The Third Table

04: Ess White

Chapter  IV

A PIECE OF THE MOON

by Dr. Ess White

Dr. Ess White  Photo By Walter Scott

Dr. Ess White Photo By Walter Scott

I first came to Riggs for an interview in 1951 after my residency at the Seton Institute. I was absolutely overwhelmed by the place. The medical offices were in an old Victorian house and I sat in the waiting room alongside several patients until the time of my appointment. A very formal figure appeared in the doorway and called my name. I felt as if I were being ushered into a royal presence. It was David Rapaport, a famous psychologist whom I respected greatly.

“What have you been reading?” he asked, breaking the ice.

I struggled to remember if I had ever read a book in my life and suddenly remembered what I had been avidly reading on the train to Stockbridge. It was the Fitzgerald novel about a psychiatrist – “Tender Is the Night.” We chatted, but he didn’t unbend a bit. At lunch we went down into the basement of the building and ate off trays. I took my plate off the tray and set it down on the table – and then I noticed it was a ping – pong table. This was in such great contrast to physical opulence — and intellectual squalor — of the places I had been in training. Toward the end of the day I took the battery of psychological tests – as we all did in those days.  Back at the Seton Institute I told gleeful tales at the lunch table about this peculiar place.  I was interrupted by a phone call. It was Dr. Edgerton Howard calling to offer me the job. I said, ” I’ll take it!”

I took the time between jobs to acquaint myself with a bit of Riggs history.

In 1907, Dr. Austen Fox Riggs left a lucrative New York practice in internal medicine and moved to Stockbridge. Like many medical professionals of that time, Riggs had a keen interest in psychiatry. By 1910 he was treating local patients for “nervous collapse.” In 1919 he established the Austen Riggs Foundation, and by his death in 1940 he had treated some 6,000 patients. Originally the patients stayed in local boarding houses because Dr. Riggs did not want to construct a compound for “sick” people. Eventually a large and comfortable brick house was bought and enlarged for patients’ accommodation. It was called “The Foundation Inn.”

Most of Dr. Riggs’s patients came from socially prominent families, and were treated with the sort of fatherly counseling depicted on the screen by Claude Rains in Now Voyager, a film based on the novel by Olive Higgins Prouty, who had been one of Dr. Riggs’s patients.

Now Voyager : A movie about Austen Riggs in the 1930's

Now Voyager : A movie about Austen Riggs in the 1930's

In the late forties, after Austen Riggs died, Dr. Edgerton Howard, who had been on the staff with Dr. Riggs, was the Associate Medical Director. He got together with Lawrence Kubey, a man of enormous intellect and foresight who was on the Board of Directors. Howard and Kubey decided they  wanted to make Riggs a psychoanalytic hospital, build a new staff, and get a new director.  They went straight to a place with a psychoanalytic point of view – Menninger’s. They talked with the star member of the staff, Dr. Robert Knight and convinced him to accept the directorship. He brought a talented and brilliant staff with him.

When I first went to Riggs for an interview Robert Knight was away. I first met him at my orientation. He was very matter-of-fact and I thought, “Oh, no! If he’s this cold, how am I going to deal with him?” But all that changed when I saw him preside at a conference. He just sat there exuding confidence and authority, without being cold or reserved or in any way competitive He was absolutely remarkable.

Dr. Robert Knight

Dr. Robert Knight

He ran the whole place; everybody counted on him to take care of everything perfectly. There was just something about the atmosphere of Riggs at that time – and you could tell it came mainly from Knight. He was a physically imposing man, at least six foot four with big hulking shoulders, but possessed of remarkable kindness and gentleness.  But as kind and gentle as Knight could be, he was very much in charge. And by the second day at Riggs I was totally gaga about him.

I settled in and started work. The office was in an old building called the Puritan House. We all had tiny cubicles for offices, in what had been the servants’ quarters at one time. I was lucky — mine had a good window. The second year I had two windows which was a total luxury. We each had a beat-up old chair, a desk, and a place for the patients to sit, and we had a Dictaphone. That was about it.

In the Puritan House there were always two activities going on during lunch break, a bridge foursome and a running ping-pong game. After lunch was finished the ping pong table was available so we all played. Bob Knight was a regular, as was I, and we always played doubles. It became quite competitive. When Knight and I played together we stood practically everybody down.

Bridge In The Afternoon

Bridge In The Afternoon

Bob Knight was also an inveterate bridge player, as was I. He, Stuart Miller, Knight’s secretary Emily, and I would often play. We all had lots of fun and it was a nice way to be friendly. By and large, the Riggs group was not very social in the ‘society’ kind of way. There wasn’t much private entertaining and, as a Southerner, I was used to being very social.  In Stockbridge there was suddenly — zilch! We played bridge but that was it. I’d never been in a place where there wasn’t a party for the new people. After six months of this I got so depressed I didn’t think I would stick it out. But once I came to realize that nobody else on the staff was in a different boat socially, I relaxed and learned to find this new freedom exhilarating.

By the mid-fifties we started plans for the renovation and expansion of the building that is now our Medical Office Building (M.O.B.). Once construction started we watched every step. They were adding two new wings to an already huge house, so it was a big job. But since we had been observing the work from the beginning, we never felt as if we were wandering into a new or strange place.

When we moved, I asked for the room right over the original front door. I wanted it because it had a fan-light with the original amber glass. Then the workmen broke it and put in plain glass. I still took the office, liked it and stayed there.

