic relationship. As a psychoanalyst, she calls attention to inhibited empathy with such phrases as: 'You didn't tell me you felt understood' or 'You were not using your empathy' - to understand that person's situation, or 'It is difficult to show compassion to someone who has hurt you so much.' She gives credit to the other person's perceptions of their own and others' feelings and emphasizes that communication is essential. One analysand recalls how she fostered relational communication with a simple statement, 'You don't seem to have your antenna up' - you are not open to and so not responding to the messages that are there. The analysand realizes her capacity to give and receive empathy, it is just not being used. What does Ruth Easser's understanding of empathy have to do with resolution of the dynamic tension and achievement of an optimal balance between attachment and autonomy? Her definition of empathetic attachment emphasizes the notions of resonance and reciprocal communication. When a person perceives the feelings of another and communicates this perception to the other, a connection is made. Resonance and reciprocal communication imply autonomy in the sense of individuality and differentiation. Autonomy is implied in the recognition of another's feelings as distinct and valid, although possibly different from the feelings and perceptions of oneself. Resonance develops as the child begins to label and validate feelings through recognition of himself in mother's empathic response. The child integrates mother's mode of perceiving his feelings and develops an ability to perceive her feelings apart from his own. Resonance denotes differentiation between the feelings of self and other.22 It implies a partial experiencing of the other's feelings but it is neither identical, nor is it of the same intensity. Empathic resonance also includes the ability to moderate one's emotional experiencing, that is, to experience oneself as a feeling person yet not be completely absorbed in one's own feelings. Easser recognizes that an early failure of empathic attunement makes intimacy painful. Narcissistically sensitive patients translate disappointment, hurt, criticism, and even affection into intolerable tension which must be avoided. Easser is con-

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vinced that the analyst must acknowledge the patient's pain and resulting anxiety. This empathic acceptance and awareness of the patient's suffering is experienced as an expression of confidence by the analyst in the patient's ability to tolerate his suffering in order to seek out its cause and eventually overcome it. Easser's understanding of empathy fosters attachment and protects autonomy for both participants and thereby makes the psychoanalytic relationship and therapeutic change possible. Ruth Easser's understanding of empathy demonstrates how one psychoanalyst with antennae directed both backward and forward and open to the moment is able to creatively integrate understanding and communicate it in meaningful words according to an analysand's healing needs. Her backward antenna hears Freud, Ferenczi, and Rado's words about empathy. Her antenna tuned to the moment hears the inspiring views of Annie Reich, and emerging views of Otto Kernberg and Heinz Kohut, as well as the insights gained from her own observations and experience, and that of her patients. Her forward antenna is tuned to her own thoughts which anticipated developments in psychoanalysis and selfpsychology.23 Ruth Easser's stable antennae are centred on a firm inner conviction of a person's symmetrical needs for attachment and autonomy. Psychoanalysts must know themselves intimately - their conscious values and those that were once unconscious, their identifications, motivations, and conflicts. This self-knowledge is used indirectly to understand their analysands and promote the development of their professional self. The optimal balance to be achieved in the psychoanalytic relationship is the development of self and other for the analyst and analysand alike. The more one knows oneself, the more one is able to understand and assist others towards self-knowledge and creative integration. As recognition of the centrality of the two-person relationship became a more integral part of the psychoanalytic paradigm the person of the psychoanalyst has received more attention. The most obvious and indisputable characteristic of the psychoanalyst as person is gender. No analyst can avoid the fact that he or she is a man or a woman. Nor is it now possible to imagine that being a man or a woman has little impact on one's development, efficacy, and life as a psychoanalyst. Facets of Ruth Easser the woman and psychoanalyst are found reflected in her two unpublished papers on 'womanhood.'24 Although she presented only two papers on female development in 1974 and 1975, her views, unconstricted by orthodoxy, were prescient of what is

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generally accepted today. Easser's views contribute a historical footnote to the growth of psychoanalytic thought on the psychology of women for the following reasons: Easser's papers demonstrate that an insightful clinician can rise above unresolved theoretical controversy about women to arrive at a way of thinking that is intuitively sensible and anticipates subsequent developments in psychoanalytic thought. She assumes an overarching developmental model based on what is now called, after George Engel (1977), a biopsychosocial frame of reference, thus suggesting a broader organization of clinical observations than the psychoanalytic paradigm of the day did. In the twenty-five years since Easser's death there has been a major revolution in psychoanalytic thinking about femininity, yet her ideas are as relevant for today's women and psychoanalysts as when she articulated them. Her position remains theoretically and clinically applicable to women's development. That these papers on womanhood were her last papers is poignant. People who knew her generally agree that she developed her sense of herself as a woman somewhat later than usual. Her own struggles made her acutely sensitive and empathetic to women and women's issues. Her women friends, colleagues, patients, and students all attest to their sense that Easser understood them as women; men acknowledge her femininity. The tone of these papers and her straightforward pride in womanhood - based on her assumption that a woman is a complete human being and that her sense of herself comes from within her own attributes as a woman - are natural and convincing. She cuts through the historical controversy over primary or secondary femininity25 that had raged fifty-five years earlier, was silenced for a time, and was just beginning to speak again in the loud voice of feminism. Ruth Easser remarks in her first paper on womanhood, entitled 'Changing Concepts of the Psychology of Women': 'Poets have sung of the mystery of women throughout the ages and there appears to be much delight and strong emotional need in preserving this mystery. Nonetheless, as psychoanalytic investigators, it is anticipated that our role is to penetrate and to resolve this mystery albeit it may require the relinquishment of certain pleasures and conceits.' During her presentation on 'Womanhood,' at the American Psychoanalytic Association meeting in May 1975, four months before her death, Easser made this statement which was remarkable at the time: 'A woman is a complete individual even when not involved in heterosexual relationships or in a pregnant state or in the act of mothering.' She notes

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that 'as we discuss the psychology of women, we still appear to be divided on the issue of whether a woman's self-perception is that of a complete self-gratifying individual or whether she is energized by a need to repair the trauma of discovering herself damaged, castrated and incomplete.' Easser proposes: Females are complete beings in themselves; if they seek heterosexuality or procreation in order to find self-validation or to recapture the lost penis, one must view this as a defensive manoeuvre indicative of a disturbed selfimage and of low self-esteem; that if sexuality or motherhood are sought primarily as modes of self-completion, this will result in disappointment, lack of fulfilment and further lowered self-esteem; and that under such circumstances these women then react with a restitutive further increase in penis envy.

Easser writes: The self system of a woman requires an ease, indeed a pleasure in her body image which includes an awareness of and a gratification in the sensations that emanate from within herself.' She aptly notes The psychoanalytic literature is peculiarly lacking in defining as a therapeutic goal the unravelling of the conflicts aroused in dealing with the difficulties and impulses that arise when women allow themselves the selfsatisfaction of being women. Heterosexuality, procreation, motherhood are much more than validation of one's sense of self. A woman must feel complete and proud within herself before she can gain pleasure and fulfilment in those other facets of femaleness. Therapeutically, the psychoanalyst must first accept that a woman is a whole, intact individual before he/ she can help female patients into self-awareness, self-pleasure and selfpride in what her body has to offer her. Then she is capable of working through her attitudes towards sexuality and towards motherhood. If analysts adhere to the now untenable Freudian concept that a woman is incomplete and to become complete requires a penis substitute either from a willing sexual partner or by giving birth, they are reversing the order of therapeutic priorities and are bound to fail.

It is fortunate for those whom she influenced that Ruth Easser never lost touch with her womanhood. Her thinking and her writing about womanhood, like her other contributions, are not limited to or by the-

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ory. Instead, in all facets of her work, she makes use predominately of her experiences and her personhood. Easser's lifelong effort to achieve and maintain autonomy from her mother who tended to control - a struggle that influenced her psychoanalytic interest in women's development of their sense of self-was reawakened towards the end of her life. As her illness progressed, she was confined to home and bed. Despite her weakened state, she continued to supervise. During this period, a supervisee met with her; as a friend he had also visited her frequently. Striking during previous visits was her insensitivity to her mother and her stubborn refusal to accept her mother's help. She was unashamedly distant and self-sufficient. One day, however, all that abruptly changed. Easser expressed a loving warmth towards and need for her mother not seen previously during her illness. That same evening Ruth Easser died. The following vignette illustrates the depth of Ruth Easser's self-integration, and of her capacity to meld the personal and professional aspects of life, to resolve the incongruities of attachment and autonomy, and to harmonize the similarities and differences in self and others. An analysand married a widower with children around the time Easser's cancer recurred. Her symptoms worsened while the analysand was away, and she stopped work for several weeks. Although obviously ill (her legs were bound because of edema), she was able to resume work for three weeks before her final summer break. During one of their last sessions the analysand was speaking about her experience in becoming a stepmother. Easser said emphatically, 'The children's first mother has died. You are not their stepmother, you are now their mother.' The analysand responded with intense feeling and awareness of the possible tragedy of her analyst's death, Tt is possible that your children might be needing a new mother.' Ruth Easser responded simply, 'Yes, that is right.' This moment of shared emotion at a time of mutual though differing vulnerability reflects an aspect of what is at the core of the psychoanalytic encounter between self and other. Ruth Easser was able to put aside her personal pain of impending death to validate the analysand's perceptions. Her empathic understanding of the analysand's new role affirmed a lasting attachment through memory. The analysand, although aware of the impending tragic loss, never forgot the words, 'You are their mother,' which sustained her through the vicissitudes of new motherhood. At the same time she was freed to get on with her life, independently from Ruth Easser's tragedy. The analysand could identify with

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their similarities - they were both mothers - without being burdened by the unfortunate differences in their fate. At least for this analysand, Ruth Easser achieved an optimal balance with her simple acknowledgment of her own fate. That she continued to work to the very end was of enduring importance to the analysand and, for Ruth Easser, an affirmation of herself both as a person and a psychoanalyst.

Epilogue

Ruth Easser did not and could not tell her own story. This is not the story of her life as an individual but the story of an image of her life as a psychoanalyst in the minds of others. What of the reality of this image as example? Arnold Modell refers to Freud's deep insight that memory is retranscribed in accordance with later experience. His understanding of Freud's concept of Nachtrdglichkeit was 'influenced by the novelist Italo Calvino, who examined the significance of levels of reality in literature and made the important observation that each level of reality acts upon another level of reality and transforms it.'1 Collective memories inevitably create an image with multiple facets in continual transformation through time and experience. The reality of such an image and the person who inspires it are less important than the levels of influence and meaning generated. The analytic mind emanates from the synergistic interaction of personal characteristics, formative influences, facilitating opportunity, and experience. The development of Ruth Easser's analytic mind provides lessons for the current generation of psychoanalysts and has been presented here through three filters: the historical, the collective memories and memoirs, and the individual - the author. Recently, the value of reassessing Sandor Rado's legacy has received recognition.2 The influence of Radovian insights and adaptational theory in the writings of Columbia's graduates, however, has not been traced. Ruth Easser's work provides evidence that her Radovian Columbia training was the base from which her views evolved.3 Nellie Thompson notes that little attention has been paid to the impact of schisms on the creativity of a psychoanalytic society or institute: 'In the case of the New York Psychoanalytic Society/Institute, many of its members were unusually creative and productive in the years fol-

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lowing the schisms created by Karen Horney's departure in 1941 and Sandor Rado's fractious disengagement during the years 1942-1947.'4 One might also ask what happens to the creativity within an institute founded out of the rebellion that led to a schism. Thompson calls attention to Ralph Greenson's suggestion of a relationship between creativity and aggression in that 'the distress and even the outrage which confrontation arouses are important antecedents to creativity in our psychoanalytic institutes.' Furthermore institutes can nurture creativity because 'the [institute] also provides a holding, structuring function ... In other words, creativity in psychoanalysis requires boundaries as well as freedom.' The founding of the Columbia institute, the 'battle of the frames of reference,' the defining of differences, and the forging of psychoanalytic extensions through schism provided the boundaries and the freedom within which Ruth Easser created her analytic mind. Over time, there is often an overlapping of concepts in psychoanalytic theory and often acclaimed changes in technique are variations on wellestablished therapeutic methods. It is by acknowledging the origin of ideas, tracking and extending them, looking at clinical material from different angles, redefining our concepts, and drawing diagnostic and technical inferences that psychoanalytic theory develops, and the therapeutic tools become more effective. When psychoanalysts work within the security of the contributions of those who came before them, with the support of colleagues, and with the freedom to challenge, they are more likely to be creative and productive. A discussion by the author5 of Peter Fonagy's theory of 'reflective function' - defined as knowing the self s mind in relation to the mind of the other - in which similarities with Ruth Easser's ideas about empathy were suggested, illustrates this notion. Fonagy's 'reflective function' encompasses many concepts, a primary one being empathy. Easser defines empathy as the capacity to appreciate others' emotional responses and as the responses of others to one's own feelings. Easser maintains that those patients who suffer from narcissistic characteristics have repressed their capacity for empathy as a defence against the shattering experience of helplessness and diffuse anxiety, and she assumes an innate empathic capacity inhibited as a result of parental empathic failure. Technically, she proposes that the challenge to the apparent lack of empathy must be made within the psychoanalytic relationship itself. Fonagy speaks of an inborn capacity for reflective function. This capacity can be developed through secure attachment relationships and, conversely, can be defensively impaired or inhibited by insecure attach-

