Chestnut Lodge Research Articles

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. Reprinted from Am J Psychiatry 1990; 147:409-418, with permission from American Psychiatric Association Publishing. Publishing. Copyright © 1990.

Commentary on Searles’s Case Conference Transcript and Chestnut Lodge

ABSTRACT These reminiscences about Dr. Searles and others at Chestnut Lodge, and about Chestnut Lodge itself, and the treatment process there, allow readers to consider changes in psychiatric and psychoanalytic thinking, alternating between biological and interpersonal orientations. Chestnut Lodge and Dr. Searles were noted for an intensive, psychoanalytic approach, and the author makes a case for its enduring value.

A Relational View of Searles and Chestnut Lodge

A review of a clinical report by Harold Searles, attending to Searles’ ways of working with psychotic patients, his influences and those he influenced, as well as contemporary thinkers (Laplanche), who speak as Searles did, of the power of the other in the construction of psychic life.

Harold F. Searles Case Conference at Chestnut Lodge

Harold F. Searles Case Conference at Chestnut Lodge

Not “Just Add Patient and Clinician and Stir”

ABSTRACT The author analyzes Searles’ case presentation through both the lens of a social worker as well as through her experience as a patient at Chestnut Lodge, the same institution in which the case presentation was based. Katz focuses on the unusual relationship between Searles and his patient, and how the pervious boundaries between the two both captured the culture of Chestnut Lodge and acted as a vehicle for a successful outcome for the patient.

Adolescent Treatment at Chestnut Lodge: What Was Learned, What Is Lost, What Can Remain

ABSTRACT Treating severely disturbed adolescents in a residential hospital required a setting, frame, and technical approach different from treating adults. This paper reviews similarities and differences between the adult and adolescent settings and suggests that elements of the adolescent model can be successfully applied to less restrictive settings, preserving some of the clinical lessons learned in the Adolescent and Child Division of Chestnut Lodge.

Prologue: Revisiting Chestnut Lodge: A Case Presentation by Harold F. Searles in 1961

Prologue: Revisiting Chestnut Lodge: A Case Presentation by Harold F. Searles in 1961

Predicting Psychosis: Field Moves From Assessment of Clinical Risk to Search for Biomarkers

Predicting Psychosis: Field Moves From Assessment of Clinical Risk to Search for Biomarkers

Past APA President Harold Eist, M.D., Dies

Back to table of contents Previous article Next article In MemoriamFull AccessPast APA President Harold Eist, M.D., DiesMark MoranMark MoranSearch for more papers by this authorPublished Online:27 Jan 2022https://doi.org/10.1176/appi.pn.2022.2.33AbstractEist was also president of the Washington Psychiatric Society for three terms and was active in the World Psychiatric Association.Past APA President Harold Eist, M.D., died December 16. He was 84.Past APA President Harold Eist, M.D., died December 16, 2021. He was 84. The cause of death was complications related to surgery, according to Ann Eist, his wife of 61 years.Eist, who served as APA president for the 1996-1997 term, was elected on a wave of membership anger with managed care, which Eist castigated as destructive of patient care. Introducing Eist at the 1997 APA Annual Meeting in San Diego, then Medical Director Melvin Sabshin, M.D., described Eist as a “populist president whose intensity of care for our profession and for our individual members has never been exceeded; a president whose assertive passion about the threats to the practice of psychiatry has never been surpassed; and a president who has mobilized us, individually and collectively, to combat those threats with all the force we can muster.”“The suffering of the mentally ill is being ignored, denied, and made invisible on the altar of managed care’s bottom line, and our patients know this,” wrote Eist in his February 7, 1997, presidential column in Psychiatric News. “This dehumanization is intolerable, and regardless of ‘contracts,’ we have to ask how physicians can participate in it?”In addition to being president of APA, Eist served three separate terms (1981-1982, 1990-1991, and 2008-2009) as president of the Washington Psychiatric Society and a term as president of the Suburban Maryland Psychiatric Society. Always active in the World Psychiatric Association (WPA), Eist was a chair of the WPA Standing Committee to Review the Abuse and Misuse of Psychiatry. In that role, he was part of a delegation that met in 2004 with the Chinese Minister of Health and other Chinese officials around allegations that the Chinese used psychiatric hospitalization to punish members of the Falun Gong for their religious and cultural beliefs (Psychiatric News).Eist completed his undergraduate and medical school training at the University of Alberta. He was trained in psychiatry at the University of Minnesota and completed his residency in 1967. It was at the University of Alberta that he met his future wife, who was getting a degree in social work. They married in 1960 while Eist was still in medical school.At APA meetings and elsewhere, the two were inseparable. “They are a true partnership, supporting each other in all areas of their lives, personal and professional,” Sabshin said in his 1997 speech. “Even his presidency has been a partnership effort.”The Eists moved to Washington, D.C., in 1967 when he was hired by the legendary Chestnut Lodge in Rockville, Md. He was trained in psychoanalysis at the Washington Psychoanalytic Institute. He was also hired as medical director of the fledgling District of Columbia Institute of Mental Hygiene. That clinic—with a staff of five and 18 patients—grew under his leadership to a staff of 150 professionals treating more than 2,500 patients a year at three sites. The clinic was a major part of Eist’s life for 22 years.In addition to his work at the clinic, Eist maintained a private practice in Bethesda, Md., and was a professor of psychiatry at Howard University School of Medicine and clinical professor of psychiatry and behavioral sciences at the George Washington University School of Medicine and Health Sciences. Mrs. Eist recalled telling her husband once that maybe he should cut back on working six days a week. He responded, “This is what keeps me going, working for my patients.”He was recipient of the NAMI Exemplary Psychiatrist Award and the WPA’s Leader in World Psychiatry Award. He was also awarded the Frieda Fromm-Reichmann Award of the Washington School of Psychiatry for his efforts to bring psychotherapy and psychoanalytic treatment to poor and underserved individuals. And he received the Jack Greenspan Award from the Philadelphia Psychiatric Society for “his efforts to preserve, protect, and defend the practice and profession of psychiatry.” In 2015, the University of Alberta honored Eist with its Distinguished Alumni Award. In addition to Mrs. Eist, Eist is survived by their three children and four grandchildren. ■ ISSUES NewArchived

