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Kutter, Peter A short history of psychoanalytic psychosomatics in German -speaking countries Revista Portuguesa de Psicossomática, vol. 2, núm. 2, jul/dez, 2000, pp. 79-86 Sociedade Portuguesa de Psicossomática Porto, Portugal

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How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative Revista Portuguesa Revistade 79PortuguesaPsicossomática Psychoanalytic psychosomatics in German-speaking countries de Psicossomática A short history of psychoanalytic psychosomatics in German- -speaking countries

Peter Kutter*

Abstract influence of outstanding figures such The author discusses the development as Paracelsus (1493-1541) and Mes- of psychoanalytic psychosomatics in Ger- mer (1734-1815) on the thinking and man-speaking countries from a historical feeling of the people in Europe about and cultural perspective. body and mind cannot be disre- Influenced by a broad European back- garded. Poets such as Novalis; phy- ground and characterised by occidental sicians such as Carl Gustav Carus philosophy and the literary epoch of Ro- (1789-1869); and philosophers such as manticism the author traces its roman ba- Kant (1724-1804), Nietzsche (1844- sis to the work of Sigmund Freud. -1900), and Schopenhauer (1788-1860) worked intensively on the compli- cated relationships between body and The Philosophical and Romantic mind. These included from the begin- Tradition ning the instincts, affects, feelings, and "evil," as well as the dreams, the In contrast to the english-spea- "illogical" or "unconscious", and se- king world, psychoanalytic psychoso- xuality. Nietzsche (1966) discovered matics in Germany, Austria, and Swit- repression: "I did this, my memory zerland has been strongly influenced says. I cannot have done it, my pride by a broad European background. It says, and remains implacable. Finally is characterized above all by the memory yields" (p. 625). Even Freud’s Occidental philosophy of the so- concept of the "id" (not I think, but it -called Enlightenment and by the li- thinks) most probably goes back to terary epoch of Romanticism. The Nietzsche. In the literature of Roman- common basis, as in the English- ticism human beings were controlled -speaking countries, is naturally the by passions and were not in control psychoanalysis of Sigmund Freud. of themselves (see the novel Lucinde From a historical view, however, the by Friedrich von Schlegel). The rela- tionship to the "occult" was close, for example, in Justinus Kerner. Ques- tions of religiosity and of the funda- *Professor at Johann Wolfgang Goethe – mental guilt of human beings were University of Frankfurt, Germany. likewise predominant. All of this was

Vol. 2, nº 2, Jul/Dez 2000 Peter Kutter 80 normal in the thoughts, feelings, and The Body-Mind Problem actions of human beings in all social classes. So it comes as no surprise that Psychoanalytic psychosomatics in this cultural environment the con- cannot be understood without the cept of psychosomatics also came to fundamental tension that exists be- be a symbol of the unity of body and tween res extensa and res cogitans mind (Heinroth, 1818). Yet every hu- (Descartes), without the bipolar con- man being was seen perfectly trast or discrepancy between matter idiographically as an individual with and consciousness, between body a wholly individual destiny. It was not and mind. It is therefore immediately by chance that the European tradition evident that the development of psy- produced the philosophical direction chosomatic theory has also been sig- of so-called hermeneutics, which is nificantly determined by this basal about original experience, under- contrast. Among psychosomatic spe- standing, and sensibility, starting with cialists there are materialists for the theologian Schleiermacher (1959), whom the body also determines the via Dilthey (1977), and up to Gadamer mind and spiritualists for whom, in- (1960). In addition, European thin- versely, the mind determines the king has addressed itself incessantly body. In the "isomorph-postulate" to the existential dimension of the hu- (Köhler, 1920), body and mind are man being: his being, his basal anxie- identical. In "emergentism" they are ty, his basic situations of anxiety, strictly separate (Bischoff, 1989). Yet struggle, guilt, suffering and death feelings and affects each have three (Kierkegaard, Heidegger, Jaspers). components: an emotional state, a The counterweight to the idiographic subjective experience and a motor view of human beings in the humani- expression. From the scientific per- ties was provided by scientific thin- spective, the emotional state is com- king, in philosophy by critical rationa- prehended as being physiological, lism, in psychology by Pavlov and experience psychological or psycho- Wundt, and in behavioral science by analytic, and the motor expression Konrad Lorenz and Tinbergen. Here sociological. Therefore, we shall en- it was a question of "nomothetic" laws counter these three dimensions in all in human life and behavior, the bio- scientific endeavors that deal theoreti- logical basics, the parallels with ani- cally with the body-mind problem or mals. "The paradigm of the machine" practically with the physical-mental is "the explanatory model for the life processes, be they healthy or ill. processes", which, like a car, must be repaired at the garage in order to function again, "particularly attrac- The Development of Psychoana- tive to doctors because clear and sim- lytic Psychosomatics in Germany ple instructions of interpretation and action can be deduced from it" According to Uexküll (1986), the (Uexküll, 1986, p. 19). following three phases can be roughly

