Ira Glass
Act one, "Burning Down the Couch." OK, so at any point in the last four decades if you've felt depressed or anxious, or for any other reason you decided to see a psychiatrist, there's a Rest of the Story story behind the treatment they offer. It's the story of a man named Ray Osheroff. He was a psychiatry patient in 1979 whose case was part of turning the entire field of psychiatry into what it is today. He became famous, or maybe I should say notorious, among psychiatrists.
Ray died over a decade ago, but one of our producers, Chris Benderev, has been digging into what happened. Here he is.
Chris Benderev
Let's begin with how a lot of psychiatrists would tell you the story of Ray Osheroff. It starts in the mid-1970s when life was good for Ray. He was a doctor, a kidney doctor, with a successful pair of dialysis clinics in the DC area. He lived in a gorgeous house in a swanky part of northern Virginia with his new wife. They had a baby on the way.
But then he descended into what we'd call today a mental health crisis. What set this off were two decisions Ray made. First, Ray sold off his ownership stake in his clinics. He'd continue to be the top doctor there, but he didn't want the stress of running them anymore.
And second, Ray had an ex-wife. And this ex-wife asked him if she could take their two boys to Europe for a year. Her new husband's job was sending him there. And Ray said OK. But Ray came to regret both decisions, felt he'd thrown away his business and felt he'd abandoned his two boys. He spiraled into a deep depression.
Rachel Aviv
He becomes increasingly repetitive almost. It was like he was stuck in these thought loops.
Chris Benderev
This is Rachel Aviv. She's a staff writer for The New Yorker. There's a chapter in her latest book about Ray.
Rachel Aviv
And he couldn't stop replaying all of his missteps. And that led him to a state of feeling suicidal, and his wife felt like he needed to be hospitalized.
Chris Benderev
Ray picked one of the most esteemed psychiatric hospitals in the country, Chestnut Lodge in Rockville, Maryland. Ray didn't know much about the Lodge. But he'd heard of it because it'd became famous as the basis of a best-selling novel called I Never Promised You a Rose Garden. The book uses different names for the main character and the location, but it basically tells the story of the author's own experience as a patient at Chestnut Lodge.
Rachel Aviv
It was about this young girl. And essentially, over the course of a year the most famous analyst there brings her from a state of psychosis to being almost entirely recovered.
Chris Benderev
The Lodge believed you could fix even serious issues by taking time to really talk them out and dissect them.
Rachel Aviv
Like you need to address whatever is causing your anguish. And through the patient listening of the analyst, you'll finally understand what is causing your illness.
Chris Benderev
It's kind of a beautiful idea. It's like you take this respite to understand yourself.
Rachel Aviv
Yeah, it felt like such a humane approach to mental illness and the spirit of optimism.
Eric Caplan
And on January 2, 1979, Ray is driven to Chestnut Lodge.
Chris Benderev
This is Eric Caplan, a historian of psychiatry who's writing a book about Ray. Eric says Ray checked himself into the Lodge expecting to be there two, maybe three months at the most. But winter turned to spring, and Ray was still inside. Eric spoke with a friend of Ray's who went to visit him around that time.
Eric Caplan
He told me Ray was this incredibly well-groomed person who only used to wear bespoke suits. And here he goes to see his friend, and he arrives, and he can't believe his eyes. Ray's hair is down to his shoulders. He's bedraggled. He's lost now 40 to 45 pounds. So none of his clothes fit. He can no longer use a fork and knife. His fine motor skills had deteriorated, so he would eat with his hands.
Chris Benderev
Eating with his hands?
Eric Caplan
Was eating with his hands.
Chris Benderev
Ray had lost his dexterity and so much weight because he was in a constant state of agitation, couldn't stop pacing around the ward, ruminating about his failures as a father and a businessman.
Eric Caplan
He would pace up to 10 hours a day, eight to 10 hours a day. So his feet became blistered and infected to the point that he needed now regular treatment from a podiatrist.
Chris Benderev
Clearly, whatever they were doing at this premier psychiatric hospital was not working for Ray. And Chestnut Lodge's failure here is what this story is about, how professionals should treat mental illness. The Lodge believed fervently in old-fashioned psychoanalysis. They were fans of Sigmund Freud. When a patient arrived, they'd take an extremely detailed history. They interviewed Ray's mother extensively, learned about his tumultuous childhood, how his father mostly wasn't around, and how when he was he'd explode at Ray and belittle him mercilessly.
