- David Courtwright
Nyswander, Marie (13 March 1919–20 April 1986), psychiatrist and developer of methadone maintenance, was born Mary Elizabeth Nyswander in Reno, Nevada, the daughter of James Nyswander, a mathematics professor, and Dorothy Bird Nyswander. In her teens she began calling herself Marie, the name she also used in her published work and by which she became professionally known. When Marie was two-and-a-half, her father divorced her mother. Dorothy Bird Nyswander took Marie to California and taught high school while completing doctoral work in psychology at the University of California at Berkeley. In 1926 Marie’s mother moved to Salt Lake City to teach at the University of Utah, then in 1936 moved to New York City to begin a four-year research project on public school health services.
Her mother’s independent, progressive outlook and the academic milieu in which she lived had a strong influence on Marie, who would later make her own contributions to health research. Marie’s first experience of medicine was as a patient, however. When she was fifteen she spent a year in a tuberculosis sanatorium, where she immersed herself in the writings of Mann, Marx, and Engels. She became concerned with the plight of those less privileged than she and joined the Young Communist League, only to become disenchanted.
In 1937 Nyswander enrolled in Sarah Lawrence College, graduating in 1941. Although deeply interested in music and nature, she chose a career in medicine on practical grounds and enrolled in the Cornell University Medical School, from which she graduated in 1944. While in medical school she was briefly married (probably in 1943–1944) to Charles Berry, a young divorced anatomy instructor. After completing her surgical internship she joined the U.S. Navy in 1945, hoping to become an orthopedic surgeon. The navy did not want women surgeons, however, and she was posted to the Lexington Narcotic Hospital run by the U.S. Public Health Service.
At Lexington Nyswander saw addicts from all walks of life branded as psychopaths, ordered about, and subjected to racial slurs. She hated the institutional atmosphere, and in her subsequent work she strove to treat addicts more humanely, as individual patients. Initially she did so within the framework of psychoanalysis, which she began to study in the late 1940s at New York Medical College. She completed her analysis under Lewis Wolberg, founder of the Postgraduate Center for Mental Health, and in 1950 began her own psychiatric practice. In 1955 she helped to establish the Narcotic Addiction Research Project, a New York–based experimental outpatient program that provided addicts with intensive individual psychotherapy. In 1957, with the aid of the sociologist Charles Winick, she set up a musicians’ clinic, which specialized in the treatment of jazz musicians addicted to heroin. During the early 1960s she also treated addicts in a storefront clinic under the auspices of the Narcotics Office of the East Harlem Protestant Parish.
Nyswander discussed her clinical experience in a book, The Drug Addict as Patient (1956). She never confined herself to treating addicts, however, and continued to see many types of patients in her private practice, including those with sexual and marital problems. They inspired her second book, The Power of Sexual Surrender (1959), which she published under the name Marie Nyswander Robinson. Leonard Robinson, Nyswander’s second husband (to whom she had become engaged in 1953), was a lay psychoanalyst and writer who lent an editorial hand to both books. (The marriage, which was childless, ended in divorce in 1965.)
Nyswander’s life and career took a dramatic turn during the mid-1960s. In 1962 Vincent Dole, a metabolic disease researcher at Rockefeller University, became interested in heroin addiction and chanced to read The Drug Addict as Patient. He invited Nyswander to collaborate in his research and arranged for her appointment to the staff of Rockefeller University.
Working with six male volunteers long addicted to heroin, Dole and Nyswander noticed that those who were given drugs like morphine remained preoccupied with getting high, constantly sought to increase their dosage, and experienced withdrawal symptoms if they did not inject themselves every few hours. Those who took methadone behaved differently. Experiencing neither craving nor intense euphoria, they were free from withdrawal symptoms for a full day and became more interested in work and school. Long-term methadone maintenance—legally stabilizing patients on a daily oral dose—seemed a promising strategy for breaking the cycle of heroin injection, reducing crime, and reintegrating addicts into society. Because methadone was itself an opiate, there was also less likelihood of relapse, the problem that had plagued Nyswander and others who had treated addicts through detoxification and talking therapy.
By 1965 Dole and Nyswander had data on twenty-two patients, some of whom had been maintained on methadone for fifteen months. They published their findings in the Journal of the American Medical Association and in several articles that followed. An important early supporter was Ray Trussell, the commissioner of New York City hospitals. Trussell helped them establish a research and demonstration project at the Manhattan General Hospital, then operated by Beth Israel Medical Center. The project was successful, and methadone maintenance, which received widespread and favorable publicity, continued to gain ground. The biggest surge came in the early 1970s, when methadone programs proliferated across the country. Robert Newman, another key ally, presided over dozens of new methadone clinics in New York City, home to roughly half of the nation’s heroin addicts. Methadone maintenance eventually spread around the world, to countries as diverse as Australia, Hong Kong, Sweden, and Thailand.
Methadone maintenance also aroused considerable opposition. Agents of the Federal Bureau of Narcotics, opposed to all forms of drug maintenance and long suspicious of Nyswander’s medical approach, tried to end the early methadone research through harassment and intimidation. They failed. More significant in the long run was the opposition of those who believed abstinence should be the ultimate goal of treatment. Methadone was still an addictive drug, they argued, on which patients remained dependent. Also controversial was Dole and Nyswander’s thesis, published in 1967, that heroin addiction was a metabolic disease to which some people were neurologically susceptible. Those who argued that addiction was rooted in personality disorder—a position that Nyswander, despite her psychiatric training, had abandoned—criticized the metabolic hypothesis as unproven.
From 1974 until her death in New York City, Nyswander fought to preserve and consolidate the gains of the methadone revolution, which remained vulnerable to regulatory counterattack. Her influence was by no means confined to her writings. An attractive woman with an infectious smile, she impressed associates with her straightforward manner, her unsentimental compassion, and her easy rapport with patients. Vincent Dole, whom she had married in 1965, remarked that her secret was her ability to see the inner person. No other American psychiatrist of her generation affected the lives of so many addicted patients.
Oral history interviews with Marie Nyswander (1981) and Vincent Dole (1982) are housed at the Columbia University Oral History Center. Portions of these interviews appear in David Courtwright et al., Addicts Who Survived: An Oral History of Narcotic Use in America, 1926–1965 (1989), pp. 310–12 and 331–43. These sources were corroborated and supplemented by telephone interviews and by video recordings of eulogies at Nyswander’s memorial service and dinner on 20 Oct. 1986. The video recordings are available through the Beth Israel Medical Center in New York City. In addition to her books Nyswander authored or coauthored numerous articles, among them “Withdrawal Treatment of Drug Addiction,” New England Journal of Medicine 242 (1950): 128–30; “The Treatment of Drug Addicts as Voluntary Outpatients: A Progress Report,” American Journal of Orthopsychiatry 28 (1958): 714–27; “Psychotherapy of Successful Musicians Who Are Drug Addicts,” American Journal of Orthopsychiatry 31 (1961): 622–36; “A Medical Treatment for Diacetylmorphine (Heroin) Addiction,” Journal of the American Medical Association 193 (1965): 646–50; and “Heroin Addiction—A Metabolic Disease,” Archives of Internal Medicine 120 (1967): 19–24. Journalist Nat Hentoff profiled Nyswander in the New Yorker, 26 June and 3 July 1965, and subsequently in a book, A Doctor among the Addicts (1968). Briefer accounts are in Vogue, May 1968, pp. 210–11, 279, and the New York Times Magazine, 15 Oct. 1967, pp. 44–64. The most complete print obituary is in the New York Times, 21 Apr. 1986.