I think that we need to reevaluate our participation in the treatment of the chronic or long term serious mentally ill individuals who require more than medication. In my travels, to many countries throughout the world, training, teaching professionals and treating these unfortunate individuals, I have seen that any faith these mentally ill individuals had in life was diminished by the over dependence of the professional on medication.

The Anne Sippi Clinic and Foundation is named after Anne Sippi who was a heroic person who responded to treatment after many years of illness. The successful treatment begins, with the treator making contact with the patient by any means at his/her disposal (I am quoting Harry Stack Sullivan, Martin Grotjahn and a host of distinguished contributors). This contact which leads to a therapeutic alliance, makes it possible for both the therapist and the patient to work together to achieve the goals set forth in treatment by both the patient and the therapist.

I will begin by discussing Anne Sippi’s history. Anne was born January 22, 1952, her birth was one month premature; she weighed 4 pounds 8 ounces. Anne’s mother believed occurred because her doctor put her on a crash weight reducing diet at the end of the pregnancy. Anne was in a premature nursery for three weeks before coming home. She seemed normal, and her development for the first year was normal.

When Anne was one year old, her parents moved to a street where there were many other children. Anne was afraid of the other children and backed away from them. Her mother’s efforts to make her more comfortable about this were not successful. At the time, Anne did crib rocking.

Anne did not talk until she was two and a half years old. At four, she held her hands over her ears in nursery school. The school recognized that something was wrong and recommended a psychologist, who told Anne’s mother that it was “too late” - she should have been seen when she was two! In kindergarten, Anne still held her hands over her ears. She also hit other children. She spent a second year in kindergarten. At 6, she was placed in a special education class in a public school. She started piano and violin lessons at this time.
At 13, Anne saw a psychiatrist at the insistence of the school. She was diagnosed as schizophrenic and given Mellaril. The diagnosis was meaningless to Anne’s parents, because they knew nothing about the illness, were told nothing, and did not know what questions to ask.

Anne entered junior high school. She took up the viola, mastering the new clef without difficulty. She played in the school orchestra, enjoyed coloring, painting by number, dancing to rock music, and taking long baths. Her relations with other children had not improved; she crossed out the pictures of children’s faces in the school books. She had no friends.

At 15, Anne entered public high school. She played in the orchestra. She began to seriously withdraw, going to bed at 6:00 P.M. each evening. A psychiatrist recommended that she be sent to a residential school for the retarded, where she stayed for 10 months. When she came home, she was badly regressed. At age 17, Anne would wander off from home. She was afraid of cars. Her parents tried to hospitalize her, but were unsuccessful. She began to see a psychiatrist four times a week, and had additional sessions with his nurse to “socialize” her. After one of these sessions, she and her mother returned home to find that her father had killed himself, in retrospect, it seems likely that Anne’s father also had a severe psychiatric illness. He suffered from mood swings and had been hospitalized several times. But the family had faired even worse in getting useful information about his illness than about Anne. He was never given a definite diagnosis.

Anne’s condition did not improve, and in 1973 at the suggestion of a friend, Anne started treatment with an Ortho Molecular Psychiatrist, Dr. Harvey Ross. She did not progress on the vitamin treatment. Her behavior was often assaultive, communication with her was nearly impossible, and her prognosis was very poor. It seemed as if she was slated for custodial care. Her doctor recognized the need for urgent intervention lest her destructive behavior cut her off from further help. In September of 1974, he recommended that she begin psychotherapy with me. In making this move, Dr. Ross set the stage for the creation of the Anne Sippi Clinic.

When I first met Anne, she was a patient at a small private psychiatric hospital. At this time, she was delusional, and she heard the voices of her dead father and other people from her past and talked back to them. She talked to plants. She was self-mutilating as well as assaultive, and was in restraints 70% of the time. When I first saw Anne, on the patio of the hospital, I said to her: “I hear that you bite people and tear their hair! Well, I do, too!” Anne was taken aback by this.

