The Inkblots

by Damion Searls

  In early September 1906, Rorschach gave his sister Anna a striking description of Olga’s background and character. “My Russian friends have mostly gone home” after the summer semester, but

  one woman I met recently, around two months ago, is leaving now. I have often thought that she in particular is someone you should meet: she is all alone on her path through life, and once, when she was twenty, she had to support her whole family for a year and a half, with tutoring and copying documents: a sick father, her mother, and two siblings. Now she is in her last year of medical school, about to turn twenty-six, full of life and high spirits, and when she graduates she wants to go be a doctor in a peasant village, far away from all higher-class people, and cure sick peasants until maybe some of them beat her to death. Would you have ever imagined there are lives like these?—This pride, this courage, that is what distinguishes Russian women.

  Noble-minded, talented, histrionic: Hermann captured Olga’s personality from the first. And also not entirely reliable—she was six years older than Hermann, so actually about to turn twenty-eight.

  Olga embodied for Rorschach the image of Russia he had formed in Dijon. When Tregubov had returned to Russia and Rorschach lost contact with him, the young student took steps to track him down: “Dear Count Tolstoy,” he wrote in January 1906. “A young man who is worried about a friend of yours hopes you will grant him a few minutes of your time.” Tolstoy’s secretary answered, and contact with Tregubov was reestablished. In the meantime, Rorschach had opened his heart to the great writer:

  I have learned to love the Russian people,…their contradictory spirit and genuine feelings….I envy them for being so cheerful, and also that they can cry when they are sad….The ability to see and shape the world, like the Mediterranean peoples; to think the world, like the Germans; but to feel the world, like the Slavs—will these powers ever be brought together?

  Russianness, for Rorschach, meant feeling: being in touch with strong, genuine emotions, and being able to share them. And “to be understood, from the heart, without formalities and tricks and heaps of erudite words,” he wrote to Tolstoy: “that is what we are all looking for.”

  He was far from alone in casting the Russians in this role. Russian novels and plays were astonishing readers from Virginia Woolf to Knut Hamsun to Freud; the Russian ballet was the toast of Paris; the physical immensity of Russia, its combination of semi-European civilization and epic otherness, spiritual depth and political backwardness, inspired awe and anxiety across the Continent. However accurate this vision of a land roiling with passions was or wasn’t, it framed Rorschach’s lifelong desire to be, in his words, understood from the heart.

  It was Zurich that made Rorschach’s increasingly intimate cultural and personal connection to Russia possible. At the same time, the question of what it meant to be understood was being investigated all around him. Rorschach’s professors were fighting a battle over the very meaning of the human mind and its desires. Psychiatry was blazing new trails in the first decade of the twentieth century, and Zurich was at the crossroads.

  The professor’s compact silhouette was recognizable from a distance. He came hurrying from the hospital at the last minute to arrive at the podium, where he stood five foot three, robustly bearded, intense, bent slightly forward. His movements were angular and jerky, and when he spoke his face was unnaturally lively, almost startling. The lectures covered clinical and laboratory techniques in workmanlike fashion, with frequent recourse to statistics, but also emphasized again and again the importance of emotional rapport with patients. Conscientious, professional, sometimes fussy, he was also unassuming and obviously kind. It was sometimes hard to remember that this was Eugen Bleuler, one of the most highly respected psychiatrists in the world, his methods taught in classrooms throughout Europe and debated by eager students afterward.

  Another lecturer in the same department was anything but modest. Tall, impeccably dressed, aristocratic in voice and manner, he was the grandson of an illustrious doctor rumored to be an illegitimate child of the great Goethe. He exuded a seductive mix of confidence and sensitivity, even vulnerability, and arrived early to sit on a bench in the hall where anyone who wanted could come over and talk. His lectures were open to students and nonstudents alike, and their high caliber and broad, engaging range made them so popular that they had to be moved to a bigger auditorium. Before long, he “acquired a devoted, highly visible female following” known as the Zürichberg Fur-Coat Ladies, named after the richest neighborhood in the city, who “marched with poise and self-assurance into his every lecture, commandeering the best seats and thereby earning the enmity of the students, who had to stand at the rear.” And that was before the Ladies started inviting him to private discussion groups in their homes. The daughter of one such Lady dismissed the professor’s fan base as “sex-starved groupies or postmenopausal hysterics.”

  Instead of offering dry statistics and instructing future practitioners in laboratory techniques, Carl Jung talked about family dynamics and human stories, often cases of women like the ones in his audience. He implied, even said outright, that their own “secret stories” held the key to more truth than the doctors could find on their own. The message was thrilling; his penetrating insight at times seemed almost magical.

  These were Rorschach’s teachers, shaping not only his own trajectory but the future of psychology.

  —

  Zurich in the first decade of the twentieth century was at the center of an enormous transformation in the understanding and treatment of mental illness. As the century began, the field was deeply split between respect for subjective inner experience and an effort to achieve scientific respectability by focusing on objective data and general laws. There were scientists known as “psychopathologists,” often French, who set out to explore the mind, and others, often German, pursuing so-called “psychophysics,” preferring to dissect the brain. This professional and geographical divide overlapped, but not entirely, with an institutional divide between psychiatrists, usually based in hospitals or clinics, and psychologists, in university labs. Psychiatrists tried to cure patients, psychologists studied subjects. There was crossover, and the greatest advances in psychology often came from practicing psychiatrists—Freud and Jung, for example, were psychiatrists and medical doctors. But psychiatrists were doctors, with an MD; psychologists were research scientists, with a PhD.

