Dr. Austen Fox Riggs
I
IT is strange to meet a man long after he is dead.
Now he is part of many of my pleasures. This, I find myself saying, Austen Riggs would also like; or, that he would have blasted as pure poppycock. He is in me now; he is a firm part of my conscience.
But at the beginning I was puzzled as to why it should be I who was to write of him. I never knew him; his science was not mine. Better, I still incline to think, that a colleague, a fellow townsman, at least a patient, should tell of Dr. Riggs. Yet of me it was asked. Letters, pictures, tributes, the medical treatises and the expositions for the layman written by the doctor, the tattered pocket journal in which through thirty years he jotted notes, were put into my hands, and these I got by heart. At the last there came to my desk a volume of my own writing, An Almanac for Moderns; fluttering the leaves, I found the margins lively with notations in the doctor’s hand. Curious, I settled down to read them.
At once I encountered a mind of immense strength, limberness, tirelessness, resourcefulness. Here was the trained and tempered skepticism I like most. But now I met it in friendly tussle. On nearly a hundred of my pages the doctor has a bone to pick, claps me on the shoulder, or murmurs an aside. ‘I didn’t know the Veery was Wilson’s thrush — how do you do!’ Concerning springhouses and my love of them, he answers, ‘Yea, brother — and best of all, they can’t very well be collected.’ Genially he puts in a word of his own about the nature of fireflies’ light and autumn coloration. His voice is in my ear as he argues with me over what the dragonfly sees with his thousand eyes, and the tactile sense of bats — the tactile nature of all senses, as acutely he points out. On teleology we see eye to eye. ‘Muddled, conceited, self-protective thinking,’ he calls it; and to my delight cries out, ‘What good is science, anyway, without the man behind it? What a necessary luxury it is for the scientist to think emotionally!’
This was an hour surely rare in life, in which I held intimate colloquy with a friend I never knew. I realized now why I might make so bold as to attempt the sketch of one I never saw. I recognized the man of science who unbends to popularize that science because he believes — as I do — that science is the property of the many. This, of course, is one way to offend the high priests who would keep their mysteries well covered.
To some of these I talked about him. ‘Riggs of Stockbridge?’ Always then the nod that confirms success. Sometimes, too, a sidewise smile and the words ‘personality’ and ‘fashionable.’ Fashionables who were his patients I have also questioned. Some talk of Riggs as if he had been God — which both amused and annoyed him intensely, since the whole aim of his work was to make the maladapted strong in themselves. One, a banker who went up to Stockbridge and successfully got over a breakdown, was asked when he got back if he had noticed the handsome fish in the doctor’s aquarium. ‘Notice them?’ He shook a puzzled head. ‘I spent two thousand dollars talking about those damn goldfish!’
That was a story Riggs told with hilarity. Of what he did for the patients, roughly one in four, who paid nothing for his treatment, he told little. How much such treatment of the suffering cost him, in effort, I glimpsed through one of his secretaries who saw it — saw how he would come into the office through even those last hard months, lean for a moment on his hand against the desk, then brace himself and enter smiling to the patient. To him Riggs would give, for unstinted hours, of science, sense, and the stuff of his own soul. They tell me that if you met a patient on the way to Riggs’s office and asked him where he was going he was likely to say, ‘I’m on my way to the powerhouse.’ But Riggs snorted when his powers were put down to personality, insisting on the value of his therapeutic methods and the theory at their base. That now, after his death, the Austen Riggs Foundation still flourishes is the best proof of his contention.
Yet. that personality was so impressive I sense it like a presence in the room. I see the handsome figure, in which the athlete masked the onetime invalid; the brown eyes searching a thought intently; the foot shut in a desk drawer as he tipped back, rocking, dictating; the large, capable, fine hands that touched the papers on the desk before him or played with the folding tortoise-shell glasses on the black ribbon around his neck. Most of all I am conscious, as I write, that over my shoulder looks the man who jotted in his notebook, ‘Honesty is more than a policy. If it is only a policy, it is not honesty.’
All right, Doctor, you shall have no blind eulogy. Tolerant as you were, forgive unwitting errors in these pages. You were the man who also said, ‘Truth, thank God, differs from accuracy. It is largely a matter of intent.’
And intent, was to Austen Riggs the whole point. When one more of the thousands of pilgrims to the little town of Stockbridge, nestling amid its Berkshire hills, sank into a chair facing the physician he had crossed a continent to seek, he met a question in those friendly, brown, intensely focused eyes.
‘Why have you come to me?’ the doctor asked.
‘Because I want to get well, Doctor, I want to get well! ‘
‘That,’ said Dr. Riggs startlingly, but with a warm smile, ‘doesn’t interest me. Why do you want to get well ?’
For ‘the great purpose of life is to live it.,’ as Austen Fox Riggs loved to quote Justice Holmes. And purpose in life was the guiding star which he helped the storm-tossed to find. ‘Happiness,’ he told them, ‘is only a by-product of successful living.’ That such living could be taught was his major demonstration. You can call his teachings psychotherapy, or inspired common sense on a medical basis. But those whose broken lives he mended know that he got them to their feet morally as well as physically. If a patient couldn’t stand on his own feet, Riggs held him up by brotherly strength, and compelled his spirit to learn all over again, or perhaps for the first time, how to walk like a man.
These were people like you and me, whose troubles had got the better of them — ‘psychoneurotics’ is the professional term. Dr. Riggs undertook to cure only the essentially normal in mind, those whose functioning had become disordered through troubling thought. They came into his office worn by pain, haunted by fears, — of insanity, suicide, death, — or literally paralyzed, perhaps, even blinded. To such lengths can a tortured psyche drive even the normal. Schoolteacher and society woman, bank clerk and big business man, they came to Stockbridge shaken, shattered, sometimes desperate; to be met with that warm smile, that strong handclasp, and finally, ending their dread, the diagnosis: ‘You’re just mixed in your thinking.’
For over thirty years, at first in a shamefaced trickle, the stream of patients came flooding to the door of Austen Riggs, six thousand or more of them. Even the sufferer who had not a cent left after his ticket to Stockbridge was bought was treated there none the less. More, those who could not pay even for lodging were guests at the inn — where no sanatorium atmosphere ever prevailed — at the expense of the Riggs Foundation. Sometimes a patient was ‘taken into the family,’ as the doctor put it to his children, in the hospitable Riggs home.
They came to Stockbridge halt in spirit, perhaps in body; they departed upright, walking in the strength of selfconfidence. Across the thirty-odd years of his devoted service their gratitude to Austen Riggs comes blowing to us: ‘I am helped and strengthened by his sentence, “Without fear there is no real courage.”’ ‘Something he once said will never be forgotten: “Is it the pain you mind, or something it stands for?” That was an eye-opener.’ ‘His words were a candle to show me the way: “There is nothing in your mind that you need be afraid to think about.”’ At parting, happy patients would say, ‘You’ve cured me!’ But Riggs would shake his head. ‘No,’ he corrected them, ‘you’ve cured yourself. I only showed you how to understand.’
For the basis of his therapy was reeducation. Body and mind are indivisible, he held, and mind must lead. As far back as 1908 he laid the cornerstone for his life work: ‘The concept of psychophysiological unity is the basis of enlightened monistic philosophy, and is the only concept, which agrees with and is supported by the laws of nature.’ Seeing man thus whole, Riggs also scrutinized his parts. He was teaching, just a few years later, that a person functions upon four levels, — the reflex, the instinctive, the intelligent, and the ethical, — all based in his anatomical structure. The elements of mood and temperament complete the picture of an individual. The individual plus his environment, Riggs liked to put it, equals adaptation or maladaptation. Out of the latter rise the problems loosely catalogued as ‘nervous,’ the psychoneuroses sometimes so elaborately cloaked by resulting physical ills. Austen Riggs undertook to bring such sufferers to health not only by physical treatment but by so educating them concerning themselves that by their own ‘clear, straight, skeptical thinking,’ to use a favorite phrase of his, they could adapt themselves successfully each to the conditions of his own life.
No treatment could have less in it of ‘faith healing,’ or of the hand-patting indulgence offered the fretful rich by some ‘fashionable doctors.’ Yet anybody with a grain of normal human irritability in him knows that such treatment would be utterly unacceptable and ineffective if it were not powered by genuine sympathy in the practitioner. Of such sympathy, unsentimental but glowingly vital, Austen Riggs possessed a great humanitarian’s boundless fund.
II
It has been said that every great institution is the long shadow of a tall man. To understand the success of the Riggs Foundation one must look well at the man behind it. Austen Fox Riggs was born on December 12, 1876, son of a doctor, and married the daughter of Charles McBurney, the surgeon famous for ‘McBurney’s Point,’ that exact spot on the abdomen for making the most economical incision in appendectomy. These ties may well have helped in causing him to shape his innate sense of responsibility to others into a medical career which from the first promised brilliantly.
