History of

Women neuropsychiatrists on Wagner-Jauregg’s staff in at the time of the Nobel award: ordeal and fortitude

Lazaros C Triarhou

University of Macedonia, Greece

Running Title:

Women Neuropsychiatrists in 1927 Vienna

Corresponding author: Lazaros C. Triarhou, Laboratory of Theoretical and Applied Neuroscience and Graduate Program in Neuroscience and Education, University of Macedonia, Egnatia 156, Thessalonica 54006, Greece. E-Mail: [email protected] ORCID id: 0000-0001-6544-5738 2

Abstract This article profiles the scientific lives of six women on the staff of the Clinic of Neurology and Psychiatry at the in 1927, the year when its director, Julius Wagner-Jauregg (1857–1940), was awarded the Nobel Prize in Physiology or Medicine. They were all of Jewish descent and had to leave in the 1930s to escape from the National Socialist regime. With a solid background in brain science and mental disorders, Alexandra Adler (1901–2001), Edith Klemperer (1898–1987), Annie Reich (1902–1971), Lydia Sicher (1890– 1962) and Edith Vincze (1900–1940) pursued academic careers in the United States, while Fanny Halpern (1899–1952) spent 18 years in , where she laid the foundations of modern Chinese psychiatry, before going to . At the dawn of their medical career, they were among the first women to practice neurology and psychiatry both in Austria and overseas.

Keywords Women in psychiatry, Jewish physicians, University of Vienna, Interwar period, Austrian Annexation

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Introduction There is a historic group photograph of the faculty and staff of the Neurology and Psychiatry Clinic in Vienna, taken on 7 November 1927 (Figure 1). A month earlier, the Nobel Committee had announced the selection of Julius Wagner-Jauregg (1857–1940), director of the Clinic, as the recipient of that year’s prize in physiology or medicine “for his discovery of the therapeutic value of malaria inoculation in the treatment of dementia paralytica.” The award ceremony took place in Stockholm on 10 December 1927. The University of Vienna, in the words of Rudolf Virchow, had become the “Mecca of Medicine” by the mid-19th century (Whitrow, 1993). At that time, the common trend of psychiatry was an isolation from other medical disciplines as exemplified in the term “alienist”, whereby psychiatrists were the custodians of incurable cases, mostly occupied with the tedious classification of clinical signs (Sakel, 1938). Even in Viennese medicine, a fascination prevailed with diagnosis, while therapy was neglected. On the contrary, Viennese psychiatry had begun a tradition of looking into the causes of and attempting to treat mental disorders. Theodor Meynert (1833–1892) was a pioneer in the effort to explain the origin of psychiatric diseases in neuroanatomical terms, and Julius Wagner- Jauregg, with a solid background in and internal medicine, experimented with remedies. The latter aimed at counteracting the “therapeutic nihilism” by developing cures for conditions which until then were considered hopeless (Whitrow, 1993). Moreover, Wagner-Jauregg organized courses that attracted students from the European mainland and overseas. In his Clinic he produced an entire generation of eminent alumni in psychiatry and neurology. After his retirement in 1928, the Chair of Neurology and Psychiatry was offered to (1876–1931), who refused it in order to be able to concentrate on his research, without distractions from administrative duties. Thus, Otto Pötzl (1877–1962) took over the direction of the Clinic. In a field dominated by men (Haymaker and Schiller, 1970), it is noteworthy that women made up one-fourth of Wagner-Jauregg’s medical staff (Figure 1). However, the only woman from the photograph mentioned by Wagner-Jauregg (1950: 63–64) in his memoirs is Klara Strasky (1875– 1952), a skilled laboratory technician in histology, and sister-in-law of psychiatrist Emil Raimann (1872–1949). During 1902–1914, Wagner-Jauregg covered her salary from his private funds. After World War I, at his request, the Ministry of Education created a permanent position for her at the University, in which capacity she was extremely helpful to medical staff of the Clinic engaged in histological research, including the cortical cytoarchitectonic studies of von Economo and Koskinas (1925: vi). When Nazi Germany annexed Austria in March 1938, two-thirds of the 5700 physicians registered in Vienna lost their licence to practice, and more than one-half of the faculty of the 4

