Leon Eisenberg: Dedicated to Letting the Outsider In

Leon Eisenberg loves to tell jokes. He has a vast repertoire from which he can snatch one to suit almost any occasion. On a rainy afternoon, at the end of a sweeping conversation about his life—from his boyhood in Philadelphia to his current position as an emeritus professor of social medicine at HMS—he picked the one about the schlemiel, the Yiddish equivalent of the village idiot, sitting in his kitchen, buttering a piece of rye bread.

“He is the son of a schlemiel, the grandson of a schlemiel, the great-grandson—it’s clearly genetic,” said Eisenberg, the Maude and Lillian Presley professor emeritus of social medicine. The schlemiel drops the bread, but to his astonishment, it lands buttered side up. Schlemiels always drop bread buttered side down, so he runs out into the village square shouting, “I’m not a schlemiel, I’m not a schlemiel!”

Bewildered, the villagers take the case to the rabbi, who pulls on his beard in puzzlement. “He takes down the holy books,” Eisenberg said. “Suddenly, he says to the schlemiel, ‘Schlemiel, you’re still a schlemiel. You buttered the wrong side!’”

The joke is a perfect fit. If there is a moral to the story of Eisenberg’s life, it is the folly of human prejudice—of believing that human beings, in all their complexity, can be reduced to a category or stereotype, or to a single force, such as genetics or environment. To hear Eisenberg’s tale is to take a front-row seat for one of the defining moments in 20th century psychiatry—the pendulum swing from a deep, almost religious belief in psychoanalytic theory to explain the human psyche and its distortions to an equally intense conviction that its secrets lie in biology—and to watch a man resist taking sides.

“What is original and powerful about Leon’s conceptualization is the understanding that the biological and social are part of one thing,” said Felton Earls, HMS professor of social medicine. “Biology is not compartmentalized from social reality. Very few people think like that.”

The story of the schlemiel fits for another reason. Eisenberg has risen to the top of his field—he has been wined, dined, feted, and festschrifted. He and his wife, Carola, have given glittering dinner parties attended by the pillars of Harvard society. He put the MGH Department of Psychiatry on the map as one of the finest and, through his appointments and students as well as his own research and writings, has helped shape modern psychiatry. He is conversant with research in farflung fields—so conversant that hearing him speak, a Nobel Prize–winning ethologist mistook him for a fellow specialist in the field. He crosses easily between departments and disciplines. With his bow tie, glasses, and suit, he appears the ultimate insider.

He sees a quite different image. According to Eisenberg, he has been, and continues to be, inspired by a deep awareness of what it feels like to be excluded, one that dates back to his childhood. This feeling of identification with those who, like the schlemiel, struggle against categorization is at the heart of what Eisenberg considers his greatest achievement, the programmatic push to open the doors of HMS to a fuller, more diverse range of students.

“I would say he follows in the great footsteps of the physician-psychologist-philosopher William James,” said Arthur Kleinman, HMS professor of medical anthropology in the Department of Social Medicine, “because James argued powerfully for the broad range of normal experience, for our tolerance of multiple ways of being human.”

Born in Philadelphia in 1922, the son of Russian Jewish immigrants, Eisenberg grew up one generation away from the shtetl. Bookish, introspective, and strongly bonded to his father, he recalls listening to Hitler’s speeches, translated into English, on the radio. “Because of that extreme threat, I remember talking to my father and both of us agreeing that the only thing they couldn’t take away from you was what you knew inside your head,” he said. His father, who dropped out of school in the sixth grade to work, dreamed that his son would go to medical school. “I don’t remember wanting anything else,” said Eisenberg.

In 1942, when he applied, medical schools had stingy quotas for Jews, “ranging from zero to a liberal 10 to 12 percent,” he said. Eisenberg was turned down by all the schools he applied to, despite nearly straight A’s in college. “My father knew a Pennsylvania state legislator, who he went to in his despair, carrying copies of my report cards,” Eisenberg recounted. A phone call was placed then and there to the provost of the University of Pennsylvania School of Medicine. Three days later, a thin letter came in the mail saying Eisenberg had been accepted “off the waiting list.” “I was on no waiting list, but I wasn’t technical about it,” he said. He accepted the offer.