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ment patterns. He points out that the relationship with the therapist remains central because the clarification of patients' feelings about themselves and about the therapist is the most effective route towards acquiring mentalizing capacity. Fonagy and Easser seem to be on a similar wave length. There has been much transgenerational transmission of ideas in the development of psychoanalytic theory and technique in the years since Ruth Easser's work. Its similarities with Fonagy's work illustrates the indirect transgenerational generativity of this profession. The collective membership represented by the interviewees' memories leaves no doubt that the growth and creativity of their analytic minds and skills were influenced by their relationship with Ruth Easser. They, along with the current generation, face a challenge which she and her analytic peers did not have to face, that is, decreased opportunity to practise analysis with many patients over time. Merton Gill, in his personal view of 'psychoanalysis in transition,' addresses this problem. He recognizes and is not dismayed that most psychoanalysts now must combine a psychoanalytic practice with other forms of therapy or professional endeavours and comments: 'I believe the therapist's identity as an analyst will be safeguarded if he practices psychoanalysis not only via psychoanalysis proper but via the therapy he must undertake with altered extrinsic dimensions. He will thus avoid the twin dangers of attempting to maintain a stiff analytic reserve in his "psychotherapy" on one hand and infusing witting unanalyzed interaction into his psychoanalysis proper on the other.'6 Easser taught through 'exquisite attentiveness' to the moment-to-moment variation in affect as expressed in the analytic relationship. Decreased opportunity to practise analysis because of today's reduced number of analysands per analyst does not preclude such 'exquisite attentiveness.' Melvin Bornstein, addressing the current concern about the future of psychoanalysts as clinicians comments: Until a few decades ago the advances in psychoanalysis were focused on the elaboration of the principle of the influence of the past on the present... However, the ramifications of the principle of Nachtrdglichkeit, the influence of the present on the past, which Freud described in his early papers, had not been considered until a few decades ago. The [current] interest in the here and now, intersubjectivity, enactments, [and] the action of psychoanalysis reflect attention to how the present influences the past. In the next few decades the influence of the present on the past will be a significant component that will influence psychoanalytic thinking and theorizing, con-

202 The Unsung Psychoanalyst siderations of what is relevant or irrelevant, accurate or inaccurate. The influence of culture, race, economics, and gender within psychoanalytic thinking and practice reflect factors that are lodged in the present that have broad effect on the understanding and activities of the psychoanalyst.7

In a similar vein, but with more of a focus on exigencies within psychoanalysis, Karen Maroda recognizes that 'the reconceptualization of the psychoanalytic situation as a two-person event has caused dramatic upheaval in the analytic world. As we struggle to understand the many nuances associated with the transition from a one-person psychology to a two-person psychology, we naturally resist change as much as we embrace it... this new understanding of the role of mutuality has breathed fresh air and excitement into an analytic discipline moving dangerously close to extinction. The problem confronting analytic theorists and clinicians today is not whether to change analytic theory and practice, but how to change them.'8 The filter of this collective memoir of interviewees reflects the dynamic reciprocal influence of the past on the present and of the present on the past. Remembrances derived from the psychoanalysts, dispersed in time and place, highlight both the historical and contemporary context within which psychoanalysis has developed and changed. The image of Ruth Easser that emerged was of a psychoanalyst whose formation in what was then a dissident institute, founded by an analyst considered heretical by the psychoanalytic establishment, led to her development as a critical thinker, a bender of paradigms of theory and technique, and an influential teacher and model for psychoanalysts who are today's extenders, modifiers, and some, possibly heretics. Remembrances of family and friends breathe life into the psychoanalyst as a person. The synergistic interaction of past and present is clear. Tracking the origin of ideas, illuminating both historical and more immediate influences, and tracing intellectual and emotional attachments enriches understanding of the development of psychoanalytic thought. Past and present can be considered separately but cannot be separated. Then and now create the future of psychoanalysis and psychoanalysts. The third filter of the Ruth Easser story is that of the author and can be considered only from personal experience. In September 1973, I began a training analysis with Ruth Easser. In September 1975, she died of cancer. Paul Lerner, a close analyst friend of mine and supervisee of Easser's, was given the rights to Easser's papers by her husband, Stanley Lesser. Over the years, as part of our mourning, Paul and I talked about

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producing a book of her collected papers but with little progress. In 1992, my husband, Frederick Lowy, thoughtfully put on my desk an article he believed would interest me. Ethel Person had an article entitled 'The Columbia University Center for Psychoanalytic Training and Research' in the American Psychoanalyst.9 I wrote a note to myself: 'find out if Person knew Easser.' When I telephoned I received the encouraging response, 'Oh what a good idea, of course I knew her. She was one of the great teachers, role models and intellectuals of psychoanalysis at Columbia.' Ethel Person agreed to an interview and gave me names of others who would have known Ruth Easser. This first 'research' trip to New York initiated this mutative odyssey. It is difficult to assess the experience of writing about my analyst. It is sometimes only from hindsight that insight is gained. Writing about my analyst, a form of post-termination contact, further integrated my analytic work and facilitated self-analysis. The reawakening and reworking of mourning enhanced my understanding of loss. More than that, it has been invaluable professionally, as I began to understand her way of thinking and working and discovered the nature of her influence on other psychoanalysts. The enrichment of this process has compensated for the loss of what might have been for me had she lived. It has deepened my conviction of the truth of internalization and the mutative impact of identification with 'the two or three simple and great images which first gained access to our hearts.'10 Learning about Ruth Easser as a psychoanalyst and as a person has been an evolving process. Given what I know now, I have to remind myself that until I began this project I knew very little about her. My experience of her was only as an analysand. For me, as for many of us, respecting the personal anonymity of one's analyst is important to the analytic work. Although I had met her and Stanley Lesser professionally, my knowledge of her personal life was vague. Neither seeking nor avoiding information about her, I was privy to little. In researching this book, I found the facts of Ruth Easser's professional life added an unexpected dimension of understanding of her as a psychoanalyst. I acquired a deeper appreciation of her thinking about analytic theory and technique and how her frame of reference was related to her as a person. Ordinarily, as candidate-analysands, we experience our analysts in a rather narrow and subjective way. Of course, this is not to say that we are not influenced by their way of working. On the contrary, identification with one's analyst frequently results in imitation, even integration of a way of working that is largely unconscious. I had

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the additional experience of coming to know how Ruth Easser thought and worked through her papers and through the eyes of her teachers, peers, and students. This provided an opportunity of supplementing my subjective experience with a more objective perspective. This produced some surprises (as I recognized myself in a case example - a slightly disconcerting but useful experience), occasional dissonance (she questioned why adopted children would want to know about birth parents her countertransference), and a few belated insights (ah ha! that is what she meant with that interpretation). Overall, my positive analytic experience with Ruth Easser was confirmed and my analytic knowledge extended and deepened. Through this process, I have experienced a wide range of emotional reactions around both wanting and not wanting to know about my psychoanalyst. I was curious, excited, intimidated, challenged to overcome hurdles, stimulated by what I did discover, elated by consistently positive receptions from interviewees, and moved by the vivid memories of how she had touched the lives of many people. I also experienced trepidation, especially when it came to very personal information about her life, her problems, her pain, and her failures. The intellectual work of the interview process provided the holding environment for my varied emotional reactions, for reworking my idealized transference and grief over her loss, and thereby integrating her humanness with what she gave me as an analyst. Speaking with Ruth Easser's teachers and colleagues was the most objective part of the research. I gleaned information about her as a student, how it was to work with her, how others saw her professionally. My sense that she was a truly gifted psychoanalyst was confirmed. It was also informative to learn about a prestigious psychoanalytic institute and those involved in its development from its dissident days to its current establishment status. Stronger feelings were aroused when I met those who were taught by her. Envy of their experiences was mitigated because as her students spoke about what and how she taught, I also learned. Interviews with family and friends raised other feelings, primarily anxieties of being voyeuristic and intrusive, as well as feelings of empathy and sadness when I learned of the life stresses she endured and of the pain of her loss to others. Concerns were raised about publishing personal material, even posthumously, without consent. There are, of course, the formal ethical guidelines for publishing. These are relatively easy to follow. But Ruth Easser is not here to give consent or to confirm or disconfirm what I have learned, nor is her husband who died before this project began. I

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included only those aspects of her family background pertinent to Ruth Easser's life as a psychoanalyst, as well as those relevant aspects of her relationship with her children and her husband as her main support and her closest analytic collaborator. Friends' anecdotes were used to highlight certain personal characteristics or attitudes related to her work. Since this book is not a history, nor a biography nor a psycho-biography, to have included other personal material would have been an invasion of privacy, unnecessary for the purposes of the project. Just as psychoanalysts keep confidentiality, there is an obligation not to disclose what is not directly relevant to Ruth Easser as a psychoanalyst. This was not difficult because interviewees also respected her privacy, and she was herself a private person. Talking with Ruth Easser's analysands proved to be a delicate process in that more of myself as an analysand was involved. I was meeting my analytic siblings. I did not experience feelings of rivalry so much as a certain discomfort in sharing information about our mutual analyst. What did I have a right to tell and how much did they want to know? Did I really want to share her and the life-changing experience she had given? Essentially, these talks proved mutually rewarding. For me this work has been of invaluable assistance in my struggles to be a good enough psychoanalyst. That Ruth Easser remains with us in our collective memory as one of the many gifted and dedicated, yet unsung psychoanalysts was movingly confirmed by this unsolicited letter from a person outside the profession, a former analysand, who wrote on 10 October 2002: I recently read your co-authored article (with Paul Lerner) on the life and contributions to analysis of Ruth Easser.11 I found it very rewarding. I was, as a young man, in analysis with Ruth Easser until several months before she died. We took 'a break' at that time at her suggestion. Although her death left our work unfinished, what we did accomplish saved my life. I was unaware she was ill at the time (wilfully blind I think), learned of her death from the notice in the Globe and Mail, and have felt a little guilty ever since. I carried a feeling of unreality about it for many years, perhaps because of the complete absence of any 'normal' social context within which to place such a relationship. No one I knew knew her. No comparing of emotional notes, no shared grief. No layperson would understand it anyway. Over time it thus assumed a mantle of fantasy for me. Did this ever really happen, did I know this person, is she really gone? I began rethinking all this a couple of years ago, (after a 25-year hiatus!)

206 The Unsung Psychoanalyst and reading around the subject of analysis in general, and Ruth Easser in particular. I was excited to find your article, and her paper, 'Empathic Inhibition and Psychoanalytic Technique.' Your description of her appearance and manner are exactly as I remember. The context of her upbringing, family relationships and culture, etc. all fit. She was, I always felt sure (complexities of a psychoanalytic relationship notwithstanding), a good person; bright, professional, genuinely compassionate. Your article contextualized my memories, rounding out her person and life. As well as highlighting her contributions to psychoanalytic thought, your article left me with the impression that she had had a lasting emotional impact on at least two others as well. With respect to that part of my life, I no longer feel quite so alone!

In a subsequent letter, dated 13 January 2003, this same analysand described his experience of terminating his work with Ruth Easser, and of a post-termination meeting as well as the therapeutic value of learning about his analyst as a person: As I recall it, in the spring of 1973 she was away for 2 weeks for surgery, 2 weeks turned into 4 or so. Suddenly one day she was untwisting mints instead of lighting cigarettes. I had at that time an aunt, with whom I was close; she was a GP, though she did not have a practice. She was a rather resigned person and smoked like a chimney. She was dying of lung cancer and I had been talking about her in sessions. When Ruth suddenly switched to mints I wondered aloud, Was she alarmed by my aunt's fate, was it out of consideration for my feelings etc. to which she replied, 'You must think me very altruistic.' After her death, and in some measure until quite recently, I was angry, feeling that she had robbed me of herself in the same manner that my aunt had. She had taken herself away. I felt guilty about feeling that way, and at the same time un-entitled, considering the loss that her family and friends must have experienced. Understanding the nature of her illness has helped resolve those feelings. I had one post-termination meeting with Ruth Easser that I can share with you. My analysis was terminated on her initiative in December of 1974, with 3 or 4 months forewarning; in essence she said, I would benefit from some life experience, but that more work needed to be done later. We had been at it for about two and a half years. I did not want to leave. In retrospect I realize this was probably driven by other considerations, but I can't be really sure. I know I wish she had told me directly that she was ill.

