Providentia

Katharine McCormick's Crusade (Part 2)

Continued from Part 1

Along with providing financial help, Katharine McCormick also provided more covert aid, including smuggling diaphragms into the United States to supply Sanger's birth control clinics throughout the 1920s.   In 1927, she hosted a reception at her home in Geneva for delegates attending the World Population Congress.  Although they failed to secure the support of the League of Nations (Catholic delegates had threatened to walk out unless Sanger's name was removed from the proceedings), McCormick and her fellow advocates were still able to win important concessions.   Unfortunately, there were limits to how far McCormick's support could extend.  Since she was still locked in a bitter struggle with the McCormick family for control of her husband's fortune, most of her financial assets could only be used for more socially acceptable causes, such as schizophrenia research.  She still managed to provide some covert support for contraceptive research and Sanger's international work, however.

As part of her search for a  cure for her husband's schizophrenia, Katharine McCormick also developed what would be a lifelong fascination with endocrinology.  Based on the research of  Harvard endocrinologist Roy G. Hoskins and the possible role of  defective adrenal glands in mental illness, she established the Neuroendocrine Research Foundation at Harvard Medical School and funded the publication of the journal Endocrinology.  With Stanley's death on January 19, 1947, Katharine inherited more than 35 million dollars from her husband's estate.  Despite a hefty inheritance tax and substantial legal fees (it took five years to settle her husband's estate, including the sale of Riven Rock), the money that she inherited from Stanley, along with the ten million dollars that she inherited from her mother in 1937,  made Katharine Dexter McCormick one of the wealthiest women in the U.S. at that time.  In Stanley's memory, she would later found Stanley McCormick Hall at MIT to provide dormitory space for two hundred female students.   While she terminated her involvement with the Neuroendocrine Research Foundation after Stanley's death, her ties to the Worcester Foundation for Experimental Biology would come in very handy during the next chapter of her life. 

Finally free to act as she saw fit, Katharine McCormick turned her considerable resources to providing women with a better method of birth control.  Both she and Margaret Sanger agreed on the need for a safe and effective oral contraceptive, as easy to take as an aspirin tablet but capable of preventing pregnancy as needed, despite very different visions of how it could be achieved.  While Sanger suggested spreading funding across different research projects,  McCormick already knew from her own experience that endocrinology research would provide the needed breakthrough.  And it was with that goal in mind that the two women met with Gregory Goodwin Pincus in 1953.

Already renowned for his work in reproductive technology, Gregory Pincus had met Margaret Sanger in 1951 and had received a small grant from the Planned Parenthood Federation of America to begin hormonal contraceptive research.  Along with his colleague, Min Chueh Chang, Pincus had demonstrated the effectiveness of progesterone in inhibiting ovulation.   When she and Sanger went to Pincus' laboratory on June 8, 1953, Katharine McCormick was impressed enough to give him a cheque for $40,000 on the spot.  It would be the first of many such cheques and she even moved to Worcester, Massachusetts so that she could monitor the development of the birth control pill more closely.  McCormick impressed everyone involved with the project with her iron determination and the need to enter clinical trials as soon as possible.   Elizabeth Pincus, Gregory Pincus' wife, described her as a warrior who "carried herself like a ramrod.  Little old woman she was not.  She was a grenadier".   Almost all of the estimated two million dollars that went into the clinical research and subsequent trials came from her.

Pincus and his associate, John Rock, could not do open research using hormones for contraception (which was still illegal in most states) so the first clinical trials were carried out with infertile patients in Massachusetts.   After the inital research trials with progesterone and several different progestins proved successful, more extensive clinical trials were carried out in Puerto Rico.  Despite concerns about side effects (which Pincus and Rock disputed based on their own research experiences in Massachusetts), the first oral hormonal supplement, Enovid, was formally approved as a contraceptive in 1960 (it had initially been marketed as a treatment for menstrual disorders).   While women were initially cautious in trusting this radical new approach to birth control, its popularity grew rapidly and over twenty percent of all American woman of childbearing age now use one of the various oral contraceptive products that were eventually developed from Pincus and Chang's original research.  More than 100 million women worldwide use some form of oral contraceptive and that number continues to grow.  The social revolution that the birth control pill unleashed is still unfolding.