Ethical Challenges in the Treatment of Anxiety.

Ethical Challenges in the Treatment of Anxiety.

Otto Will and the Artistry of Relationship: More Simply Human than Otherwise

Otto Will was one of the most creative psychotherapists of the twentieth century, yet his work is relatively unknown today. This paper strives to transmit his legacy. During his career at Chestnut Lodge and Austen Riggs, Will taught by example, inspiring others to engage in long-term, psychoanalytic treatment of psychosis. Deriving inspiration from his analysts, Harry Stack Sullivan and Frieda Fromm-Reichmann, he explored the healing power of human attachment and relatedness. As a therapist, he presented himself in all of his flawed humanity, admitting mistakes, and acknowledging limitations. Such human responsiveness engendered similarly human responses in the other. Through cultivating attachment and forging vital relationship with severely traumatized patients, he manifested a unique gift for connection. I draw upon my own experience as his student and colleague of twenty-three years to recount his personal and professional history and to examine his unique contributions to technique. Clinical examples and stories demonstrate Will’s singular “artistry of relationship.”

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.

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.

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.

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.

Chestnut Lodge: The Transformative Power of Creating Connection

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.

The Nut House

The author, a writer, teacher, and former theatrical agent, recalls his terror when, in 1959, as a troubled adolescent, he found himself unable to attend school or get a job—the only choices he felt were open to him—and ended up at Chestnut Lodge as an in-patient. His experience left an indelible impression, which he shares in this article.

Restoring Dyadic Connection in the Face of Multiple Disruptions: Accounting for Vicissitudes in the Therapist’s Capacity for Reflective Functioning

ABSTRACTThis article describes the working method of our study group comprised of former Chestnut Lodge Hospital therapists and focusing on understanding therapeutic work with severely disturbed adolescents. Using process material from one therapy session, the therapist’s commentary on her feelings and reactions in the session, and the group’s discussion of the work, we explore factors disrupting the therapist’s moment-to-moment capacity to maintain a theory of her own and the patient’s minds. We then discuss what allows her to refind her theory of mind in the face of the patient’s aggressive nihilism and her own sense of loss. Salutary factors included the therapist’s empathy for the patient’s shared sense of grief, the patient’s offering the therapist cues to his inner state, and the dyad’s capacity to tolerate the therapist’s vulnerability in the patient’s presence.

Some Thoughts on Empathy: The Eighteenth Annual Frieda Fromm-Reichmann Memorial Lecture

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.