University of Vienna Medical School were dismissed on racial or political grounds. Traditionally, neurology and psychiatry in Vienna, like many other specialties, were characterized by a high percentage of Jewish professionals who, from 1935 onwards, were confronted with humiliation and persecution after the introduction of “racial hygiene” laws. Career prospects were ruined and lives jeopardized (Schlossmacher, 1998; Gröger and Stacher, 1999; Seidler, 1999). This paper presents the biographical portraits and showcases the destinies of six remarkable women neuropsychiatrists of the Vienna school (Figure 2). At the dawn of their medical career, they were already among the first women to practice neurology and psychiatry both in Austria and overseas. Even 80 years after their forced exile, only two of them (Annie Reich and Lydia Sicher) appear in PubMed, while the profiles of the others remain unheeded. They all overcame the constraints of the fascist regime, ultimately settling in America to nurture their ambitions and pursue their interests as physicians, teachers, and authors. Some maintained a private practice and others held prominent research and consulting positions in top academic institutions of the New World.

Alexandra Adler (1901–2001) Alexandra Adler was one of the first women neurologists at Harvard, and left valuable contributions to the study of post-traumatic stress disorder, psychosomatic syndromes, visual agnosia, psychopharmacology, and schizophrenia. She was born in Vienna on 24 September 1901 to Alfred Adler (1870–1937) and his Russian wife, Raissa Timofeyevna Adler (née Epstein, 1872–1962), the daughter of a Jewish merchant. With a gift for music, Alexandra enjoyed playing piano à quatre mains with her father during the Vienna years. Most of the following biographical information derives from an editorial in The Harvard Gazette on 18 January 2001 (News and Announcements, 2001) and from an article by Vande Kemp (2003). Adler graduated in medicine from the University of Vienna in 1926, where she subsequently trained in psychiatry and neurology under Wagner-Jauregg, and directed the neurological wing for women. In 1934, she was in charge of a child guidance center until it was shut down by the Nazis. Coming to America in 1935, Adler was offered a position at Harvard University and Massachusetts General Hospital as neurology instructor. At the time, no women occupied faculty positions at Harvard Medical School. Therefore, she was included in the research staff, with a yearly appointment, renewed annually through 1944. During those years, Adler published a study with Tracy Jackson Putnam (1894–1975); they were among the first researchers to propose a vascular cause for multiple sclerosis (Putnam and Adler, 1937), having conducted a neuropathological examination of a woman diagnosed with the disease, and found plaques of demyelination spread in proximity to large epiventricular veins. After spending a couple of years in North Carolina as Visiting Professor of Psychiatry at Duke 5

University, Adler moved to New York City in 1946. She became Associate Clinical Professor of Neurology at New York University School of Medicine and Associate Attending Neurologist at Bellevue and University Hospitals of New York, and Professor in 1969. In 1948 she became medical director of the Alfred Adler Mental Health Clinic in Manhattan and edited the International Journal of Individual Psychology . As a staff member of the Gracie Square Hospital, she worked for 20 years with female offenders at the New York City Department of Corrections, and published observations on 1000 patients (Adler, 1955). In 1959, Adler married Halfdan Ingstrup Gregersen (1896–1980), a Danish-born graduate of Stanford and subsequently Professor of Romance Languages and Dean of Williams College in Williamstown, Massachusetts. Gregersen was the author of Ibsen and Echegaray [1933] and Ibsen and Spain; A Study in Comparative Drama [1936]. On 28 January 1965, at the request of the New York Academy of Medicine, Adler delivered the Memorial Address on the life and work of her former Viennese colleague, Paul Ferdinand Schilder (1886–1940). In that speech she highlighted the milestones of Schilder’s multifarious scientific life (Adler, 1965). In 1977 she was honored with the Goldenes Ehrenzeichen by the City of Vienna, and in 1999 she was included as a case study in a book on Jewish women in exile in New York (Hartenstein, 1999). Alexandra Adler died in New York City on 4 January 2001 in her 100th year. Her books include Guiding Human Misfits; A Practical Application of Individual Psychology [1938, 1948, 1973] and Alfred Adler’s Individual Psychology [1973].