At Harvard (where he did not work especially hard) he was carried to enthusiasm at least by William James, whose Pragmatism was to bear fruit at Stockbridge. Riggs enjoyed also walks and talks with Santayana. For the rest, he was happiest in the activity and companionship of that life. He went out for rowing, and became an expert and graceful fencer, showing already those marked gifts for rhythm and precision which presently appeared in a faculty for clog dancing and a fondness for drums; the busy doctor liked to put records of Sousa marches on the phonograph and interpolate his own percussions and drum breaks. At Harvard he sang in a Hasty Pudding show, and all his life enjoyed exercising his good baritone in Negro spirituals. From the time of boyhood vacations on the coast of Maine, he was a passionate sailor, loving nothing more than a good boat, ropes and rigging, and the smell of the sea. True beauty, he was wont to say over the ship model he was carving, lies in the perfect relation between structure and function.
Graduating from Harvard with the class of 1898, Riggs entered Columbia medical school. Now he saw his way clear; now he buckled to, scholastically, winning the Harsen prize. He became engaged to Alice McBurney; the courtship was swift and untroubled except for a short time before their marriage in 1904, two years after his graduation from medical school. For a time it seemed to the dismayed young woman that her lover was actively avoiding her. His absences were explained when he brought her a wedding ring made with his own hands.
It was many years from that moment to the day when he was to build a handsome shop for occupational therapy at Stockbridge. But the germ of the idea was there. Riggs was one of the first to see that handcraft is a health builder, for he practised it early on himself. He was a master craftsman, from the making of perfect ship models and his own bows and arrows to the design of fullscale boats with a naval architect.
The young doctor seemed to fly up the rungs of the ladder to medical fame and fortune. He was successively interne at Presbyterian Hospital, special worker in pathology and medicine at Johns Hopkins, assistant instructor at Columbia medical, assistant in medicine at Vanderbilt Clinic, assistant in the rich and fashionable practice of Dr. Walter B. James in New York City — all in the space of a few short years. The way was open now to the very top. Young Riggs had driving interest, intense concentration, enough of worldly ambition both for the good things of life and for the highest rewards of honor. No one doubted his ultimate triumph in that city of towering successes.
But the eager young doctor had taken one final straw on his load — work as attending physician at the House of Rest for Consumptives. Perhaps in those days precautionary measures were not so carefully taken. Slowly he began to suspect; he took a look through his own microscope, then, hoping against hope, sent in the specimen, with that of a patient, to the bacteriological laboratory. That evening he was called to the phone; the voice from the laboratory told him that his own sample was positive. ‘Oh, yes,’ his wife heard him say calmly, ‘but about that other specimen?’
The glittering career was cut short. Riggs dragged himself with his young family away from the promise and cheat of the great city, to the farm of his wife’s family up in the Berkshires, at Stockbridge. There, as the winter of 1907 wore into the chill New England spring, he lay outdoors, in his invalid’s wrappings, looking at his life before him, that seemed to be broken off, a stump. He read, too, the works of the few who at that date had fumbled along the labyrinth of the human mind. He read William James again, James who says that when your emotions are aroused you should do something with them constructively, even if it’s only being pleasant to your old grandmother. He read Freud and Charcot, the hypnotist of Paris, and perceived that, while suggestion was a vital method in therapy, actual hypnosis might be most dangerous in practice and was certainly of very limited use.
So, pondering, accepting, discarding, he began to think his own thoughts about the still very young science of psychiatry. He began to remember, too, all the cases he had seen that had not yielded to merely physical treatment. That woman, now, who had entered the hospital with — so the doctors suspected — duodenal ulcers. They had treated her, until they could at least pronounce to their own satisfaction that she did not have any ulcers. So she was discharged as cured — and went home to die, of self-administered poison.
Austen Riggs began to see light — the light that was to lead him the rest of his life, and illumine the darkness of thousands of fellow sufferers. He began to see how he, then crippled in physique, could help to carry the crippled in spirit. Lying there in the painful patience that he must endure, he saw that he was to be always at the mercy of treacherous and disabling enemies to health. But in morale he was a giant, and a young giant still.
At that time the torment now called psychoneurosis was not widely recognized for the malady it is. The sufferer was often damned as either morally or mentally deficient.. Riggs always had respect for the ‘old family doctor’ type of physician who perceived through homely good sense that a patient’s troubling thoughts were bound with his physical ills, but the science of psychotherapy was still largely unexplored, and Austen Riggs became one of its pioneers.
