Georg Groddeck and the Interrelation of Art and Science in Psychoanalysis

“Art versus Science” is a false dichotomy that has harmed psychoanalysis. The case of Georg Groddeck, father of psychosomatic medicine, illustrates in concrete terms the problematic consequences of this false dichotomy: a missed opportunity for psychoanalysts to treat prevalent psychosomatic illnesses.

Psychoanalysts and critics of psychoanalysis alike often claim that psychoanalysis is different from other sciences, or even that psychoanalysis does not qualify as a science at all. In making this case, proponents and critics sometimes characterize psychoanalysis as an art rather than a science. One such argument goes: Psychoanalysis attempts to understand human beings' subjective experiences, just as novels and films do; in this sense, it pursues an artistic form of knowledge—what literary critic A.D. Nuttall has called “experiential knowledge.”1 Similarly, psychoanalysts will point out that patients suffering from subjective experiences cannot be successfully treated according to protocol, in the way one treats, say, a sinus infection. Freud himself often made the case that the intimate nature of subjective experiences makes it impossible to study them using the methods of experimental psychology—especially when repression actively hides certain thoughts and feelings from both the investigator and the subjects themselves. Postmodern analysts like Paul Ricoeur celebrate psychoanalysis as a form of “storytelling” or “narrative intelligibility.” “Psychoanalytic reports are kinds of biographies and autobiographies,” Ricoeur writes, “whose literary history is a part of the long tradition emerging from the oral epic tradition of the Greeks, the Celts, and the Germans.” (Ricoeur 1977, p. 869) And then there are critics like Allen Esterson or Paul McHugh who agree that Freud was a storyteller, but consider it a vice, not a virtue. They denigrate Freud's

theories as spurious, unbelievable products of his “romantic” imagination. (Esterson 2001; McHugh 2006) Every one of these attempts to designate psychoanalysis as an “Art” reflects an underlying conviction that psychoanalytic knowledge differs from scientific knowledge.

Such attempts to polarize knowledge in this way overlook the fundamental interrelationship of art and science. “Art versus Science” is a false dichotomy. Successful scientists incorporate artistry and creativity into their work; successful artists likewise bring technical knowledge to their craft and a scientific dedication to the accurate depiction of reality. Art and science are not mutually exclusive products of the human mind, one fantastical and false, the other clear-eyed and true. Rather, they are distinct but often compatible attributes of human activity. Even a “hard” science like paleontology demands artistry and imagination. Thus Richard K. Stucky, a paleontologist and former curator of the Denver Museum of Nature and Science, had no hesitation in declaring that “Paleontology is art, science, and imagination.” (Stucky 2000)

Consider, for example, the intangible skills required to find fossils. Paleontologist Steve Brusatte depicts the hunt for fossils as a matter of luck and intuition, passion and persistence. More than a few of the successful fossil hunters who appear in his book The Rise and Fall of the Dinosaurs are not in fact scientists, but hobbyists and adventurers. Helmuth Redschlag, for instance, is an architect. In 2005, he discovered a juvenile triceratops skeleton in the Hell Creek formation in Montana. The celebrated skeleton has been named Homer and stands in the Burpee Museum of Natural History in Rockford, Illinois. Redschlag's artistic “attention to the details of shapes and textures,” Brusatte writes, is what makes him “a very good fossil hunter.” (Brusatte 2018, p. 237)

Paleontologists not only rely on artistry and “feel” in their fieldwork but also rely on imagination in the genesis of their theories. They have always told imaginative stories of how it might have been with the dinosaurs, and their visions of the remote past have necessarily stretched beyond what could be proven at the time. In the late 19th century, for example, Thomas Huxley proposed that birds evolved from dinosaurs. Many doubted the theory, and it was only in 1995, more than a hundred years later, that the first feathered dinosaur fossil turned up. (p. 275) Paleontologists like Huxley and others persist in their sometimes

eccentric notions, Brusatte notes, despite such dry spells in the evidentiary record. They live according to the hopeful maxim, “Absence of evidence is not always evidence of absence.” (p. 59)

How about an even “harder” science like physics? According to Albert Einstein, intuition outweighs empirical observation in the formulation of physics theories. In a 1919 essay entitled “Induction and Deduction in Physics,” Einstein wrote: “The truly great advances in our understanding of nature originated in a way almost diametrically opposed to induction. The intuitive grasp of the essentials of a large complex of facts leads the scientist to the postulation of a hypothetical basic law or laws.” (Quoted in Isaacson 2007, p. 118) Moreover, Einstein depended not only on deduction and intuition, but on imagination. His special theory of relativity, for instance, drew inspiration from the fanciful popular-science writer Aaron Bernstein, who led his readers on a “fantasy trip through space” (“Eine Phantasie-Reise im Weltall”) riding on an electrical impulse in a telegraph wire. Einstein took that journey in his mind and reconceived of time and space. (Isaacson 2007, pp. 18-19; Canales 2015)

Is psychoanalysis any different from paleontology or physics when it comes to its uses of art and science? Yes, but it needn't be. Sigmund Freud wrote eloquently about the interrelation of art and science in an April 8, 1915 letter to Sandor Ferenczi. In it, Freud described the secret of productivity as “the succession of daringly playful fantasy and relentlessly realistic criticism.” (Freud 1915) The description could be applied to all scientific work, and for that matter to every art.

