Mad, Bad, and Sad: A History of Women and the Mind Doctors

by Lisa Appignanesi

  Then, too, if Marilyn was to have recourse to psychoanalysis, Greenson was eminently qualified. When he arrived at her bungalow at the Beverly Hills Hotel, he was quick to note her slurred speech and sedated manner. Asking for a list of the stimulants and sedatives Marilyn was on, he told her she had taken enough medication to put five people to sleep. ‘I promised she would sleep with less medication if she realized she is fighting sleep as well as searching for some obvious oblivion which is not sleep.’ It was the beginning of a therapy which would last until Marilyn’s suicide: the wish for oblivion won out. Greenson never altogether got over it.

  Ralph Greenson (1911–79)

  Ralph Greenson was born Romeo Greenspoon, alongside his twin sister Juliet, on 20 September 1911, to Russian Jewish immigrants in Brooklyn. By dint of hard work and imagination, his pharmacist father became a doctor while his wife, who had worked alongside him while he went to medical school, transformed herself into a successful artists’ manager. The children’s names give away the family’s love of theatre, opera, music and the arts; before he became Ralph–or Romi to his friends–Greenson had already had an education in the cultural classics and the high drama that its interpreters could engage in both on stage and off. The great Russian ballerina Pavlova was one of his mother’s clients. In 1931, after university, Greenson went to medical school in Berne (a quota for Jews still applied in America). Here he met his wife Hildi, and learned to read Freud in German. Drawn to Vienna, he had an analysis with the indefatigable Wilhelm Stekel, one of Freud’s earliest followers, who had been abandoned by Freud to go his own way.

  By all accounts a charming, loquacious enthusiast of a man, with a great gift for lecturing and none for modesty, Greenson came to Los Angeles in 1936 to find himself rejected by the existing psychoanalytic society because of his links with Stekel. He did a second analysis with the highly respected Viennese analyst Otto Fenichel who had recently arrived in America, and effectively completed his analytic ‘training’ during the war, when he headed the combat-fatigue unit at the Army Air Force Convalescent Hospital in Fort Logan, Colorado. His experience in dealing with war neuroses found its way into Captain Newman MD, in which Gregory Peck plays the heroic army psychiatrist who brings three distressed soldiers back to normal life after their traumatizing war experience. Greenson had dramatically recounted his war stories for the film’s writer, Leo Rosten, and when the film appeared in 1963, the same year as John Huston’s Freud, it played to packed houses–unlike the Huston film, in which Marilyn Monroe, possibly on Greenson’s advice, had refused the part of Freud’s young hysterical patient.

  In 1960 Greenson had helped Marilyn enough to see her through the filming of Let’s Make Love. Then she returned to New York and to Marianne Kris. In July and August of that year, the fateful shoot of The Misfits took place in Reno, Nevada. The heat was as intense as the passions that swirled around the set, not least between Miller and Monroe. The film was based on a short story he had written about her early in their relationship. It portrays a vulnerable, sensual, supremely feminine young woman whose sensitivity is such that she manages, mostly through her trembling passivity, to bind together a group of male ‘misfits’ and stop them preying on the wild horses they hunt.

  Marilyn felt she was being called upon to play what was effectively a ‘misconstrued concept of herself’. This idealized Marilyn–for which Marilyn Monroe Productions had paid Miller $250,000–eradicated the shameful and shaming past that had made her. Miller had never been able to acknowledge that past; nor, it seems, the Marilyn she was. She is quoted as saying about the scene in which her character, Roslyn, persuades the cowboys not to kill the wild horses: ‘I convince them by throwing a fit, not by explaining anything. So I have a fit. A screaming crazy fit…And to think, Arthur did this to me…If that’s what he thinks of me, well, then I’m not for him and he’s not for me.’ Meanwhile, the film’s director John Huston lauded Marilyn, by saying that she had not been acting. ‘The role was Marilyn, but Marilyn plus. She found things, found things about womankind in herself.’