I decided that Anne was treatable on the grounds that I was able to get a response from her, and a person who can respond, can become responsible. I suppose that my method echoes that of the 19th Century “moral treatment” psychiatrists who place emphasis on whether or not they could “catch the patient’s eye”. Having been assured that I could catch and hold Anne’s attention, I believed that she could progress, but didn’t know how much.
At this point, Anne’s vocabulary had shrunk to a few words: “Oh,” “Okay,” “Yes,” “No.” Her affect was flat and she appeared to be retarded, but when she was angry, she came to life.
Anne now entered “marathon therapy”. She was seen seven days a week in sessions lasting from 45 minutes to 2 hours, at intervals throughout the day. Whenever I had any free time, between my other patients, I would go to the hospital (which was next door to my office) and “go after” her. After three weeks of this treatment, Anne showed some fear and apprehension about what was happening. There was less acting out. She was moved from the closed ward to an open ward of the hospital. She started to come out of her room from time to time, and she stopped assaulting people. At this time, I effected another modality of treatment which was rather unique at that time in the history of treatment. I think it was one of the earlier expressions of psychosocial rehabilitation. I engaged two individuals Chess and Leora Brodnick who joined the treatment team and they started to work with her on a daily basis. They took her for the day after my opening session with her. They reintroduced her to the world. They took her to parks, beaches, restaurants, the May Co. etc. They often took Anne to their own apartment. Anne was now more often angry, and used more words, instead of the rigid yes, no type answer, she how began to argue and converse. She seemed very quick and sharp and lost her retarded demeanor.

At first, Anne was very happy to go on the outings with Chess and Leora, very complacent about her good fortune. She was only anxious occasionally. She was doing so well that it was thought that she could be discharged from the hospital. Anne had other ideas. In February 1975, she precipitated a scene in the May Co., screaming and pulling her hair. Chess and Leora were forced to call a security guard to help them get Anne out of the store (and to make it clear they were not maltreating this poor child !). Anne went to her home where she seemed to be all right for two or three weeks and even helped with the house work. I called on Saturdays and Sundays to see how she was fairing; the rest of the week, Chess and Leora picked her up and brought her to the clinic as usual.

Both conceptually and on a feeling level, Anne began to understand the consistency and determination of her therapists in bringing her back into the world again. Her resistance stiffened, and she now refused to come out of the house voluntarily to go to the office. She demonstrated that she could throw up at will (which she did with great effect at the dinner table). She began to urinate everywhere; in her bed, in the car, in the office. I stopped this by putting some lemon juice in a paper cup, cornering her and telling her that I was going to force her to drink this “pee” if she didn’t mend her ways. She stopped this, but began to put the cat’s feces and food under her pillow and to defecate in the shower. These maneuvers made her so uncomfortable and seemed so half hearted that they were ignored and she soon stopped. On one occasion when her family was planning to go out without taking her, she ripped an earring out of her ear. On another occasion, she rode her bike to the beach, was picked up by the police and taken to county hospital. Finally, Anne disappeared from a family outing at the beach in her bikini and stayed away for three days. This caused the desire to mount of consternation to her family and her therapist, who wondered if they had lost her forever. However, she turned up three days later, having met a nice young couple who had given her some clothes and a bus pass. She returned to the hospital for one year.

The therapeutic battle now began in earnest. Anne had a topsy-turvey set of values: “fun” was screaming, hitting, and upsetting others; “punishment” was going to the movies or to the park. She spoiled any fun that she might have had. She spoke of herself in the third person and avoided any responsibility for what happened to her. She used other people only to act up against them and get them to put her away. Her therapist worked to reverse this: Anne had to get to the point to take the responsibility for what happened to her, rather than experiencing herself only as someone who was acted upon, for good or ill, by the outside world. She had to be made to feel that she could make her own fun. She had to be intrigued, made curious, seduced with the delights of the outside world, so that she would see it as a possible source of good things for her. The pattern of institutionalization had to be broken.
Anne had to be taught that she had to control her own impulses confrontation therapy helped her understand that this had to happen. She developed a healthy respect for the therapeutic authority! Anything remotely “good” in her behavior was now generously rewarded anything bad was rigorously suppressed. She was not allowed to act badly. Chess worked on getting Anne to say why she did things. He questioned her about everything: “why did you say that? why did you do that?” so that she would begin to feel that she was making choices whether she admitted it or not.