Revista Portuguesa de Psicossomática Revista Portuguesa de 81Psicossomática Psychoanalytic psychosomatics in German-speaking countries identified: a first phase in which peo- many psychoanalysts saw physical ple start to be interested not only in illnesses in the perspective of the the somatic substratum, the structure, "conversion process" as hysteria. but also in its functions. Physiologists While Georg Groddek was the most such as Johannes Peter Müller (1801- uncompromising in interpreting all -1858) made the first moves and doc- possible physical illnesses as hysteria, tors interested in internal diseases, other psychoanalysts such as Felix such as Ludolph von Krehl and Viktor Deutsch were more circumspect. It is von Weizsacker in Heidelberg or true that in terms of psychophysical Gustav von Bergmann in Munich, dualism he made distinctions be- expanded this direction. A "pathology tween body and mind, yet he tried to of functions" replaced the hitherto bridge the mysterious leap between predominant "pathology of anatomic body and mind by understanding the structures" (Uexküll, 1986, p. 20). The "symbolization as a formative stage human being is now no longer the of the conversion process" (Deutsch, object of research that is diagnosed 1959, pp. 7597). and given therapy; decisive is the The second phase developed for "subjective factor" or the "sick person" the most part in English-speaking (Weizsäcker, 1951, p. 232) and thus his countries (after the forced exodus of personal biography. In place of Jewish psychoanalysts caused by the objectifying medicine a medical an- Holocaust), especially in the United thropology appeared. This is demon- States, "when the emigres came to strated not only in the writings of America" (Kurzweil, 1995, p. 196 ff.). Viktor von Weizsäcker but also in The following authors are merely a those of Richard Siebeck (1953), who, few outstanding examples of this im- in line with Johannes Müller and portant epoch of psychoanalytic Ludolph Krehl, linked the origin of psychosomatics: Dunbar (1935), physical illnesses with the intensely Weiss and English (1943), Alexander personal life history of the patients. (1950), Grinker (1953), Garner and As early as 1925 there was a compre- Wenar (1959), and Fliess (1961). With hensive psychopathology of diseases Alexander, French, and Pollock of all organic systems (Schwarz, (1968), the specificity theory of psy- 1925). chosomatic illnesses reached its ze- The new anthropological view, nith. An example of the fate of an which came from the old European emigre that was confined to Europe tradition, proved to be greatly com- is that of Erich Stern (1950) who be- patible with the discoveries of came a professor at the University of Sigmund Freud. Although Freud, in Giessen in 1920, emigrated to Paris in a letter to von Weizsäcker of 16 Octo- 1933, and advocated, as early as 1950, ber 1932 (von Weizsäcker, 1947, p. 6), a theory of unspecificity for psycho- had been dismissive of the use of his somatic conditions (see Putzke 1996, psychoanalysis for physical illnesses, p. 128).

