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FIRST PERSON

Psychiatry and Neurology, From Paris to Rikers Island

By Alan Rainess '57

When I matriculated at Columbia in 1953, giants walked the brick pathways of Morningside Heights. Moses Hadas taught freshman Humanities, John Herman Randall ’18 taught the “History of Philosophy,” Charles Frankel taught philosophy and Michel Rifaterre taught a seminar on French drama. What I learned then formed the foundations of how I think today. But then I was a pre-med who was wet behind the ears, wondering why uncovering the meaning of life had to include mastering the anatomy of the fetal pig.

Alan Rainess ’57 and his wife, Maree.

I entered medical school in Paris, much taken with the readings I had done in my Columbia French classes. There was no tuition in France, which made Paris a magnet for students from all over the world. I made the rounds, taking the prescribed clinical rotations in hospitals around the city. I studied neurology at the Salpetriere, where Freud attended Charcot’s lectures. My psychiatry professor was Jean Delay of the French Academy, whose discovery of the use of chlorpromazine opened the era of biological psychiatry.

I returned to New York and began seeing Maree, a head nurse at New York Hospital, whom I met while I was an undergraduate and she was a student at Saint Luke’s School of Nursing. In those years, the doctor draft was a reality. I was called in January 1967 and sent to Fort Sam Houston in San Antonio for indoctrination as a military doctor. My first assignment was to the U.S. Army Hospital in Heidelberg, Germany. Maree and I married in Switzerland in 1968.

In Germany, I treated soldiers who had been drafted from all over the country. Some were remarkably young and unworldly. There were old veterans too, some of whom had fought in Korea and World War II. I met men who had survived Normandy, battles in the Pacific and battles with Jim Beam.

During 23 years as a military physician, I held administrative and clinical positions in Texas, Alabama, Arizona and Washington. I practiced psychiatry and neurology and held faculty appointments in both specialties. I was elected president of the Uniformed Services Society of Neurologists as well as a distinguished Life Fellow of the American Psychiatric Association.

I retired from the Air Force in 1994 as a colonel. Interested in a new career, I began working at the Manhattan Psychiatric Center on Ward’s Island. Shortly after I arrived, an escapee pushed a woman onto the subway tracks. There had been escapes throughout the years, but this one made it clear that drastic changes in the hospital’s administration were needed. All civil admissions were stopped, but paradoxically forensic transfers continued. The result was a shift in patient demographics from elderly, chronic patients to a younger, violent, criminal population, and a new treatment program had to be created. I was asked to step in as clinical director, but after two years, I returned to patient care, having had enough of conflicting interests.

After I retired from New York State in 2002, I remained interested in the psychiatric treatment of patients in jail. I decided to explore the subject of correctional psychiatry and was offered a job at Riker’s Island.

There are 10 jails at Riker’s Island, housing up to 16,000 inmates. I work in the Otis Bantum Correctional Center. Some inmates are confined to cells that they may leave only for an hour a day. It has been called “a jail within a jail” because it is where inmates are sent after committing crimes in less restrictive Riker’s housing.

On the whole, my patients are glad to see me. I try to help them reconstruct their autobiographies. It is salutary for them to listen to their words and see currents and themes connecting isolated experiences.

Most of my patients have been dependent on street drugs. Some have committed violent felonies. Some are sexual offenders. Some are murderers. Some are masters of deceit. Others are of limited intelligence. Not long ago, I asked a man in his 20s charged with two murders how he came to be a hardened criminal. He said: “When you’re raised with wolves, you become like them.” Most of the inmates are raised by one female parent — their mother or grandmother — and say the women don’t know how to raise boys. They are given too much freedom. I ask them if their sisters are criminals, too. They say no. The sisters are clerks, health aides, even corrections officers. I discovered that often the successful siblings have different fathers, and usually, my patients are the offspring of a particularly disliked partner. Their mothers say to them, “You’re just like your father. You look like him. You act like him.”

The Correctional Punitive Segregation Unit is not the place to practice insight-oriented psychotherapy; these patients have never met anyone like me. I provide a novel form of identification for them — a new ego ideal. But, as Freud said, first comes the transference. It is important to maintain objectivity and to remember during psychotherapy that the patients’ behavior and demeanor with me is no doubt different from that prior to their incarceration.

I have witnessed the closing of many mental hospitals and the failure to provide community-based alternative care. The result has been the conversion of the prison system into de facto mental institutions. When I became a psychiatrist, psychoanalysis ruled. While both patients and psychiatrists were being psychoanalyzed — including me — I always was fascinated by the patients. I still love to listen to them and to try to see what they were searching for in their starless winter nights.

Alan Rainess ’57 graduated from the Faculty of Medicine of Paris and is a psychiatrist at Riker’s Island. He is listed in Who’s Who in America, Who’s Who in the World and Who’s Who in Medicine and Healthcare. He and his wife, Maree, have a daughter, Alice, a social worker, and had a son, James Alan, who passed away in 1981.

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