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I don't know whether I would have been better or worse with the truth. I have wondered when she terminated her other cases. In any event, I saw her once more, on my initiative, six months after termination, sometime in early June 1975. I wrote her; I was travelling and going to be in Toronto for a short time. She answered my letter, I think with a phone call, and seemed enthusiastic. I know I was pleased. We met in her office. I remember very little of what we discussed. I think I told her what I had been doing. I was electrified by her presence, felt obligated to be doing well, not to have failed, and underneath, confused. No talk of resuming. Why had I been sent away? Had she given up on me? I remember this: At the beginning she said, 'You look wel and I replied, 'You do too.' As I said it I realized she didn't. I didn't know what to do. At the end of the hour she stood, walked over to me, extended her hand, which I took, and said, 'I've missed you.' To my profound regret I replied, 'Oh I don't believe that.' I could see her disappointment and I felt my own. I left confused and distressed. It had been so good to see her. If I could take just one thing back in my life, that response would be it. It was not until after I learned of her death that I understood she was saying goodbye. I have come to accept that she did care about me, and missed me, as I did her. I have wished ever since that I'd had the courage to express those things and been able to respond to her needs at that difficult time. Empathic inhibition, not incapacity. What, if anything, does that say about the prudence of post-termination meetings? As indicated above I have come, rather belatedly, to appreciate the obvious and rewarding fact that therapeutic relationships do involve genuine feelings on both parts. As you put it in your article so well, a good therapeutic relationship, i.e., an effective one, is a specialized, intense, intimate relationship between two mutually caring persons. From a lay perspective, it is therefore difficult to see how the extension of such a relationship, or some aspects of it, in many if not most circumstances, can be bad. Why wouldn't or shouldn't, for example, the struggle to maturity include a fuller 'de-idealization' or humanization of one's analyst, post-termination? My gut reaction accords with your thesis. A meaningful analytic relationship, successfully terminated, should be open to further communication. Although my analysis with Ruth Easser was incomplete, and my followup meeting with her remains a poignant and painful memory, I will be forever glad that it took place. I have come to see her, largely as a result of that meeting and the emotion expressed therein, as a genuine warm human being, complete with whatever vulnerabilities she may have possessed who cared about me and helped me a great deal, and who I feel I loved.

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Afterword

I am one of the beneficiaries of Barbara Ruth Easser's quiet genius. Senior to me by fourteen years, she was my psychotherapy supervisor during my psychiatric residency, then my psychoanalytic teacher and supervisor during my psychoanalytic candidacy, ultimately a friend and colleague, and always a mentor. When I began to teach and supervise, she was a powerful model. As a result, my students and supervisees are also the beneficiaries of her genius; most know of her through my accounts of experiences with her and with the patients she supervised. That is the way it has always been in psychoanalysis. The formal intellectual structure of the discipline - history, concepts, theory, technique, and the like - can be found in texts and journal articles, and is taught in classes and seminars. At the same time, side by side with this is the clinical tradition and wisdom that is largely transmitted orally and personally, from supervisor to supervisee and indirectly from training analyst to candidate-patient. In this sense learning to be a psychoanalyst may be more akin to learning to be a chef or a performing artist than a scientist or engineer. However, psychoanalysis and psychoanalytic education have changed in the forty years since I was Ruth Eassser's supervisee. They have changed in ways of which she would approve, and changed to incorporate important themes that reflect her major interests. The profession is far less interested in theory for theory's sake - papers and presentations have to have some relationship to patients and to the clinical process or they are unlikely to find an audience. Our interest in psychodynamics, development, and psychopathology continue, but there has been a spectacular growth in interest in the treatment itself, in what transpires between analyst and patient, their relationship, and in much that was

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Afterword

long taken for granted, described as 'going without saying,' subsumed under such general terms as 'fact.' Ruth Easser's teaching was always marked by close attention to affects, to subjective experience, to what goes without saying, and these subjects have been the major focus of attention in contemporary psychoanalytic discourse. Of course, these developments not only reflect the internal dialogue of the profession, they are also responsive to changes in the outside world. Psychoanalyst are more likely to be involved in their communities - providing psychotherapy and often pharmacotherapy, working in hospitals, clinics, schools, and community agencies, and using their knowledge in programs designed to prevent illness, promote health, and facilitate rehabilitation, as well as in the treatment of traditional psychoanalytic patients. These developments are also taking place in the context of a new attitude towards psychoanalytic research. We study what we do and expect to learn from the results of those studies. It is no longer sufficient to derive our methods from tradition or authority, and we will be quite disappointed if our students don't know more than we do, including knowing that which we long believed to be true that turned out to be wrong. Finally, and only in the last few years, these developments have begun to affect psychoanalytic education. There is much less of the transmission of known truths, much more of a dialogue of inquiry and searching. Authority is questioned in educational as well as clinical contexts. The superior teacher is one who supports and encourages the student's exploration rather than one who knows the correct answers and expects the student to learn them. In brief, the superior teacher today reminds us very much of Ruth Easser. If Ruth Easser could visit us today she would be very comfortable with the evolving changes in psychoanalysis. Her style of teaching and writing - close to the clinical material, light on abstract theory and strong on specific data, comfortably drawing on medicine, psychiatry, developmental psychology, neurobiology, family and cultural studies, and curious and open-minded about what it all might mean - would fit into today's psychoanalytic community even more comfortably than her own. Mary Kay O'Neil has done us an immense service by bringing Ruth Easser's memory and story to life, and by doing so helps us to recognize how psychoanalysis has evolved, and how the seeds of that evolution were present in the lives and work of some of our most gifted forebears. ROBERT MICHELS, MD

Appendix 1 Collected Papers of Ruth Easser

Early Research on Amenorrhea Kelley, Kenneth, George E. Daniels, John Poe, Ruth Easser, and Russel Monroe. Psychological correlations with secondary amenorrhea. Psychosomatic Medicine, 16: 129-47,1954. Easser, Ruth. A case of amenorrhea showing psychohormonal interrelationships. Psychosomatic Medicine, 16: 426-32,1954. Presented to the Association for Psychoanalytic Medicine, April 1954. Collaborative Research Karush, Aaron, B. Ruth Easser, Arnold M. Cooper, and Bluma Swerdloff. The evaluation of ego strength. 1: A profile of adaptive balance. Journal of Nervous and Mental Disease, 139: 332-49, 1964. Cooper, Arnold M., Aaron Karush, B. Ruth Easser, arid Bluma Swerdloff. The adaptive balance profile and prediction of early treatment behavior. Developments in Psychoanalysis at Columbia University (Proceedings of the Twentieth Anniversary Conference, Psychoanalytic Clinic for Training and Research, Columbia University, 30 Oct. 1965), ed. by G.S. Goldman and D. Shapiro. New York: Hafner, 1966, pp. 183-214. Early Papers on Clinical Technique Easser, B. Ruth. Indications and centra-indications for reconstructive analytic treatment. Presented to the New York Section for Clinical Psychiatry, New York County District Branch, March 1962. - Cure in psychoanalysis. Panel presentation, William Alanson White Institute, New York, Dec. 1962.

212 Appendix 1 - Special forms of resistance: Extra-analytic contacts in training analysis. Panel presentation to the American Psychoanalytic Association, May 1965. - Fate of the transference neurosis at termination: Special reference to the female analyst. Presented to the Association for Psychoanalytic Medicine, April 1968. Bulletin: The Association for Psychoanalytic Medicine, 8: 22-8, 1968. Papers on Hysterical Personality Easser, Barbara Ruth, and Stanley R. Lesser. Paper on hysterical personality presented to the American Psychoanalytic Association, May 1963, and to the Association for Psychoanalytic Medicine, Oct. 1963. Bulletin: The Association for Psychoanalytic Medicine, 3: 35-8, 1964. - Hysterical personality: A re-evaluation. Psychoanalytic Quarterly, 34: 390-405, 1965. - Transference resistance in hysterical character neurosis - technical considerations. Developments in Psychoanalysis at Columbia University (Proceedings of the Twentieth Anniversary Conference, Psychoanalytic Clinic for Training and Research, Columbia University, 30 Oct. 1965), ed. by G.S. Goldman, and D. Shapiro. New York: Hafner, 1966, pp. 69-80. Lesser, Stanley R., and Ruth Easser. The marital life of the hysterical woman. Human Sexuality, 4: 27-37, 1969. Papers on Affect and Narcissism Easser, Ruth. Some observations on the treatment of narcissistic character. Presented to the Canadian Psychoanalytic Association Annual Meeting, 1972. - Affect, the self and psychoanalytic technique. Presented to the Association for Psychoanalytic Medicine, 17th Sandor Rado Lecture. 22 March 1973. Bulletin: The Association for Psychoanalytic Medicine, 13: 4-8, 1973. - Character sequelae of prolonged illness in childhood. Presented to the Toronto Psychoanalytic Society, 1974. - Empathy and narcissism. Presented to the Toronto Psychoanalytic Society, 1974. - Empathetic inhibition and psychoanalytic technique. Psychoanalytic Quarterly, 43: 557-80, 1974. (Published 1973 Sandor Rado Lecture.) - A discussion of the paper by H.M. Southwood on 'Analysis as Experience.' International Journal of Psycho-Analysis, 57: 167-77, 1976. Papers on Psychological Aspects of Physical Handicap Lesser, Stanley R., and Ruth Easser. Personality differences in the perceptually handicapped. Journal of the American Academy of Child Psychiatry, 11:458-66,1972.

Appendix 1 213 - The psychiatric management of the deaf child. (Unpublished.) Easser, Ruth, and Stanley R. Lesser. Perceptual style, defensive structure and personality organization in the perceptually handicapped. (Unpublished and unfinished, worked on 1974-5). Papers on Social Issues Easser, Ruth, and Sarah McCall. A hospital staff copes with abortion. Presented to Mount Sinai Hospital, Department of Psychiatry, University of Toronto, meeting, 1973. Lerner, Paul, Ruth Easser, and Stanley R. Lesser. The effect of changes in lifestyle of contemporary youth on psychiatry: Diagnosis and treatment. Presented to the Ontario Psychiatric Association, 1974. Papers on Womanhood Easser, Ruth. Changing concepts of the psychology of women: A reconsideration of female sexual development and the role of women. Presented to the Canadian Psychoanalytic Association, June 1974. - Womanhood. Presented to the American Psychoanalytic Association Annual Meeting, May 1975, as part of a panel on the Psychology of women: Late adolescence and early adulthood. Eleanor Gaelenson, reporter. Journal of the American Psychoanalytic Association, 24: 631-45, 1976. Prepared Discussions B. Ruth Easser prepared discussions (listed in chronological order) of the following works. Rarush, Aaron, and Lionel Ovesey. Unconscious Mechanisms of Magical Repair. Presented to the Association for Psychoanalytic Medicine, April 1961. Van Leoween, Kata. Pregnancy Envy in the Male. Presented to the American Psychoanalytic Association Meeting, Dec. 1961. Peck, Arthur. On Being Sick. Published in Bulletin: The Association for Psychoanalytic Medicine, 5:11-12, 1962. Stern Aaron. Termination in the Service of Treatment Goals. Published in Bulletin: The Association for Psychoanalytic Medicine, 5: 23-6,1965. Moulton, Ruth. Sexual Responsiveness in Women. Presented at the William Alanson White Institute, Feb. 1967. Sperling, M. A Case of Petit Mai. Presented at the American Psychoanalytic Association Meeting, May 1973.

214 Appendix 1 Presentations (Text Unavailable) Easser, B. Ruth. A diagnostic revision: A psychodynamic prospectus. Presented to the Department of Psychiatry, Columbia University, Sterling Forest Conference, Oct. 1968. - Leader and chairman of the presentation of the Psychoanalysis of an adult case, American Psychoanalytic Association, March 1971. - Demonstration of a case presentation. Clinical Program for the 75th Anniversary Celebration of the New York State Psychiatric Institute, New York, Oct. 1971. - Chairman, Panel on the changing patient in psychoanalysis. Columbia University Psychoanalytic Clinic Symposium, Oct. 1972.

Appendix 2 Interviews

New York - Columbia Anders, Thomas. 5 Nov. 1994 Bernstein, Anne. 1 May (Tape), 6June 1994 (Interview) Casselman, Juanita. 4 Dec. 1994 (telephone interview) Center for Advanced Psychoanalytic Studies. 23 Oct. 1993 (Group interview: Calder, Kenneth,^ Furst, Sidney, Whitman, Roy, Richter, Peter) Cooper, Arnold. May 1992 and June 1994 Doidge, Norman. 29 Jan. 1995 Eisold, Kenneth. 16 Dec. 1994 Frankel, Alice. 2 April 1992 Click, Robert. 3 June 1994 Goldman, George.f Nov. 1992 Karush, Aaron.t March 1993 Kennedy, Janet.1 22 Oct. 1993 Klein, Henriette.f 13 Oct. 1992 Levine, David. 30 July 1997 MacKinnon, Roger. 25 Oct. 1993 Meyers, Helen. 2 May 1992 Michels, Robert. 9 Oct. 1992 and Feb. 9, 1995 Moulton, Ruth.f 24 Oct. 1993 Ovesey, Lionel.1 1 April 1992 Person, Ethel Spector. 2 April 1992 Rainer.John. 14 Dec. 1993 Schachterjudy. Dec. 1992 Schachter, Joseph. Dec. 1992; 16 Dec. 1993, and 20 Dec. 1994 Shapiro, Daniel. 17 Dec. 1993 (not recorded)

216 Appendix 2 Stern, Daniel. 4 Nov. 1994 Swerdloff, Bluma. 1 April 1992 and 12 Oct. 1992 Toronto - Toronto Psychoanalytic Institute Boujoff, George. 17 Sept. 1993 Forrester, Roland.^ Jan. 1991 Frayn, Douglas. 14 July 1994 Greben, Stanley. 4 Sept. 1992 Lerner, Paul. 25 June 1997 and 24 Oct. 1997 Silver, Danny. 14 Sept. 1992 Tennen, Alan.^ Jan. 1994 (not recorded) Whitfield, Margaret. Oct. 1995 New York and Toronto - Family Easser, Sam. Father, taped in 1970 for Irving Abella Collection, Archives of Ontario (3 hours) Easser, Sarah. Mother, taped in 1977, Multicultural History Society of Ontario. (3 hours) Easser, Percy and Lorna.^ Brother and sister-in-law, Nov. 1992 Milling, Joan. Sister, 1 Nov. 1992, also interviewed in 1994 and 2003 Lesser, Beth.* Daughter, 1993 and 1999 Lesser, Ralph.1* Son, 1993 Lesser, Adam.* Son, 17 Dec. 1993 Lesser, Gershon.* Stanley Lesser's brother, Oct. 1992 Lesser, Holly.* Stanley Lesser's second wife, Oct. 1992 New York and Toronto - Friends Craig, Lois. Classmate in medical school Lerner, Carol. Friend in Toronto, 24 Oct. 1997 Wechter, Dena. Friend in New York, May 1993, 22 Oct. 1993, and 17 Dec. 1993 Unrecorded Conversations Psychiatrists and Psychoanalysts connected with Columbia (notes made) Altschuler, Kenneth. 10 Feb. 1995 * None of the Lesser family interviews were recorded.