Fanny Halpern (1899–1952) Fanny-Gisela Halpern is the founder of academic psychiatry in Shanghai, a city that became the most active center for the development of mental health in China. She was born in Kraków on 1 August 1899 to Simon Halpern (1865–1939), a surgeon-general of the Austrian Army, and Rosalie Halpern (née Salkind, 1875–1951), a native of Kremenchzuk on the Dnieper (Grau, 2014; SFU Archives, 2015). After graduating in medicine from the University of Vienna in 1924, Halpern worked as an Assistant in Neurology and Psychiatry at the Clinic headed by Wagner-Jauregg and subsequently by Pötzl. Between 1922 and 1930 she also conducted research at the Department of Physiology headed by Arnold Durig (1872–1961) and Rudolf Allers (1883–1963). Her first scientific publication, while still a medical student, was on tactile sensory perception (Allers and Halpern, 1922). She further studied the effect of local hyperemia on sensory threshold (Halpern, 1922), spatial perception by means of thermoception (Halpern, 1924), nitrogen and protein ratios in the cerebrospinal fluid (Halpern, 1929), inverted vision (Halpern, 1930a), cerebral 6 achromatopsia (Halpern and Hoff, 1929), frontal lobe function (Halpern, 1930b), the effect of drugs on respiration (Allers and Halpern, 1930), a case of myasthenia in a lymphoepithelial tumor of the thymus (Halpern and Popper, 1931), and iodine treatment with Jonojod , a compound manufactured by her brother’s pharmaceutical and cosmetic factory (Halpern and Kamin, 1932). In November 1933, Halpern was solicited by Yen Fu Ching (1882–1970, occasionally written Yan Fuqing), the President of the National Medical College in Shanghai, for an appointment as Professor of Psychiatry and Neurology there. Fu Ching, a graduate of Yale Medical School, planned to develop psychiatry in China with the help of Austrian neuropsychiatrists. The American psychiatrist Richard Sherman Lyman (1891–1959) played a role in Halpern’s recruitment; he afterwards moved to Peking Union Medical College (Blowers, 2013). Historically, the First Institute of Psychiatry had been founded in 1908 in Guangzhou. In the early 20th century the mentally ill generally did not receive much medical care, were mostly kept at home, and the widely held opinion was that mental illness is incurable. Halpern’s task was to reverse those trends. Halpern established degree programs in neurology and psychiatry in 1934. At the Red Cross Hospital in Shanghai, she held consultations, and her students completed internships. She also hosted psychiatric nurse training courses in Shanghai attended by students from St. John’s University Medical School and the Women’s Christian Medical College (Grau, 2014; Stupnicki, 2016). In the summer of 1935 she organized China’s first modern psychiatric facility, a mission hospital with 300 beds, the Shanghai Mercy Hospital for Nervous Diseases at Beiqiao, midway between Shanghai and Minghong, and was appointed as its medical director. The nursing staff were the Foreign Mission Dominican Sisters of Mary Knoll from the United States and the Missionary Brothers of Charity from Trier, Germany. Patients flocked from all parts of China and the Far East. At the same time, Halpern served as consultant to several other medical institutions. She headed the Psychiatry Department of the Red Cross Society Hospital, the General Hospital, the Lester Chinese Hospital, the Chun-Shan (Sunyatsen) Memorial Hospital, and St. Luke’s Hospital (Xu, 2009). The founding of the Mercy Hospital was the starting point for the history of psychiatry in Shanghai. In her position, Halpern fully demonstrated her professional ethos and organizational skills. Today this hospital of 2500 beds is called “Center for Mental Health” and employs 1300 people, 1000 of whom medical professionals, including 100 physicians and 20 professors. Halpern is still credited for the success of the clinical and research institutions (Stupnicki, 2016). In November 1935, at a conference of the Chinese Medical Association in Guangzhou, Halpern (1935) made a presentation on the status of psychiatry in China from a medical, social and legislative perspective. She was hardly sympathetic toward Freudian psychoanalysis (Kirsner and Snyder, 2009). Thus, in her report, Halpern (1935) gave psychoanalytic training low priority, given the more pressing 7 need to improve general psychiatric facilities. She offered a systematic plan, and a Committee on Psychiatry was formed to study all those issues. Fu Ching was appointed chairman, and Halpern, the only female member, secretary. The tasks of the Committee included the training of psychiatrists and nurses, the establishment of psychiatric care services, the promotion of mental health and preventive psychiatry, the creation of schools for the mentally ill, institutions and clinics to train psychiatry educators and social workers, and the reform of mental health legislation. At its inaugural meeting in February 1936, the Committee composed a draft legislation on mental disorders to be submitted to the National Government. However, the outbreak of the Sino-Japanese War in August 1937 prevented its fruition (Xu, 2009). Nevertheless, that Committee is still considered the most important event in the history of Chinese psychiatry (Stupnicki, 2016). The Committee on Mental Health in Shanghai became the Mental Health Association of that city (SFU Archives, 2015). In 1939 Halpern was appointed Dean of the Faculty of Neurology and Neurasthenia at St. John’s University Medical School. In her teachings and examinations, she included neuropathology, besides psychiatry proper (Stupnicki, 2016). For most of her time in Shanghai, Fanny shared her life and home with her mother Rosalie, who joined her there after Simon Halpern’s death in 1939. Fanny’s brother, George-Robert Halpern (1902–1989), a Ph.D. in chemistry and philanthropist, and his wife Ida Halpern (née Ruhdörfer, 1910– 1987), a D.M.A. and noted ethnomusicologist, had left Vienna and moved to Shanghai in October 1938, but in the summer of 1939 they emigrated to , Canada. After her mother’s death in 1951, Fanny settled in Vancouver in November of that year. She died on 26 June 1952, one year to the day after her mother. George and Ida Halpern became noted benefactors to the and convocation founders of in 1965. Their financial support enabled the construction of the “George and Ida Halpern Centre” at the latter institution (SFU Archives, 2015).