The Lodge believed so strongly in classical psychoanalysis that it usually wouldn't pair it with psychiatric medications. Whether a patient had depression or schizophrenia, the Lodge used drugs sparingly. So when Ray asked for antidepressants, which by 1979 would have been common in a psychiatric hospital--
Eric Caplan
They explained to him, no, we're not going to give you any drugs. And the direct quote that he's told by the ward administrator, a guy named Wesley Dingman, was, "You're going to need every neuron you have to fight this disease."
Chris Benderev
And so the Lodge continued with its treatment-- lots of psychoanalysis, no antidepressants. And Ray continued to unravel. Sometimes he'd hit himself. Other times, he'd pick fights with the other patients. And of course, he kept pacing. The Lodge did get Ray to calm down somewhat when they threatened to strap him down in ice-cold bed sheets for hours, something they were known to do with unruly patients.
In the Lodge's own internal notes, Ray's doctor admitted that Ray's symptoms weren't improving. But no matter. Their approach would be slow and steady. At one meeting, Ray's doctor said, quote, "If he does stay in treatment for five or 10 years, he may get a good result out of it." Another doctor said maybe Ray could switch to being an outpatient after three years. As best I can tell, the Lodge did not inform Ray about this timeline. Again, here's Rachel Aviv.
Rachel Aviv
I think that is the assumption that's so insulting, that it's OK to just take a decade out of your life to be a patient who learns to understand yourself better.
Chris Benderev
Ray's mother, who was horrified at her son's deterioration inside the lodge, eventually checked Ray out and transferred him to a treatment center in Connecticut. There, he was finally prescribed antidepressants and other psychiatric medications. Once that happened, Ray's pacing lessened and eventually stopped altogether. By his 10th day, his depression and numbness began to lift. Here's an archival recording of Ray.
Ray Osheroff
I think the first change I noticed in myself was that I could experience the feeling of sadness. What I had experienced before was different from sadness. And so one day when I woke up, I thought about, my God, I haven't seen my kids, oh, in a year, and then I started to weep. That is the first time I recall crying during that period of time.
Rachel Aviv
There's a Jane Kenyon poem that describes when you take antidepressants, you suddenly feel like you've been forgiven for a crime that you realize you didn't commit. I think it is such a profound moment where all of these obsessive thoughts suddenly don't feel necessary anymore. There's just space in your brain. And that seems to be what happened for him.
Chris Benderev
Within three months, Ray was back to his old self-- well groomed, cracking jokes. He went home to Virginia. But it had been almost a year, and a lot had changed.
For one thing, Ray's ex-wife had gone to court to change their custody agreement. And because Ray was locked up at the Lodge, he'd lost his visitation rights with his kids. Meanwhile, Ray's new wife, who'd already moved out with the baby, was now divorcing him. And finally, when Ray returned to the dialysis practice that he'd helped build, the doctor he'd left in charge decided to open a competing office in the same building.
Rachel Aviv
He felt like he had lost everything. He lost his children. He lost his wife. His house was empty because his wife had taken all the furniture. His patients followed this doctor to the new business, so he didn't have enough patients to fill a day of work.
Chris Benderev
And now he knows because he went to two very different psychiatric hospitals that like, oh, maybe I could have just been gone for less than two months.
Rachel Aviv
Yeah, exactly. And for him, that was infuriating.
Chris Benderev
And this is the part of the story that Ray's known for because he leapt into action to get back what he'd lost, like Uma Thurman in Kill Bill or Liam Neeson in Taken, if those revenge movies had taken place in Virginia and Maryland civil court proceedings. First, Ray petitioned to get back his visitation rights with his kids and got them. Then he sued his former colleague for undermining the business and won. And finally--
Arbiter
This is the health claims arbitration case of Raphael J. Osheroff v. Chestnut Lodge et al.
Chris Benderev
He sued Chestnut Lodge for malpractice. Ray's legal team argued that the Lodge had harmed him professionally and personally by withholding antidepressants and instead trying to break him down during countless therapy sessions. Here's one of Ray's lawyers describing how unusually harsh the Lodge doctors were.
Lawyer
The therapy, you'll hear, was confrontative. And I'm quoting now. I'm not making this up.
"Cut the shit, Ray. You're symbolically dead. You'll disappear off the face of the earth. No one else wants to hear from you. The only person who feels guilty about what happened to you is your mother. The rest of the world could care less. Take a tin cup and go beg on Connecticut Avenue if things are so bad for you."
