Chestnut Lodge: 1948–1951

The author of the acclaimed novel, I Never Promised You a Rose Garden, a fictionalized account of her 3-year in-patient treatment at Chestnut Lodge, shares her personal memories and impressions of the experience. Treated by Frieda Fromm-Reichmann at the Lodge from 1948 to 1951, the author mines her memories of the facility, staff, fellow patients, and the treatment itself (including cold packs for sedation). She reflects on an earlier time in the history of treatment for the mentally ill.     

Towards a New Chestnut Lodge

The author, who was a staff psychiatrist at Chestnut Lodge from 1976 until it closed in 2001, reflects on the history of the Lodge and her experience working with psychotic patients. This spanned a period when the Lodge moved from treating schizophrenic patients without psychotropics to the current age of medication. The author makes a case for the earlier Lodge treatment model and questions the extensive use of anti-psychotic medication that she believes stalls the psychoanalytic project and—as current research is showing—may have a negative effect on the patient’s neurobiology. She imagines a return to the Lodge’s earlier days.     

Chestnut Lodge: An Unreal Place

The author, a staff psychiatrist at Chestnut Lodge from 1986 to 1991, worked there at the same time contributor Liat Katz was a patient. Using her article as a jumping-off point, he offers a personal portrait of the Lodge from the staff perspective, based on what struck him as unique and most salient about the hospital and the hospital community. Among other characteristics, Chestnut Lodge encouraged patients and staff to be themselves. This was one of the core therapeutic features of the Lodge, and it stimulated creativity among its patients and staff. Thus, both were helped in overcoming ubiquitous and often harmful pressures to conform. The author continues to mourn the Lodge, which closed in 2001.     

Lessons in how to ruin a study in psychotherapy effectiveness: a critical review of the follow-up study from Chestnut Lodge

The principal publications from the follow-up study of former patients at Chestnut Lodge are reviewed and critiqued. Originally, the follow-up study was intended as a study of the psychotherapeutic process and its outcome. While widely referred to as a follow-up study, it is not possible to make conclusions about psychotherapy from the study. Data about the psychodynamic aspects of therapy have been collected but never analyzed. Additionally, the study does not fulfill the requirements of a psychotherapeutic outcome study. The conclusion of the current review is that as the study turned out, it only allows one to draw conclusions about different kinds of illness courses and predictor factors.     

Sexual Contact between Patient and Therapist

The author describes how her experience as an adolescent in residential treatment at Chestnut Lodge informs and enriches her work in creating connection with the patients she treats as a community social worker.     

Damn the Torpedos! A Treatment Memoir*†

A former patient reflects on her treatment with Martin Cooperman, M.D., director of psychotherapy at Chestnut Lodge from 1958 to 1968. As noted in the short introduction by Jay S. Kwawer, Ph.D., who obtained this memoir for us, Cooperman left the Lodge to join Otto Will, M.D., at the Austen Riggs Center, where the author encountered him in his private practice.     

An Intensive Study of Twelve Cases of Manic-Depressive Psychosis†

BEFORE embarking on the subject of this evening, I would like to share with you some memories of Frieda—memories of the late forties and early fifties, when I met her and worked with her at Chestnut Lodge.     

The Chestnut Lodge follow-up study. I. Follow-up methodology and study sample

Chestnut Lodge is a small, private psychiatric hospital in Rockville, Md, specializing in the long-term residential treatment of severely ill (and usually chronic) psychotic and borderline patients. Four hundred forty-six (72%) of the patients treated at Chestnut Lodge between 1950 and 1975 were followed up an average of 15 years later. This first report details the rationale and methods for this investigation.     

The psychiatric patient's right to effective treatment: implications of Osheroff v. Chestnut Lodge

Although Osheroff v. Chestnut Lodge never reached final court adjudication, the case generated widespread discussion in psychiatric, legal, and lay circles. The author served as a consultant to Dr. Osheroff and testified that Chestnut Lodge failed to follow through with appropriate biological treatment for its own diagnosis of depression, focusing instead on Dr. Osheroff's presumed personality disorder diagnosis and treating him with intensive long-term individual psychotherapy. The author suggests that this case involves the proposed right of the patient to effective treatment and that treatments whose efficacy has been demonstrated have priority over treatments whose efficacy has not been established.     

The contribution of Harold F. Searles to an emerging therapeutic relationship with a chronic schizophrenic man

The article describes the personal experience of the author, the development of a nontherapeutic relationship with a deeply regressed man, inspired and developed side by side with the study and the knowledge of the writings of Harold F. Searles. At the beginning of this experience, the author had just begun his university education in psychology. He found inspiration and self-confidence reading articles Searles wrote during his time at Chestnut Lodge. The experience of the author, developed out of theoretical models and knowledge, demonstrates that it is possible to engage psychotic people without formal psychotherapeutic training, accepting and sharing the idiosyncratic behavior of the other in a spontaneous and quiet way, using intuition and empathy.     