  Portraying this naked, wounded creature, Marilyn felt isolated and abandoned, ‘worthless’, merely the sexualized female of the male unconscious she was always bumping into. She was drinking heavily. In the first week of August, she collapsed and had to be flown back to LA, where Greenson tried once more to wean her from alcohol and pills. He put her back together enough so that she could return to finish the shoot. But when the film wrapped in January and she returned to New York, Marianne Kris judged her state and threats of suicide so frightening that she had her hospitalized at the Payne Whitney Clinic in Manhattan. Monroe voluntarily signed in as Faye Miller, but then realized that this was no rest and rehabilitation centre. ‘There was no empathy…The inhumanity was archaic…There were screaming women in their cells,’ she later wrote to Ralph Greenson.

  Marilyn herself was amongst them. She was put in a locked, padded room and threatened with a straitjacket when she screamed her demands to be released. This was too close to the demented maternal reality. She spent three days at the hospital and finally managed to reach her ex-husband Joe DiMaggio, who flew in and demanded her release. The torrent of rage Marilyn subsequently released on Marianne Kris had the older woman trembling: ‘I did a terrible thing, a terrible thing. Oh God, I didn’t mean to, but I did.’

  A place was found for Marilyn at the Columbia Presbyterian Hospital. From here she wrote to Greenson to ask him to become her primary analyst. She was moving back to LA. By June she was hailing him as her saviour. Perhaps this second cultivated Jew was in some ways a standin for the Miller who had never, she felt, properly understood her. Greenson evolved a radical form of treatment for Marilyn. In the early days of psychoanalysis it would have been called ‘wild’. It was certainly unconventional in the world of neutral American analysts. Some said he had simply fallen under Marilyn’s spell. Greenson not only had erratically long sessions with his star patient, sometimes allowing these–when she was in serious trouble at the studio, for example–to extend to five hours. He also took to seeing her at the end of the day and in the informal environment of his own home, where she might then stay on for dinner, and later help with the washing up or attend one of the chamber concerts the Greensons held. She became friends with his wife and children–unusually for Marilyn, coming early for sessions so that she could chat to them. She attended Greenson’s art school daughter’s birthday party, taught her dance steps, gave her advice on boyfriends. She went to lectures–indeed, one by Greenson–with his student son, or, disguised in a black wig, helped him flat-hunt. She phoned Greenson at home at any hour of the day or night, to the point where he himself began to feel trapped by her. He delayed a long-planned trip to Switzerland with his wife in order to be on hand for Marilyn who was once more in trouble over filming, this time the Cukor comedy Something’s Got to Give.

  Greenson had a rationale. Marilyn, he determined, was a borderline personality: addictive, needy, impulsive, prone to bouts of rage and feelings of self-abasement compounded by sexual and emotional excess, unstable in her relationships as well as in her own identity. An amorphous term often redefined (for example, by feminist therapists) as embodying one of the personality disorders or a post-traumatic stress disorder arising from childhood abuse, borderlines, though not psychotic, can also sometimes somatize like old-style hysterics. Analytic hearsay has it that the mark of borderlines is that they can talk about themselves for five hours at a stretch without the analyst getting a realistic picture of who they are. Indeed, borderlines were most often considered unreachable by psychoanalysis, certainly in its American fifties configuration. However, analysts like Frieda Fromm-Reichmann, let alone the British Kleinians and French Lacanians–as Greenson was well aware judging from his many reflections on technique, particularly post-Marilyn–had devised methods of using talking therapies with more extreme cases. As Greenson writes in 1974:

  Most Freudian analysts believe that the borderline and psychotic patie
nts…suffer predominantly from a deficiency in the ego’s capacity to form and retain mental object representations and are therefore not suitable for psychoanalytic therapy…Analysable patients have a relatively well developed and intact ego, with the capacity to distinguish inside from outside and self from others. In addition they have the ability to develop and sustain both a transference neurosis and a working alliance in order to work effectively and endure the demands of the analytic situation. Patients lacking the resilient ego functions necessary for these developments will not be able to comprehend, feel, integrate and utilize interpretations of their unconscious reactions…Conflict disorders with an intact ego usually respond well to interpretive interventions. The ego deficiency disorders require primarily structure building techniques.