Appendix 2 217 Bennett, Stephen. 21 April 1995 Bernard, Viola.f 3 April 1992 Kernberg, Otto. 27 Feb. 1992 Kaufman, Edward. 21 April 1995 Kolb, Lawrence. 21 April 1995 Rado, Peter. 22 April 1995 Mosher, Paul. 15 Oct. 2000 Talbot,John. 21 April 1995 Udell, Mel. 21 April 1995 Weiner, Jerry. 9 Feb. 1995 Letters Received Sacks, Oliver. 22 Dec. 1994 Scott, Clifford.* 23 March 1992 Shelly, Brian. 10 Oct. 2002 and 13 Jan. 2003 Tate, Agatha (Wilford). 27June, 2001 Urquhart,Jane. 26Jan. 1994

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Notes

Introduction 1 Arnold M. Cooper, Otto F. Kernberg, and Ethel Spector Person, eds., Psychoanalysis toward the Second Century (New Haven: Yale University Press, 1989), 1. 2 Martin S. Bergmann, The historical roots of psychoanalytic orthodoxy,' International Journal of'Psycho-Analysis, 78, 1997, 81. 3 Sigmund Freud, The Question of Lay Analysis (London: Hogarth Press, Standard ed., vol. 20, 1964 [1926]), 253-4. 4 Ibid., 253. 5 To reconstruct something of Ruth Easser's life as a psychoanalyst, her teachers, colleagues, students, supervisees, analysands, family, and friends all generously gave of their time and memories in more than thirty-five recorded interviews (see Appendix 2). 6 Cooper et al., Psychoanalysis, 5. 7 Sigmund Freud, Analysis Terminable and Interminable (London: Hogarth Press, Standard ed., vol. 23, 1964 [1937]), 216-53. 8 Right refers to people with problems that are known to benefit from psychoanalysis or people for whom other therapies have been ineffective, or for those who will not benefit sufficiently from shorter-term psychoanalytically oriented therapies, and for those who have the resources and desire for a more in-depth psychoanalysis, and who are able to make an extensive commitment. 1: Beginnings 1 Merton M. Gill, Psychoanalysis in Transition (Hillsdale, NJ: Analytic Press, 1994), 15, 28.

220 Notes to pages 15-36 2 Francis McLaughlin, 'Some perspectives on psychoanalysis today,' Journal of the American Psychoanalytic Association, 26, 1978, 4. 3 Arnold M. Cooper, Otto F. Kernberg, and Ethel Spector Person, eds., Psychoanalysis toward the Second Century (New Haven: Yale University Press, 1989), 2. 4 Arnold M. Cooper, 'Psychoanalysis at one hundred: Beginning of maturity,' Journal of the American Psychoanalytic Association, 32, 1984, 245-67. 5 Robert Michels, 'The future of psychoanalysis,' Psychoanalytic Quarterly, 57, 1988, 167. 6 Neville Symington, The Analytic Experience (New York: St Martin's Press, 1986), 9, 15. 7 Ruth Easser's family and personal history was gleaned from interviews with her sister Joan Milling, her brother Percy Easser, and sister-in-law Lorna Baynes; from audio-tapes of Sarah and Sam Easser at the archives of the Multicultural History Society of Ontario; and from an unpublished autobiography of Sam Easser that Joan Milling's family is putting together. 8 There is a history of the Toronto Labour Lyceum preserved as an oral history in the Archives of Ontario and at the Toronto Workman's Circle. 9 Letter to author from Agatha Tate, 26 June 2003. 10 Paul Roazen and Bluma Swerdloff, Heresy: Sandor Rado and the Psychoanalytic Movement (Northvale, NJ: Jason Aronson Inc., 1995), 32-3. 11 Arnold Cooper, 'The impact of clinical work on the analyst's idealizations and identifications,' panel presentation, American Psychoanalytic Association, 87th annual meeting, Toronto, 3-4 May 1998. 12 Robert Coles, Anna Freud: The Dream of Psychoanalysis (New York: AddisonWesley, 1992), 84. 13 Ibid. 14 Dodi Goldman, In Search of the Real: The Origins and Originality ofD.W. Winnicott (Northvale, NJ: Jason Aronson Inc., 1993), xxv. 15 Nathan J. Hale, The Rise and Crisis of Psychoanalysis in the United States: Freud and the Americans, 1917-1985 (New York: Oxford University Press, 1995), 250. 16 Ella Freeman Sharpe, Collected Papers on Psycho-Analysis by Ella Freeman Sharpe, ed. by Marjorie Brierly (London: Hogarth Press, 1969 [1947]), 11. 17 The first formal training programs, beginning in Europe in the early 1920s, were the independent psychoanalytic institutes organized by local psychoanalytic societies. These institutes eventually came under the auspices of their national and international associations and common standards developed. By the 1930s official institutes of the International Psycho-Analytical Association were established in the United States and Britain, and in 1959 in Canada. Later, a few institutes, accredited by their psychoanalytic associations, were founded within university postgraduate training programs.

Notes to pages 37-48 221 18 In Henriette R. Klein, Psychoanalysts in Training: Selection and Evaluation (New York: Psychoanalytic Clinic for Training and Research, Department of Psychiatry, Columbia University, College of Physicians and Surgeons, 1965), 7. 19 Robert R. Holt and Lester Luborsky, 'The selection of candidates for psychoanalytic training: On the use of interviews and psychological tests,' Journal of the American Psychoanalytic Association, 3, 1955, 666-81. 20 Anna Freud, The ideal psychoanalytic institute: A Utopia,' in The Writings of Anna Freud (New York: International Universities Press, 1971), 78-9. 21 Coles, Anna Freud, 119. 22 Klein, Psychoanalysts in Training, 128. 23 Richard C. Simons, 'Our analytic heritage: Ideals and idealizations, 'Journal of the American Psychoanalytic Association, 38, 1990, 10. 24 Coles, Anna Freud, 119. 25 Letter dated 15 March 1946 from Dr Jessie Gray, chairman of Intern Committee, Women's College Hospital, Toronto. 26 Jeffrey Masson, who publicly turned against the Toronto Psychoanalytic Institute in his book, Final Analysis: The Making and Unmaking of a Psychoanalyst insisted (in a personal communication to a colleague) that 'nobody really knows what kind of analyst anybody is, and maybe that is why nobody at the Toronto Institute told him what he already knew - that he himself did not have the gift.' Sandra Palef, 'Non-medical psychoanalysts in Toronto: An uneven playing field in training and practice,' in Psychoanalysis in Toronto, Douglas H. Frayn, ed. (Toronto: Ash Productions, Coach House Press, 2000), 62. 27 These excerpts were taken from the oral history interview of Mrs Sarah Easser, recorded by the Multicultural History Society of Ontario, 6 June 1977. 28 Cooper, 'Impact of clinical work,' 5. 29 Edith Kurzweil, The Freudians: A Comparative Perspective (New Haven: Yale University Press, 1989), 1. 30 Ethel Spector Person, 'The Columbia University Center for Psychoanalytic Training and Research,' American Psychoanalyst, 24, 1990, 9. 31 John Frosch, 'The New York psychoanalytic civil war,' Journal of the American Psychoanalytic Association, 39, 1991, 137. 32 George S. Goldman, in Developments in Psychoanalysis at Columbia University, (Proceedings of the Twentieth Anniversary Conference, Psychoanalytic Clinic for Training and Research, Columbia University, 30 Oct. 1965), George S. Goldman and Daniel Shapiro, eds. (New York: Hafner, 1966), 69-80. 33 Person, 'Columbia,' 10. 34 Lionel Ovesey, 'Culture and psyche: Introduction,' in Psychoanalysis: Toward

222

35 36 37 38 39 40

41

42 43 44 45 46 47 48

Notes to pages 48-61

the Second Century, Arnold M. Cooper, Otto Kernberg, and Ethel Spector Person, eds. (New Haven: Yale University Press, 1989), 9. Arnold M. Cooper, 'Fortieth anniversary dinner address,' Bulletin: The Association for Psychoanalytic Medicine, spring/summer, 1986, 70. See Otto F. Kernberg, 'Thirty methods to destroy the creativity of psychoanalytic candidates,' International Journal of Psycho-Analysis, 77, 1996, 1031-40. Robert Michels, 'Training analysts and the psychoanalytic community,' International Psychoanalysis, 9, 2000,19. Kernberg, 'Thirty methods.' Having been taught and analysed by Rado, Goldman was one of the first Radovian analysts to teach at the Columbia Institute. The William Alanson White Institute was founded when Clara Thompson broke away from the New York Psychoanalytic Institute just prior to Rado's defection and was thought to have a more culturalist than orthodox analytic frame. Joan Fleming and Theresa Benedek, 'The experiential nature of psychoanalytic learning,' in The Teaching and Learning of Psychoanalysis: Selected Papers of Joan Fleming, MD, Stanley S. Weiss, ed. (New York: Guilford Press, 1987 [1961]), 1-2. Helmut Thoma, 'Training analysis and psychoanalytic education: Proposals for reform,' Annual of Psychoanalysis, 21, 1993, 3-75. Klein, Psychoanalysts in Training, 24. Columbia University Bulletin, Faculty of Medicine, Center for Psychoanalytic Training and Research, 2002-2003. Michels, 'Training analysts,' 19. Klein, Psychoanalysts in Training, 24. Letter from clinic secretary M.E. Marquette, 29 Aug. 1946. Michels, 'Training analysts,' 19. 2: Becoming

1 John Bowlby, 'Charles Darwin: A new biography' (London: Hutchinson, 1990), quoted in Jeremy Holmes, John Bowlby and Attachment Theory (London: Routledge, 1993), 127. 2 Jessica Benjamin, Like Subjects, Love Objects (New Haven: Yale University Press, 1995), 6. 3 Other psychoanalytic theories (e.g., based on the need to satisfy drives or the need for a self or objects) also inform the nature of the analytic relationship. Attachment theory, as an aspect of object relations theory, was more fully developed and integrated into psychoanalytic theory only in the last two decades subsequent to Ruth Easser's death. However, object rela-

Notes to pages 61-79 223 tions theory seems to best account for the nature of the analytic relationship described in her writing and experienced by those who were treated and taught by her. 4 Stanley E. Greben and Stanley R. Lesser, 'The question of neutrality in psychotherapy,' American Journal of Psychotherapy, 30, 1976, 629. 5 Theodore Shapiro, 'A view from the bridge, 'Journal of the American Psychoanalytic Association, 30,1993, 926. 6 Jessica Benjamin, Shadow of the Other (New York: Routledge, 1998), xii. 7 Michael Ignatieff, The Needs of Strangers: An Essay on Privacy, Solidarity, and the Politics of Being Human (New York: Penguin Books, 1984). 8 Donald W. Winnicott, 'The capacity to be alone,' in The Maturational Processes and the Facilitating Environment (London: Hogarth Press, 1969), 29. 9 Arnold Modell, The Private Self (Cambridge: Harvard University Press, 1993), 3. 10 Ruth B. Easser, 'A discussion of H.M. Southwood on "Analysis as experience,"' International Journal of Psycho-Analysis, 57, 1976, 176. 11 Anthony Storr, The School of Genius (London: Andre Deutsch, 1988), 21. 12 Christopher Bellas, 'Expressive use of the countertransference,' Contemporary Psychoanalysis, 19, 1983, 1-3. 13 Merton M. Gill, 'The interpersonal paradigm,' Essential Papers on Countertransference, ed. by Benjamin Wolstein (New York: New York University Press, 1988), 307. 14 Neville Symington, The Analytic Experience (New York: St Martin's Press, 1983), 293. 15 David J. Lynn and George E.Vaillant, 'Anonymity, neutrality, and confidentiality in the actual methods of Sigmund Freud: A review of 43 cases, 19071939,' American Journal of Psychiatry, 155, 1998, 163-71. 16 John Bowlby, 'The role of the psychotherapist's personal resources in the therapeutic situation,' Tavistock Gazette, 1991, 16. 17 Joan Fleming, 'What analytic work requires of an analyst: A job analysis,' in The Teaching and Learning of Psychoanalysis: Selected Papers of Joan Fleming, MD, Stanley S. Weiss, ed. (New York: Guilford Press, 1987 [1961]), 60-1. 18 Ella Freeman Sharpe, 'The psycho-analyst,' in Collected Papers on Psycho-Analysis by Ella Freeman Sharpe, Marjorie Brierly, ed. (London: Hogarth Press, 1969 [1947]), 122. 19 Richard C. Simons, 'Our analytic heritage: Ideals and idealizations, 'Journal of the American Psychoanalytic Association, 38, 1990, 15. 20 Kenneth Eisold, 'The intolerance of diversity in psychoanalytic institutes,' International Journal of Psycho-Analysis, 75, 1994, 785-800. 21 Sharpe, 'The psycho-analyst,' 121.