As for Katharine McCormick, her role in the development of the birth control pill was largely forgotten in the years following its release.  When she died on December 28, 1967, her obituary wasn't carried in most papers except for for those few that honoured her for her philanthropy.  Gregory Pincus also died in 1967 and his obituary, which proclaimed him to be the developer of the birth control pill, made no mention of her at all.   In her will, Katharine McCormick left five million dollars to the Planned Parenthood Federation of America and one million dollars to the Worcester Foundation for Experimental Biology.  She was inducted into Michigan Women's Hall of Fame in 2000 and the PPFA founded the Katharine Dexter McCormick library in her honour.

Would the birth control pill have come into existence without Katharine McCormick's financial assistance and determination?  Perhaps, but it's introduction would certainly have been delayed by decades.   It was the crash program that she funded and encouraged with her enthusiastic vision that allowed birth control to become a major issue in the years that followed.  Today's world might be very different without it. 

Resilience Training and Returning Veterans

An article which  originally appeared in Journal of Consulting and Clinical Psychology, (record 2009-17643-013)  and later reprinted in Sport, Exercise, and Performance Psychology examines recent research into treatment of returning veterans with mental health problems.  Researchers have found that there is an increase in mental heath problems as a result of military-related traumatic events, and such problems increase in the months following return from combat. Nevertheless, researchers have not assessed the impact of early intervention efforts with this at-risk population. In the current study, the authors compared different early interventions with 2,297 U.S. soldiers following a year-long deployment to Iraq. Platoons were randomly assigned to standard postdeployment stress education, Battlemind debriefing, and small and large group Battlemind training. Results from a 4-month follow-up with 1,060 participants showed those with high levels of combat exposure who received Battlemind debriefing reported fewer posttraumatic stress symptoms, depression symptoms, and sleep problems than those in stress education. Small group Battlemind training participants with high combat exposure reported fewer posttraumatic stress symptoms and sleep problems than stress education participants. Compared to stress education participants, large group Battlemind training participants with high combat exposure reported fewer posttraumatic stress symptoms and lower levels of stigma and, regardless of combat exposure, reported fewer depression symptoms. Findings demonstrate that brief early interventions have the potential to be effective with at-risk occupational groups.

For the abstract.

Off to New Orleans

I'll be spending the next few days in New Orleans attending CSIcon from October 27-30.  I'm looking forward to having a great time there and having a chance to meet some of my all-time idols in science and skepticism.  Since I've never been to New Orleans there, it gives me a chance to learn more about the city and its rich history so if you notice a certain Cajun theme to some of my future posts, you'll know why. 

Follow me on Twitter at @rvitelli as I try my hand at livetweeting CSIcon and join me for a tweetup if you can.

 

The Strange Case of Phineas Gage

by Elaine Hirsch

This is a guest post by Elaine Hirsch who describes herself as "kind of a jack-of-all-interests, from education and history to medicine and videogames. This makes it difficult to choose just one life path, so she is currently working as a writer for various education-related sites and writing about all these things instead."

There’s a photo of Phineas Gage that, when the reader discovers the story behind it, is astonishing. A handsome and well-dressed man sits holding what looks like a long and dangerous spear. The only thing that’s odd is one of his eyes is missing. As it turns out, what put out his eye is the spear-like object he’s holding. But there’s more and worse to come. The spear, which is actually what was called a tamping rod, not only took out Gage’s eye but went straight through his head and came out the other side of his skull. Yet the man is still living, and seemingly whole and healthy despite the loss of his eye and a chunk of his brain. How can this be? Gage's case is one of the most famous neurological oddities ever documented, and in psychology education from high schools to online PhD programs it remains a celebrated and fascinating fixture.

The story is this: in September, 1848 Gage was a foreman on a railroad construction job in Vermont. He was about 25 at the time. The job involved blasting rocks to make way for the railroad and one of his jobs was to put blasting powder, fuses, sand and a charge into a hole that had already been bored into the rock. An iron rod was used to tamp the ingredients into the hole. Gage was no doubt used to this job, as he was the one who decided where the initial holes would be drilled and how much explosive to put in them. However, one afternoon the charge prematurely went off, probably because he neglected to put sand in the hole and was distracted by his men. The 13.25-pound tamping rod still in the hole was shot completely through Gage’s head, and landed some twenty yards away.

