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.
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
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
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.