In previous blog posts, we took a deep dive into the problematic psychosomatic literature on cancer. In the 1950s, psychoanalytic researchers argued that people developed cancer because they repressed their emotions or, in the case of women with breast cancer, because they rejected the feminine role. One of the psychiatrists involved, Dr. Richard Renneker, wrote a revealing testimony in 1957. It provides a rare glimpse behind the scenes of psychosomatic research.
“We were biased researchers”, Renneker wrote. “Biased in the sense that we believed, on the basis of our preliminary study of cancer of the breast, that there was a psychological trigger factor in some cases. Our disregard of cancer knowledge was appalling…” In this blog post, we take a closer look at Renneker’s remarkable paper.
The Institute for Psychoanalysis
Dr. Richard Renneker was a research psychiatrist working at the Institute for Psychoanalysis in Chicago. The Institute was created in 1932 by the famous Franz Alexander, one of the founders of psychosomatic medicine. Dr. Alexander initiated a new approach where psychoanalytic concepts were applied to somatic diseases. Rheumatoid arthritis, colitis, diabetes, heart disease, and many other conditions were studied through a psychosomatic lens. For a long time, however, cancer remained a remarkable exception.
Our main character, Dr. Renneker, was part of a research team at the Institute for Psychoanalysis led by Dr. Catherine Bacon. They were pioneers in studying the personality and emotional background of cancer patients and worked in collaboration with Dr. Robert Cutler of the Chicago Tumor Institute. Together these researchers published one of the first scientific studies on the psychosomatic aspects of cancer. Forty patients with cancer of the breast were examined, using “the sort of dynamic evaluation which Alexander and his co-workers have popularized.”
Their method consisted mostly of interviews and psychoanalytic interpretations of anything that seemed unusual. Renneker and colleagues listed the behavioral abnormalities that, in their view, characterized their cancer patients: a masochistic character structure, inhibited sexuality, inhibited motherhood, an inability to deal appropriately with anger, and a general hostility covered by a façade of pleasantness. The researchers confidently claimed that they had “developed a ‘feeling’ for a malignant history.” Their findings were published in the journal ‘Psychosomatic Medicine’ in 1952 and would frequently be cited by researchers studying psychosomatic aspects of cancer later in the century.
The approach of a charlatan
Renneker and colleagues believed that the “disturbances” they had described were related to the development and growth of cancer. They offered their cancer patients psychoanalytical psychotherapy, but it seems that few were interested. As one of their papers explains:
“One of the difficulties in securing subjects for the study was caused by the patients’ apparent lack of interest in psychological therapy. Most (94 per cent) of the Tumor Institute subjects to whom therapy had been recommended declined, with only 3 accepting treatment.”
Six percent is a very low response rate, and it seems that this frustrated the researchers. “…the difficulty in finding patients who would agree to psychotherapy”, they wrote, “suggests that the most masochistic women were excluded as they preferred to keep their neurotic problems.”
In the 1950s, a psychosomatic approach to cancer was new and controversial. The illness was often a death sentence, even more than it is today, making speculations about a masochistic character structure or inhibited sexuality, rather inappropriate. Pioneer Lawrence LeShan testified how much resistance there was to psychosomatic research on cancer: “It was often stated that even to investigate this area was the approach of a charlatan!” During a 1966 conference on the psychosomatic study of cancer in New York, Dr. Morton Reiser, chair of the panel discussion, highlighted the ‘bravery’ of another pioneer “because many people wondered, when they looked at the title of the paper, whether he was serious about it or not.” This is the background to the remarkable testimony of Dr. Renneker.
Facing the idea that our therapeutic efforts might be in vain
Renneker admitted that his research team started with the premise that, in some cases, cancer had a psychogenic cause. “We were biased researchers”, he said. “Biased in the sense that we believed, on the basis of our preliminary study of cancer of the breast, that there was a psychological trigger factor in some cases. Our disregard of cancer knowledge was appalling.”
The need to believe in a psychosomatic cause was strong. Otherwise, their efforts would be useless. As Renneker explained:
“We were convinced that it could be a psychosomatic disease, but we had little idea how and why this came about. This need to believe the psychosomatic connections in cancer and its vulnerability to psychoanalytical treatment was an early universal reaction designed to avoid facing the idea that our therapeutic efforts might be in vain.”
Negative results meant failure as a therapist
An interesting aspect of Renneker’s testimony, which was published in Psychosomatic Medicine in 1957, is that it explains how researchers felt pressure to find results that fit well into psychosomatic theory. “Each analyst had a narcissistic investment in the outcome of the analysis”, he explained. “This involved the need to perform well because of the importance of being thought well of by his fellow analysts and by the Institute.”