Chris Benderev
Chestnut Lodge defended itself by saying they believed Ray's depression was secondary to deeper underlying issues which they had to fix first. The lawsuit dragged on for years. And as one professor put it, Ray's case was, quote, "discussed in every academic department of psychiatry in North America." Because on one side you had doctors like the ones at Chestnut Lodge. And on the other side, rooting for Ray, were a lot of psychiatrists who felt places like the Lodge had made their profession look reckless and out of touch, who worried their fellow doctors had basically forgotten the M in MD.
And in 1987, Chestnut Lodge settled and paid Ray an undisclosed amount of money. He later said it was around $350,000, nearly a million dollars in today's money. In essence, Ray won. Afterwards, psychiatrists everywhere were put on notice. Now, if they didn't at least offer medication when the evidence showed it could help, they might get sued too.
Ray's case is not the only reason that when you walk into a psychiatrist's office today you are far more likely to be offered pills than a Rorschach test, but it contributed to that shift. In the late '80s and early '90s, Ray's case was written about in big academic journals. He spoke at psychiatry's biggest annual conference. The Philadelphia Inquirer and The New York Times wrote about the case.
Then in 1989, The Washington Post wrote a long feature about Chestnut Lodge and Ray. It ended by saying he'd found love again and reestablished relationships with his three sons. The reporter wrote that Ray, quote, "feels lucky that he's been able to work his way back to normalcy." And Ray basically became lore.
Rachel Aviv
The way that I confronted the story, like in textbooks-- I had read an obituary of him in 2012, was he won this case. It represented the triumph of biological psychiatry. We can no longer deprive people of medications they need. And he lived happily ever after. And that's pretty much where the story ends. But that's just not what happened.
Chris Benderev
The truth is it was not happily ever after. The simple story that the meds made him better, it wasn't that simple. Here's the rest of the story.
By the time Ray died in 2012, in terms of family at least, Ray was largely alone. He'd been divorced four times, and he'd been estranged from all three of his children. So what happened? What went wrong?
Obviously, I couldn't ask Ray directly. But in a memoir he later wrote, he made it pretty clear who he thought was responsible-- Chestnut Lodge. Quote, "By destroying every facet of my personhood, they deprived me forever of love and any possible measure of security and satisfaction that I could ever gain thereafter. They amputated my past, deprived me of a future."
In that memoir, which was never published, Ray writes that he'd had an idyllic relationship with his sons. They'd bond during car rides. He'd give them baths and gently tuck them into bed at night.
Then came the move to Europe, his depression, and, most importantly, Chestnut Lodge. After all that, he wrote, it was too late to salvage a relationship. The thing is, Ray's kids don't see it that way. Here's Sam Osheroff, Ray's oldest son.
Sam Osheroff
So I think there are two truths. I think he was maltreated at Chestnut Lodge. I think he should have sued. I think what happened to him was a tragedy. Yeah. And he did lose things to that. But I would say that even if my father had never gone through that acute depression and went into Chestnut Lodge, he still would have been in the same position at the end of his life.
Chris Benderev
Sam says his dad wound up cut off from so much of the family because of problems with his behavior that predate his time at Chestnut Lodge and his spiral into depression, and even his kids moving to Europe. They were there from as early as Sam can remember.
Sam Osheroff
As a child, you don't know what that means to be mentally ill, but you can certainly sense it, yeah. And it pervaded everything.
Chris Benderev
What do you mean by that, pervaded everything?
Sam Osheroff
I think every interaction with him, every overnight visit, it was off. Everything was off. Things were weird and tense. And yeah, I don't remember ever a moment of relaxation with him. I think he carried around an enormous and unrelenting amount of rage with him at all times.
Chris Benderev
Was it scary? Like did you did you worry about him focusing it on you?
Sam Osheroff
Yeah. I never worried about him-- OK, here's an incident. I remember once we were spending the night at his house. And I had a friend spending the night. And as you do when you're eight, you stay up, and you laugh, and you read comic books.
And he came in and started screaming at us to go to bed. And he opened the door and slammed it, and then opened it and slammed it, and opened it and slammed it. He must have done it 25 times. So that's the kind of rage. And yeah, that's, you know. I wouldn't say it was directed at me. I was the unlucky recipient for being in the wrong place at the wrong time and doing something innocuous that happened to set it off at that moment.
