A Belated Obituary: Raphael J. Osheroff, MD

On March 20, 2012, a death notice appeared in the New Jersey Star-Ledger: “Dr Raphael J. Osheroff, 73, passed away in his sleep. He was beloved by his countless friends, colleagues, and patients.”¹

Grateful patients signed the online guestbook, 10 in all. Columbia College and Creighton University School of Medicine, which Dr Osheroff attended, mentioned his passing in single sentences. While searching online, I uncovered Osheroff’s articles published in medical journals; his letters to the editor about crossovers between psychiatry and nephrology; and even his letter to the editor of the American Journal of Psychiatry, rebutting the expert witness who testified against him in his lawsuit against Chestnut Lodge.²

No official obituary surfaced, which surprised me, given Dr Osheroff’s significance to psychiatric practice in the 1980s. For many, Dr Osheroff’s situation personified the changes that swept psychiatry at that critical juncture. He successfully sued the much-storied bastion of psychoanalysis because Chestnut Lodge offered psychoanalytic approaches only, without prescribing medication, even though Dr Osheroff’s mental and medical conditions deteriorated during his 7-month hospitalization. A successful nephrologist who owned 11 dialysis centers before entering Chestnut Lodge, Dr Osheroff reportedly paced relentlessly, slept little, and lost 40 pounds. His analyst pressured him to regress, to peel away his presumed narcissistic personality disorder. Eventually, his mother arranged his transfer to Silver Hill Hospital in Connecticut, where his symptoms remitted after a mere 3 weeks of treatment with medications. He was discharged 3 months later.

Dr Osheroff’s passing nearly went unnoticed by the psychiatric community, although his attorneys discussed Osheroff vs Chestnut Lodge at the American Academy of Psychiatry and the Law (AAPL) meeting in 2012.³ Chestnut Lodge, in contrast, remains etched in our memories, even though it did not survive as long as Dr Osheroff did. The Lodge closed in 2001, a victim of managed care’s shortened stays and tenacious adherence to treatment techniques that did not withstand the test of time. Chestnut Lodge employed psychoanalytic legends, including Harry Stack Sullivan and Frieda Fromm-Reichmann. Fromm-Reichmann and Chestnut Lodge are immortalized in the semiautobiographical novel, I Never Promised You a Rose Garden, by Joanne Greenberg (under the pen name Hannah Green).⁴

About a year after Dr Osheroff’s death, almost to the day, Psychiatric Times published an illuminating article written by their Editor-in-Chief, James L. Knoll IV, MD.⁵ In the article, titled “The Humanities and Psychiatry: The Rebirth of Mind,” Dr Knoll traces late 20th-century gyrations in psychiatric approaches, connecting these changes with Osheroff vs Chestnut Lodge.

Dr Osheroff’s court case attracted attention through its all-star cast, whose names and affiliations included Gerald Klerman, MD, Harvard professor and Director of Research at Massachusetts General Hospital; William Z. Potter, MD, PhD, Chief, Section on Clinical Psychopharmacology, National Institute of Mental Health; Frank Ayd, MD, Professor of Psychiatry, West Virginia University Medical Center, and pioneer for the use of chlorpromazine (thorazine); Donald F. Klein, MD, DSc, Professor of Psychiatry, Columbia University, and Director of New York State Psychiatric Institute; and more. These titans indicted traditional psychiatry at the same time that they testified on behalf of the physician-turned-patient/plaintiff, Dr Osheroff.

Osheroff’s case proved that psychiatry was a house divided. Civil war waged as Harvard Professor Dr Alan Stone attributed Dr Osheroff’s recovery to a better therapeutic alliance with his new psychiatrist, rather than to medications alone. Dr Klerman⁶ argued that “the issue is not psychotherapy versus biological therapy but, rather, opinion versus evidence.”^6,7 The hallowed walls of psychoanalysis were tumbling down. “Evidence-based medicine” became our buzzword.