He graduated valedictorian of his medical school class, but was denied, along with the seven other Jews who applied, an internship at the University of Pennsylvania hospital. He went to Mt. Sinai Hospital in New York, where he discovered psychiatry. During an isolated and rather unhappy adolescence, he had been captivated by Thomas Mann’s wildly popular The Magic Mountain, which depicts a young man’s inner turmoil and growth. He was drawn to psychiatry’s promise to “get in and understand things—myself and other people,” he said.

He was intrigued by his first reading of Freud’s Interpretation of Dreams—“It seemed such exciting and out-of-the-way stuff”—but soon found psychoanalysis “politically unacceptable. How could you use a treatment that would take so long per person when the burden of mental illness was so high? And second, there was no real evidence that it worked,” he said. In 1952, after a two-year stint in the Army teaching physiology to military doctors, he began a residency in child psychiatry at Johns Hopkins University, where his doubts about psychoanalysis were encouraged by the great psychiatrist, Leo Kanner.

Just 10 years earlier, Kanner had identified 11 boys with an unusual constellation of traits—extreme social isolation, an inability to look people in the eye, a preoccupation with objects and ritual, and hand-flicking and other repetitive movements. Eisenberg would join him in his exploration of the newly identified psychiatric disorder, autism, paying special attention to the social, and especially, the family setting of the children in which it appeared.

Though Eisenberg suspected a genetic basis to the then rarely diagnosed disease, it would be years before the tools existed to look at it. In subsequent years, he turned his attention to more common childhood problems, such as school phobia, looking once again at the social setting in which they occurred.

In 1962, Eisenberg launched the first randomized clinical trial of a psychiatric medicine. “As simple as it seems, as straightforward, child psychiatry had gone on for 40 years before somebody did a randomized clinical trial,” said Earls.

In 1967, only months after arriving to chair the Psychiatry Department at MGH, he was asked to join a small committee, including HMS professors Jon Beckwith, Ed Kravitz, and David Potter, that was pushing to increase the number of black students at HMS. It was the invitation he had been waiting for.

“Since being Jewish was no longer an issue in medical school after about 1950, I had thought that my job was to fight for the people who were being excluded, which were blacks,” he said. He was asked to chair the HMS commission on black community relations and the HMS admissions committee for the first seven years of affirmative action. “It was a wonderful place to see to it that the plan was implemented.”

Remarkably, this was the same period that saw the MGH Psychiatry Department become transformed from a small conclave of mostly psychoanalysts to one of the most intellectually exciting and diverse departments in the country.

“Leon created an incredible academic environment—probably there has never been an environment quite like that as measured by the number of trainees who went into full-time academic careers,” said Kleinman, who entered the Psychiatry Department soon after Eisenberg arrived. “It was a treasure chest,” said Earls, another early student.

In 1980, he was invited by then HMS dean Daniel Tosteson to build the Department of Social Medicine which, under the stewardship of Eisenberg and then Kleinman, helped to ignite the careers of students such as Paul Farmer, the Maude and Lillian Presley professor of social medicine, and Jim Kim, HMS professor and chair of social medicine. According to Kleinman, the entire lineage has been shaped by its exposure to Eisenberg.

“He is a perturber and disturber,” Kleinman said. A case in point was a festschrift held on the occasion of his 60th birthday. Former students presented an extraordinary array of papers, each of which Eisenberg thoroughly critiqued.

“At the end, when you would have expected Leon simply to say, ‘I’m so delighted, and I want to thank you for what you’ve done,’ well, he said all those things, and then he said, ‘You know, I just want to be honest with you,’” said Kleinman. “‘You’ve all become professors now, and you’re all outstanding in what you do, but I want to ask you this—have you used your tenure to go up against the system that we’re in? Have you spoken out?’”