That Gage survived such a horrific accident was miraculous. He was actually able to walk away from the accident, and upon examining him Doctors Edward Higginson Williams and John Martyn Harlow found him amazingly lucid even as he hemorrhaged and his traumatized brain began to protrude from the hole in his skull. But even a small injury to the brain is dangerous, and Gage soon lapsed into a state of restlessness and delirium (he likely contracted meningitis as a result of his injury and subsequent infection). His friends and family not surprisingly expected him not to survive. However, by November Gage was able to walk around and claimed to feel pretty much recovered, and he moved back to his parents’ home in New Hampshire. Aside from the loss of the eye and some scars, he seemed to be completely recovered. It soon became apparent, though, that he wasn’t quite as recovered as he may have initially seemed.

Gage never returned to his job at the railroad, though he was probably physically capable of it. The problem was his mental state. Before, he had been responsible and handy, but after the accident he became profane, unreliable, inconsiderate, and perverse. However, whatever happened to him mentally either eased or wasn’t severe enough to prevent him from holding other jobs, including giving lectures and taking a job as a stagecoach driver in remote Chile. Even his doctors didn’t speak much about his personality or intellectual changes. In 1848 no one really knew how the brain worked, past the reasonable conclusion that if it were damaged the way Gage had damaged his, a person couldn’t really be expected to survive. Harlow did publish a report on Gage’s psychological state, but it was in 1868, eight years after Gage died, and not much attention was paid to it at first.

Scientists still don’t know exactly which parts of Gage’s brain were destroyed, but given the changes in his personality they’ve made educated guesses. Harlow decided that given the trajectory of the tamping rod the damage to the frontal and middle left lobes of Gage’s brain had been irreversible and that their functions had been taken over by his brain’s right hemisphere. By the 1980s, CT scans could be used on Gage’s skull to more precisely map the damage. Researchers did conclude the injury was mostly to the left hemisphere of his brain, but the right hemisphere had been damaged as well.

Some psychologists believe that despite his brain injury, Gage found enough structure in his life to make what’s called a “social recovery,” regaining much of the resourcefulness he lost in the accident. The discipline, modicum of courtesy and respect due his passengers, and a very set routine could have retrained his injured brain. Even today, a highly structured environment is regarded as beneficial in rehabilitating patients with brain injuries.

Theoreticians stand by varying theories about the effects of brain damage. Some still see such damage as was caused to Gage as not only catastrophic, but irreversible. Some believe the brain can heal itself in remarkable ways, even after trauma on the order that Gage suffered. Gage died in February of 1860. At the request of Dr. Harlow he was disinterred and his damaged skull removed. It remains on display at the Warren Anatomical Museum in Harvard Medical School, its secrets still not completely deciphered.

Sex and Gender in Schizophrenia

A recent paper published in Schizophrenia Bullen examines data collected in a study of sex differences in schizophrenia to show the utility of distinguishing between sex and gender in the study of schizophrenia. Schizophrenia and schizoaffective disorder were combined to yield 213 patients (141 men, 72 women). There were 98 healthy controls (41 men, 57 women). The relative contributions of sex and gender to the prediction of age of first hospitalization and neuropsychological functioning were examined in linear regression analyses. Sex, but not gender, was a significant predictor of age at first hospitalization, even when controlling for illness severity. Among patients, sex and gender significantly contributed to the prediction of neuropsychological performance, beyond the contributions of education, age, and illness severity. Comparable results were found among healthy controls, although gender was significant only for women. For both healthy subjects and patients, more frequent endorsement of female typical social roles predicted better neuropsychological functioning. Being female also predicted higher neuropsychological scores in patients. The findings suggest that some aspects of schizophrenia study, such as the disorder's onset, may be best pursued from a more biological (sex difference) perspective, while a sociocultural (gender difference) perspective may best serve other aspects of study, such as neuropsychological functioning.

For the abstract.

Rescued Chilean Miners Face Uncertain Future

A year after their dramatic rescue following 69 days trapped underground, many of the 33 Chilean miners who became international celebrities are having difficulty dealing with the long-term consequences of their ordeal.   When 19-year old Jimmy Sanchez emerged from the mine on October 13, 2010, he stated that he thanked God for his deliverance and that he was sustained by thoughts of his infant daughter.  Following his rescue, he enjoyed the international attention and the opportunity to travel to Britain, Greece, and the United States.  A year later, he is unemployed and suffering from posttraumatic stress disorder which requires him to travel to Santiago, Chile twice a month to see his psychiatrist.    As one of nine miners collecting sick pay for posttraumatic stress, he is forced to take the 11-hour bus ride regularly since there are few local treatment options in the tiny town of Copiapo, Chile where he lives.    ''Most of us are in the same place with emotional and psychological problems,'' said Mr Sanchez,  now 20. ''It was the fear that we would never again see our families, that we were going to die. We just can't shake those memories.''   

Only a handful of the miners were able to return to mining, the rest remain unemployed and face a bleak economic future since non-mining jobs remain scarce in the area.  Two other former miners, Victor Zamora and Dario Segovia are making a meager living selling fruits and vegetables.  Many of the miners continue to report problems with sleeplessness, nightmares, and claustrophobia.  When one miner, Jose Ojeda, attempted to return to work underground in February, he had a panic attack after being left alone 1,000 feet below ground.  As he would state afterward, “I started to sweat a lot, a cold sweat,” he said. “I don’t even remember how they took me out; I blacked out.”   While antidepressant therapy has helped stabilize their symptoms, other potential employers in the Copiapo area have been reluctant to hire the miners due to concerns over potential psychological problems.  There have also been accusations that the miners were exploiting their celebrity status and exaggerating their symptoms for gain. 

Although a Chilean magnate gave each miner more than $15,000 U.S. dollars each after the rescue,  the lack of work has left many of them in dire economic need.  While some miners received offers to do inspirational speeches, the rest find their instant celebrity overwhelming and some have turned to drugs and alchohol as a result.  Rodrigo Gillibrand, the Santiago psychiatrist treating the ten miners on sick leave, described their psychological reaction to the ordeal and their adjustment following their rescue as being very similar to Vietnam veterans.   He has recommended that none of the miners in his care return underground again.

Many of the miners have pinned their hopes on a planned movie based on the miners' ordeal.  Producer Mike Medavoy purchased the rights to the miners' story.  After visiting the area recently, Medavoy announced that shooting would occur in the Atacama desert with many of the miners and their relatives as extras.   Not all of the miners are planning on the film to provide financial relief however.  Several are attempting to reeducate themselves to find jobs in other fields.   One of these miners, Pedro Cortez, was inspired by the use of video feeds so that the trapped miners could talk with their families and is  now studying electronics.  Much of the money for his tuition came from a Swiss-Chilean man from Zurich who had heard about his need for educational funding.  

“I have to get my family ahead; we can’t be in the same place we were before,” Mr. Cortez said. “They fought for me for 70 days. Now it’s my turn to step up.”

For more information

 

 

 

 

 

 

 

 

Motherhood and Schizophrenia: A First-Person Account

A recent issue of Schizophrenia Bulletin contains a gripping first-person account by a woman describing her personal experience with schizophrenia and motherhood.  In the abstract, she states: "With this article I want to give insight into what having children and dealing with schizophrenia is like. I go from a young woman wanting to experience motherhood, to being diagnosed with schizophrenia, to marrying and having two children. It is not easy dealing with schizophrenia and mothering, but the rewards are wonderful. In my case, I had one very serious schizophrenia episode, and I became homeless and my children went to live with their father. I eventually got better and reunited with my children, but our lives had changed. In this article I describe the adjustments we all had to make, the heartaches, the struggles, and finally the love that has prevailed. Today, especially with the newer medications, more persons suffering with mental illness are marrying, and the possibility of starting families is very real. Perhaps a young person with a diagnosis of mental illness will read my factual account, and it will help her to make a decision that will change the rest of her life. In closing the article, I raise the question, "If I had to do it over again, would I?" I also share the reason for my decision."

For the abstract

It's World Mental Health Day

Since 1992, the World Federation for Mental Health (WFMH) and the World Health Organization (WHO) have marked October 10 as the annual date for World Mental Health Day.    Observed in more than 100 countries around the world through local, regional, and national events, World Mental Health Day and this year's theme: "The Great Push: Investing in Mental Health" is intended to call attention to the need for greater investment in mental health services.   This is especially true low and middle-income countries that spend less than 2 % of their total health budget on mental health.  WFMH and WHO are dedicated to increasing public awareness of the extent to which mental illness remains underreported and undertreated compared to other diseases which receive greater attention. 

The sheer range of need for treatment services is unquestionable.  According to WHO statistics from 2002, more than 150 million people globally suffer from  depression alone with other forms of mental disorder accounting for an additional 300 million (almost 25% of the world's current population).   Despite this overwhelming need for services, many countries have less than one mental health professional per one million population.  Even when health dollars are allocated, the focus is typically on large hospital settings rather than the community-based services that are likely to be most effective.

