This paper provides the historical, cultural, and clinical context for the relationship between Bruno Bettelheim (1903–1990) and Rudolf Ekstein (1912–2005). Both were Viennese-born and trained intellectuals who received doctorates in the human sciences from the University of Vienna in 1937. Both were deeply identified with lay analysis, emphasizing that for psychoanalysis to perpetuate itself it needed to promote serious and rigorous forms of research. Because Bettelheim was the better known of the two, this introduction focuses on Ekstein's family history, with special emphasis on his experience of loss and trauma and his capacity to recover from personal and educational obstacles. It argues that Ekstein was a representative product of Austro-Marxism in the period between the wars, embracing the ethical brand of democratic socialism and group solidarity that was integral to the theory and practice of Austrian Social Democracy. It discusses Ekstein's training with Moritz Schlick in philosophy and his immersion in the Vienna Circle of logical positivism. From Schlick, Ekstein evolved into a philosophical thinker who learned how to think his own thoughts. Ekstein joined the circle of psychoanalytic pedagogues who clustered around the Vienna Psychoanalytic Society, under the tutelage of Willi Hoffer,August Aichhorn and, above all, Anna Freud. The clinical component of psychoanalysis emanated from his commitment to understanding the inner world of the child. Bettelheim and Ekstein first became aware of each other from reading the analytic literature and finally met in America in the 1950s. They shared a professional interest in conducting research and doing clinical work on severely disturbed children and adolescents, including those with psychotic, borderline and autistic diagnoses. They debated the value of milieu therapy versus psychoanalytically oriented psychotherapy on such children. As their relationship evolved, the two collaborated and began a fascinating correspondence that gradually evolved into an intimate friendship. They both engaged in a polemic with Bernard Rimland, who was massively critical of their clinical work and a hostile critic of psychoanalytic approaches to the treatment of disturbed children. Rimland was an advocate of a neurological approach to mental illness, with an emphasis on biology and psychopharmacology. The 22 letters that constitute the Bettelheim-Ekstein exchange began with clinical concerns, including the varieties of solitude, isolation and countertransference disruptions that may trouble the psychoanalytic researcher and clinician in dealing with primitively disordered children. It moves to other issues, including mutual support during the Rimland Affair. As the two became more friendly, a pattern of good-natured competition and envy appeared. The two engaged in a heated exchange on the question of whether contemporary Vienna remained as anti-Semitic as it had been in their respective youths: Bettelheim, the concentration camp survivor, argued that nothing had changed and that most Austrians remained viscerally anti-Semitic; Ekstein, the Austro-Marxist, contended that one could not blame a generation born after World War II, holding that in his experience many Austrians had examined their consciences and held distinctly different opinions from their parents or grandparents. Toward the end of their correspondence, we encounter Ekstein's tender sensitivity to Bettelheim's descent into depression as a result of the death of his wife, Trude, leading eventually to recurrent episodes of suicidal ideation and plans for his own suicide. The letters testify to a unique friendship with a somewhat old-world quality.
Defensive mechanisms and personality structure in an early adolescent boy: process and outcome issues in a non-intensive psychoanalytically oriented psychotherapy