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In Germany, psychoanalysis and outstanding figure was Alexander psychosomatic medicine had been Mitscherlich. In resistance to Hitler massively perverted by the national- and as a scientific observer at the -socialist dictatorship. There did ex- Nuremberg trial of German doctors, ist a so-called "German Institute of he was predestined to develop a com- Psychological Research and Psycho- pletely new theory and practice of therapy", which even enjoyed the psychosomatic diseases, from the support of the National Socialist ru- very beginning in line with Freudian lers, but the psychoanalysis of Freud psychoanalysis. Through his contacts was banned. Psychosomatic illnesses, to politicians and the support of the as a record of the diagnoses shows Rockefeller Foundation, he was able (Lockot, 1985, p. 219), were not inves- to found in 1949 the Psychosomatic tigated or treated there. Despite the Department at the University Clinic political suppression of psychoanaly- in Heidelberg. From the very begin- sis, however, unconscious processes ning he took into account, following were still seen, if in more globally con- in the tradition of the so-called "Criti- ceived concepts and influenced by C. cal Theory" and the "Dialectics of the G. Jung (e.g., in Gustav R. Heyer, Enlightenment" (Horkheimer and 1932). But for the theory of psychoso- Adorno, 1947) and their sociological matic diseases it was no longer un- view critical of society, the "meritoc- conscious processes and sexual con- racy as a pathogenic field" for the ori- flicts that were decisive, but "phy- gin of psychosomatic diseases sique and character" (Kretschmer, (Mitscherlich et al., 1967). 1931). More covering processes than Mitscherlich, influenced by Engel uncovering ones appeared in therapy, and Schmale (1967) as well as by such as "autogenous training" (J. H. Schur (1955), and perfectly in line Schultz, 1932) or hypnosis (Stokvis, with the psychoanalytic theory of 1941). The only one who genuinely defense, postulated the following used psychoanalysis for a better un- important hypotheses: derstanding of psychosomatic di- seases was Viktor von Weizsäcker 1. Every psychoanalytic disease is (1947). preceded by a psychoneurotic The third phase of psychoanalytic condition. psychosomatics after World War II 2. It is triggered by real or imagi- was characterized in the German- ned object loss. -speaking world by the following fea- 3. The basic affects are hopeless- tures: it developed, following the Eu- ness and helplessness. ropean philosophical and Romantic 4. After an initial phase to ward off tradition outlined at the beginning, the illness with neurotic symp- less in the area of classical psychia- toms, a second phase of defense try, as in English-speaking countries, appears forming psychoso- but from internal medicine.The most matic symptoms through soma-