An initiative led by Dr. John Copeland and WFMH (titled The Great Push For Mental Health) is attempting to correct years of neglect, especially in developing nations where mental health services are often non-existent.   With its themes of Unity, Human Rights, and Recovery, the WFMH initiative, partnered with the Movement for Global Mental Health, has already launched pilot projects in India, Australia, and Europe to provide appropriate and culturally appropriate treatment for various mental disorders. 

Through grass-roots campaigns, fundraising initiatives, and public awareness programming, work with international aid organizations, and consultation with local community groups,  the WFMH seeks to combat stigma and provide better mental health care worldwide.  Following the  Declaration of Human Rights and Mental Health, adopted in 1989 as the Declaration of Luxor, the WFMH stresses the need for governments to recognize their most vulnerable populations and to provide a safe environment where they can receive the necessary treatment as well as employing the full range of social support initiatives to prevent mental illness wherever possible.   

The various possible initiatives, as recommended by the WHO include:

• early childhood interventions (e.g. home visits for pregnant women, pre-school psycho-social activities, combined nutritional and psycho-social help for disadvantaged populations);
• support to children (e.g. skills building programmes, child and youth development programmes);
• socio-economic empowerment of women (e.g. improving access to education and microcredit schemes);
• social support for elderly populations (e.g. befriending initiatives, community and day centres for the aged);
• programmes targeted at vulnerable groups, including minorities, indigenous people, migrants and people affected by conflicts and disasters (e.g. psycho-social interventions after disasters);
• mental health promotional activities in schools (e.g. programmes supporting ecological changes in schools and child-friendly schools);
• mental health interventions at work (e.g. stress prevention programmes);
• housing policies (e.g. housing improvement);
• violence prevention programmes (e.g. community policing initiatives); and
• community development programmes (e.g. 'Communities That Care' initiatives, integrated rural development).

Please join the WFHM initiative and help promote mental health issues in your community. To learn more about Mental Health Day, go to  http://www.wfmh.org/00WorldMentalHealthDay.htm.

For more information and to support the WFMH. 

 

 

 

Sabina's Saga (Part 2)

Continued from Part 1

Despite her success as a psychoanalyst, Sabina Spielrein did not get along well with her colleagues in Geneva due to differences over how psychoanalysis was being taught.  She continued to correspond with Freud until 1923 (her last known letter to Jung was in 1919) and it was at Freud's suggestion that she move to Moscow rather than to Berlin as she had originally planned.  In that same year, she returned to Russia to visit relatives and colleagues and quietly took a new position at the Moscow Psychoanalytic Institute.    Although the changes brought on by the Bolshevik Revolution made life more difficult, her Moscow career flourished for a time and she held posts as director of child psychology at First Moscow University and as pedagogic medical consultant to the Psychoanalytic School of Moscow.   She was also one of the leading lights of the Russian Psychoanalytic Society which brought her into contact with other prominent Russian intellectuals such as Aleksandr Luria and Lev Vigotskii.  It also meant a reunion with her husband and daughter and they lived for a time in a student residence in the heart of Moscow.  That reunion was likely awkward at first considering that she and her husband had been apart for many years and he had already had a child with another woman during their separation.

Psychoanalysis in Russia already had a turbulent history but its influence was strongest between 1921 and 1923.  The Moscow Psychoanalytic Institute was established in 1922 under the direction of Moshe Wulff with Spielrein joining the staff full-time in 1923.   She then became involved with an ambitious new project in children's learning known as the Detski Dom Laboratory (which also became known as the White Nursery due to the all-white furniture used).   Founded in 1921 by Vera Schmidt (who had also been one of Freud's students),  the Detski Dom was intended to teach children based on Freud's theories.  Along with Schmidt's own son, the school had children from prominent Bolsheviks (including Josef Stalin, whose son Vasilii was enrolled as well).  Use of discipline was avoided and children were allowed maximum freedom of movement.  Sexual exploration and curiosity was also permitted (which is likely what provoked the eventaul crackdown on the school).   The school was closed in 1925 following allegations of pornography and sexual abuse.