In other words, researchers needed to get the results they wanted, otherwise, it would reflect badly on them as if they let the team down. Negative results were blamed on the researcher’s incompetence. As Renneker explains:
“When your patient developed a recurrence or a metastasis, your dream shattered. It meant that you had failed somehow as a therapist. We tended within the group to substantiate this by silently blaming the analyst. We communicated this to each other by look and corridor intimations. This came about because we had to believe that our therapeutic goal was possible. The patient’s personal tragedy of cancer return threatened our therapeutic orientation; thus, to preserve it we had to explain the outcome by feeling that if the analyst had handled certain things differently, the result would have been changed. The unfortunate analyst, whose patient took an unexpected turn for the worse, thus actually received quiet censoring from the group as well as from himself.”
Nobody wanted negative findings. Renneker captured this idea in one elegant sentence when he wrote: “we denied the uncontrollability of cancer with the belief in our therapeutic powers.”
When something did not go as planned, the patient, not the therapist or treatment, was to blame:
“You must defend the omnipotence since it is a nuclear defense within your own organization. This can only be achieved by distortion of reality—denial of cancer progression, projection of the blame to the patient who is not trying hard enough, hostile provocation of the patient into stopping therapy, or else you can stop yourself with the major rationalization that the patient does not need help anymore.”
Responding to the therapist’s need to cure
His testimony goes on to explain how researchers could easily influence their patients to give them the answers they wanted. This is an interesting point because it remains an issue in psychosomatic research to this day. Renneker understood that the problem is not so much that the researcher willingly tries to manipulate the results but that test subjects easily pick up on his intentions. They then play along in the direction they suspect the researcher wants to go. Or as Renneker phrased it, they responded to the therapist’s need to cure. He wrote:
“The analytic investigator is in a particularly favorable position unconsciously to influence the field under investigation, so that the desired positive results are obtained. There are usually no external controls upon him and so the positive transference patient, desiring to please, can pick up the ingredients of the analyst’s pet theory for the thing under investigation and play it back to him as raw data. Many alleviations of somatic stress come about as “temporary transference cures” and not for the reason the analyst might believe. Failure to follow up the case leads to failure to challenge the cause-and-effect hypothesis. With such positive transference patients sometimes respond to the therapist’s need to “cure” the disease by playing down severity of physical symptoms.”
Renneker highlighted how strong the need was for ‘positive’ results. He wrote:
Research persons in all fields must be viewed as biased investigators whose unconscious motivating needs are best satisfied by positive results (i.e., successful research). The researcher trains himself to accept negative results (i.e., unsuccessful research) but they are not sought after, nor do they produce satisfaction.”
Elsewhere he phrased this idea more dramatically: “You dreamed of being a successful explorer. You said that you were prepared for negative findings, but who wanted them?”
There is some obvious disillusionment and frustration in Renneker’s words but it does not seem that he wrote his testimony to attack his colleagues or the psychosomatic approach in general. He published his testimony in 1957 but submitted a paper on “Psychoanalytical Explorations of Emotional Correlates of Cancer of the Breast” five years later. The most likely explanation for his unusual account is that he wanted to apply psychological analysis, not only to patients but to psychosomatic researchers themselves. In our view, this makes his paper all the more interesting.
We were unable to find much about Renneker’s further life and career. He seems to have stopped publishing scientific papers and moved with Franz Alexander to the Mt. Sinai Hospital in Hollywood. He continued to work with cancer patients and gave lectures on the psychological and psychosomatic aspects of cancer.
We also found an unusual newspaper account from 1960 where he was mentioned. While Dr. Renneker was having a swordfish dinner on vacation, a man threatened to kill himself by jumping off a tall building. A crowd gathered around the desperate man. A catholic priest walked towards him, but his help was not accepted. Dr. Renneker, however, took a different approach, and shouted:“you’re ruining my dinner, you know that?” The man then came down and was escorted by the police. Perhaps Dr. Renneker was just an unusually upfront man. “I lied to that fellow up there,” he told journalists. “My dinner isn’t ruined. It’s only cold.”
Dr. Richard Renneker passed away in 1995 at the age of 75. His obituary in the Los Angeles Times noted that “professionally, he will be remembered for his pioneering research on the non-efficacy of psychoanalytic therapy, therapeutic communication, and emotions and cancer.”
Read our series on the dark psychosomatic history of cancer here: