The Art Critic

ART AND IMAGES IN PSYCHIATRY

SECTION EDITOR: JAMES C. HARRIS, MD The Art Critic

I love you and need you always, I know I am extremely difficult at times due to my absorbtion (sic) in my work....Ifyoudecide you want to be free, I consent but I earnestly believe we can have our best lives together. Norman to Mary Rockwell, undated, 19501(p376) “I pray thee, then,/Write me as one that loves his fellow-men.” Abou Ben Adhem, poem read at Norman Rockwell’s funeral2(p59)

HEN INTERVIEWED FOR A MAGAZINE PRO- in his career, as a matter of artistic technique, he was advised to file in 1960, Norman Rockwell (1894- invite the viewer into his illustrations. His success in engaging 1978) emphatically defined himself as viewers through their active imaginations was widely appreci- a genre painter. To make sure his in- ated. Adored by his viewing public and frequently scorned by terviewer got it right, he spelled it out avant-garde critics, Rockwell always hoped for more positive criti- forW her, “That’s spelled g-e-n-r-e.”1(p432) For more than 60 years, cal recognition. Despite his art training and familiarity with mod- beginning with his first Saturday Evening Post cover, Boy With ern art (Picasso was one of his favorite artists), overall he did Baby Carriage, published on May 20, 1916, his anecdotal vi- not receive such recognition. A re-evaluation of his work is un- gnettes chronicled American life and values. In all, Rockwell com- der way,3 initiated by a traveling exhibition of selected art works pleted 322 covers for the Post over nearly half a century. He rep- from the Norman Rockwell Museum in Stockbridge, Mass. resented America’s proud patriotic strength and its democratic Rockwell married Irene O’Connor in 1916; the marriage ended principles during 2 World Wars, and when the civil rights move- in 1930. Irene remarried 5 days after the divorce that she had de- ment began, he documented the injustice of bigotry and the con- manded was finalized. Afterwards, Rockwell rarely spoke of her. sequences of racial hatred. Throughout, as a keen observer of Filled with self-doubt when his fame and wealth were not enough human nature, he depicted with a wry wit and a real sense of to sustain his marriage, he immersed himself in his work, his life- humor the hopes and struggles of growing up in America. Early long pattern when stressed. Later that year, he married Mary Barstow, a 22-year-old school teacher 14 years his junior whom he met on a blind date. She gave birth to their 3 sons (Jarvis, Tom, and Peter) during the first 6 years of their marriage. With the onset of World War II, Rockwell turned his talents to the war effort. To help America understand what our troops were experiencing, he introduced GI Willie Gillis on Post covers. Gillis, an everyman filled with quiet strength and determi- nation, appeared on 11 covers over the next 5 years, first as an Army recruit and finally as a college student, apparently supported by the GI Bill. Rockwell’s most important contribution to the war effort was his Four Freedoms paintings based on freedoms proclaimed in President Franklin Delano Roosevelt’s State of the Union address on January 6, 1941. Roosevelt hoped for a secure new world based on freedom of speech and expression, freedom of worship, freedom from want (economic security), and freedom from fear (a reduction in armaments so that no one nation has the means to commit an act of aggression against another). Freedom from Fear (Figure 1) shows a mother tucking sleeping children safely into bed while the father warmly looks down on them. The father holds a newspaper in his left hand with headlines that describe the Battle of Britain, reporting on the bomb- ing of London (September 7, 1940, and May 16, 1941) by the Ger- man Luftwaffe. The Four Freedoms were completed in 6 months, and the Post published them on successive weeks beginning Feb- ruary 20, 1943; each was accompanied by an essay. The poet Stephen Vincent Bene´t wrote the essay on Freedom from Fear. These paintings became enduring national symbols4 that explained to Americans why they were fighting (N. and T. DeRobertis, oral communication, December 2006). The images were the center- Figure 1. Freedom from Fear. ©1943 SEPS: Licensed by Curtis Publishing Co. piece for a traveling war bond drive that raised more than $130