Since psychoanalysis was a special interest of Leon Trotsky, shifting politics ensured that the psychoanalytic movement didn't long survive Trotsky's downfall in late 1923.   Given the worsening status of psychoanalysts in Moscow and partly motivated by the birth of her second daughter, Renata, in 1925, Spielrein and her husband decided to return to Rostov-on-Don where she opened a child psychoanalytic nursery.  Although she attempted to remain active in the international psychoanalytic movement and taught at the local university, her last formal publication would be in 1931.   By 1936, psychoanalysis was formally banned by Stalin across the entire Soviet Union and she lost her university position.  The years of terror following Stalin's rise to absolute power took a heavy toll on Spielrein and her family.  Among the victims of Stalin's various purges were her husband and her brother Isaac (a prominent psychologist in hs own right).

There is little available documentation on Sabina Spielrein during this final period of her life.  Relatives described her as being a solitary figure, very intense with a puritanical appearance, dressed in old clothes since she preferred to spend little money on herself despite working long hours in her practice.  Her tragic story came to an end with the Nazi occupation of her town during World War II.    Despite being driven out of the area once previously, the Nazis managed to retake Rostov-on-Don in the summer of 1942 for an extended period of time.  During the months that they held Rostov, the Nazis targeted the Jewish residents of the city, which included Spielrein and her two daughters.   The last known sighting of the three of them was in a column of Jews being herded by the Einsatzgruppen towards the Zmeyevsky gully where they were all shot.   Nothing more is known about her fate although the house where she lived and saw patients is still standing. 

Although Sabina Spielrein was largely forgotten after her  death, the story of her relationship with Jung resurfaced in 1977 when Aldo Carotenuto, a Jungian psychoanalyst at the University of Rome, discovered some long-lost documents in the former headquarters of the Geneva Institute of Psychology.  The documents had been written by Spielrein during her time in Geneva and she had apparently left them behind fwhen she returned to her native country.  The papers included a series of letters that both Freud and Jung had written to her as well as her personal diary and copies of the letters that she had written to them.  Carotenuto published the letters in his 1982 book, A Secret Symmetry,  and highlighted the intimate nature of Spielrein's relationship with Jung and the significant role that she had played in developing early psychoanalysis.   In his 1992 book, A Dangerous Method, John Kerr explores the complex relationship between Spielrein, Jung, and Freud even further.   In what he described as "an unusually gruesome ghost story", Kerr examined the reasons for the estrangement between Jung and Freud and why both of them neglected to give Sabina Spielrein proper credit for her psychoanalytic contributions. 

Will new revelations about Sabina Spielrein (not to mention the Cronenberg movie) help restore her to her rightful place as one of the pioneers of psychoanalysis?  Time will tell.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sabina's Saga (Part 1)

Happy Ada Lovelace Day!  As my contribution to this international effort, I submit the following story:

David Cronenberg's new film,    A Dangerous Method, planned for release this year,  delves into the early years of Sigmund Freud and Carl Jung, their joint contributions to psychoanalysis and some of the complex reasons behind their eventual estrangement.  His film also promises to cast a new light on a long-forgotten pioneer of psychoanalysis, the controversial Sabina Spielrein.

Many of Freud's early female supporters, including Melanie Klein, Karen Horney, and Margaret Mahler often chafed under Freud's male-dominated view of psychoanalysis.  For most of them,   their own contributions only become possible when they broke away from the orthodox Freudian model.  While Anna Freud was also a prominent psychoanalyst, her determination to uphold her father's theories prevented her from developing her own unique perspective.

As for Sabina Spielrein, she took a most unorthodox route to becoming a psychoanalyst in her own right.  Born on November 7 1885 to a prominent Jewish family in Rostov-on-Don, Russia, Sabina Spielrein was a highly intelligent and lively woman who apparently developed emotional problems stemming from the death of her sister in 1901.  After travelling to Switzerland to study medicine (which wasn't possible for a woman in her native Russia), her symptoms worsened and she was later diagnosed with hysteria (a common diagnostic label for women mental patients of the time).  On August 17, 1904, she was admitted to the Burgholzi Clinic in Zurich, Switzerland following a "great commotion" at a local hotel where she had been staying as a guest.  Whatever the nature of the commotion, she was placed in the clinic by a police medical doctor and her own uncle although she insisted that she was not insane, simply that she could not stand "people or noise".  According to surviving records, Spielrein was behaving very strangely on intake, including "laughing and crying in a strange mixture, sticking out her tongue, jerking her legs, and complaining of a headache".   She needed several days to become used to the hospital setting.