224

Notes to pages 79-105

22 Batya Gur, Sunday Morning Murder, translated from Hebrew by Dalya Bilu (New York: Harper Collins, 1992), 125. 23 Simons, 'Our analytic heritage,' 15. 24 Arnold Cooper, 'The impact of clinical work on the analyst's idealizations and identifications,' panel presentation, American Psychoanalytic Association, 87th annual meeting, Toronto, May 1998, 5, 6. 25 Otto F. Kernberg, 'A concerned critique of psychoanalytic education,' International Journal of Psycho-Analy sis, 81, 2000, 117. 26 Ruth Easser served on the American Psychoanalytic Association's board of professional standards, as a fellow, 1960-70; membership committee, 19641970; and program committee, 1970-5. 27 Donald W. Winnicott, 'Metapsychological and clinical aspects of regression,' in Collected Papers (London: Tavistock, 1958), 285-6. 28 Glen Gabbard and Eva P. Lester, Boundaries and Boundary Violations in Psychoanalysis (New York: Basic Books, 1996), 24. 29 Gur, Sunday Morning Murder, 61. 30 Sharpe, The psycho-analyst,' 121. 31 Gabbard and Lester, Boundaries and Boundary Violations, 122—4. 32 Sharpe'The psycho-analyst,' 121. 33 Thomas H. Ogden, Subjects of Analysis (Northvale, NJ: Jason Aronson Inc., 1954), 104. 34 Symington, The Analytic Experience, 329. 35 Sharpe, 'The psycho-analyst,' 122. 36 Easser, 'Discussion of H.M. Southwood,' 177. 37 Ruth Easser and Stanley Lesser were among the first of the postwar generation of psychoanalytic couples. As such, they were models for the increasing numbers of women who chose to combine the analytic profession with marriage and family and of men who married women who were professional equals and often collaborators. 38 Ogden, Subjects of Analysis, 105. 39 Storr, School of Genius, 21. 40 Ibid., 154. 41 Cooper, 'The impact of clinical work,' 1, 2. 3: Being 1 Anthony Storr, The School of Genius (London: Andre Deutsch, 1988), 169. 2 Arnold M. Cooper, 'Psychoanalysis at one hundred: Beginning of maturity,' fournal of the American Psychoanalytic Association, 32, 1984, 255. 3 Melvin Bornstein, Philip Escoll, and Howard B. Levine, eds., 'Where have all

Notes to pages 105-18 225 the psychoanalytic patients gone? Commentaries Inspired by Arnold Rothstein's 'Psychoanalytic Technique and the Creation of Analytic Patients,' Psychoanalytic Inquiry, 20, 2000, 449-628. Nathan G. Halejr, The Rise and Crisis of Psychoanalysis in the United States: Freud and the Americans, 1917-1985 (New York: Oxford University Press, 1995). 4 Barbara Ruth Easser and Stanley R. Lesser, 'Hysterical personality: A re-evaluation,' Psychoanalytic Quarterly, 34, 1965, 390-405. 5 B. Ruth Easser, 'Empathetic inhibition and psychoanalytic technique,' Psychoanalytic Quarterly, 43, 1974, 557-80.

6 Ibid. 7 Ruth Easser, 'Cure in psychoanalysis,' panel, William Alanson White Institute, 1962, 2. 8 Evelyne Schwaber, 'Countertransference: The analyst's retreat from the patient's vantage point,' International Journal ofPsycho-Analysis, 73, 1992, 358. 9 Ruth Easser, 'Some observations on the treatment of narcissistic character,' presented to the Canadian Psychoanalytic Association, annual meeting, June 1972. 10 Easser, 'Empathetic inhibition,' 569. 11 Ibid., 570. 12 Ibid., 569. 13 Robert Caper, 'Does psychoanalysis heal? A contribution to the theory of psychoanalytic technique,' International Journal of Psycho-Analy sis, 73, 1992, 287. 14 B. Ruth Easser, 'A Discussion of the paper by H.M. Southwood on "Analysis as Experience,"' International Journal of Psycho-Analysis, 57, 1976, 176. 15 B. Ruth Easser, 'Indications and centra-indications for reconstructive analytic treatment,' presented to the New York County District Branch of the New York Section for Clinical Psychiatry, March 1962. 16 Aaron Karush, B. Ruth Easser, Arnold M. Cooper, and Bluma Swerdloff, 'The Evaluation of ego strength. 1: A profile of adaptive balance, 'Journal of Nervous and Mental Diseases, 139, 1964, 332-49. 17 Marie Cardinal, The Words to Say It (Cambridge, Mass.: Van Vactor and Goodheart, 1984), 26-7. 18 Arnold M. Cooper, 'Some limitations on therapeutic effectiveness: The "burnout syndrome" in psychoanalysts,' Psychoanalytic Quarterly, 55, 1986, 576-98. 19 Storr, School of Genius, 7. 20 Neville Symington, The Analytic Experience (New York: St Martin's Press, 1986), 327. 21 Judith Krantowitz, The Patient's Impact on the Analyst (Hillsdale, NJ: Analytic Press, 1996), 230.

226 Notes to pages 118-50 22 Easser, 'Cure in psychoanalysis,' 2. 23 Easser, 'Empathetic inhibition,' 576. 24 Levin, Charles, Allannah Furlong, and Mary Kay O'Neil, eds., Confidentiality: Ethical Perspectives and Clinical Dilemmas (Hillsdale, NJ: Analytic Press, 2003). 25 White was a supervisee of Easser's. 'She became ill and died during that brief period of working with her, but such was her superior intelligence and quietly powerful influence that she left a lasting impression. Because of her own experience she encouraged me to think about having my office in my home.' 26 Patricia White, 'The Training and practice of Toronto female analysts,' Psychoanalysis in Toronto, Douglas H. Frayn, ed. (Toronto: Ash Productions, Coach House Press, 2000), 45-54. 27 Easser, 'Some observations on the treatment of narcissistic character,' p. 21. 28 Otto F. Kernberg, 'A concerned critique of psychoanalytic education,' International Journal of Psycho-Analysis, 81, 2000, 117. 29 Kenneth Eisold, 'The intolerance of diversity in psychoanalytic institutes,' International Journal of Psycho-Analysis, 75, 1994, 785-800. 30 See Chapter 1. 31 Robert Michels, 'Confidentiality, reporting, and training analysis,' in Levin etal., Confidentiality, 2003, 113-17. 32 Ronald Britton, 'Confidentiality and training analysis,' in Levin et al., Confidentiality, 2003, 107-12. 33 For example, Jeffery Masson condemned his training analysis in his book, The Final Analysis: The Making and Unmaking of a Psychoanalyst. His analyst had little recourse even though Masson later admitted his own lack of ability to function as a psychoanalyst. 34 B. Ruth Easser, 'Special forms of resistance: Extra-analytic contacts,' presented to the American Psychoanalytic Association meeting, May 1965. Also presented as 'Extra-analytic contacts in training analysis,' at the First Joint Columbia-Emory faculty meeting, Arden House, New York, 8-9 Nov. 1969. 35 Joan Fleming, 'The education of a supervisor,' in The Teaching and Learning of Psychoanalysis: Selected Papers of Joan Fleming, MD, ed. by Stanley Weiss (New York: Guilford Press, 1987), 143-65. 36 In Betty Joseph, 'How do I teach?' International Psychoanalysis, 1995, 23-5. 37 What Frayn learned in his discussion of this case with Ruth Easser about preverbal communication and the more primitive forms of intersubjectivity and empathy is considered in Chapter 2. 38 Jacob A. Arlow and Charles Brenner, 'Scientific collaboration in psychoanalysis,' International Psychoanalysis, 1993, 19-21.

Notes to pages 150-9 227 39 Lionel Ovesey, Homosexuality and Pseudohomosexuality (New York: Science House, 1969). 40 George H. Wiedeman, 'Homosexuality, a survey,' Journal of the American Psychoanalytic Association, 22, 1974, 677-84. 41 Eric R. Kandel, 'Biology and the future of psychoanalysis: A new intellectual framework for psychiatry revisited,' American Journal of Psychiatry, 156, 1999, 505. 42 Ibid. 43 John Olds and Arnold M. Cooper, 'Dialogue with other sciences: Opportunities for mutual gain,' International Journal of Psycho-Analysis, 78, 1997, 219. 44 Kandel, 'Biology and the future of psychoanalysis,' 506. 45 Kenneth Kelley, George E. Daniels, John Poe, Ruth Easser, and Russell Monroe, 'Psychological correlations with secondary amenorrhea,' Psychosomatic Medicine, 16, 1954, 130-47. 46 Karush et al. 'Evaluation of ego strength.' 47 Arnold M. Cooper, Aaron Karush, B. Ruth Easser, and Bluma Swerdloff, 'The adaptive balance profile and prediction of early treatment behavior,' in Developments in Psychoanalysis at Columbia University (Proceedings of the Twentieth Anniversary Conference, Psychoanalytic Clinic for Training and Research, Columbia University, 30 Oct. 1965), George S. Goldman and Daniel Shapiro, eds. (New York: Hafner, 1966), 183-214. 48 Eric R. Kandel, 'A new intellectual framework for psychiatry,' American Journal of Psychiatry, 155,1998, 458. 49 John J. Weber, Henry M. Bachrach, and Murray Solomon, 'Factors associated with outcome of psychoanalysis: Report of Columbia Psychoanalytic Center Research Project (11),' International Journal of Psycho-Analysis, 12, 1985, 127-41. 50 See Appendix 1: Collected Papers of Ruth Easser, 'Early Papers on Clinical Technique.' 51 See Arnold H. Modell, Other Times, Other Realities: Toward a Theory of Psychoanalytic Treatment (Cambridge Mass: Harvard University Press, 1990). 52 In Ernst, Kris, The personal myth - A problem in psychoanalytic technique,' Journal of the American Psychoanalytic Association 4, 1956, 653-81. 53 Easser, 'Indications and centra-indications for reconstructive analytic treatment'; 'Cure in psychoanalysis'; 'Special forms of resistance: Extra-analytic contacts in training analysis'; 'Fate of the transference neurosis at termination: Special reference to the female analyst.' 54 A. Lazare, 'The hysterical character in psychoanalytic theory,' Archives of General Psychiatry, 25, 1971, 134. 55 This population included patients who are said to be fixated at pregenital

228 Notes to pages 159-160

56

57

58

59

levels as well as those said to be fixated at the phallic-genital levels of development. The formulations of these authors are based on their attempt to integrate libido theory with ego psychology. By doing so, they are not only able to produce a subtle and clinically rich picture of the hysterical character, but they are also able to put to rest the controversy [between libido theory and ego psychology]. In the process, we witness a common occurrence in science: that a new concept, method, or instrument (in this case, ego psychology and modifications of the psychoanalytic technique) removes a seemingly insoluble impasse while generating new observations. T. Millan, 'The borderline construct: Introductory notes on its history, theory, and empirical grounding,' in Borderline Personality Disorder, John Clarkin, Elsa Marziali, and Heather Munroe-Blum, eds. (New York: Guilford Press, 1992), 11. 'In many instances the hysteroid would appear to be a caricature of the hysteric, much as the hysteric has been said to be a caricature of femininity. Each characteristic is demonstrated in even sharper dramatic relief. The bounds of social custom and propriety are breached. The latent aggressivity of the exhibitionism, the competitiveness and the self-absorption becomes blatant, insistent, bizarre. The chic becomes the mannequin; the casual, sloppy; the bohemian, beat. 'The adaptational functioning of the hysteroid is erratic. Inconstancy and irresponsibility cause the patient to suffer realistic rebuffs, injuries, and failure. 'The hysteroid starts friendships with great hopes and enthusiasm. The friendship commences with idolatry and ends in bitterness when the expectation of rescue, nurture, and care is not fulfilled. These relational ruptures are often succeeded by detachment, isolation, depression, and paranoid-like trends. 'The hysteroid's family life is often much more disturbed, disorganized, and inconsistent. 'Grosser fluctuations of the hysteroid personality are to be anticipated from the more infantile fixation and the consequent weaker integration and synthesis of the ego. Thus we encounter less emotional control, a lessened ability to hold and tolerate tension, and more proneness to action and depression.' Easser and Lesser, 'Hysterical personality,' 399-400. Otto F. Kernberg, 'Borderline personality organization, 'Journal of the American Psychoanalytic Association, 15, 1967, 641-85, and 'A psychoanalytic classification of character pathology,' ibid., 18, 1970, 800-22. Joan Fleming, 'Discussion: The phobic reaction (Ovesey) [and] resistance to transference in hysterical character neurosis (Easser and Lesser),' in Developments in Psychoanalysis, Goldman and Shapiro, 81-6.