  Despite advances in neurology and disease classification, a nineteenth-century psychiatrist could do almost nothing to help people. This was somewhat true of medicine in general—no antibiotics, no anesthesia, no insulin. Describing a slightly earlier doctor, Janet Malcolm points out that “medicine in Chekhov’s day did not have the power to cure that it has only recently begun to wield. Doctors understood diseases they were helpless to cure. An honest doctor would have found his work largely depressing.” Psychiatry was in even worse shape.

  Outside of medicine, the very borders between science and the humanities were being redrawn. Should the goal of psychology be to scientifically define a condition, with lists of symptoms and laws of how diseases progress, or to more humanistically understand a unique individual and his or her suffering? In practical terms: Was an aspiring young psychologist supposed to study science or philosophy? In the early days—before Freud, before modern neuroscience—psychology was generally classified as a branch of philosophy. There was simply no other way to grasp the mind. Medical doctrines, too, largely coincided with religious teachings about virtue and sin, character and self-restraint. Psychiatrists tried to cure cases of demonic possession. Their most advanced technology was mesmerism.

  Rorschach was a student when all that was starting to change. Freud had synthesized a theory of the unconscious mind and sexual drives that brought together psychopathology, psychophysics, and a new and effective psychotherapy, at the same time reintegrating the humanities into natural science and redefining the distinction between normality and illness. The apparently meaningless fantasi
es of psychotic patients were being deciphered, and healed, with methods based on assumptions that seemed incredible to materialistic brain scientists.

  When Rorschach entered medical school, though, all Freud had was a couch in Vienna and a narrow range of upper-class neurotics for clients. The Interpretation of Dreams, published in 1899, sold 351 copies, total, in its first six years in print. In terms of scientific and institutional respectability, and the resources and international reputation needed to establish psychoanalysis as a lasting movement, the place that mattered was Zurich.

  The University of Zurich medical school was a hybrid institution connected to the Burghölzli: a laboratory, university psychiatric clinic, and teaching hospital opened in 1870 and by Rorschach’s time widely considered the best in the world. It was a large facility run by the canton of Zurich, housing mostly uneducated, lower-class patients suffering from schizophrenia, tertiary syphilis, or other dementias with physical causes. But its directorship was tied to the newly founded chair of psychiatry at the university.

  At most universities, prestigious psychiatry professors were brain researchers, with small clinics and a few short-term cases to teach from. But any professor of psychiatry at Zurich, as the historian John Kerr writes, would be in charge of more than a hundred patients, mostly incurable. And they were locals, speaking Low German or the Zurich dialect of Swiss German: the professor literally could not understand their language. Not surprisingly, a series of clinic directors quickly jumped ship, and while the university professorship gained in stature, the Burghölzli was soon “better known locally for the brothel situated on the far side of its grounds” than for its hospital. It started to improve under director Auguste Forel, but even he took early retirement. In 1898, he passed the position to a man named Eugen Bleuler (1857–1939, Freud’s exact contemporary).

  Bleuler was from Zollikon, a farming village outside Zurich adjacent to the Burghölzli. His father and grandfather had been part of the struggle in the 1830s to win equal rights for farmers and establish the University of Zurich in the first place. Bleuler was the second person from his village ever to graduate university and the first to attend medical school. Throughout his life, he remained deeply conscious of his rustic appearance and background, and also of the class struggle and political organizing that had made his career possible. Crucially, he spoke the local language, so he could understand what his patients were saying.

  The prevailing wisdom was that the kind of people under Bleuler’s care were hopeless. In the words of Emil Kraepelin, the psychiatrist who had given the name dementia praecox to what is now called schizophrenia: “We know now that the fate of our patient is determined mainly by the development of the disease; we can rarely alter the course of the disease. We must openly admit that the vast majority of the patients placed in our institutions are forever lost.” Even more brutally: “The great mass of uncured patients piling up in our mental institutions belongs to dementia praecox, whose clinical picture is marked above all by the more or less far-reaching collapse of the personality.” They “belonged to” the disease. Freud, too, had said that these patients were unreachable. But Bleuler, down in the trenches, learned otherwise. The line between mental illness and health was not as hard and fast as his university colleagues believed, and seeing patients as a “great mass” “piling up” was part of the problem.

  Before becoming director of the Burghölzli, Bleuler had lived for twelve years at the largest asylum in Switzerland, an island monastery-hospital (originally a twelfth-century basilica) called Rheinau, with six to eight hundred patients. There and at the Burghölzli, Bleuler immersed himself in the world of the seriously psychotic, visiting the wards up to six times a day and talking to unresponsive catatonics for hours. He gave his assistants enormous workloads, typically eighty-hour weeks—morning rounds before 8:30, writing up case histories after the evening rounds, often until 10:00 or 11:00—and enforced monastic celibacy and abstinence from alcohol. The doctors and staff slept in large shared bedrooms, with very few exceptions. They couldn’t complain, since Bleuler worked harder than any of them.