  Marilyn had an ego deficiency and there was work to be done before analysis could bite, before she could use interpretations. There was no hope here for a conventional analysis. What was clear to Greenson was that her childhood had given Marilyn no indication of how to live. The mad mother, the lack of a father, the changing foster homes and the abuse, though invoked in her erratic, earlier analyses, had done no more than educate her in a language. She would speak easily enough of ‘Oedipus’–in fact, on several occasions, she talked of finding her father and sleeping with him. She elaborated a fantasy, reported as real, of donning a wig and seducing the ageing Lothario, so that she could then confront him with his own history of seduction and abandonment. For Greenson, to create a therapeutic alliance with this wild Marilyn would mean first of all laying down the foundation of what a life with attachments might mean. Attachments here, as they were for Bowlby, are real–not only, or also, unconscious fantasies. So Greenson set out to provide a version of the good foster home, a model surrogate family for orphan Marilyn to internalize. He had her buy her first house and furnish it. He found her a kind of nurse/housekeeper who displaced her cadre of fawning helpers. He tried to keep her working. She tried, too. It needed time. But time ran out.

  Undoubtedly an ever flamboyant Greenson also revelled–at least to begin with–in his seductive celebrity patient, who dazzled and was helpless by turn. He became her surrogate father, battling for her with the studios, always available on the phone. The vagaries of the transference were hardly in control, and Marilyn seems to have ended up repeating with him some of the patterns of her other love affairs. She became deeply dependent on him. One of the case histories cited in his Explorations in Psychoanalysis, ‘On Transitional Objects and Transference’, bears a marked resemblance to Marilyn. In this case of ‘an emotionally immature young woman’, Greenson can only absent himself from the patient who has developed a ‘very dependent transference to me’ when she finds a ‘transitional object’ to stand in for his presence. This is a ‘white knight’ from a chess set she has been given which she thinks looks–through a champagne glass–just like him. She wraps this talisman in a handkerchief and keeps it with her to protect her from ‘nervousness, anxiety or bad luck’. The case history makes one wonder what Winnicott might have made of Marilyn.

  Before judging Greenson too harshly–as many, particularly fellow analysts, did and as his own later attempts at self-justification imply he did too, gutted as he was by Marilyn’s suicide–it’s worth noting that his unconventional ‘therapy’ with Marilyn bears many comparisons with recent reports on best practice for the National Health Service in Britain. This recommends that borderline patients are given what is effectively education and support for ‘life’–a resident treatment scheme which combines detox with regular therapy, teaching and work-monitoring.

  In May 1962 Greenson, who had been in thrall to Marilyn, her breakdowns and absenteeism from the shoot of Something’s Got to Give, at last took his delayed trip to Switzerland. He left Marilyn in the care of a colleague and, one can only assume, the protection of some talismanic ‘white knight’. But things took on a treacherous momentum. Something’s Got to Give was going badly. On 19 May, a terrified Marilyn flew to New York to perform in the much publicized fund-raising gala at Madison Square Gardens for John F. Kennedy’s forty-fifth birthday. Her breathless rendition of ‘Happy Birthday Mr President’ has become history. It was perhaps only made possible by long phone calls to Greenson in Switzerland, with his son and daughter stepping in to comfort and reassure–an attentive, supportive family for the waif who had never had one. John F. Kennedy and some fifteen thousand members of the public watched her give a dazzling performance in a dress which left little room for secreted talismans. The President, whose purported fling with Marilyn later acquired notoriety, commented, ‘I can now retire from politics having had Happy Birthday sung to me in such a sweet, wholesome way.’ Kennedy’s comments have an eerie ring, given that he had only another eighteen months before his retirement was forced upon him by a gunman. The woman who said to feminist Gloria Steinem, ‘That’s the trouble, a sex symbol becomes a thing. I just hate to be a thing’, had even less time than that.

  On her return to LA, the studio executives were hardly pleased with Marilyn’s New York performance. In something very like executive pique, they fired her from Something’s Got to Give and mounted a publicity campaign against her. It was the first time Marilyn had been fired. Greenson cut short his trip. Marilyn’s state on his return was such that he considered having her hospitalized, but feared that might make things even worse. The concatenation of being fired, the bad press, combined with the news of Arthur Miller’s new wife’s pregnancy, exacerbated what was already a precarious state.