Notes to pages 160-73 229 60 Daniel N. Stern, The Interpersonal World of the Infant (New York: Basic Books, 1985) ,146-61. 61 Ethel Spector Person, The Sexual Century (New Haven: Yale University Press, 1999), xi. 62 Stanley Goodman, 'Collaboration in peer groups: The GAPS experience,' International Psychoanalysis, 1993, 21-3. 63 Easser, 'Some observations on the treatment of narcissistic character'; 'Affect, the self and psychoanalytic technique,' Bulletin: The Association for Psychoanalytic Medicine, 13, 1973, 4-8; 'Character sequelae of prolonged illness in childhood,' presented to the Toronto Psychoanalytic Society, 1974; 'Empathy and narcissism,' presented to the Toronto Psychoanalytic Society, 1974. 64 Easser, 'Discussion of the paper by H.M. Southwood.' 65 Stanley Lesser and Ruth Easser, 'Personality differences in the perceptually handicapped,' Journal of the American Academy of Child Psychiatry, 11, 1972, 458-66. Stanley Lesser and Ruth Easser, 'The psychiatric management of the deaf child' (unpublished, 1974); Easser and Lesser, 'Perceptual style, defensive structure and personality organization in the perceptually handicapped' (unfinished, 1974-75). 66 Ruth Easser and Sarah McCall, 'A hospital staff copes with abortion,' paper presented to the Mount Sinai Hospital, University of Toronto, meeting, Department of Psychiatry, 1973; Paul Lerner, Ruth Easser, and Stanley Lesser, 'The effect of changes in lifestyle of contemporary youth on psychiatry: Diagnosis and treatment,' paper presented to the Ontario Psychiatric Association, 1974. 67 Ruth Easser, 'Changing concepts of the psychology of women: A reconsideration of female sexual development and the role of women,' paper presented to the Canadian Psychoanalytic Association, June 1974; 'Womanhood,' paper presented to the American Psychoanalytic Association Annual Meeting, May 1975, as part of a panel on the Psychology of women: Late adolescence and early adulthood, Eleanor Gaelenson, reporter, Journal of the American Psychoanalytic Association, 24, 1976, 631-45. 68 Storr, School of Genius, 169. 4: Integration 1 Anthony Storr, The School of Genius (London: Andre Deutsch, 1988), 151. 2 Barbara Gerson, ed., The Therapist as a Person: Life Crises, Life Choices, Life Experiences and Their Effects on Treatment (Hillsdale, NJ: Analytic Press, 1966). 3 Stanley R. Lesser and B. Ruth Easser, 'Personality differences in the perceptually handicapped,' Journal of the American Academy of Child Psychiatry, 11,

230 Notes to pages 173-89 1972, 458-66; 'The psychiatric management of the deaf child' (unpublished, 1974); Easser and Lesser, 'Perceptual style, defensive structure and personality organization in the perceptually handicapped' (unfinished, 1974-75). 4 Kenneth Altshuler, 'Personality traits and depressive symptoms in the deaf,' Bulletin: The Association for Psychoanalytic Medicine, 2, 1963, 55. 5 Janet Silver, 'Clinical note on the early development of the deaf infant,' Psychoanalytic Review, 75, 1998, 469. 6 Oliver Sacks, Seeing Voices (Berkeley: University of California Press, 1989), 119. 7 Daniel Stern, The Interpersonal World of the Infant (New York: Basic Books, 1985), 162,172. 8 Fred M. Levin, Mapping the Mind (Hillsdale, NJ: Analytic Press, 1991), 158. 9 John Gedo, in his Foreword to Levin's book (ibid.) notes: 'Fred Levin is one of the very few psychoanalysts capable of working in such a sign language; I believe that his experience in working with deaf patients was an important influence in alerting him to the importance of understanding thought processes in neuropsychological terms.' 10 Sacks, Seeing Voices, xi. 10 Stern, Interpersonal World of the Infant, ix. 11 Eugene H. Kaplan, Stanley S. Weiss, Lebert H. Harris, and M. Marga Dick, Termination imposed by the analyst's relocation: Theoretical and practical considerations,' Canadian Journal ofPsychoanalysis, 2, 1994, 253. 12 Roland Forrester, 'Why we have to say good-bye,' Canadian Journal of Psychiatry, 1970. 13 Robin Hunter once commented to a colleague that, for his money, Easser was the best analyst in town and would be his first choice for anyone close to him. 14 Ruth Easser and Sarah McCall, 'A hospital staff copes with abortion,' presented to the Mount Sinai Hospital, Department of Psychiatry, University of Toronto, Meeting, 1973; Paul Lerner, Ruth Easser, and Stanley R. Lesser, 'The effect of changes in lifestyle of contemporary youth on psychiatry: Diagnosis and treatment,' presented to the Ontario Psychiatric Association, 1974. 15 B. Ruth Easser, 'Empathetic inhibition and psychoanalytic technique,' Psychoanalytic Quarterly, 43, 1974, 557. 16 B. Ruth Easser, 'Some Observations on the treatment of narcissistic character,' presented to the Canadian Psychoanalytic Association, annual meeting, 1972; 'Affect, the self and psychoanalytic technique,' Bulletin: The Association for Psychoanalytic Medicine, 13, 1973, 4—8 (Report of the Sandor Rado Lecture); 'Character sequelae of prolonged illness in childhood,' presented to the Toronto Psychoanalytic Society, 1974; 'Empathy and narcissism,' presented to the Toronto Psychoanalytic Society, 1974; 'A discussion of the

Notes to pages 190-2 231 paper by H.M. Southwood on "Analysis as Experience,"' International Journal of Psycho-Analysis, 57, 1976, 167-77. 17 Annie Reich died in 1971 at the age of sixty-eight. A published volume of seventeen papers 'represents her life's work, the careful observations of an exceptionally gifted psychoanalytic clinician ... She was a keen observer with profound empathy for her patients. She never became lost in psychoanalytic jargon, and described her patients so vividly that they became alive in her presentations. Annie Reich was first and foremost a brilliant clinician. In so far as she advanced theoretical conclusions, they were based on well-documented observations.' Annie Reich: Psychoanalytic Contributions (New York: International Universities Press, 1973), vii. 18 Ibid., 288-311. 19 Empathy has been defined as 'a special mode of perceiving the psychological state or experiences of another person. It is an emotional knowing of another human being rather than intellectual understanding. To empathize means temporarily to share, to experience the feelings of the other person. One partakes of the quality but not the quantity, the kind but not the degree of the feelings. The capacity for empathy is an essential prerequisite for the psychoanalytic therapist. Usually a preconscious phenomenon, it can be consciously instigated or interrupted. It can also occur silently and automatically and may oscillate with other ways of relating to people. The essential psychic mechanism is the analyst's partial and temporary identification with the patient.' David Berger, Clinical Empathy (Northvale, NJ: Jason Aronson Inc., 1987), 6. 20 Here Easser makes her unique contribution to the understanding of the development of a capacity for empathy. Her views provide insight into problems of empathic relatedness, not just for those with narcissistic sensitivities but for most people whose empathic capacities can become inhibited in certain circumstances. 21 'Character sequalae of prolonged illness in childhood' (1974) deals with the second source of inhibited empathy - severe bodily failure. Easser calls attention to the fact that analysts are conditioned to look for certain traumata, for example, specific mishandling by parents or parental loss but not to consider the effects of common hazards of growth which may have profound effect on the later character structure and markedly influence relational style. She advances the understanding of bodily failure as a contributor to narcissistic character traits in three patients who as a consequence of rheumatic fever were confined to bedrest at a critical phase of their development. Despite 'good enough' mothering, the physical incapacitation and parental inability to compensate can result in relational problems because of defen-

232 Notes to pages 193-5

22

23

24

25

sive omnipotence, emotional isolation, and independence. That is, to compensate for the induced helplessness the person becomes master of her or his own fate. 'To depend upon another human being, no matter how well intentioned, would appear to threaten a return to that period of traumatic disillusionment when immobilization was required and the important relational objects were helpless to prevent the catastrophe.' In her discussion of the paper by H.M. Southwood, 'Analysis as Experience,' Ruth Easser takes issue with the advocacy of a more interactive, bilateral, 'mutual identifying' relationship between analyst and patient. She challenges Southwood's view of the role of the mother in defining for the child her or his sense of reality, a view which he takes as a model for the analyst visa-vis the analysand. For Easser, empathy is not an echoing but a resonance which does not distort, constrict, infantalize, or provoke emotional flight. Empathic words, interpretations, do not define another's reality but rather clarify, organize, and give meaning to an analysand's unique inner world. Evidence of Easser's prescience is found in Ethel Spector Person's remarks on the cover of KJ. Maroda's book, published twenty-five years after 'Empathetic inhibition.' Seduction, Surrender, and Transformation provides the single best in-depth comparison of one-person and two-person psychologies and the single best presentation of the technical interventions necessary to effect the emotional engagement at the heart of the two-person model that I know. While respectful of classical analysis, Maroda is persuasive in her insistence that therapeutic change depends on the emotional experience of analysis, which dictates "mutative interventions" in place of "mutative interpretations." Of special note are her delineation of "responsible techniques" for facilitating the patient's affective experience and her very shrewd analysis of the changing conceptions of power and authority within the analytic dyad.' Karen J. Maroda, Seduction, Surrender, and Transformation (Hillsdale, NJ: Analytic Press, 1999). Ruth Easser, 'Changing concepts of the psychology of women: A reconsideration of female sexual development and the role of women,' presented to the Canadian Psychoanalytic Association, annual meeting, June 1974; 'Womanhood,' presented to the American Psychoanalytic Association, annual meeting, May 1975, as part of a panel on the Psychology of women: Late adolescence and early adulthood, Eleanor Gaelenson, reporter. Journal of the American Psychoanalytic Association, 24, 1976, 631-45. This controversy centred around the questions: Is a woman born a woman psychologically, or is she made a woman when she discovers she is not a man? And 'is anatomy destiny?' which by the mid-1920s resulted in two differing theoretical positions: (1) Freud, Helena Deutsch, and Jeanne Lampl

Notes to pages 195-9 233 de Groot ascribed to the theory that, until the oedipal period, the development of both sexes is essentially identical (masculine) and only with the discovery of her lack of a penis does the identity and personality of the girl diverge, while (2) Karen Horney, Ernest Jones, and Otto Fenichel ascribed to the point of view that gender identity, i.e., femaleness, was an inborn phenomenon and that conscious awareness of one's feminine identity occurs from the earliest of conscious awareness of one's sense of self. Epilogue 1 Arnold H. Modell, Other Times, Other Realities: Toward a Theory of Psychoanalytic Treatment (Cambridge, Mass.: Harvard University Press, 1990), 5-7. 2 Paul Roazen and Bluma Swerdloff, Heresy: Sandor Rado and the Psychoanalytic Movement (Northvale, NJ: Jason Aronson Inc., 1995); Craig Tomlinson, 'Sandor Rado and Adolf Meyer: A nodal point in American psychiatry and psychoanalysis,' International Journal of Psycho-Analysis, 77, 1996, 963-82. George J. Makari, 'On Sandor Rado: A book review essay,' Psychoanalytic Quarterly, 57, 1998, 484-95. 3 Ruth Easser's general orientation to psychoanalysis, like Columbia's, was based on a biopsychosocial model, a multidisciplinary approach, and an attitude of scientific inquiry. The concept of adaptation provided the underpinnings of her perspective on psychological health and illness and was clinically meaningful to her understanding of the goals and limitations of psychoanalysis. Rado's theory of levels of ego development contributed to Easser and Lesser's diagnostic insightfulness in distinguishing between hysterical personality and hysteroid on the basis of the level of ego integration. Rado in his teaching had paid constant attention to the affective transactions between patient and analyst. Easser placed importance on the mode of expressing feelings and the words used to communicate needs and establish relationships. Throughout she struggled to understand affect development. She thought that exaggerated, inappropriate expression of affect or denial of feelings can be both adaptive and defensive. Adaptively, it can be a defence against painful acknowledgment of deprivation, deficit, or trauma. In true Radovian tradition, she maintained that people who are frightened often employ 'emergency' emotions of anxiety and rage; that people who do not receive affectionate nurturing are impaired in their use of 'welfare' emotions of empathy, mutuality, and tenderness; that inappropriate feelings are often expressed by people who cannot make sense of their experience and those who deny emotions are inhibited rather than lacking in feeling. Easser's understanding of emergency affects and welfare emotions, her exquis-

234 Notes to pages 200-8

4 5

6 7 8 9 10 11

ite attentiveness to analyst-analysand interaction, her own empathic capacity, and her understanding of self-development led to her work on narcissistic personality and empathic inhibition. Like Rado, Easser continually strove to extend the boundaries of psychoanalytic understanding and therapeutic efficacy. Rado's work, having taken issue with Freud's belief in the role of penis envy in women's development, paved the way for Ruth Easser to view penis envy as defensive rather than formative and to understand women's selfdevelopment as emanating from a sense of being complete from birth. Nellie L. Thompson, 'Psychoanalytic approaches to history in the era of theoretical pluralism,' American Psychoanalyst, 29, 1995, 3. Mary Kay O'Neil, 'Discussion of Peter Fonagy's, "Pathological attachments and therapeutic action: Attachment over the life cycle,"' at the Annual Elliott Sokoloff Clinical Day, Jewish General Hospital, Montreal, 13 Nov., 1998. Merton M. Gill, Psychoanalysis in Transition: A Personal View (Northvale, NJ: Analytic Press, 1994), 157. Melvin Bornstein, 'Prologue,' Psychoanalytic Inquiry, 20, 2000, 500. Karen J. Maroda, Seduction, Surrender, and Transformation (Hillsdale, NJ: Analytic Press, 1999), 1. Ethel Spector Person, The Columbia University Center for Psychoanalytic Training and Research,' American Psychoanalyst, 24, 1990, 9-11. Richard C. Simons ,'Our analytic heritage: Ideals and idealizations,' Journal of the American Psychoanalytic Association, 38, 1990, 15. Mary Kay O'Neil and Paul M. Lerner, 'Ruth Easser, MD,' Psychoanalytic Review. Special issue: Early American Women Psychoanalysts, 85, 1998, 11738.