  By living in such close contact with his patients, Bleuler realized that they had more nuanced, less compulsive reactions to their environments than had been thought. For instance, they behaved differently with different relatives, or with members of the opposite sex. Biological determinism could not completely explain their symptoms. Nor were they doomed, at least not necessarily—even the progression of the most severe cases could sometimes be halted, or reversed, if doctors developed good personal relationships with patients. Bleuler would suddenly discharge patients who seemed severely ill, or invite a particularly violent patient to a formal dinner at his house. He pioneered work therapy and other “reality-oriented tasks”—chopping firewood, caring for fellow patients who had typhus—for chronic cases long thought hopeless, resulting in cures that seemed little short of miraculous. When his schizophrenic patients were working the fields he would join them, doing work familiar to him from his youth in Zollikon. Bleuler devoted his life to establishing an emotional connection with everyone in his care. Both the patients and the staff tended to call him “Father.”

  It was Bleuler who named the disease schizophrenia—his most well-known contribution to science, along with inventing the terms autism, depth psychology, and ambivalence. He did this because Kraepelin’s earlier label, dementia praecox, means “early-onset loss of mind,” something biological and irreversible, whereas “a split mind” (the meaning of schizophrenia) is not hopelessly lost: it may still have functioning, living powers. Bleuler also wrote that he wanted a new term because there is no way to use dementia praecox as an adjective. In his view, illness should not be a medical object—a noun in Latin—but one way among many to describe a particular, human sufferer.

  This empathy for patients had personal roots: when Bleuler was seventeen, his sister had developed catatonia and was hospitalized near their village at the Burghölzli. The family was outraged at brain doctors who seemed, as the locals said, more interested in microscopes than people and who couldn’t even speak her language. Bleuler decided, or in some versions of the story his mother inspired him, to become a psychiatrist who could truly understand his patients. While he never wrote or spoke publicly about his sister Anna-Paulina’s illness, her decisive influence on him is undeniable. One of Bleuler’s assistants at the Burghölzli in 1907 and 1908 recalled: “Bleuler often told us that even the most serious catatonics can be influenced by verbal persuasion. He gave his own sister as an example….One time, Bleuler had to get her to leave the building while she was in a state of acute excitement. He refused to use force and…talked to her for hours and hours, until eventually she put on her clothes and left with him. Bleuler used this example as proof that verbal persuasion was possible.”

  She lived with him in his apartment at the Burghölzli for almost thirty years, from their parents’ death in 1898 until her death in 1926. His assistant recalled: “I could see her monotonously pacing back and forth all day long from my room across the hall. Bleuler’s children were very young at the time, and they did not seem to notice his sister. Whenever they wanted to climb up anywhere, they simply used her like an inanimate object, like a chair. She showed no reaction whatsoever, no emotional relationship at all with the children.” Bleuler had lived face to face with extreme schizophrenia for decades before the term existed, and during his entire career at the Burghölzli he had a living example of the schizophrenic’s humanity right there in the room. His pioneering efforts began at home.

  Of course, every generation sets out to correct the mistakes of the previous one; psychiatrists regularly accuse their predecessors of being heartless or at least misguided. In fact, psychiatrists before Bleuler, from Forel to Kraepelin to the father of brain-centered psychiatry, Wilhelm Griesinger, were by all accounts sympathetic and caring doctors too. But the Burghölzli truly was different. Bleuler’s assistant recalls: “The way they looked at the patient, t
he way they examined him, was almost like a revelation. They did not simply classify the patient. They took his hallucinations, one by one, and tried to determine what each meant, and just why the patient had these particular delusions….To me, that was altogether new and revealing.” The transformation toward patient-centered care didn’t start at the Burghölzli, or end there, but Bleuler mentored generations of psychiatrists, both students and assistants—including his son Manfred, Carl Jung and Sabina Spielrein, two of Rorschach’s later bosses, and Rorschach himself. If it is unthinkable today that a psychiatrist would be unable to speak his patient’s language, that is largely thanks to Eugen Bleuler.

  —

  Carl Jung arrived at the Burghölzli in December 1900, to work as Bleuler’s assistant. He set about becoming the prominent, then preeminent, figure who would repeatedly transform the field of psychology in the decades to come.

  Starting in 1902, Jung and the Burghölzli’s other assistant doctor, Franz Riklin, developed the first experimental method to reveal patterns in the unconscious: the word association test. Subjects were read a list of a hundred prompt-words and were asked to say the first thing that came into their heads, while the doctor timed their responses with a stopwatch; then they went through the list again and were asked to remember their initial responses. Any aberrations—long delays, memory lapses during the second round, surprising non sequiturs, getting “stuck” and repeating responses—could be explained only by unconscious acts of memory and repression, a kind of hidden black hole pulling and warping the person’s answers toward concealed desires, or prompting feints in the opposite direction. Jung called these hidden centers “complexes.” The test found, empirically, that most of them were sexual.