Chris Benderev
Sam and others say that Ray was always quick to anger and just aggressive. Sam's stepdad told me that Ray once threatened to have him killed by a hit man, said Ray told him he'd figured out exactly how much the job would cost. And the thing is, even after Ray got out of Chestnut Lodge, got on meds, won his visitation rights back, and became semi-famous for his miracle cure, his sons say that he kept doing the same kinds of disturbing things that he'd done before he'd been hospitalized.
Like this one time in 1987, Ray was trying to rebuild his relationship with Sam and his younger brother Joe. The boys had developed an interest in theater, so Ray took them to a show at the Kennedy Center in DC. Joe says his dad was sometimes really generous in that way.
But then during the show, Ray's beeper started going off over and over. Remember, he's a doctor. Multiple times, Ray got up, shuffled down the aisle, and took the calls. Here's Joe.
Joe Osheroff
This thing was so loud, this beeper. It would reverberate off the walls. So at the end of the show, we're in a sea of audience members trying to leave the theater. And someone said, hey, next time, leave your beeper at home. And he said, lady, I hope your mother gets sick as shit someday and nobody comes to take care of her. And he didn't just say it under his breath. He was screaming it at her.
Chris Benderev
What do you and Sam do during a moment like that?
Joe Osheroff
Oh, we walked 50 feet ahead of him all the way to the parking lot.
Chris Benderev
Huh.
Joe Osheroff
Even as I talk about it now, I get butterflies in my stomach.
Chris Benderev
For his sons, Ray was still just as uncomfortable to live with as he had been before the Chestnut Lodge saga. They did notice one thing had changed about their dad though. He began talking often about how because of what he'd gone through at the Lodge, he was on his way to becoming a household name.
Sam Osheroff
He would hint. He'd say, this incredible thing happened to me. You wouldn't believe it. I'm writing a book. It's going to be a movie. I've talked to these producers. It's going to be the biggest movie of the year.
Chris Benderev
Ray gave Sam and Joe the latest draft of his memoir. As time went on, their relationship with their dad became more strained. And they say Ray started directing more of his anger at them. For Sam, this all came to a head a bit after he'd graduated from college.
Sam Osheroff
He actually stood up in the middle of a restaurant and began screaming at me. And at that point, I walked out of the restaurant. And I had no idea where I was. I don't think I had more than $5 on me at the time. And eventually found my way to some relative's house, spent the night there. The next morning, rented a car, drove home, and I did not see him again for many, many years.
Chris Benderev
Joe cut off contact with Ray around the same time. Joe and Sam say Ray's third son, who they haven't heard from in 30 years, cut off contact with their dad even earlier. I reached out to him, but did not hear back.
These parts of Ray's personality that persisted after getting out of Chestnut Lodge and getting on meds, they actually came up in the lawsuit because the Lodge had a theory to explain them.
Lawyer
Can you explain what is meant in psychiatry as the narcissistic personality?
Manuel Ross
Features will include grandiosity, absorption with self, shallow, brittle relationships with other human beings, and very--
Chris Benderev
This is Ray's former doctor at the Lodge, Manuel Ross.
Manuel Ross
Those features would define a narcissistic personality disorder.
Lawyer
Did you arrive at an opinion as to whether that was involved with Dr. Osheroff?
Manuel Ross
Yes, I thought there was no doubt about it.
Chris Benderev
Now, I should say over a dozen psychiatrists were deposed for the lawsuit. And there was disagreement over whether Ray would have met the clinical criteria for narcissistic personality disorder when he was at the Lodge. Some said no. Some weren't sure. Some thought he had some kind of personality disorder. Some said the depression made it hard to tell. But some, like Dr. Ross, were sure.
Manuel Ross
I felt that the narcissistic personality disorder had been an enduring feature of his life that had dogged him, that led to repeated difficulties with people in his life and essentially compromised his ability to lead a successful and rewarding existence.
Chris Benderev
Was Dr. Ross' diagnosis correct? I've tried to answer that question definitively, and I'm still not sure. But for whatever it's worth, I did read Ray's memoir, and here's what I can say.
It does not read like a memoir. It reads like a disorganized, 500-page screed against a lot of the people he worked and lived with. He retraces his downfall over and over, each time with new conspirators working against him. And the tone is grandiose.
Ray writes unironically that he'd been a, quote, "king on a very shaky throne," whose success had drawn a host of predators. He'd been duped by, in his words, "vengeful wives" who'd introduced "avowed enemies" and "Trojan horses" into his dialysis practice in order to destroy it. Ray also rails against the lawyer who won him his settlement money against Chestnut Lodge because Ray felt he deserved millions more. In the book, Ray's greatest ire is saved for Chestnut Lodge though, who subjected him to a, quote, "one-man holocaust."