By the end of 1975, Anne began to show some interest and concern for others. She found that she could inspire people by being nice to them, instead of feeling that she could only inspire them by acting crazy, frightening them, or inducing piety. In June, 1976, plans were made to move Anne from out of the hospital to a board and care home this was not intended to replace her treatment but merely offer her an alternative to the hospital so that she could continue her treatment with me and my assistants. She was taken three times a week to her new home in order to get used to it. She was frightened and all her earlier behavior returned, but she was told that no matter what she did, she would be leaving the hospital. The move was made in due time, with Anne angry and acting out (“I’m mad! I’m mad! I want to go back to the hospital!”), but there was no regression. She had special aides for six months, but gave them up without difficulty. She now acquired a by weekly tutor to help her with her educational deficiencies.

In March 1977, Anne was moved to a smaller board and care home, along with other patients from the clinic. (I should tell you that at that time the clinic was a day care center). Therapy directed Anne to other people telling her to ask them questions and talk with them. Anne began to have a social life. Her controls were now better, and she made no attempt to be rehospitalized. A few months later, she was moved to a still better board and care home, once again with other patients from the clinic. On the first day, she said “I like it here.” And she put her clothes away. Anne no longer thought it normal to be crazy. She viewed critically the newly arrived patients who were still acting crazy and said they are “weird”. She then felt guilty about having used other people, especially her mother, to control and confine her. She brought her viola to the clinic and played it there.

She was and continues to be an inspiration. In 1978 the Anne Sippi Clinic a residential treatment center was named after her. She was a teacher of therapists. The valiant struggle of the treatment group overcoming her resistance and helping her find a way out her schizophrenic lifestyle has made it possible for many individuals to benefit from the efforts that she and her treatment team made together.

Tragically she developed a heart condition and suffered a fatal heart attack more than 20 years after her treatment began with me.

Like Helen Keller, Anne Sippi found herself in a pattern of immoral and ungratifying behavior in response to a perceptual catastrophe. Anne Sullivan, Helen’s teacher realized that Helen’s worst problem was not that she was deaf and blind, but that no one any longer expected her to behave like a human being. Her first move, accordingly, was to establish her moral authority with Helen and make it clear that she cared too much for Helen to allow her to behave like an animal. If this involved physical fights on the floor of the Keller dining room, so be it. Helen got the message and began to cooperate with the teacher who eventually freed her from her solitary existence.

Anne Sippi got the message too. That we would not allow her to slip away into craziness. Having a schizophrenic illness does not require that anyone acts crazy, any more than being deaf and blind requires that one takes food from other people’s plates. Direct Confrontation therapy, like the “moral treatment” of the 19th century and like Anne Sullivan’s method with Helen Keller, has as its premise that a person who is behaving in a crazy or subhuman fashion would like to stop doing that and join the human race, but does not know how. It is the therapists’ task to find ways of getting the crazy acting person out of this bind.

We had been told that Anne Sippi was a “nuclear schizophrenic,” that she was retarded, that “her synapses will never come together.” We believe that the only proper use of diagnostic terms is to tell the person and his/her family what they are up against, where they can get help, what experts are available to them, what research is being done. In stead many of the professionals who saw Anne labeled her, and the meaning of those labels was all too clear: you are a headache, get lost, we don’t want you here, nothing can be done to help you. What we saw when Anne was alive at the clinic that was named for her, she had made a great deal of progress and we considered her potential future growth unknown and unlimited. We feel that way about people who are individuals with a long history of schizophrenia and the severe mentally ill.

Until we meet again,
Jack Rosberg

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