It was at the Burgholzi Clinic where she first met Carl Jung and became his patient.  The exact nature of their relationship remains controversial and whether what appears to have been a love affair between them was ever actually consummated (Cronenberg's film assumes that she and Jung had been lovers).   Jung had only recently read Freud's On The Interpretation of Dreams (published in 1900) and was impressed enough by the fledgling field of psychoanalysis to begin using it with his own patients.   Sabina Spielrein was his first analysis patient and together they worked out radical new concepts that would become part of Jung's own theories of human psychology.   By June of 1905, Sabina Spielren had been discharged from the Burgholzi and registered as a medical student at the University of Zurich.   She continued as Jung's patient however and recurring rumours about their relationship was one of the reasons for Jung's resigning from Burgholzi in 1909.

By 1906, Jung began corresponding with Freud directly asking for advice in treating the "difficult" case involving the "Russian girl student" who was his patient.   During their joint sessions together, Jung and Spielrein developed an intense emotional attraction towards one another which seemed to reach its peak between 1908 and 1911.   Given the inappropriateness of the "countertransference" that had developed between them, both she and Jung wrote to Freud asking for advice and Jung broke off contact with her in 1909 to head off a potential scandal.   While Spielrein requested a personal consultation with Freud, he declined and she continued with her own work in psychoanalysis.  Her sessions with Jung resumed in 1911 after she asked his advice on her medical dissertation.   By then, they seemed to have learned to channel their attraction towards one another into an intellectual partnership.  Spielrein completed her dissertion in 1911 and she went to Vienna where she finally metFreud for the first time.  

A month later,  Sabina Spielrein presented her first theoretical paper "Destruction as the cause of coming into being" in which she presented the concept of a death instinct.  Although Freud did not agree with Spielrein's ideas, Jung later incorporated her death instinct concept into his own theories.   The death instinct was later credited to both Freud and Jung but it was Sabina Spielrein who developed it first.  When she later expressed concern about Jung using her ideas without giving her proper credit,  Jung reassured her as best he could and credited her as being "his" representative in Vienna.    Spielrein also became closer to Freud and was eventually accepted into the Psychoanalytic Society based on her dissertation on schizophrenia.   At the same time,  she was married to a Russian Jewish doctor named Pavel Naumovitsch Scheftel on June 14, 1912.  This was apparently a marriage arranged by her family and Spielrein chose to live in Vienna instead of Russia with her husband and newborn daughter, Irma.  While she made frequent visits home, her surviving writings have virtually no mention of her husband and daughter and  she seemed to devote all of her time and energy to continuing her relationship with Jung and Freud.  As the two men became increasingly estranged, it was Sabina Spielrein who  worked to heal their relationship until she eventually realized it was useless.

Over the following years, Spielrein worked as an analyst in numerous cities throughout France and Switzerland.   While she still returned home when she could, World War I and the Russian Revolution in 1917 ensured that the new Soviet Union had become a very different place from the country she once knew and she preferred to remain abroad.  Her restlessness seemed to be linked to her stormy relationship with Carl Jung who eventually cut off all ties with her despite the important role that she played in developing his theories.   By 1920, she was working at the Jean Jacques Rousseau Institute in Geneva where she provided therapy to developmental psychologist Jean Piaget.   It wasn't a particularly successful therapeutic relationship since treatment was terminated  after only eight months.  Piaget was never a formal disciple of Freud but  he and Spielrein were members of the Geneva Psychoanalytic Society and he entered into psychoanalysis as a "learning experience".     In his own writings, Piaget described the  "didactic analysis" that Spielrein provided.    There are differing versions describing why the treatment was terminated and whether it was due to Piaget being "immune to the theory" or whether Spielrein simply decided that further treatment was unnecessary (perhaps a little of both).   

Whatever their differences regarding psychoanalysis, both Sabina Spielrein and Jean Piaget shared an intense interest in child psychology.  Although Piaget preferred to focus on cognitive processs underlying how a child learned language and formed ideas, Spielren stressed the role of subconscious thought as being the "principal mode of thinking".   She advocated teaching methods that encouraged children to become more intuitive and favoured more subjective approaches to encouraging creativity.  Piaget rejected what he termed "autistic thought" (including poetry and mysticism) and stressed the role of objective thought processes in learning.  There were definite similarities in many of the ideas that they presented in their respective writings during that period but it took them in different directions despite the considerable impact that they had on one another. 

Continue to Part 2