In 2010, Ray reached out to Sam on Facebook after years apart. He wanted to meet up. Sam's first child had just been born.
Sam Osheroff
And I thought, well, this will be interesting. Maybe this will be a chance to introduce him to his granddaughter and perhaps we'll find some sort of way to move forward here. So we decided to meet in a town about 45 minutes away. And I remember it was a restaurant, and we were outdoors. So we must have been outside at a picnic table.
Chris Benderev
Sam says his dad looked older and seemed gentler. He didn't raise his voice at all. But once they got their food--
Sam Osheroff
It was like no time had passed. He picked up exactly where he left off. He was, again, obsessed with the Chestnut Lodge thing, obsessed with his book. And that's all he really wanted to talk about. He didn't really ask questions about my life, didn't really ask about his new granddaughter, just launched right back into the same old stuff as if we hadn't missed a decade together.
Chris Benderev
And when he see-- I mean, this is his granddaughter. How does he react when he sees her?
Sam Osheroff
Well, I think he was happy to meet her, and he cooed over her a bit, but then pretty much directly afterwards went straight back into his spiel. You won't believe this. You have to read the new version of it. It's going to be a movie. And I know the rest of the however many hours we spent together was spent with him talking about himself and his Chestnut Lodge experience, and his book. And this is, what, 30, 35 years after the fact.
Chris Benderev
I mean, you told me he handed you a copy of his manuscript of his book when you were a teenager, and he's basically doing the same thing again.
Sam Osheroff
He brought another copy and gave me another copy.
Chris Benderev
He brought a copy of the book?
Sam Osheroff
Yep.
Chris Benderev
And it sounds like you did go in hoping maybe it'd be different.
Sam Osheroff
Yeah. I mean, I think you always have that hope with a living parent until you can't anymore, that there can be some sort of way to salvage some part of a relationship. So it was pretty disappointing.
Chris Benderev
I want to clarify that not everyone experienced Ray this way. For instance, a couple long-time friends of Ray's told me that he was definitely not a narcissist devoid of empathy. For one thing, as a doctor he cared deeply about his patients, sometimes helped pay their rent or fund funerals. And one of Ray's friends told me he was a good listener, someone that she could vent to for an hour uninterrupted. This friend believed Ray had other kinds of mental disorders though and admitted that he could get, quote, "obsessional," especially about the Chestnut Lodge ordeal, which colored the rest of his life. He was a great friend, she said, but probably somebody who was very difficult to live with.
Whatever ailed him, Ray did seem to know that there was something wrong with him. All his life, he kept receiving psychotherapy and various medications. He even did electroshock therapy. But it never seemed to help with his closest relationships. I put all this to Rachel Aviv.
Chris Benderev
Reading about Ray and learning about Ray, he does make me think of certain people I know. And I think maybe we all know people like this who are just difficult. And it's just like they can't seem to change. And I don't know. I find myself interested in that because I don't know what they're supposed to do or what we're supposed to do if they're kind of truly unchangeable.
Rachel Aviv
Yeah, I think everyone knows someone a little bit like him. And I think the really hard thing is that there isn't actually a good cure for that.
Chris Benderev
Right. There isn't a pill that we give for that.
Rachel Aviv
No. And that feels like a challenge to the project of psychiatry, that there are people who have personality problems, but that are not that receptive to treatment.
Chris Benderev
If Ray did have a personality disorder, it's worth noting that they are, as the American Psychological Association put it, notoriously hard to treat. It's funny. The story that Ray's best known for is a hopeful one. The moral is meds can help us. Psychiatry can help us.
But when you look at the whole arc of Ray's life and see what his family saw, and how he ended up, that story falls apart. Yes, meds can help. But if anything, Ray's life shows the limits of what psychiatry can do for us, how some of us have problems that psychiatry still has a hard time defining and an even harder time trying to fix.
Ira Glass
Chris Benderev is a producer on our show. Rachel Aviv's book that features a chapter on Ray is called Strangers to Ourselves. Eric Caplan is looking for a publisher for his book about Ray's case. It's called Do No Harm.
Coming up, you get to a certain age with your parents and what could they ever do to surprise you? What cards could they still hold up their sleeve? One man finds out in a minute from Chicago Public Radio when our program continues.