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©2007 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/30/2021 million. His Freedom of Speech was purchased for the permanent collection at the Metropolitan Museum of Art. After the war, America gradually returned to a time of normalcy. However, Rockwell was dealing with new fears and anxieties. By 1948, Mary’s alcoholism, mood swings, and depression were apparent to him, their family, and their friends. It became clear that she required treatment as she was sneaking off to a neighbor’s home for a drink or reaching for a flask when driving her mother-in-law home.1(p353) Rockwell was loyal to his wife but was increasingly concerned about her unreliability in representing him. “No one could be sure if she would have her drinking under control, or if she would talk coherently at all.”1(p380) He put Mary first and was distressed when she raised questions about a divorce (epigraph) while ill. In the summer of 1952, she began treatment at the Austen Riggs Cen- ter in Stockbridge, Mass, with its director, Dr Robert Knight. In 1953, Mary drove weekly from Vermont to the Austen Riggs Cen- ter for treatment. However, after 2 automobile accidents, her driving license was revoked. When the severity of her condition was made clear to him, Rockwell arranged to sell their home in Ver- mont and move permanently to Stockbridge in December 1953. In August 1952, Rockwell sought therapy for depression himself. His therapist was Erik Erikson, himself a painter in his earlier years. Erikson was concerned that Rockwell might be at risk for suicide. Rockwell asked his son to remove his gun from the studio. Rockwell used his art to work through his emotions; Erikson Figure 2. Stained Glass. ©1960 SEPS: Licensed by Curtis Publishing Co. noted that, “His happiness is determined by the progress of his following a 2-year hospitalization at McLean Hospital in Boston. 1 work.” In the summer of 1954, Rockwell started The Art Critic Mary was treated with electroconvulsive therapy again in 1958. (cover), published in the Post on April 16, 1955. His son Jarvis, an Then, on August 25, 1959, “They were enjoying being to- aspiring art student, was his model for the young art critic, and Mary gether...,”Jarvis recalled, but she seemed “sluggish at lunch.” modeled for the woman whose pendant is being examined with a After lunch, Mary took a nap.6 When Rockwell went upstairs to magnifying glass as the older men holding tall glasses in the ad- wake her, he found her dead. “Heart failure” was the diagnosis jacent painting glare at him with scorn and disapproval. This paint- on the death certificate, but the family initially assumed it was ing seems to reflect 2 common attitudes toward Rockwell’s work, suicide. Some suggested that she poisoned herself with pills; how- sentimental approval by the general public for his innocent themes ever, her daughter-in-law indicated that there was no note and andcondescendingdismissalbythe“artcommunity.”CriticClement that no medications were missing. Later, Rockwell wrote to friends, Greenberg referred to these attitudes as avant-garde and kitsch,5 “She was so unhappy, try to think of it as a release for her.”1(p427) with Rockwell falling in the second category. Mary was 51 years old when she died. She was buried in the Rockwell’s methods reveal a greater depth of knowledge about cemetery adjacent to their first home in Stockbridge. Friends wrote art than generally appreciated. For The Art Critic, although Mary encouraging letters to Rockwell: “Mary knew you had given her was the model for the woman, Rockwell based the composition much to live on in your life together and felt you to be a pillar in on a portrait by Frans Hals, Portrait of a Woman, and a sketch by her often troubled life.”1(p428) It was support from his friends and Peter Paul Rubens of his first wife, Isabella Brant.1 The attitude of his sense of irony that saved him from despair. The April 16, 1960, the woman can be traced in 20 preparatory photographs and oil Post cover (Figure 2) seemed to many to be a tribute to Mary. It paintings. In them, Rockwell teased out Mary’s most evocative ex- is the only one of his covers that shows a stained glass window. pressions, photographing each facial characteristic until he found Rockwell paints himself hard at work completing an angel. the visual humor he sought. At first, she overreacts to the young Norman Rockwell remarried on October 25, 1961, and Erikson man who stares at her; then she is more attentive and disapprov- attended the ceremony. It was a happy marriage, and Rockwell ing; and finally she appears delighted, even flirtatious. Rockwell continued to paint until the last 2 years of his life. When Norman privately referred to this painting as a sexual joke; it was one that Rockwell died in 1978, his funeral service began with his favor- Jarvis did not appreciate.1(p401) Initially, the adjacent painting was ite poem, Abou Ben Adhem. The poem (epigraph) reflects a landscape, but it gradually shifted to become 3 Dutch elders who Rockwell’s life philosophy about love for others. Many would seem appalled at the young man’s impudence. The image of the agree that, most of all, this democratic, American g-e-n-r-e artist’s elders is a parody of Frans Hals’s A Banquet of the Officers of the St paintings do indeed reflect his love for his fellow-men. George Militia Company and Rembrandt’s The Syndics of the Cloth- makers’ Guild (but 3 judges are shown instead of 6).1 While Rock- James C. Harris, MD well worked onThe Art Critic, his son Tom was accidentally stabbed in a freak fencing accident.1 Under considerable family stress, REFERENCES Rockwell was admitted for a “month’s rest” to St Luke’s Hospital. In June 1955, the Austen Riggs psychiatrist referred Mary to 1. Claridge L. Norman Rockwell: A Life. New York, NY: The Modern Library; 2001. 2. Hunt L. Selected Writings. New York, NY: Routledge; 2003. the Institute of Living in Hartford, Conn, where she had the first 3. Hennessey MH, Knutson A. Norman Rockwell: Pictures for the American People. of her treatments with electroconvulsive therapy for depression, New York, NY: Harry N. Abrams, Inc; 1999. remaining there for 6 months. For Rockwell, her illness was remi- 4. Murray S, McCabe J. Norman Rockwell’s Four Freedoms: Images That Inspire a Nation. Stockbridge, Mass: Berkshire House; 1993. niscent of that of his first wife, who died in 1934, 4 years after 5. Greenberg C. Art and Culture: Critical Essays. Boston, Mass: Beacon Press; 1989. their divorce, an apparent suicide by drowning (in the bathtub), 6. Rockwell N. My Adventures as an Illustrator. New York: Harry N. Abrams, Inc; 1988.