Edith Klemperer (1898–1987) Edith Klemperer was born on 9 August 1898 in Vienna to Karl and Marianne (née Deutsch) Klemperer, a couple of Jewish-Bohemian origins. She obtained her medical degree from the University of Vienna in 1923. In December of that year she joined the Vienna Medical Association. From 1924 until 1938 she was assistant to Wagner-Jauregg (Figure 1) and Pötzl in the Clinic of Neurology and Psychiatry. In 1936–1937 she worked at the Rothschild-Spital, the hospital of the Vienna Israelite Community (Korotin, 2016: 1668). About Wagner-Jauregg, on the occasion of the commemoration of his centennial birthday by the American Psychiatric Association, she wrote: “Being a pupil and great admirer of Wagner-Jauregg, I would like to add a few facts, interesting especially for Americans. It was Wagner-Jauregg who 8 introduced postgraduate courses for foreign physicians and he is the originator of the American Medical Association of Vienna, which brought about an important exchange of medical knowledge and culture between both countries. Wagner-Jauregg was also the first to recognize the significance of radiology and worked actively for the establishment of a Central Institute for Radium. Many of the internationally known founders of radiology, a science whose importance is now more evident than ever, came from this Institute” (Klemperer, 1957). During the Vienna years, Klemperer conducted research and published 24 papers, nine of them co-authored with Max Weissmann (1895–1957), on topics such as chemical analyses of blood, urine, and cerebrospinal fluid samples in diverse psychiatric and brain disorders, progressive paralysis, the use of insulin in the management of delirium tremens, the body reaction to hypnosis, and Korsakoff syndrome after insulin treatment of diabetics (Kreuter, 1996: 720–1). Insulin was discovered in 1921 in Toronto and used in the treatment of diabetes. Klemperer was one of the earliest physicians to try insulin for the management of psychiatric diseases; in 1926 she administered insulin to patients with delirium tremens, the psychotic syndrome resulting from alcohol withdrawal (Klemperer, 1926b; Shorter and Healy, 2007: 10–11). In the years that followed, Manfred Joshua Sakel (1900–1957) used insulin shock therapy in schizophrenia (Sakel, 1938; Peters, 1992). Klemperer also measured carbonic acid content in the cerebrospinal fluid of patients with progressive paralysis, who had been inoculated with malaria by Wagner-Jauregg in the attempt to contain nervous tissue inflammation (Klemperer, 1937). Her work on blood tests (Klemperer, 1925, 1926a, 1930a, 1935) made news in America: “An important discovery that may revolutionize the treatment of psychic disturbances has been made by Dr. Edith Klemperer, Vienna Jewish physician. Through an analysis of human blood, Dr. Klemperer is said to have proved that psychic emotions are due to chemical changes in the blood, the emotional attitute being nothing more than the exterior manifestation of the chemical blood mixture” (Biron, 1937). Klemperer developed an anatomical brain model (US patent 1951422, Figure 3) as an aid for teaching, and demonstrated it both at the First International Neurological Congress in Bern, Switzerland, in September 1931 (Klemperer, 1932a) and at the 95th Annual Meeting of the American Psychiatric Association in Chicago in May 1939 (Klemperer, 1939). In that three-dimensional model, functionally associated parts, e. g. nerve tracts, could be luminously represented in the same color, making it possible to demonstrate both the physiological course of tracts and reflexes and their changes in pathological conditions. The Press wrote: “ Jewish Woman Physician Uses Electrical Device to Duplicate Nerve Impulses .