In reality, psychiatry was already changing course and veering into turbulent waters, in the very year that Osheroff entered Chestnut Lodge: 1977. In 1977, then-president of the American Psychiatric Association, Melvin Sabshin, MD, urged psychiatrists to “return to their medical roots.” In 1980, DSM-III appeared.⁸ In an earnest attempt to encourage a more scientific psychiatry, DSM-III delineated diagnoses carefully, omitting the metaphorical language and mythical allusions of psychoanalysis. Dr Osheroff filed suit 2 years after the publication of DSM-III. His attorneys reached an out-of-court settlement in 1987. The 1990s were dubbed the “Decade of the Brain.”

Dr Knoll’s article details Osheroff’s clinical condition, highlighting the stressors that possibly contributed to his depression, as well as the nuances of his clinical care. A hyperlink leads to the AAPL presentation by Osheroff’s attorneys³ [for a pdf, please click here]. Yet it makes no mention of Dr Osheroff the person, nor does it mention his passing-perhaps because he lives forever via the legacy of Osheroff vs Chestnut Lodge.

Raphael Osheroff’s Facebook page remains eerily alive, with a book cover as his personal photo. The title, Finding Our Fathers: How a Man's Life Is Shaped by His Relationship with His Father, is intriguing, although enigmatic.⁹ The fact that the author of the book is a Harvard psychologist, Samuel Osherson, PhD, begs for psychodynamic explanations.

In searching for more information, I spoke with Philip Hirschkop, Esq, Dr Osheroff’s one-time attorney. He recalled that Dr Osheroff was devastated by the loss of contact with his sons during his hospitalization, just as he was demoralized when locked in wards with “incurable” schizophrenics, where his self-esteem was intentionally attacked. Above all, the attorney focused on Osheroff’s psychological plight, even though economic losses were impressive. Mr Hirschkop added that Dr Osheroff had hoped to write a book about his experiences and expected the book to turn into a movie. Interestingly, IMDB icons appear on that archived Facebook page, presumably because 2 of his sons are actors who appeared in the television series, Law & Order. There might be a movie yet.

Acknowledgements: Special thanks to Philip J. Hirschkop, Esq; Jonathan R. Mook, Esq; and Rabbi Ben Goldstein for help with researching this article.

References:

1. Dr Raphael J. Osheroff [Obituary]. The Star Ledger. March 20, 2012. http://obits.nj.com/obituaries/starledger/obituary.aspx?pid=156595347. Accessed June 24, 2013.
2. Osheroff RJ Comments on the Klerman-Stone Debate n Osheroff v. Chestnut Lodge.Am J Psychiatry. 1991;148:142-a-142. http://ajp.psychiatryonline.org/article.aspx?articleID=167341. Accessed June 24, 2013.
3. Hirschkop PK, Mook JR. Revisiting the lessons of Osheroff v. Chestnut Lodge. Presented at AAPL, Montreal, October 2012). [for a pdf, please click here].
4. Greenberg J. I Never Promised You a Rose Garden. New York: New American Library; 1964.
5. Knoll JL. The humanities and psychiatry: the rebirth of mind. Psychiatric Times. March 15, 2013. http://www.psychiatrictimes.com/forensic-psychiatry/humanities-and-psychiatry-rebirth-mind. Accessed June Accessed June 24, 2013.
6. GL Klerman, The psychiatric patient’s right to effective treatment: implications of Osheroff v. Chestnut Lodge. Am J Psychiatry. 1990;147:409–418. http://ajp.psychiatryonline.org/article.aspx?articleid=166680. Accessed June 24, 2013. 7. Oldham JM. Psychodynamic psychotherapy for personality disorders. Am J Psychiatry. 2007:164:1465-1467. http://ajp.psychiatryonline.org/article.aspx?articleid=98993. Accessed June 24, 2013.
8. American Psychiatric Association. DSM: History of the Manual. http://www.psychiatry.org/practice/dsm/dsm-history-of-the-manual. Accessed June 24, 2013.
9. Osherson S. Finding Our Fathers: How a Man’s Life Is Shaped by His Relationship with His Father. New York: Ballantine Books; 1986.