His work began right there in Stockbridge, a town of two thousand souls. Some of them were troubled, and with them Austen Riggs began his great work of reëducating the nervously disordered, for intelligent living. As he gained strength and confidence — in time he became a figure of impressive vitality — he opened an office also in the neighboring town of Pittsfield, a rapidly growing industrial city, where he spent two crowded days of his week and where later a clinic was established by the Foundation. Now, hearing rumors of his successes, former colleagues in New York began sending Riggs the kind of patient that needed him. People came from Boston, from Chicago; at last from all over the country they were beating a path to his door. Because, in the days of his work’s beginning, people were ashamed to admit to ‘nerves,’ since a ‘breakdown’ meant to many either a piece of sissy self-indulgence or indication of incipient insanity, men of position, women of society, in those early days came to Stockbridge secretly for the help they needed.
There came, too, patients who desperately required the doctor’s help but had not enough money to stay in Stockbridge for it. One day in 1914, as a patient was leaving, she said, ‘Here is a little check for you to use so that someone who otherwise cannot afford this treatment may have it.’ And she gave him fifty dollars. This was the inspiration that began the Austen Riggs Foundation. The ‘discretionary fund’ thus started has been kept active, without solicitation, for over a quarter of a century; from it Riggs drew for his patients’ crying needs, sometimes even 1o buy a dress for one, for another to pay that overdue grocery bill which in sickness had become a nightmare.
III
The Foundation itself is a non-profitmaking corporation. The profit made by the inn from patients who can pay, added to by private subscription, makes the fund which carries those unable to pay. In the first twenty-one years after the establishment of the Foundation, more than 6000 people had enjoyed the hospitality of the inn and the benefits of the occupational therapy shop. Approximately one quarter of these patients, or nearly 1500, had been treated absolutely free and supported during their treatment.
And Stockbridge, at first suspicious of the Foundation lest it might be some sort of newfangled ‘booby hatch,’ grew proud at last of the institution that came to make it famous. In the doctor himself the village early recognized a good neighbor. It could thank him for gathering its tradesmen into a chamber of commerce, for founding and encouraging a Boy Scout troop, serving on the school board, fighting for better conditions for the children. When anyone in town wanted a thing fixed, from a broken heart to a broken ski harness, he took it to the biggest and busiest man in town, the doctor.
From this elm-shaded village rayed out an influence that has bettered innumerable lives. The method of treatment evolved by Riggs is one of frank discussion with the patient, the doctor seeking to understand the patient’s life and personality and to bring him to self-understanding and self-help. But not only during their stay at Stockbridge were these patients Riggs’s concern; out of about a thousand cases, for instance, 25 per cent would stay less than three weeks, half of them less than five weeks, 75 per cent less than seven. And after their departure into the fray of their personal lives, touch was not lost; they were encouraged to write concerning their problems, and in return were sent letters of guidance and helpful analysis.
Coincident with the reconstruction of the patient’s mental attitude goes medical care, with diet and exercise, of course, playing their part. But the essence of the therapy evolved by Austen Riggs is that mind must be the master. Even sleep can be achieved by intelligent habits of rest. If you do not sleep, it is because you have not learned to rest, for insomnia, is only a symptom of restlessness, and it is this which must be cured. To this end, four habits of life are emphasized in the Stockbridge teaching: that of balanced living, with work, play, and rest all in proportion; that of living in the present; that of accepting reality; and that of directing one’s energies with useful purpose. Days so spent will tend toward peaceful sleep; as the doctor tersely puts it, ‘Once conquered through understanding, insomnia should not recur, for to err is human, but to repeat the same mistake in the face of knowledge is idiotic.’
‘Sleep,’ he taught, ‘is of small relative importance. . . . Rest is the foundation upon which all normal sleep occurs, and it is directly and voluntarily obtainable while sleep is not. . . . One rests when one ceases trying . . . the very spirit, of rest is acceptance. No philosophy is realistic enough to rest upon unless it includes a doctrine of frustration, for there is always the past to regret and the future to meet.’
Here is a tonic doctrine, surely, but pure of bitterness and infused with an elixir of courageous purpose. You taste the essence of that in a jotting from his private notebook: ‘Lincoln was great, not because he started life in the squalor of a log cabin, but in that he left it.’ Always there is this emphasis on choice. We need not, if we choose, become the victims of our nerves, for, says Austen Riggs, ‘Nervousness is not a disease but a disorder . . . simply a maladjustment on the part of an otherwise perfectly sound, essentially normal person, and therefore it is avoidable.’