—By operating switches to control several hundred different electric circuits it is possible to duplicate the nerve impulses received and sent out by the brain…Neon tubes 9 running through the huge model are controlled by the electrical switches to duplicate flashes of thought, automatic movements such as breathing, and the complex reactions of disordered minds in various forms of mental disease when the telephone-switchboard of the brain develops short circuits” ( The Bee from Danville , Virginia, Thursday, 11 May 1939). Upon the Nazi Annexation, Klemperer left Austria, with her brain model, her clothing, and the equivalent of two dollars in cash. She sailed in September 1938 from Southampton to New York, permanently moving to the United States. In 1940 she was briefly affiliated with the Longview State Hospital and the Department of Psychiatry of the University of Cincinnati College of Medicine (Tietz et al., 1941), where she participated in a study to monitor body temperature in hypoglycemic coma in relation to the recovery from schizophrenia after insulin shock therapy (Tietz et al., 1941), an interest that had begun during her Vienna years (Klemperer, 1926b, 1930b, 1932b). Another Viennese expatriate, Ilya M. Scheinker (1902–1954), was also working at the University of Cincinnati College of Medicine from 1941 until about 1952 as Assistant Professor of Neuropathology and Neurology. In 1941–1942 Klemperer worked as Clinical Assistant in Psychiatry at the Outpatient Department of the Neurology Service of Mount Sinai Hospital, together with Annie Reich and Ludwig Eidelberg (Arnstein, 1941). Klemperer also became affiliated with the Hillside Hospital of the Long Island Jewish Medical Center (1942–1943) and, as senior psychiatrist, with the Bellevue Hospital of New York (1943–1946) and the Morrisania Hospital in Bronx County (1952–1958). She was counseling psychiatrist for the Workmen’s Compensation Board and adviser for the Department of Social Welfare of New York City (Korotin, 2016: 1668). Between the 1940s and the 1960s, she practiced in New York City and pioneered the use of hypnosis, hypnotherapy and hypnoanalysis (Gruenewald, 1969; Klemperer, 1947, 1952, 1954, 1965a, 1968, 1969), the latter field generally associated with the name of Lewis R. Wolberg (1905–1988) of New York Medical College and his book on the subject (Wolberg, 1945). Between 1954 and 1969 Klemperer lectured at the Society for Clinical and Experimental Hypnosis and published several papers on hypnoanalysis in the Journal of Clinical and Experimental Hypnosis , discussing technique, past ego emerging states, projective phenomena, primary-object relationships, the spontaneous self- portrait, and changes in the body image (Klemperer, 1954). She also applied hypnosis to control tobacco smoking (Klemperer, 1953) and lectured on alcoholism before the 1964 Annual Conference of the New York Chapter of the American Society of Group Psychotherapy (Klemperer, 1965b). Edith Klemperer died on 23 September 1987 in New York.