Anna Freud lived her father's creed as a psychoanalyst who could be both artful and scientific. She was herself an innovator who described original defense mechanisms like “altruistic surrender” and “identification with the aggressor,” she enlarged our theoretical understanding of the defenses involved in grief, and she founded the discipline of child analysis as a field with its own separate practices and views of child development. “[S]he also could regress creatively,” writes her biographer Elisabeth Young-Bruehl, “enjoying what Ernst Kris called ‘regression in the service of the ego.’” (Young-Bruehl 1988, p. 380) On the other hand, she collaborated much more closely with experimental psychologists than her father ever did. The collaboration yielded the first psychoanalytic diagnostic questionnaire and the Hampstead Index, the first

organized compendium of psychoanalytic case studies. Anna Freud had this to say about Liselotte Frankl, one of the experimental psychologists with whom she worked at the Hampstead Clinic:

She does not paint pictures (as we more daring people do), she builds with bricks (which is probably much less pleasure). She is a very good teacher when she is alone with the students and, I believe, the Clinic feels that her need for solid structures serves as a very good counterweight against my quicker flights of imagination… I value her very much as a coworker. (Quoted in Young-Bruehl 1988, pp. 373-374)

In practice, however, most psychoanalysts have excelled at the artistry of therapy and at creative theorizing more than they have at “relentlessly realistic criticism,” which in other sciences usually means testing one's hypotheses through experiment and meticulous data collection. I have suggested previously that emotional factors have long interfered with psychoanalysts' efforts to test and prove their hypotheses. (Ratner 2018, 2019) I would argue that this aversion to proof underlies some analysts' inclinations to view psychoanalysis as art, not science.

To illustrate the problematic consequences of this false dichotomy between art and science in psychoanalysis, I would like to consider the case of Georg Groddeck, the physician and novelist who first coined the term “Es” or “Id.” In 1923 Freud borrowed the term from Groddeck, who had used it somewhat differently in his own writing, and repurposed it for his classic tripartite Id-Ego-Superego picture of the personality. But Groddeck made another, more critical contribution to science than naming the Id. “There can be few doubts,” writes Lazslo Antonio Avila, “that Groddeck was the founder of modern psychosomatic medicine.” (Avila 2003, p. 97) Just as hysteria and neurosis could be explained by unconscious, irrational emotion and relieved by conscious, rational recognition of it, Groddeck argued, so could physical syndromes like chronic pain. Groddeck wrote in Imago in 1922, “The symptom of neurosis—and I personally believe the same thing is true of organic symptoms—express symbolically a tendency of the unconscious.” (Quoted in Grotjahn 1945, p. 16)

Martin Grotjahn has suggested that Groddeck epitomized the “intuitive” type of analyst, versus the “more learned” or scientific type. (Grotjahn 1945, p. 22)

Groddeck never formally trained as an analyst, but he read Freud's work and applied it to the treatment of psychosomatic illnesses at his clinic in Baden Baden. He published in psychoanalytic journals and also published fantastical novels. Hristeva and Poster tell us that “Groddeck was not part of a group, he never established a school, and he introduced himself as a ‘wild analyst’ at the 6th International Psychoanalytic Congress in The Hague in 1920 in spite of the fact that he had been accepted and welcomed by Freud.” (Hristeva and Poster 2013, p. 250) He empathized so deeply with his patients' irrational ideations, rooted in the magical thinking of their childhoods and the dream-logic of their defense mechanisms, that he came to prize fluency in the irrational language of the unconscious over fluency in the rhetoric of science, as if the two were incompatible:

If I then were told that all this is nonsense, I must take it, but I keep on believing in it even without proof. Yes, perhaps because there is no proof. The longer one concerns oneself with proof, the more suspicious one becomes of it. If someone should tell me: “You indulge in fantasies”—I would reply, “Yes, and I thank God for it.” (Quoted in Grotjahn 1945, p. 16)

Making such colorful and provocative statements in defiance of conservative scientific mores may have earned him Freud's respect, but it unsettled many other leaders of the psychoanalytic movement who were fighting to establish the credibility of their new field. (Avila 2003, pp. 95-96; Bos 1992, p. 435)

Having rejected science and critical thinking, Groddeck could be over-reaching and reductive. “In Groddeck's psychosomatics,” Avila writes, “intentionality can be found behind all disease.” (Avila 2003, p. 89) Such a notion sweeps aside shelves full of pathophysiology with startling naïveté, and furthermore embarrasses Freudian interpretation with its cavalier and distorted uses of it. When Groddeck for example diagnosed the presbyopia of middle age as the expression of an unconscious wish not to see, he was ignoring the material reality of the eye, which obeys natural laws of its own; we now understand presbyopia as a stiffening of the lens with age, which hampers changes of focus. Alas, entropy is no product of psychology, but a feature of the physical universe that does not respect human intentions, whether conscious or

unconscious. Groddeck's way of practicing medicine and psychoanalysis could be reckless.