Easily said? And done, if not easily, at least by intelligent, effort. To avoid a ‘nervous breakdown,’ Dr. Riggs leaves us ten commandments, here abbreviated: —
1. Neither run away from emotions nor yet fight them. Accept them as the wellsprings of all action. They are your automatically mobilized energies. Force these energies into the channels of your choice ... it is like guiding spirited horses.
2. Be efficient in what you do. Do not drive your tacks with a sledge hammer. Find out how easily you can do things well, and take pride in such skill.
3. Do one thing at a time. Only thus can we practise concentration. I do not mean that violent overdramatization of effort, but the gentle art of controlling the attention.
4. Make clean-cut practical decisions, subject to change in the face of new facts or additional knowledge.
5. Do not accept hurry as a necessary part of modern life. Quality of work, not quantity, spells success, and quality is destroyed by hurry.
G. Worry is a complete circle of inefficient thought whirling about a pivot of fear. To avoid it, consider whether the problem in hand is your business. If it is not, turn to something that is. If it is your business, decide if it is your business now. If so, decide what is best done about it. If you know, get busy. If you don’t know, find out promptly. Do these things; then rest your case on the determination that, no matter how hard things may turn out to be, you will make the best of them — and more than that no man can do.
7. Keep work, play, rest, and exercise in their proper relative proportions; not only in the space of decades, but year by year, month by month, week by week, day by day.
8. Shun the New England conscience. It is a form of egotism which makes a moral issue of every trivial thought — nothing better than worry about self.
9. When a decision has been reached, when something has to be done, waste no time in ‘getting up steam — just do it.
10. Accept the material of life. Do not criticize your part in the play, study it, understand it, and then play it, sick or well, rich or poor, with faith, with courage, and with proper grace.
Always the tone is manly, and always the note is hopeful. Long before the phrase was coined, ‘Be glad you are neurotic,’he was encouraging people not to be ashamed of their illness and teaching the sensitive to understand and use this quality which, misused, caused their suffering. ‘We could hardly imagine a Christ or a Lincoln without exquisite sensitiveness as well as a high order of intelligence.’
So he calls upon the best in all of us, not denying the natural emotions in each. Of course you’re afraid, said Riggs, to the man who stood in real danger. Not until you are afraid do you have a chance to be brave. Of course you’re jealous, said Riggs to the woman who was afraid of losing her husband. Use the drive of that jealousy to make yourself so understanding and charming that he’ll never leave you. Of course you’re angry, of course you’re blue. We aren’t responsible for the surge of our emotions, any more than for feeling heat or cold. But—and here the kindly and humorous friend is the stern teacher too — we are responsible for what we do with them.
So, at last, is discoverable the secret of this doctor’s power. In himself, for all the genial steadiness with which he met the world, lay the torturing emotions with which his patients struggled. He was great because he had found out how to use them. He knew the rack of suffering, the gall of frustration, consuming angers, black depressions, the mood swings that shake a man to the soul. But these he mastered, employed as tools for understanding others, for teaching them to understand themselves.
In the notebook in which for years he jotted down his private thoughts, I found this entry: —
To feel every quality from the vilest to the best, in one’s own individuality, really and honestly to feel the shame of the disgraced, the joy of the happy, the sorrow of the oppressed, is to love and understand humanity, and forever to renounce the doubtful privilege of sitting in judgment. The sorrow of knowing that there is evil in the best is far outbalanced by the joy of discovering that there is good in the worst.
Accept reality, was this man’s cry. Take the truth to your breast. Put it to work. Make a good thing of your life, whatever it lacks. There is no perfect success, no absolute failure. However hard the fact, accept it. As to how to deal with it, your spirit has always the High freedom of choice.
Having defeated the inroads of one fatal malady for more than thirty years, Austen Fox Riggs succumbed on March 5, 1940, to a more painful and hopeless one. Dying, he lamented only that he would not be able to put his shoulder under the bogged-down life most lately brought to him. But the way of life he had worked out for thousands did not die with him. In his own words, penciled in the private notebook, it is put thus: —
A WAY OF LIFE
To accept with courage and gratitude the debt we owe all men and women whose lives have made this a world of better opportunity. . . .
To live fully, taking eager advantage of the opportunities these lives have given us, by making such contributions to welfare and happiness as we may, so that in the short span of our own lives a little at least of that debt may be repaid. . . .
For the best and most lasting success, the real success of life can be, must be, written only in terms of service.