Annie Reich (1902–1971) Annie Reich was born on 9 April 1902 to Alfred Pink, a business entrepreneur, and Theresa Pink (née 10

Singer), a teacher, who died at the end of World War I during the flu epidemic. In 1922 Annie Pink married Wilhelm Reich (1897–1957), to whom she was introduced by a mutual friend, the “second generation” psychoanalyst Otto Fenichel (1897–1946). She studied medicine in Vienna beween 1921 and 1926 and then trained in neurology and psychiatry under Wagner-Jauregg. She also resumed the psychoanalytic training, begun with Wilhelm Reich while still a student, now with Anna Freud and Herman Nunberg, and in 1928 became a member of the Vienna Psychoanalytic Society (Gifford et al., 2005: 201). In 1930, Annie and Wilhelm Reich, and their two daughters, Eva and Lore, moved to Berlin (Danto, 1999). Two years later the couple separated. Wilhelm went to Copenhagen and then Oslo, and Annie with her children to Prague, where she developed her own voice as a psychoanalyst (Kitlitschko, 2013). There, in 1938, she married the historian Jakob Reich (pseudonym “Genosse Thomas” in the 1920s, later Arnold Rubinstein, 1886–1955) and they emigrated to the United States. Annie became a member of the New York Psychoanalytic Society (Gast, 2005) and was also affiliated as a psychoanalyst with the Outpatient Neurology Service of Mount Sinai Hospital (Arnstein, 1941; Blumesberger et al., 2002: 1101–2). The Hungarian-American psychoanalyst George Gerö (1901–1993) called Reich an exceptionally gifted psychoanalytic clinician, who never became lost in psychoanalytic jargon, and always based her theoretical conclusions on documented clinical observations (Gerö, 1973). Her first paper, “Analysis of a case of brother-sister incest” [1932], showed her unique clinical qualities. Subsequently, she published studies on narcissism, self-esteem, female psychology, and analytic technique. In her last paper, “Empathy and countertransference” [1966], she revisited the problems of analytic epistemology and addressed questions of how does an analyst gain insight into a patient’s unconscious processes and what is the nature of the analyst’s intuition and empathy. She emphasized that countertransference is not a source of true insight into a patient’s emotional life, and suggested that analysts shift from intuitive understanding to an evaluating, intellectual attitute (Gerö, 1973). In 1961 Annie Reich had a stroke that led to hemiparesis. In 1970 she suffered additional strokes that left her paralyzed and aphasic. She died on 5 January 1971 in Pittsburgh, Pennsylvania (Jacobson, 1971). Her collected psychological writings, spanning over 35 years, were compiled in a volume posthumously (Reich, 1973).

Lydia Sicher (1890–1962) Lydia Bak was born on 19 December 1890 in Vienna, where she attended the First Humanistic Mädchengymnasium (Davidson, 1991; Korotin, 2016: 3066–7). 11

In 1913 she married the anatomist Harry Sicher (1889–1974), Assistant and later Professor in the Dental Institute of Vienna and, after the Anschluss , Professor and Chairman of Anatomy at Loyola University School of Dentistry in Chicago. Harry Sicher, who had trained under Julius Tandler (1869– 1936), was a renowned physician, anthropologist, lepidopterist, biologist, and musician. Some of the books that he authored or co-authored, including Oral Anatomy [1949], Bone and Bones [1944] and Oral Histology and Embryology [1962, 1966, 1972] became authoritative texts for dentists worldwide (Grant, 1975; Christen and Christen, 2003). In 1915, during World War I, Lydia and Harry Sicher volunteered as physicians in the Austrian Army. Her task was to fight typhoid fever and malaria in the troops at the Montenegro and Italian Fronts. She also gave lectures to hospital staff members. For her services she was decorated by the Army and the Red Cross. In 1916 Lydia Sicher graduated in medicine from the University of Vienna. She could read Latin and Greek, and spoke German, English, French, Serbian and Croatian. After the War, she worked in the First Anatomical Institute under Tandler, where she completed her thesis on the development of the pharyngeal derivatives and the thyroid of the lapwing (Vanellus cristatus) , a small European bird of the Charadriidae family (Sicher, 1921) and obtained a doctorate in zoology. She next worked for six years as a Fachärztin (specialist physician) in neurology and psychiatry in Wagner-Jauregg’s Clinic. Sicher closely followed Freud and psychoanalysis, but became more interested in the work of Alfred Adler. She actually met Adler in 1919, when she consulted him about one of her patients. Sicher worked under Adler while he directed the Clinic for Nervous Diseases at the Mariahilfer- Ambulanz (later Kaiser-Franz-Josef Ambulatorium) in Vienna. When Adler left Vienna for the United States in 1929 to head the Medical Psychology Department at Long Island University, he appointed Sicher as his successor in the direction of the Clinic, with Franz Plewa (1903–1971) as her assistant, and of the Vienna Society of Individual Psychology. The handling of over 3000 cases (with Plewa) by means of individual psychological methods in the ensuing years made her an unrivaled expert in Adlerian theory. The Clinic was closed by the Nazis in 1938. Between 1929 and 1938 she also taught classes in England, Holland, Latvia, Lithuania, and Poland. In 1938 she left Vienna and spent a year in London. In April 1939 she sailed from Southampton to New York aboard the S.S. President Roosevelt . In the United States she served as President of the American Society of Adlerian Psychology and edited the Journal of Individual Psychology . She initially worked as consultant psychologist at the Family Service Society of Salt Lake City, Utah, the School for Social Work of the University of Utah, and the Agricultural College in Logan. In Salt Lake City she founded a Group of Individual Psychology. In 1941 she moved to Los Angeles, where she worked as Assistant Clinical Psychiatrist at the Los 12