After Knight’s group arrived in the late forties, it became apparent that if you simply ran the hospital for purposes of analysis, a group of borderlines (or worse) in an open place like this were going to act out like crazy.  Analysis encourages looking inward and supports a letting-go of feelings.  Just before I got to Riggs there had been rampages of noise, fury, destruction and sexual promiscuity. The question was what could be done to contain the situation without relinquishing the freedom and analytic point of view.  That is why we developed a therapeutic Community Program.  We had to find a way for people to interact in relationships while learning respect for each other’s boundaries .   Living together and yet being able to be independent – these were the two ideals we were always juggling.

The idea of therapeutic community programs was not so entrenched that everybody knew how to do it.  We felt perfectly free to discover for ourselves, to put things into effect with the community and to struggle along as best we could.  As soon as I overcame my shyness and ignorance I plunged right in wholeheartedly. I chaired a committee of four elected patients charged with creating the format for programs designed to embody the daily workings of the community.   We all agreed, staff and patients, that patients would take on more responsibility for their government, their healing and themselves.

We established a meeting of all the citizenry of the hospital at least once a month.  We decided that the purchasing of snacks should be in the hands of the patients rather than with the dietary staff and, most notably, we instituted the Common Work Program.  Its basis was that each patient put in an hour’s work per day which professionals had once been paid to do. It could be as simple and cleaning the Inn or the Shop, or working in the greenhouse to grow flowers for decorating the buildings.  There were administrative positions available such as schedulers in the program.  The resulting savings went to a Patient Aid Fund and were used to help patients in financial straits.

Besides my work with the therapeutic community, I was learning to be a psychoanalytic psychotherapist.   In 1955 I started analysis with Margaret Brenman.

Margaret Brenman

Margaret Brenman

She was still quite young, in her late thirties. She had become an analyst in Topeka before the age of thirty, which was unheard of in those days.   She had been in analysis with Bob Knight and he always paid a great deal of attention to her.  Margaret had a brilliant sense about people.   She wasn’t formal and removed or overly intellectual with people.   People liked to talk with her and confide in her.  So it was no surprise that her patients seemed to be doing very well as they moved through the hospital.

Margaret was a very good therapist for me and I got a lot from her.  But orthodox, no!

Erik Erikson

Erik Erikson

Erik Erikson, too, could be described as a brilliant therapist.   He was a poet and an artist who made all these brilliant pronouncements that seemed to come out of some kind of ether.  He was not intellectually precise like David Rapaport.  Erik was just the opposite. Rapaport thought he had to keep Erik honest, and Erik let him think he was doing that.  They admired and supported each other.

Rapaport was a kind of Vesuvius.  He was a most brilliant man yet he could be very jealous of his little provinces.   He held “bull sessions” for the Fellows in his office Wednesday afternoons at four or five.  These were fascinating, wide-ranging conversations.

David Rapaport

David Rapaport

If someone wanted to talk about art history or mythology, we’d talk about art history or mythology.  No matter what was brought up, he had an encyclopedic knowledge of it, knew the appropriate books to read and even the relevant page numbers. He, along with Merton Gill and Roy Schafer, wrote the first big book about diagnostic clinical testing that was an immediate standard and probably still is.

Knight was a wonderful therapist but he was a more reserved person than Rapaport, a kind of Grandfather figure. He never would have said so, but I think he was comfortable with my background – waspy, slightly upper-crust.  My family wasn’t really upper-crusty but the people I ran with had those values and I acquired them.  Knight did have that background and he certainly had the manner.

In the fifties hospitals were devoted to the idea of occupational therapy, but Joan Erikson,Erik’s wife, would have none of it. She wanted to give patients a second chance to grow and create. She wanted a program that was almost a kind of apprenticeship in the arts or crafts. Her ideas were revolutionary at the time. Erik was behind her and he was very influential. There was the great surge of enthusiasm from the patients, the Fellows and the young people for Joan’s program and for the Community Program that made these innovations more acceptable to the conservatives at Riggs.  Margaret Brenman was very supportive and my guess is that David Rapaport was too.  That left Bob Knight.  He often said that sweeping change was tomfoolery.  But if anyone was crazy enough to try, he usually didn’t get in the way.

Miss Breed named it the Lavender Door

Miss Breed named it the Lavender Door

The shop was a part of Riggs from the year one, but when Joan’s Activities Program took over it was felt “the shop” needed a less generic and more appealing name. Edith Breed, the Head Nurse, came up with it.  She said, “Why don’t you paint the door a distinctive color so it will stand out? I think lavender would be terrific!”

Oddly neither Joan nor Edith was on the Executive Committee.  Many of the women who mattered were never allowed to sit on it.   In the fifties women simply were not considered for big administrative jobs. But Bob Knight respected Edith’s clinical insights. If there was a debate in a patient conference about keeping the patient on, Knight always turned to Edith and asked her opinion. Edith was not inclined to give up on people, so if she felt Riggs was not the right place for the patient Knight gave her opinion great weight. “Okay,” he would say, ” that’s worth ten votes, let’s hear from the rest of you.”

Edith came from Stockbridge and worked at Riggs before Dr. Knight took over in 1947. By that time she was already Head Nurse.  She was one of the few nurses who stayed. She fitted in beautifully.  Edith was a great worker in the Community Program.  She accepted the ideas rapidly and helped everyone else with them.

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