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©2007 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/30/2021 3. Rosenbaum PR, Rubin DB. The central role of the propensity score in obser- Another stimulating issue, absolutely relevant from a vational studies for causal effects. Biometrika. 1983;70(1):41-55. 4. Becker SO, Ichino A. Estimation of average treatment effects based on pro- clinician’s perspective, is whether patients with observ- pensity scores. Stata J. 2002;2(4):358-377. able beneficial effects during the first week of treatment 5. Moses-Kolko EL, Bogen D, Perel J, Bregar A, Uhl K, Levin B, Wisner KL. maintained or incremented such beneficial effects dur- Neonatal signs after late in utero exposure to serotonin reuptake inhibitors: literature review and implications for clinical applications. JAMA. 2005;293 ing the subsequent weeks of therapy and were eventu- (19):2372-2383. ally rated as responders at the study end point. Obvi- 6. Perneger TV. What’s wrong with Bonferroni adjustments. BMJ. 1998;316(7139): 1236-1238. ously, by its intrinsic nature, reanalyses of aggregate data cannot answer such questions. Possibly, reanalyses of individual-patient data would provide useful insights on 3 Publication Bias in Systematic Reviews this compelling issue. Systematic reviews should routinely include details not reported in scientific journals and data from trials that he systematic review carried out by Taylor et al1 have never been published; additionally, systematic re- suggested that selective serotonin reuptake in- views should increasingly include reanalyses of individual- hibitors (SSRIs) begin to have observable ben- T patient data. To realize these aspirations, new rules should eficial effects in depression during the first week of treat- be implemented at a global level.4 From now on, scien- ment. This result was obtained from the analysis of tific journals should require, before accepting reports of randomized controlled trials of SSRIs vs placebo that re- clinical trials, a statement in which authors agree that data ported outcomes for at least 2 points in the first 4 weeks may be accessed by organizations involved in research of treatment. From 107 trial reports, Taylor et al identi- synthesis. Reports of clinical trials should not be ac- fied 50 randomized controlled trials meeting the inclu- cepted without such a statement. Only in this way would sion criteria, of which 28 were incorporated in the pri- the damage of publication bias be mitigated. mary analysis. This pattern of trial selection was a consequence of the fact that not all studies took repeated- Corrado Barbui, MD outcome measures and not all studies that took repeated- Andrea Cipriani, MD outcome measures presented the results for all points. We argue that the criteria of including only studies Correspondence: Dr Barbui, Department of Medicine and reporting outcomes for at least 2 points in the first 4 weeks Public Health, Section of Psychiatry and Clinical Psy- of treatment might have systematically selected positive chology, University of Verona, Policlinico Rossi, Piaz- trials, that is trials showing significant differences be- zale Scuro 10, 37134 Verona, Italy (corrado.barbui@univr tween placebo and active drugs during the early phases .it). of the trial. In other words, it is possible that the authors Financial Disclosure: None. of primary studies reported more often early outcome data suitable for reanalysis when differences emerged. This 1. Taylor MJ, Freemantle N, Geddes JR, Bhagwagar Z. Early onset of selective seems particularly true in this sample of trials that must serotonin reuptake inhibitor antidepressant action: systematic review and meta-analysis. Arch Gen Psychiatry. 2006;63(11):1217-1223. have been financially supported by drug companies in 2. Perlis RH, Perlis CS, Wu Y, Hwang C, Joseph M, Nierenberg AA. Industry most, if not all, cases.2 Drug companies might have given sponsorship and financial conflict of interest in the reporting of clinical trials in psychiatry. Am J Psychiatry. 2005;162(10):1957-1960. emphasis to differences when these differences emerged, 3. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of che- without reporting any early outcome information when motherapy and hormonal therapy for early breast cancer on recurrence and no early differences emerged. Additionally, some nega- 15-year survival: an overview of the randomised trials. Lancet. 2005;365(9472): 1687-1717. tive trials comparing SSRIs with placebo might have re- 4. Barbui C, Cipriani A. Evidence-based mental health: an agenda for the future. mained completely unpublished. Evid Based Ment Health. 2007;10(1):4-6.

Correction

Error in Text. In the Art and Images in Psychiatry ar- ticle titled “The Art Critic,” published in the April issue of the Archives (2007;64[4]:398-399), the text con- tained an error when referring to one of Norman Rock- well’s sons. His son Peter, not Tom, was accidentally stabbed in a freak fencing accident.

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