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tization or re-somatization sultation and liaison system in Eng- (Mitscherlich, 1961 /62, p. 9). lish-speaking countries. Clinics of this kind have opened at many universi- In the formation of theories the ties and also, supported by the health conversion model has continued to insurance companies, in spas and play an important role. To this the ef- health resorts (Neun 1987). fects of the modern narcissism theory Despite the meaningful European have been added in the wake of tradition, modern psychosomatic re- Kohut and self psychology and the search in the important German- theory of object relations (Kernberg). -speaking centers of the post-war era Influences from the French school lives essentially from the achieve- (Marty, de M’Uzan, and David, 1963) ments of the advances made in the on German-speaking psychosomatics English-speaking countries, particu- were not long in coming. It is never- larly in the United States. The regu- theless perfectly legitimate, starting lar proceedings of the European Con- with Weizsäcker, to speak of a ferences on Psychosomatic Research Mitscherlichian direction of psycho- are an example of this. At present, analytic psychosomatics in the Ger- similar to the United States, new psy- man-speaking world, with authors chosomatic models are being tested, such as de Boor, Cremerius, Thomä, "which are not only derived from psy- and Overbeck. It has been influenced choanalysis but also from research in just as much by the European tradi- psychology as well as from the bio- tion as by social-critical aspects logical sciences that are pointing to- (Kutter, 1984, 1992). ward a view of humans as self-regu- Another outstanding figure was, lating cybernetic systems" (Taylor, and still is, Uexküll. He developed the 1992, p. 479). At the same time physio- model of the so-called circle of func- logy is being conditioned by bio- tions, where recognizing and influ- graphical events and linked with encing factors via fully individual quite specific meanings so that, de- socialization processes and life expe- pending on the biographical event, riences produce fully subjective reali- dispositions to psychosomatic ill- ties in which mental processes have a nesses are acquired quite individually direct effect on the body. His influence (Uexküll, 1986, p. 23). in the German speaking regions can- To what extent and in how many not be emphasized enough. His fields in the German-speaking world model of the circle of functions has psychosomatic research on a psycho- facilitated research into virtually all analytic basis has been and will con- organic systems and culminated in tinue to be pursued is demonstrated Psychosomatic Medicine (1996). by the regular new editions of the ex- The development of psychoana- tensive textbook Psychosomatische lytic psychosomatics has taken place Medizin, (von Uexküll, 1996). There is in in-patient clinics, unlike the con- a German College for Psychosomatic

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Medicine (DKPM), that organizes two fairer distribution of the means of pro- congresses every year and coordi- duction with the greatest possible nates research. Numerous journals development of individuals, of so- deal specifically with psychosomatic ciety as a whole, and of the groups medicine (Yearbook of Medical Psycholo- functioning within it. The essential gy), and there have been numerous condition for this is freedom of constructive contributions to research thought and action. "In illness [how- in the field of psychoanalytic ever] freedom is lost" (Mitscherlich, psychosomatics, of which Egle and 1977, p 73) and that for the sake of Hoffmann (1993) is an example. avoiding suffering. Here he can build Overviews of the field have been pro- on Freud’s early work, " 'Civilized' vided by Söllner, Wesiack, and Wurm Sexual Morality and Modern Ner- (1989), Studt (1983), and Strauss and vous Illness" (1908), as well as on his Meyer (1994). later writings, "The Future of an Illu- sion" (1927) and "Civilisation and Its Discontents” (1930). Mitscherlich des- The Political Dimension of Psy- cribes the complexity of social influ- chosomatic Medicine ences on the development and treat- ment of psychoses and neuroses, cas- Since Weizsäcker introduced the tigates the conservative attitude of "subjective factor" (in the sense of the psychiatry in Germany, and describes human being) into medicine, instead how modern society causes indi- of only seeing man as an "object" of vidual illness by investigating the diagnosis and medical therapy, pathogenic structures of society. In Mitscherlich (1966) builds on the pre- particular Mitscherlich names the im- vious works of Weizsäcker and con- poverishment of social relations as a sequently applies psychoanalysis to factor that produces and maintains psychosomatic disturbances. A fierce illness when the individual feels help- debate begins between "psychoso- lessly exposed to the anonymous matic and conventional medicine" (p. agencies so that he can only passively 53) and results in a "revolution" in conform at the expense of illness and medicine. With meticulous scientific the loss of freedom. In this respect investigations Mitscherlich was suc- Mitscherlich became a reformer of cessful at opening up reluctant phy- medicine, similar to Lindemann sicians to a medicine in which the (1979), who could now try to achieve patient and not the illness became the changes in the law and in the parlia- center of scientific interest. ments, to improve the social and po- The other point was that Mitscher- litical situation of people and to lich applied political science and so- optimize the work of the government ciology to psychosomatic medicine: in social and health policies with rele- political action is all about changing vant information and to change the power structures toward an ever jurisdiction to such an extent that psy-

