Delving Into the Core of the Self

Yale University Press has just published “Life Is With Others,” a collection of essays written by the late Donald J. Cohen and various colleagues. Cohen, who succumbed to cancer in 2001 at the age of 61, directed the Yale Child Study Center for nearly two decades, conducted pioneering research into autism and Tourette’s Syndrome, and helped craft social policy, which included early work on the Head Start program and a collaboration between Yale psychiatrists and the New Haven, Conn., police to assist children exposed to violence. Cohen, who also forged research alliances with scientists throughout the Middle East and Europe, was remembered at his funeral as the son of Joseph and Rose from Chicago, of Moshe and Molly from Berditshev, Ukraine, and of Mashie and Avrum from Bialystok, Poland.

The memorial volume of Cohen’s work was edited by Yale child psychiatrist Andrés Martin, who is Cohen’s son-in-law, along with longtime Yale colleague Robert A. King. I met with the co-editors on a rainy day, in Martin’s office at the Yale Child Study Center.

MUL: The volume — from its title to the concluding essay by Donald’s son, Matthew — places a heavy emphasis on the collaborative, socially integrated nature of psychiatric research. What was the nature of Donald Cohen’s collegial relationship with you?

RK: I think that isn’t universally true of psychiatric research; it was true of Donald’s vision of psychiatric research and scholarly enterprise and life in general. I met Donald about 40 years ago at a library where we were both students. He was reading [René] Descartes, and we started chatting and discovered that we had a lot of interests in common and then discovered that we were distantly related, and we became very close friends for the rest of our lives. That was emblematic of Donald’s talent for making connections with people and finding areas of not only shared intellectual interests but shared passions.

MUL: So you are describing a kind of Jewish geography, elevated….

RK: Yes, elevated to an art form. And I think he really saw all of life as making connections with people. It was part of his genius as a chairman, as a collaborator. He would always be introducing people to each other to find areas of commonality. Sometimes those were literal shidduchs, resulting in marriages. Andrés can tell you more about that [he smiles]. Other times, they were intellectual ones leading to collaborations like we’ve had with the Israelis over the years. That was very much his style of work, and then from the intellectual point of view, he had a vision that that was how children developed. And that comes through in his writings: It wasn’t that kids first developed intellectually or perceptually, and then secondarily stumbled into an interpersonal world. People were shaped interpersonally right from the get-go, and that was the locomotive that drew the rest of development.

MUL: And to what extent was that a novel idea?

RK: I don’t know that it’s completely novel intellectually, but with Donald there was a kind of unity to the way he lived personally, practiced professionally and thought intellectually about things. He taught a brilliant course for many years for the child psychiatry fellows, although it soon gathered a large crowd of spectators. He would start out interviewing pregnant couples and would talk with mothers about their thoughts about the growing baby inside of them, and then he would interview mothers with young infants, and at the end the course would culminate with the pinnacle of human development: the graduating Yale senior. These interviews were absolutely riveting. It was like reading a play or seeing a novel every week. He was particularly interested in what psychoanalysts call internal-object relations but which one might talk about more colloquially as people’s internalized images of other important people in their lives, both for ill and for good, and their relationship to these continuing presences. Sometimes it would be a hated other or a deeply ambivalent other that somebody was struggling against. It was just a vivid and fascinating experience that brought a lot of people into the field of child psychiatry and psychoanalysis.

MUL: How did Cohen’s career most fully express his Jewishness?

RK: There was something very Jewish about his deeply ironic and at times pessimistic sense of the world, his sense of seeing people not just as free-floating monads or atoms in a vacuum, but engaged in a specific community with a history, a dialect, a shared experience.

MUL: All of which seems to imply a kind of other-directed ethics….

AM: He was democratic in the full sense of the word. He came from a humble background and he always felt very connected to that. He lived in a city that embodied the polarities, and he felt equally connected with the highfalutin high levels of money and power, and also with the poorest of the poor. Some of his best ideas came from going to juvenile detention and seeing kids really suffer. And if you look at where he invested his time and effort at the peak of his career, it wasn’t in, let’s say, the American Psychiatric Association or the American Child. He could have had any of those. He went to the Eastern Mediterranean, to the Third World, to countries that didn’t have any infrastructure, to start creating that. That was very ethically motivated.

MUL: Much of his career and much of the current volume are devoted to autism research, with some attention to Tourette’s Syndrome. Could you address the value of such apparently rare disorders for the general enterprise of child psychiatry?

RK: The reasons were twofold. First of all, these were very serious and disabling disorders. They were very often chronic and derailed not only children’s lives but whole extended families’ lives, as well. So I think there was that humanitarian aspect of Donald that was deeply touched by the desperation of these families for whom there was almost no place to turn. I think it was also his philosophical interests that they very much engaged. I mean, these weren’t just any old disorders. These were disorders that really went to the core of what it meant to be human. In the case of autistic individuals, it mean, “What does it mean to have a self?” “How do I know other people have minds?” “What does it mean for somebody else to have a self?” “What does it mean for somebody to be the locus of feelings and intentions?” It was exactly that core of our humanity that seemed to be off in these kids no matter how bright they might seem to be in various ways. In that sense, it was an experiment of nature that I think Donald saw very early on as a window onto how to get a handle scientifically on these most important questions. Tourette’s was somewhat similar. It wasn’t just that these kids had strange twitches or grunts. Once you began to talk with them, you discovered that their selves were deeply divided, that these weren’t just involuntary things like hiccups, but things that they both desperately wanted to do and at the same time desperately didn’t want to do. So it sort of called into question all our usual notions about what’s voluntary or involuntary, what’s self, what’s not self, what’s me, what’s my disorder, what’s my soul, what’s my body. So I think that far beyond any public health agenda, that’s what really grabbed him about those disorders.

MUL: In his introduction, Dr. James Leckman describes Cohen’s role in founding research programs in Israel, Gaza and the West Bank among other places. Yet none of the articles in this volume addresses those efforts. Could you comment more on these projects?

AM: There’s no writing on that and not a lot on his international activities because he was so busy doing. But the programs in Israel have really gelled and are really thriving, and there is a lot of writing that’s come out of the seedlings there, like the programs with the army. He formed a center in Tel Aviv for children exposed to trauma, which is part of the crisis response for the whole country. They were called on after the earthquake in Turkey. They’ve had a major regional influence. In terms of Gaza, I don’t think there has been the thriving presence he would have liked. But what is thriving is an association that’s a mouthful. It’s called the Eastern Mediterranean Association for Child Analysis, Psychiatry and Allied Professions. He helped found that and surreptitiously brought the Israelis to the table. There’s also a Donald Cohen fellowship to bring students to Melbourne, and we’ve had an incredible number of applicants from Palestine, Lebanon, Jordan, Iraq, Iran, Tunisia, Morocco, Egypt….

MUL: What is the most critical benefit these essays have to offer the layperson?

AM: Your average patient, ourselves included, goes to the doctor and feels that the doctor is only interested in my tests, my disease, my disorder…

RK: my insurance!

AM: … but what about seeing the person in me for all that I am? I think that’s really what Donald did. And he saw much deeper than just labels and neurotransmitters into whole personhood.

This story "Delving Into the Core of the Self" was written by Miriam Udel-Lambert.

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