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Index

abstinence rule, 68 'abstractability,' 178 Ackerman, Nathan, 48 action interpretation, 142 adaptive balance / defences, 52, 79, 112, 150, 155 Adaptive Balance Profile, 112, 149, 155-6 affect: of analysands, 107-10, 146; development, 151, 233-4n3; 'emergency affect,' 146; importance of naming, 177; relational modes, 161; research on, 151-2; response of analyst to, 146 Ainsworth, Mary, 151 aloneness, 64 Altshuler, Kenneth, 173-4 amenorrhea, 112, 153-4 American Psychoanalytic Association (APsaA),ix, 166-8 American Sign Language, 178. See also under deafness, and signing analysability, 78, 157 analysands: affect of, 107-10, 146; defined, 16; inner world of, 64; lack of curiosity regarding analyst, 128-9; role in psychoanalysis, 105. See also psychoanalytic relationship

analysis. See psychoanalysis analysts. See psychoanalysts analytic. See psychoanalytic Anders, Tom, 32-3, 180 anti-Freudians, ix Arlow, Jacob, 148 Association for Psychoanalytic Medicine, 173-4 attachment: between analysts and analysands, 64-5; with deafness, 176; and differentiation, 150; needs, 62, 68; patterns in infancy, 151; theory, 60-2, 151, 222n3 attunement, 162 'battle of the frames of reference,' 47, 149, 200 becoming/beginning/being defined,101 Benedek, Therese, 112 Benjamin, Jessica, 61-2 Berenson, Bernard, 101 Bergmann, Martin, 5 Bernard, Viola, 48 Bernstein, Anne, 33, 39, 81, 86, 92, 144 Bion, W.R., 109 biopsychosocial, 157, 195

242 Index Bellas, Christopher, 65 borborygmi, 65,147 borderline personality disorder, 15961 Bornstein, Melvin, 201-2 Boujoff, George, 63, 84-6, 144-6 boundaries: and demeanour, 99,126, 128; in psychoanalytic relationships, 65, 67, 90-3, 95 Bowlby, John, 60, 67-8, 148, 151 Brenner, Charles, 148 Bruch, Hilda, 112, 186 Budapest Psychoanalytic Institute, 57 Calder, Kenneth, 167 Calvino, Italo, 199 Canadian Jewish Congress, 24 Cannon, James, 153 Caper, Robert, 109 Cardinal, Marie: The Words to Say It, 113-14 Casselman, Juanita, 39-40 Center for Advanced Psychoanalytic Studies, 166-7 Columbia Records Project, 156-7 Columbia University Clinic for Psychosomatic and Psychoanalytic Medicine: affiliation with Easser, viii (see also under Easser, Ruth: analyst, student); Bulletin, 149; child analytic program, 48; commemorative books, 149; culture of, 44-8; curriculum, 49-50, 52-3, 55-6; director of, 169; founders of, viii, 43-4, 48,153; and Freud, 46, 49-50; history of, 43-4; influence of, 172, 200; innovation of, 44, 48; on personal training analysis, 226n30; relationship with American Psycho-

analytic Association (APsaA), ix, 149-51; teachings of, 47, 53-4 confidentiality, 122, 132 Cook, Mrs (Cookie, housekeeper), 21,26 Cooper, Arnold: as analyst, 99, 102, 115; as analyst (at Columbia), 76, 150-1, 155; and Easser, 80-1, 164, 172; on Freud, 15, 87; and psychoanalysis, progress of, 5, 11; as student, vii-x, 31, 44, 48, 84 Co-operative Commonwealth Federation (CCF), 22 Co-operative Commonwealth Youth Federation (CCYF),23 Cotton, Lorna, 25 countertransference, 65-6, 117, 140, 144-5, 180, 204 Daniels, George, 43, 46, 48, 153-4, 172 deafness: and analyst training, 178; in children, 176-7; communication and attachment, 176; psychological aspects of, 173-80; and selfdevelopment, 175; and signing, 176, 178-9, 228n9 Doidge, Norman, 53 Downstate Medical Center, 46 dynamic tension, 98-9, 171-3, 193 Easser,Joan (sister), 21, 26, 71-2 Easser, Percy (brother), 21, 23, 25, 27 Easser, Ruth - personal: birth, 17; Canadian, 17; death of, 10; demeanour of, 26-31, 70, 80-1, 96, 117, 202; ethnic background, 17, 29, 71; family, gender equality in, 24-5; family, role in dual analyst, 123-5; family back-

Index 243 ground of, 17, 21-6, 71; family's influence on, 25-6; father, relationship with, 24, 26, 28; and female analyst, 59; gender, impact of, 967,125, 195-6, 222n37; illness of, 10, 81, 226n25; marriage of, 9, 69-73, 127,164-5,222n37; military service, 29; mother, relationship with, 23, 26-30, 38-9, 71-2, 197; mother-inlaw, relationship with, 70, 125; motherhood, 73, 122, 126, 163, 173-4, 182-3; personality, influence of New York on, 71-2; physical appearance of, 59, 111, 135-6, 146, 177; sister-in-law, relationship with, 125 - student: at Columbia University Clinic, 45, 49; Columbia University Clinic, application to, 38-9, 43; demeanour of, 38,50-1; education, viii, 24-5, 28-31, 38-9; influences to study psychoanalysis, 30-1, 34-5; personal training analysis: cost of, 57; personal training analyst of, 579; psychoanalytic institutes applied to, 43; psychoanalytic training: cost of, 38-9; Sandor Rado, application interview with, 43; supervision component of training, 50; training, formal framework of, 82 - analyst: affiliations, ix, 9, 87, 154, 166; analysands, relationship with, 95, 205-7; author's perception of, 202-5; and candidates, 41; career as clinical scientist, 151-61; career as collaborator, 148-51; career as teacher, 130-48; career as writer, 151-61; career choice of, 30, 34-5, 222n37; career history, 9, 13, 75-6, 101-2, 148-61; career roles of, 102;

collaboration with Stanley Lesser, 156, 164-5,168, 172, 187; collaborative work, 82-3, 148-51, 155; Columbia University Clinic, affiliation with, viii, 9-10, 38-9, 76, 87-8, 149; Columbia University Clinic, resignation from, 184; Columbia University Clinic, selection committee, 39-40; demeanour and boundaries, 99, 126, 128; demeanour and compassion, 108-10; demeanour of, 87,110,118,167-8, 186-7, 202, 209-10; demeanour with patients, 63, 80-2, 89; gender, impact of, 9, 96-7,120,146-7, 163, 166, 185, 194-6, 233n25; 'good enough analyst,' 171; Hann-Kende, influence of, 57-9; influences on, four major, 189-90; influences on, personal, 59; obstetrics and gynecology psychiatric consultant, 154; office, description of, 79-81; on the perceptually handicapped, 169; psychoanalysis, goals of, 112; psychoanalysis, theory of, 105; psychoanalyst, early development as, 74, 99-100, 118; psychoanalytic technique, contribution to, 160; psychoanalytic theory, influence on, 11,191; and Radovian views, 82; reputation of, 10, 113, 231 n 13; Sandor Rado Lecture, 187-9, 191; theoretical position, 82; Toronto, relocation to, 169-70, 172, 183, 185-6; on womanhood, 169; work, compensation for, 120; as writer, 10, 150-1, 161-3 - teacher: candidates, relationship with, 133-5, 143-8; demeanour of, 10-11, 63, 89-90, 92-3, 135, 146-8;

244 Index female candidates, rapport with, 113; humour, use of, 140; interactive approach, 138-9; personal training analysis, position on, 1323; as personal training analyst, 1301; 'special technique,' 134; as supervisor, 139-42; theory and observation, integration of, 104-5, 138-9 - papers (sole author): 'A Case of Amenorrhea Showing Psychohormonal Inter-relationships,' 83; 'Changing Concepts of the Psychology of Women,' 195; 'Character Sequelae of Prolonged Illness in Children,' 232n21; 'Cure in Psychoanalysis,' 105, 158; 'Empathetic Inhibition and Psychoanalytic Technique,' 169, 187-8, 191, 206, 232-3n23; 'Fate of the Transference Neurosis at Termination,' 158; 'Indications and Contraindications for Reconstructive Analytic Treatment,' 77-8, 111, 157; 'Some Observations on the Treatment of Narcissistic Character,' 83, 189; 'Special Forms of Resistance: Extra-analytic Contacts,' 158; unpublished, 1962 to 1968, 157-8 - papers (with Stanley Lesser): 'Hysterical Personality: A Re-evaluation,' 83, 159-60, 165-6; 'The Effect of Changes in Lifestyle of Contemporary Youth on Psychiatry,' 187; 'The Marital Life of the Hysterical Woman,' 161; 'Transference Resistance in Hysterical Character Neurosis,' 160 - papers (collaborations): 'AHospi-

tal Staff Copes with Abortion,' 187; 'Psychological Correlations with Secondary Amenorrhea,' 82-3; 'The Adaptive Balance Profile and Prediction of Early Treatment Behaviour,' 149; 'The Evaluation of Ego Strength,' 149 Easser, Sam (father): family background, 18-20; Jewish identity, 212; marriage to Sarah Foster, 19-21; political interests, 20-3 education. See training to become an analyst ego: analytic instrument or 'work ego,' 54; differentiation, 112; id and superego, 109; integration and organization, 154, 159; psychology, 48, 150 Ego Strength Project, 155. See also Adaptive Balance Profile Eisold, Kenneth, 75, 88, 131 electroencephalography, 152 emergency affect, 146 emotions: balance of, 83; 'emergency,' 175; 'emotionally healthy,' defined, 112; in psychoanalytic relationship, 93-4 (see also transference); 'welfare,' 175 empathy: acceptance, 194; and attachment, 193; and autonomy, 193; capacity for, 175, 192-3, 232n20; defined, 200-1, 231-2nl9; inhibition, 192-3, 206-7; mother's role in developing, 193, 232n21-2; resonance, 193; as a therapeutic tool, 191 'enactment,' 91 endocrine studies, 152 Engel, George, 195 'exquisite attentiveness,' 201

Index Fairbairn, W. Ronald D., 162 family psychodynamics, 48 femininity and sexuality, 154 Ferenczi, Sandor, 31, 57, 162, 194 Fleiss, R., 68 Fleming, Joan, 68, 112, 138, 160, 166 Fonagy, Peter, 149, 151, 200-1 Forrester, Roland, 168, 181-2 Foster, Sarah (mother), 17; on Easser's application interview, 43; family background, 19-20; Jewish identity, 20; personality of, 29; political interests, 20-3 frames of reference. See 'battle of the frames of reference' Frankel, Alice, 52-3 Frayn, Douglas, 65-6, 146-7 Freeman Sharpe, Ella, 35, 69, 76, 901,94-5 Freud, Anna, 34, 37, 148 Freud, Sigmund: anti-Freudians opinion of, ix; Columbia University Clinic's teaching of, 48; legacy, 15; and medical profession, 6; Nachtrdglichkeit, 201-2; penis envy, 196, 233-4n3; psychoanalysis, major concepts of, vii, 4, 7, 15; psychoanalysis, method of, 5—6; psychoanalysis, vision of study of, 47; and psychoanalytic movement, 6; psychoanalytic profession, 12; publications, 4; theory and technique of, 67 Frosch, John, 45-6 gender: femininity and sexuality, 154; impact professionally, 9, 95-8, 1203, 146-7, 158-9, 163-6, 185, 194-6, 233n25; issues of, 24-5, 35, 123, 224n37, 226n25, 233-4n3; male hys-