Revista Portuguesa de Psicossomática Revista Portuguesa de 85Psicossomática Psychoanalytic psychosomatics in German-speaking countries chosocial connections will also be • Garner AM, Wenar C. The Mother-Child- taken more into consideration in the Relationship in Psychosomatic Disorders. legal field than they have been hither- Urbana: University of Illinois Press, to. 1959. • Grinker RR. Psychosomatic Research. New York: Norton, 1953. REFERENCES • Heinroth JCA. Lehrbuch der Störun-gen des Seelenlebens. Leipzig: Vogel, 1818. • Alexander F. Psychosomatic Medicine. • Heyer GR. Der Organismus der Seele. New York: Norton, 1950. Munich: Lehmanns, 1932. • Alexander French TM, Pollock GH. Psy- • Horkheimer M, Adorno TW. Dialektik chosomatic Specificity. Chicago: Univer- der Aufklärung. Amsterdam: Querido, sity of Chicago Press, 1968. 1947. • Bischoff N. Emotionale Verwirrungen. • Köhler W. Die physischen Gestalten in Oder: Von den Schwierigkeiten im Ruhe und im stationären Zustand. Umgang mit der Biologie. Psychol Braunschweig: Vieweg, 1920. Rundschau 1989; 40: 188-205. • Kretschmer E. Köperbau und Charakter. • Deutsch F. On the Mysterious Leap from Berlin: Springer, 1931. the Mind to the Body. New York: Interna- • Kurzweil E. USA. In: Psychoanalysis In- tional Universities Press, 1959. ternational, Vol. 2, America, Asia, Aus- • Dilthey W. Gesammelte Schriften. Cited tralia. ed. P. Kutter. Hillsdale, NJ: The by H. Anz in: Hermeneutische Positionen, Analytic Press, pp. 186-234, 1995. ed. H. Birus. Gottingen: Vanden-hoeck • Kutter P. Die Dynamik psychosomatis-cher & Ruprecht, pp. 59-88, 1977. Erkrankungen – Damals und heute. Psy- • Dunbar F. Emotions and Bodily Changes. che 1984; 38: 544-562. New York: Columbia University Press, • Kutter P. Germany. In: Psychoanalysis 1935. International, Vol. 1, ed. P. Kutter. • Egle T, Hoffmann SO. Der Schmerzkran- Hillsdale, NJ: The Analytic Press, pp. ke. Stuttgart: Schattauer, 1993. 114-136, 1992. • Engel G L, Schmale AH. Psychoanalytic • Lindemann E. Beyond Grief. New York: theory of somatic disorder. J Amer Aronson, 1979. Psychoanal Assn 1967; 15: 344-365. • Lockot R. Erinnern und Durcharbeiten. • Fliess R. Ego and Body Ego. New York: Zur Geschichte der Psychoanalyse und Schulte, 1961. Psychotherapie im Nationalsozialis-mus. • Freud S. "Civilized" sexual morality and Frankfurt: Fischer, 1985. modern nervous illness. Standard Edition, • Marty P, de M’Uzan M, David CH. 9: 181-204. London: Hogarth Press, L’investigation psychosomatique. Paris: 1959. Presses Universitaires de France, 1963. • Freud S. The future of an illusion. Stand- • Mitscherlich A. Anmerkungen über die ard Edition, 21: 5-56. London: Hogarth Chronifizierung psychosomatischen Press, 1961. Geschehens. Psyche, 15:1-37, 1961/62. • Freud S. Civilization and its discontents. • Mitscherlich A. Krankheit als Konflikt. Standard Edition, 21:64-145. London: Studien zur psychosomatischen Medizin, Hogarth Press, 1961. Vol. 1. Frankfurt: Suhrkamp, 1966. • Gadamer H-G. Wahrheit und Methode, • Mitscherlich A. Freiheit und UnfreEheit. Grundzüge einer philosophischen Studien zur psychosomatischen Medizin, Hermeneutik. Tübingen: Mohr, 1960. Vol. 3. Frankfurt: Suhrkamp, 1977.

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