The Interpersonal Legacy of Chestnut Lodge

This article addresses the context in which Chestnut Lodge Sanatorium evolved its legendary status. Early years of interpersonal psychoanalysis (1920s–1950s) locate the Washington, DC, and Baltimore areas as crucial contexts, both for the professional support they provided to the beginnings of an interpersonal viewpoint, and for the derisive, dismissive attitudes targeting the early proponents of the interpersonal perspective. Chestnut Lodge and the developing White Institute evolved along parallel organizational lines. The development of a compatible clinical sensibility is noted, conceptually linking those identifying as “interpersonal.” Both organizations (“The Lodge” and “White”) share a common intellectual ancestry and a comparable approach to clinical technique. Likewise, both organizations share an emphasis on rejecting dogma and managing to resist organizational pressures in favor of nonconformity and defiance of rigidity. Both organizations are shaped by theorists who are drawn to work intensively with “difficult” patients, as well as with facing powerful personal and political challenges and credible threats of professional exclusion.     

A personal response to Gail Hornstein's To redeem one person is to redeem the world: the life of Frieda Fromm-Reichmann

This article summarizes events surrounding the closing of Chestnut Lodge, as a backdrop to the author's reactions on reading Frieda Fromm-Reichmann's biography. This anecdotal piece forms a complementary essay with the 2000 Frieda Fromm-Reichmann Lecture, "The Current Relevance of Fromm-Reichmann's Works." It illustrates aspects of treatment of schizophrenia and of the individuals involved in such work.     

Narcissistic, antisocial, and noncomorbid subgroups of borderline disorder. Are they distinct entities by long-term clinical profile?

This study evaluates the influence of narcissistic and antisocial features on the long-term functioning of individuals with borderline personality disorder. Borderline patients discharged from Chestnut Lodge Hospital, an inpatient residential treatment facility, were followed up an average of 15 years later to assess longitudinal clinical profile. Despite differences in baseline psychopathology, members of Narcissistic, Antisocial, and Noncomorbid Borderline subgroups turned out to be roughly equivalent on almost all long-term course and outcome dimensions. The implications of these results for the nosology and treatment of personality disorders are discussed.     

Predicting outcome in schizoaffective psychosis

Predictors of long-term outcome are identified for 68 patients with schizoaffective psychosis from the Chestnut Lodge Follow-up Study. Two dimensions regularly predicted better outcome: better developed premorbid instrumental skills and fewer typically schizophrenic symptoms.     

The prognostic significance of obsessive-compulsive symptoms in schizophrenia

Obsessive-compulsive symptomatology has been described in schizophrenia for more than 60 years, but its clinical significance has yet to be explored systematically. This report details the clinical characteristics and long-term course of a group of 21 schizophrenic patients with prominent obsessive-compulsive symptoms from the Chestnut Lodge Follow-Up Study. While this group differed on admission only minimally from schizophrenic patients without obsessive-compulsive symptoms, their long-term outcome in the areas of social relations, employment, psychopathology, and global functioning was significantly, and almost uniformly, poorer. Persistent obsessive-compulsive symptoms thus appear to be a powerful predictor of poor prognosis in schizophrenia.     

Identität und Dissoziation im Cyberspace

OBJECTIVE: By mediating dissociative experiences, the Internet can challenge the boundaries of people's sense of identity. To illustrate this hypothesis, a case of dissociative identity disorder (DID) is presented. CLINICAL PICTURE: A young unemployed woman created and frequently played several characters in an online game. For more than 2 years she spent up to 12 h a day in the Internet, assuming various personalities, which in return intruded upon her neglected real life. TREATMENT AND OUTCOME: During the course of an inpatient psychotherapeutic treatment, the clinical diagnosis of DID was confirmed by psychometric testing. After 12 weeks of psychotherapy, the patient had managed to identify her fragmented identities as character traits and integrated them into her core personality. She rearranged her real everyday life, found a new job, and reduced her online activities. DISCUSSION: Even though the patient's psychopathology stems from a disposition in terms of a personality disorder with histrionic and narcissistic features, excessive internet role play obviously functioned as a trigger to develop DIS. Conclusively, cyberspace's anonymous interactivity may offer the possibility to explore one's identity while also putting at risk its coherence.     

Testing four diagnostic systems for schizophrenia

Four diagnostic systems for schizophrenia--New Haven, Feighner et al, Research Diagnostic Criteria, and DSM-III--were tested for reliability, comprehensiveness, concordance with established clinical use, specificity, and predictive validity. The sample consisted of 400 patients admitted to Chestnut Lodge, Rockville, Md, 330 of whom received long-term follow-up assessment by interview an average of 15 years after discharge. Diagnostic system criteria were applied retrospectively to abstracted medical records. Findings replicated recent studies on schizophrenia diagnosis and extended the generalizability of current nosologic systems to chronically ill patients. Results also indirectly supported the validity of applying these systems to medical records. This study demonstrated advantages and disadvantages of each system.     

Identifying unmet therapeutic domains in schizophrenia patients: the early contributions of Wayne Fenton from Chestnut Lodge

Wayne Fenton, MD, died on September 3, 2006, while giving emergency clinical care. His leadership at National Institute of Mental Health provided a framework for therapeutic discovery. He crafted a new approach to psychosis based on poor functional outcomes and the psychopathology domains underlying long-term morbidity. His research and clinical observations during his career at the Chestnut Lodge clarified the unmet therapeutic needs in schizophrenia and provided the foundation for his vision. The results have radically changed the paradigm for discovery with emphasis on impaired cognition and negative symptom psychopathology.