Angeles Psychiatric Service and as a staff member of the Psychiatric Outpatient Department of the Cedars of Lebanon Hospital. In 1948 she founded the Institute for Individual Psychology and the Child Guidance Clinic in Bakersfield, and directed the Alfred Adler Counseling Center, a service for low income groups. Sicher remained loyal to the teachings of Adler and is considered one of the outstanding Adlerian psychologists. Her writing style was direct and succinct, closely resembling that of Adler (Mozdzierz, 1997). She wrote little, aside from a large number of book reviews. She traced the views of Adler to the fundamental philosophical notions of Hegel, and created a synthesis, whereby conflict is part of a continuous dialectic process and a stimulus for further growth (Bach, 1978). Her collected papers and lecture transcriptions were published in a volume posthumously (Sicher and Davidson, 1991). Her works include “A case of manic-depressive insanity” [1928], “The first individual psychological outpatient Clinic in Vienna” [1931], “On personality” [1933], “The individual in the community” [1935], “Guilt” [1950], “Is the human race a mistake of nature?” [1953], “Education for freedom” [1954], “Neurotic sovereignity” [1958], and “Aggression as a secondary phenomenon” [1967], co-authored with H. H. Mosak (Korotin, 2016). Sicher died on 2 April 1962 in Los Angeles. In 2016, a street, Lydia-Sicher-Gasse , was named after her in Aspern, Vienna’s District 22.

Edith Vincze (1900–1940) Born in Vienna on 10 August 1900, she was the only child of Beno Vincze (1870–1935) and Elsa Vincze (née Kamerman, 1874–1959), a couple of Jewish-Hungarian heritage from Ungvár (today Užhorod in the Ukraine). Edith’s paternal grandparents were Bernard Weinberger (1859–1901) and Hermine Weinberger (née Neugebauer). Edith Vincze graduated in medicine from the University of Vienna and subsequently trained in neurology and psychiatry under Wagner-Jauregg. In 1928 she married the pathologist Daniel Laszlo (1902–1958), a native of Kassa (today Košice in Slovakia). In September 1938 the couple, with their 7-year old son Hans, emigrated to the United States to escape the Nazi regime. Daniel and Edith Laszlo served on the medical staff of Mount Sinai Hospital, Edith as Clinical Assistant in Psychiatry at the Outpatient Department of the Neurology Service, and Daniel as Research Assistant at the Laboratory of Morbid Anatomy and as Clinical Assistant at the Outpatient Department of the Medical Service (Arnstein, 1939). Edith Vincze-Laszlo died in New York on 22 November 1940. Daniel Laszlo was a cancer researcher of international renown for his studies on the metabolism of radioactive isotopes by the human body. He died in Riverside, New York on 1 June 1958 13

(Blumesberger et al., 2002: 789).