His idea, however, that a physical symptom could be “a kind of speech” (quoted in Avila 2003, p. 90) expressing an unconscious emotion, was a valuable insight if applied more judiciously. Many experts now agree that psychosomatic factors should be considered, for example, in cases of chronic low back pain, a condition which affects as much as 10% of the U.S. population and whose prevalence may still be rising. (Freburger et al. 2009). Physician John Sarno, a specialist in rehabilitation medicine, has described his success treating chronic low back pain with a simple psychotherapeutic intervention: urging patients to consider a psychosomatic explanation instead of a structural explanation. Merely considering the possibility relieved many patients of pain. (Sarno 2007)

Sarno cites Freud as an influence, but the literature on psychosomatic medicine generally makes little use of Freudian psychology and the field is in any case very young. Only in the last 20 years have subspecialties in psychosomatic medicine been recognized by accrediting bodies. Consequently, low back pain continues to be treated with drugs and surgery at a high rate, despite changes in published treatment guidelines, which now urge that “a biopsychosocial framework should guide management of low back pain” with “less emphasis on pharmacological and surgical treatments.” In 2011, for example, Americans spent $13 billion on spinal fusion surgeries, which amounted to the “highest aggregate hospital costs of any surgical procedure” that year. (Foster et al. 2018, pp. 2369, 2375) Meanwhile, we're in the middle of an opioid crisis spurred in part by a general problem with pain and a hunger for anesthesia. (Stoicea et al. 2019) More psychotherapy and less opioids would benefit millions of people.

What if Groddeck had more carefully observed Freud's productivity credo and followed his “daringly playful fantasy” with some “relentlessly realistic criticism”? Perhaps more psychoanalysts would have listened to him. As it was, they generally did not. Felix Deutsch, Franz Alexander, and a few others continued Groddeck's work on psychosomatic medicine, but the psychoanalytic mainstream ignored him. Over the past 50 years, psychoanalysis itself has been marginalized, putting Groddeck's work at an even farther remove from mainstream medicine. Groddeck's

shocking idea—that the unconscious can speak not only in dreams, hysteria, and neurosis but also in real physical symptoms like back pain—remains obscure. From its remote position in the intellectual hills, it cannot reach the millions of sufferers of chronic low back pain.

Even if Groddeck had been better able to merge art and science in his own professional life, however, the failure of the wider psychoanalytic community to embrace experimental science would have limited Groddeck's reach, just as it's ultimately limited Freud's reach. It doesn't necessarily matter how well individual practitioners live up to scientific and artistic ideals, but it does matter how well a community does. The psychopharmacology community has invested so thoroughly in the inductive process that it often neglects creative, theoretical, original thinking and practices a psychiatry barren of insight. The psychoanalytic community's underdeveloped apparatus for testing its assumptions and new ideas, on the other hand, has endangered its theories just as much by failing to nurture them from the critical and empirical side. Instead of looking to evidence, for example, to test and refine Groddeck's psychosomatic theories, the field has taken its usual approach of assigning him a camp. Some might say, “He is an Artist and a wild analyst, not a Scientist, so I needn't pay attention to his flaky ideas.” Other analysts meanwhile celebrate him for a postmodern approach “marked by anti-scientism and a more philosophical, speculative attitude than Freud's psychoanalysis.” (Hristeva and Poster 2009, p. 235) Hristeva and Poster attribute to Groddeck a salutary “maternal turn” in the direction of psychoanalysis. Both rejection or celebration of Groddeck as an artist, not a scientist, reflect a defensive attitude of “splitting and avoidance.”

There is simply no need to divorce art from science or theory from experiment in psychoanalysis or in any other field. As Grotjahn concludes:

It would be wrong to call Groddeck an artist—which he was—in opposition to a scientist—which he also was. To differentiate between Art and Science in analysis would be a meaningless undertaking. The question is just as falsely put as the question concerning the Body-Mind problem once was wrongly formulated. The true problem is in both questions the interrelation between the one and the other part. (Grotjahn 1945, p. 22)

The practical consequences of the failure to integrate art and science are huge for both psychoanalysis and for patients who could benefit from a Freudian style of treatment. In the case of chronic low back pain, the U.S. healthcare system wastes vast resources on the wrong treatments, patients suffer, and psychoanalysts forfeit an opportunity to expand their reach and lead the nascent field of psychosomatic medicine.

If the field of psychoanalysis is ever to stop perseverating on whether it is an art or a science and instead wed the two—or weld them as the case may require—psychoanalysts will have to recognize the longstanding problem of their aversion to proof, to inductive method, and to academia, an aversion that Groddeck, Freud, and even Anna Freud shared to varying degrees. When I have presented my work on proof aversion to certain analysts they have responded with a yawn and told me they are “bored as can be” with being “lectured” about evidence. Such chaste devotion to an unfertile status quo reminds me of the Protestant sect once known as the Shakers, who advocated celibacy among their members so successfully that they no longer exist.