  On Saturday 4 August, Greenson saw her, noted that she was depressed, but no worse than she had often been before. She rang him at home later and they chatted before he went out to dinner. Then, at three in the morning, the fateful call came from her carer-companion. Marilyn Monroe, at the age of thirty-six, was dead. According to the coroner’s report her blood contained a dose of the barbiturate Nembutal amounting to forty or fifty capsules. This was no accident. And there had been no intercourse that night.

  But in this final act of Marilyn’s life, it is harder than ever to unravel all other facts from fiction. The rash of biographies implicate a range of culprits from furtive presidential brothers to the mafia and the FBI, to slandering studio bosses who hounded what was already a wreck of a dope-ridden actress in a daze, to a lone, possibly murderous, Svengali or Comintern agent of a shrink who tried to counter the effect of an overdose of pills by prescribing a killing enema of chloral hydrate. The truth is probably rather more prosaic: like Plath, it is likely that Marilyn found life intolerable and, in a confusion of drugs, took her own life. Whether any form of drugs prescribed by her GP, or a therapy that was more radical, more responsible or more conventional, could have saved her at this stage is impossible to answer. She would not then, in any event, have been Marilyn.

  Ralph Greenson never got over her death. He wondered what grandiosity had provoked him to think he could succeed where other analysts had failed, but he had always been something of a gambler. For the last ten years of his life, he replayed his handling of Marilyn by worrying over transference and countertransference in his articles, and pondering what was the most effective technique. Even though he had often counted himself a traditional Freudian in the American sense–which implied a technique of studied neutrality and an analyst who was as objective as the later computer programs some said they preferred–Greenson’s wide reading of Ferenczi and the British school has him coming down, if a little restlessly, on the side of the unconventional therapist who can allow empathy or some kind of holding environment into the analytic twosome.

  one cannot work effectively unless one is willing and able to become emotionally involved. It is not possible to empathize with a patient unless one feels a goodly amount of liking…The only time indifference may be a therapeutic response is in regard to intense and prolonged emotional outbursts in borderline and psychotic patients. They may need your indifference to reassure themselves that their hostile or sexual assaults are not deadly or ove
rwhelming to you.

  Whether Greenson had withdrawn into temporary indifference at the wrong moment remains an open question. This argumentative, some said charismatic, man who held top posts both at the LA Psychoanalytic Institute in the fifties and throughout his career at the UCLA School of Medicine, and published widely, remained a controversial figure amongst both analysts and patients until his death at the age of sixty-eight in 1979. As Anna Freud wrote for a memorial meeting in 1980, ‘we have not yet discovered the secret of how to raise the real followers of people like Romi Greenson, namely, men and women who make use of psychoanalysis to its very limits; for the understanding of themselves, of their fellow-beings; for communicating with the world at large; in short, for a way of living’.

  As for Marilyn, Time’s obituary stated: ‘her life kept hopeless plans alive, her death was the trigger of suicides in half a dozen cities’. Indeed, Marilyn’s death made suicide attractive–a dramatic conclusion to a life of glamour, emotional extremes and pills taken to counter psychic anguish.

  For young women growing up in the sixties, her plight as a beautiful woman tossed on the stormy seas of her gender and sexuality and trapped by the unconscious of others also reinforced their sense of a need for radical change. That need for change encompassed the psychiatric and psychoanalytic professions, which as guides for ‘a way of living’ seemed to have failed both Marilyn and Sylvia Plath, let alone countless unsung others.

  In her 1987 biography of Marilyn, the feminist Gloria Steinem charges Freudian assumptions of female passivity and penis-envy–applied to Marilyn by her analysts–in Marilyn’s indoctrination to dependent status. Steinem also raises Marilyn’s childhood rape to the level of fact, using as evidence the commonness of abuse in women’s childhoods and the widespread nature of men’s disbelief. Her Marilyn emerges as a double victim: both male society and the world of the mind doctors have conspired against her. Steinem’s feminist reading of Marilyn’s life and her attack on the psychoanalytic way of seeing that allegedly helped to give it a tragic turn are informed not only by the seventies and eighties history of the women’s movement, but by that more generalized attack on the mind doctors and their institutions which began with the sixties.