Conclusion A trend is currently growing of eschewing more well-known names in favor of women whose accomplishments are rarely treated, if at all, within histories of medicine. The stories of women provide increasingly important reminders and sources of encouragement for women in male- dominated fields and the future inclusion of new names to the ever-growing list of women in the basic and clinical sciences (Link, 2017). The neuropsychiatrists profiled in the present study had two challenges complicating their careers: they were women, and they were Jewish. Heinrich Kogerer (1887–1958), who headed the Neurology Section of the Clinic, tacitly took for granted that psychotherapists were men; he considered the suitability of women for practicing psychotherapy, insofar as they fell into two categories, those who were “very motherly” and those who had “markedly male traits” (Freis, 2017). On the other hand, Paul Schilder, who headed the Psychiatry Section of the Clinic, was more open-minded, and the overwhelming majority of young medical staff chose psychiatry (Adler, 1965). The founders of both new schools of psychology in Vienna, and Alfred Adler, as well as many of their followers, were Jews. Psychoanalysis in particular, in German-speaking countries in the early 20th century, was attacked as a “Jewish science” inside and outside academia, and Jewish psychoanalysts and individual psychologists faced substantial hurdles in their university careers (Freis, 2017). Wagner-Jauregg’s stance toward the psychological theories of Freud and Adler was rather critical (Beckh-Widmanstetter, 1965; Whitrow, 1993; Rieken, 2015). Although he found their work intelligent, he judged that their theortical constructs were the product of subjective intuition, having little to do with true science. There is an anecdote: when Freudian colleagues rushed in 1927 to congratulate him on the Nobel award, he responded by saying that, some day, they might also be considered for the Nobel Prize, in Literature (Wallace, 1962: 198). Yet, in 1937, Wagner-Jauregg nominated the 81-year-old Freud for the Nobel Prize in Physiology or Medicine for his “work on pathological psychology” (Nomination Database, 2014a). A year earlier, Romain Rolland had actually nominated Freud for the Nobel Prize in Literature among 27 candidates for the 1936 prize (Nomination Database, 2014b), which ultimately went to Eugene O’Neill. Wagner-Jauregg favored a “somatic” (organic or biological) approach to psychiatry and had little interest in the new psychological approaches. Nonetheless, he allowed a number of his staff to moonlight as psychoanalysts, as long as such activity would not impinge on their daily duties at the University Clinic. Furthermore, in 1922 he supported the creation of an outpatient psychotherapy 14 clinic at the suggestion of Erwin Stransky (Freis, 2017). In contemplating some of the long-term sequels of National Socialsm on the Vienna school of , it becomes evident that the life stories of the Wagner-Jauregg alumnae told here lead us to conclude that Freudian and Adlerian elements endured in their commotion and may have even defined to a certain extent the frontiers of psychological therapy from the American northeast to the boundaries of eastern Asia.

Acknowledgments The author gratefully acknowledges the help with archival photographs from Dr. Ruth Koblizek, Bildersammlung Josephinum, Medical University of Vienna.

Disclosure Statement The author reports no proprietary or commercial interest in any product mentioned or concept discussed in this article. 15

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Captions for figures

Figure 1. Group photo of Wagner-Jauregg’s clinical staff in Vienna, 7 November 1927. This is a slightly different pose from the version presented by Adler (1965) and deposited at the National Library of Medicine. Courtesy of Bildersammlung Josephinum der Medizinischen Universität Wien. Used by permission and protected by Copyright Law. Copying, redistribution or retransmission without the author’s express written permission is prohibited.

Figure 2. Upper row, left to right: Alexandra Adler (1901–2001), Fanny Halpern (1899–1952), Edith Klemperer (1898–1987). Lower row, left to right: Annie Reich (1902–1971), Lydia Sicher (1890–1962), Edith Vincze (1900–1940). Credits: National Library of Medicine (A.A.); Grau (2014) / SFU Archives (2015) (F.H.); Bildersammlung Josephinum der Medizinischen Universität Wien (E.K.); Reich (1973) (A.R.); Davidson (1991) (L.S.); photo shared by N. Laszlo on www.ancestry.com, 12 August 2017 (E.V.). Copying, redistribution or retransmission without the author’s express written permission is prohibited.

Figure 3. Edith Klemperer’s patent for a three-dimensional anatomical model of the brain and nerve tracts, for purposes of instruction, with luminous tubes and strip-like lamps of various colors. Source: www.google.ch/patents/US1951422.