245 terics, 144; male work ethic, 123. See also womanhood genius, defined, 101 Gill, Merton, 15, 66, 201 gnosis (knowledge base of training), 54-5 Goldman, Dodi, 34 Goldman, George, 46, 50-1, 84-5, 155,169,184, 222n39 'good enough analyst,' 104, 171 'good enough mothering,' 174 'good transference neurosis,' 133 Gottschalk, Louis, 156 Greben, Stanley, 25-6, 30-1 Greenson, Ralph, 200 Gur, Batya, 79 habitual abortion, 154 Hale, Nathan, 35 Hann-Kende, Fanny von, 57-9, 82, 86 Hartmann, Heinz, 148, 150 Holy Blossom Synagogue, 21 homosexual imagery, 162 Horney, Karen, 45, 200 Horowitz, Mardi, 156 Hunter, Robin, 185, 231nl3 hyperemesis in pregnancy, 154 hysterical personality: diagnosis of, 104-5, 159-60; symptoms of, 174-5; treatment of, 154; understanding of, 144, 161; writing of papers about, 83, 159-60, 165-6, 228n55 hysteroid, 159, 228n55, 233-4n3 Ignatieff, Michael, 62 infancy: attachment patterns, 151; psychodynamic development, 54 integration, defined, 171 internal object world, 98 internal working models, 64, 151

246 Index International Psycho-Analytical Association, 220nl7 interpersonal-interactional focus, 145 interpsychic. See psychoanalytic relationship intersubjective: analytical relationship, 63-4; constructions, 98 intrapsychic: and becoming an analyst, 61, 64; boundaries, 91; focus, 145; meaning of psychoanalytic interactions, 139-40 Jewish Bund movement, 21-2 Jewish Labour Committee, 24 Jewish socialist movement, 21-2 Jones, Ernest, 185 Joseph, Betty, 139 Joseph, Edward, 167-8 journals in 1950s and 1960s, 149 Kandel, Eric, 151-2, 156 Kaplan, Eugene, 181 Kardiner, Abram, 44, 46, 48 Karush, Aaron, 58, 82, 118, 150, 155, 166, 172, 184; collaboration with Easser, 173 Kennedy, Janet, 70, 73 Kernberg, Otto, 5, 11, 15, 48-50, 85, 131, 160-1, 190, 194 Klauber, John, 94 Klein, Henriette, 37, 48, 56, 58, 71, 154, 166 Klein, Melanie, 148 Knowles, Stanley, 22-3 Kohut, Heinz, 89, 139, 190, 194 Kolb, Lawrence, 36-7, 53, 184 Krantowitz, Judith, 116 Kris, Ernst, 148, 157 Kurzweil, Edith, 45

Labour Zionist group, 21-2 language: and deafness, 177-80, 230n9; power of, 25; use of clear, 63, 112, 138-40, 142, 154 Lazare, A., 159 Lerner, Paul, 33-4, 40, 89-90, 187, 202-3, 205 Lesser, Gershon (brother-in-law), 72 Lesser, Stanley: as child psychoanalyst, 125; children, relationship with, 127, 163; on Easser, 172; family background, 70; personality of, 73,164-5; as teacher, 148; Toronto, relocation to, 169, 184 Levin, Fred, 178-9, 230n9 Levine, David, 32, 44-5 Levy, David M., 44, 46, 48 Lewis, David, 29 Lewis, Nolan D.C., 46 libido theory, 44, 47-8, 228n55 Loewald, HansW.,96 Lowenstein, Rudolph, 148 Lowy, Frederick, 185, 203 Luborsky, Lester, 156 Maclnnis, Angus, 22-3 Maclnnis, Grace, 25 MacKinnon, Roger, 142 Macphail, Agnes, 22-3, 25 Mahler, Margaret, 53 Main, Mary, 151 Malan, David, 156 male hysterics, 144 male work ethic, 123 Markson, Elliot, 147 Maroda, Karen, 202, 232-3n23 maternal attunement, 151 McCall, Sarah, 187 McLaughlin, James, 91

Index 247 menarche and menses, 154 mental illness, 14 Meyer, Adolf, 153 Meyers, Helen, 53, 87, 106, 136, 143 Michels, Robert, 16-17, 49, 56, 69, 812, 93, 99, 104, 143-4, 147; Afterword, 209-10 Millan, T., 159 Milling, Joan. &eEasser,Joan mind: model of interrelationships of, 14,81 mind-body relation, 153 Mitchell, John, 22-3 Modell, Arnold, 62-3, 157, 199 modelling (in training analysts), 63, 81-2, 132 motherhood, 151, 197-8 Moulton, Ruth, 52, 84, 168 Mount Sinai Hospital, 172, 185, 187 Nachtrdglichkeit, 199, 201-2 narcissism: and empathy, 191-2; narcissistic injury, 139, 144; narcissistic personality, 107, 139, 190; narcissistic personality disorders, 80, 105, 107, 161, 188-9; self-concept, development of, 191; and tension state, 192-3 National Institute of Mental Health, 156 neurohormones, 152-3 neuroscience, 15, 152-3 neurosis: cause of, 52 neurotic conflict, 34, 78 New York Medical College, 45 New York Psychoanalytic Society and Institute, 45-7, 58, 131, 199-200, 222n40 New York psychoanalytic war, 45-7, 149, 200

New York University School of Medicine, 46 object relations, 152 Ogden, Thomas H., 94 OHIP (Ontario medical insurance), 185 Olds, John, 151 O'Neil, Mary Kay, x, 135, 202-5, 210 Ovesey, Lionel, 47, 49, 58, 149-50, 162,168 passions of the unconscious, 109 pathophysiological processes, 152 perceptual handicaps, 173-80. See also deafness Person, Ethel, 5, 11, 15, 45-6, 86-7, 109,162, 164,166,168, 182-3, 203 personal training analysis: the analyst's, 130-8; candidate and analyst, 133-5; description of, 56-7, 226n30; goal of, 55; as indirect teaching method, 66, 132; and personal relationships, 125; and psychological maturity, 125; rewards and pitfalls, 136, 226n33 personality: disorders, 80, 105, 107, 159-61, 188-9; essence of, 14; infantile, 160; profiles, 155 praxis (supervisory component of training), 55 pregnancy, 154 prognostic caution, 78 psyche, essence of, 14 psychiatry, development of, 14 psychoanalysis: assessment of potential analysands for, 77, 110-11; changes, external, which influenced, from 1940s to 1960s, 104; as creative endeavour, 115; definition

248 Index of, vii, 15-16, 150-1; definition of the use of words in, 96; doctrinaire authoritarianism of, 44; goals of, 14,112,133,158; history of, 5-7, 147, 151; hypotheses of, 152; and interdisciplinary study, 151-2; knowledge of, 5; limits of, 12, 83, 219n8, 233-4n3; method of, 14,16, 36; nature of, 5-6, 60,105,109,115; process of, viii, 112; and psychotherapy, 157; recent change in perception of, x; as a research tool, 152-3; 'science of the mind,' 152; tenets of, 12, 15, 105-6; 'the impossible profession,' 171; theory of, 5, 8, 105, 188-9; training for, 35-7, 52-4; in transition, 201 psychoanalysts: analysand's affect, attention to, 107-10; anonymity in analytic relationship, 129; attitude of, 105-6; as clinical scientists and writers, 150-3; collaboration among, 148-51; education of, viii, 38-9,48-9; effective, 36,67; effect of analytic training on, 53; emotional impact of profession, 115, 125, 129; fees of, 120; gender issues, 95-8,123, 158-9,164,194,233n25; identity, 74; mistakes made by, 141-2; motivation of first generation to become, 31-4; parent institute, of link with, 45; professional life, phases of, 7-8, 13,74-6,102; and relocation, 180-2; role of, 16, 114—16; self-knowledge, 117, 129, 171, 194; as teachers (see teaching); technique, acquisition of, 76; tools of, 140 psychoanalytic candidates: acceptance of, 36-7, 42-3; as analysands, 113; and attachment, 61, 64-5; and

extra-analytic knowledge, 133; integration of personal analysis, 54; rejection, 37, 41-2; supervision of, 138; 'thirty methods to destroy the creativity of,' 48-9. See also personal training analysis psychoanalytic practice: burnout, prevention of, 115, 122; consulting room, 79-80; impact on family and friends, 122, 126-8; practical and financial issues affecting, 104, 11921; study of, 8; time commitment, 122 psychoanalytic relationship: analysand's use of, 66; assessment of potential analysands, 78,110-12, 116; boundaries, 65, 67, 90-3, 95; decision to end, 180-1; emotions directed towards analysts, 106-7; intersubjective and intrapsychic, 61; nature of, 68, 109-10, 115-16; psychoanalyst's role in psychoanalysis, 105, 129; responsibilities of analyst and analysand, 109, 114. See also transference psychodynamics, 48, 141 psycho-hormonal interrelationships, 153-4 'psychological power of the pair,' 131 psychology: approaches of, 15; oneperson, viii, 145, 202; two-person, viii, 145, 202 psychopharmacology, ix psychosomatic medicine, 48, 153 psychotherapeutic process, 153-4 psychotherapy outcome research scale, 155 Rado, Sandor: adaptational theory, 50, 150-1, 199-200; at Columbia

Index 249 University Clinic, viii, 47, 153, 222n39; on Easser, 43; influence on Easser, 82, 194, 233-4n3; on libido theory, 44; and New York Psychoanalytic Institute, 222n40; opinions of, 31, 48; professional history of, 46; relationship with American Psychoanalytic Association, ix; Sandor Rado Lecture, 187-9, 191; as teacher, 46, 48, 50-2, 142 rage, 106 Rainerjohn, 78, 173 Rapaport, David, 150 reactivity, individual, 79 referrals, 119-20 'reflective function,' 200-1 regression, 190 Reich, Annie, 112, 190, 194, 231nl7 Ross, Nathaniel, 51-2, 84 Ruth Easser Memorial Lecture, 186 Sacks, Oliver, 176, 179 Sandier, Joseph, 150 Schachter, Joseph, 32, 44, 52, 86, 110, 116-17, 140-2,144-5, 157-8 Schachter, Judith, 45, 110, 116-17, 157, 168 schizophrenia, 141 Schwaber, Evelyne, 105-6 'science of the mind,' 152, 156 Scott, Clifford, 147 self: development of, 151, 175-6; object issues, 139; paradoxical nature of, 62-3; psychoanalyst's effective use of, 67-8, 139-40; and self-organization, 188-9; 'self psychology,' 139 Selye, Hans, 153 Shapiro, Daniel, 188 Shapiro, Theodore, 62

silence, use of, 66, 140 Silver, Daniel, 89, 168, 186-7 Silver, Jane, 176 Simons, Richard, 37, 69, 82 Sloane Endocrine Clinic, Columbia University, 153 social sciences, 15 Stauffer, Ruth, 26, 28 Stern, Daniel, 33, 53, 108-9, 147-8, 151, 177-80 Storr, Anthony, 64, 101,115-16, 169, 171 structural theory, reifying of, 109 super-ego ideal conflict, 123 supervision, 138, 141 Swerdloff, Bluma, 58-9, 86, 155, 172 Symington, Neville, 16-17, 67, 115-16 Tate, Agatha, 26, 28-9 teaching: as clinical scientists and writers, 148-53; as control case supervisors, 138-46; as personal training analysts, 57-9, 130-8; as seminar leaders, 146-8 tension state, 192-3 theory and technique, 82 third-party payment, 104, 119-20 Thompson, Nellie, 199-200 Toronto, psychoanalytic environment of, 185 Toronto Labour Lyceum, 22, 220n8 Toronto Psychoanalytic Society and Institute, 9, 169, 172, 185 training to become an analyst: application for, 38-9; cost of, 38-9, 57; and deafness, 178; description of, 35-7, 52-3; development of, viii-ix, 36, 48-50, 220nl7; effect of, 53; framework of, 82; knowledge base of, 54-5; risks of, 35; supervisory

250 Index component of, 55; use of modelling, 63, 81-2,132. See also personal training analysis; teaching transference: affect as not only, 108; described, vii-viii; and gender, 159; nature of, vii-viii; neurosis, 133; non-contaminated, 133; resistance, 160-1; role of, 64-6, 139-40, 144-5 two-tier socializing, 127-8 unconscious, 15, 109 University of Toronto, 172, 185 unsung psychoanalyst, 8-9, 12 urges, creative and destructive, 106 Urquhart.Jane, 3

Weber, John, 156-7 Wechter, Dena, 70-3, 125, 127, 163, 165 Weiss, Stanley, 54 White, Patricia, 123, 226n25 Whitman, Roy, 167 William Alanson White Institute, 46, 52,158,168, 222n40 Winnicott, D.W., 34, 61-2, 88, 190 womanhood, 194-6, 233n25, 233-4n3 Woodsworth, Grace, 22-3 WoodsworthJ.S., 22-3 word modelling. S^ modelling (in training analysts) work ethic, 123 Workman's Circle, 22

vocational functioning, 78 Zetzel, Elizabeth, 159, 160, 228n55 Waelder, Robert, 112