Austin Ratner clearly understands, as he states in his first sentence, that “Art versus Science is a false dichotomy.” Yet he is preoccupied with a critique of psychoanalysis for failing to carry out sufficient scientific research. In this paper, he lays this critique at the feet of Georg Groddeck, a German physician highly esteemed by Sigmund Freud and mentor to Sandor Ferenczi, Freida Fromm-Reichmann, Erich Fromm and Karen Horney.
In order to better understand the roots of Ratner's critique, I read his book The Psychoanalyst's Aversion to Proof (2019). In that book he grounds the same critique at the feet of Sigmund Freud. He cites Freud's personal failings—shame, anxiety and Oedipal guilt about exposing his sexual theory—as the basis for Freud's “inviolate silence” in the face of calls for scientific study of psychoanalysis. He may as well have added Freud's formation of a Secret Committee as a “central committee for polemics.” Or, just as well, the formation of the International Psychoanalytic Association wherein only he would decide who could be a member. Such “adherents” would publish their names as such and others would be “repudiated” (Freud, 1910). That decision resulted in the loss of Eugen Bleuler, his most esteemed supporter, who left specifically because, as he wrote to Freud, such is the stuff of religion, not science (Alexander and Selesnick, 1966). Indeed, Alfred North Whitehead (1917) warned, “A science which hesitates to forget its founders is lost.”
Ratner's critique re: the relative neglect of scientific research in psychoanalysis, starting with Freud and extending through his epigones, is well-researched and well-taken. Ratner admits to having “a decidedly Freudian-rationalist worldview” (p. 186). He further traces what
he describes as a postmodern, relational view back to ancient skepticism and the verum factum (made truth) of 18th-century philosopher Giambattista Vico (i.e., not a new paradigm shift, but another form of authoritarianism). Nevertheless, there is scientific value in both nomothetic (general laws) and idiographic (specific cases) research.
Ratner generously shares with the reader of his book his personal history of losing his biological father at age 3 and being warmly raised in the Hannah Perkins psychoanalytic nursery in Shaker Heights, Ohio. Accordingly, his attachment to psychoanalysis at its best is personal and emotional. Later, he trained at Johns Hopkins under Paul McHugh and endorsed Eric Kandel's call for the objective study of the psychoanalytic treatment procedure. Perhaps having teachers who do not practice psychoanalysis influenced Ratner's valuing of science over art, even when his premise is that such is a false dichotomy. Ratner's view of both Freud and Groddeck, not to mention psychoanalysis and psychosomatic medicine, seems to be both aggrandized and then subjected to inordinate criticism. Ratner correctly notes that “psychoanalysis itself has been marginalized.” However, the reasons for this are much more complex than Freud's personality defects (see Eisold, 2007; Stepansky, 2009). Likewise, psychosomatic medicine has long since been intertwined with and/or superseded by consultation-liaison psychiatry. The reasons for this are also complex and largely related to politics and funding (see Brown, 2000; Lipsett, 2001). Furthermore, while the psychological component of physical illness is very much larger than Ratner suggests, psychoanalysis is a very minor component of the alternative medicine and bodily treatment healthcare industry.
Ratner charges that my co-author Galina Hristeva and I were “splitting” when we described Groddeck's “maternal turn” (2013). On the contrary, we were noting the important addition that Groddeck (1923; and later Horney, 1926; Gilligan, 1982; Corpt, 2017; and many others) made by adding a maternal perspective to Freud's phallocentric psychoanalytic theory. Indeed, Ratner acknowledged in his book with regard to this very issue that Horney (who credited Groddeck in her landmark 1926 paper challenging Freud's male bias) “was right and Freud was wrong” (p. 156). Just to highlight the complexity, Hristeva herself has written a whole book (2008), available in German, that too was highly critical of Groddeck's anti-scientism.
Freud was actually very interested in maintaining die Sache (the cause, or psychoanalytic movement) on a scientific basis. However, he also was highly ambitious (see Breger, 2009). When Freud lost his Aryan hope, Carl Jung, as a successor, he embarked on an authoritarian path (as Ratner properly notes). It can be noted that only months previously Freud had taken an avuncular and humble stance and credited Breuer and his hysterical patient Anna O. (Bertha Pappenheim) with founding psycho-analysis (Freud, 1910a, p. 9).
Ferenczi coined the term utraquism (1933a, p. 221) to describe Freud's ability to bridge psychology and medicine, the very linkage of art and science that Ratner espouses. In that paper, titled “Freud's Influence on Medicine” (1933a), Ferenczi wrote that Freud's “intellectual honesty led him to the realization of the fact that the psychic life is only accessible from the subjective side by means of introspective methods…Thus Freud became a dualist, a term that most scientists at that time and even today considered almost shameful. I do not believe that Freud objected to the monistic conception of knowledge. His dualism merely states that this unification will be possible neither at present nor in the near future” (p. 221). To the credit of Ferenczi, he wrote this paper even as Freud was browbeating him about publishing his own trauma theory in what has become a landmark paper in all of traumatology, Ferenczi's Confusion of Tongues (1933b).
Groddeck was more comfortable with monism. Ironically, he is credited with being “the father of psychosomatic medicine,” a dualistic term of which he would not approve. Nor was he interested in being the father of any theory or movement. As Freud said, Groddeck was “not a propagandist.” He was a master clinician who treated patients from all over Europe. Groddeck was steeped in the medical science of Berlin, his own physician father and his mentor Schwenninger, a strict authoritarian physician. But being a clinician, he came to appreciate that all disease had a causa interna and a causa externa. Groddeck found that listening to and using his concept of das Es as an interpersonal, even an inter-psychic, positive construct brought about remarkable therapeutic results, including in patients with physical illness. Freud, however, appropriated Groddeck's das Es and turned it into the wild Id of his more scientific appearing tri-partite model. Groddeck was more interested in trying to understand (verstehen) the individual case whereas Freud
prioritized designing a model of the mind as a scientific explanation (erklaren). Freud recognized that Groddeck and Ferenczi shared an “artistico-intuive” bent. That is why Freud immediately referred his “loyal son” Sandor Ferenczi to Groddeck, and they became great friends (Poster, 2009). They analyzed each other (certainly not a scientific undertaking in the strict sense, but very much so in the sense of trial-and-error experimentation). Ferenczi wrote to Freud that Groddeck was the “master of psychoanalysis in organicis” (Poster et al, 2016).
Being a talented writer himself, Ratner might be interested to know that English professor and psychoanalyst Peter Rudnytsky (2002) described Groddeck's The Book of the It as “arguably the greatest masterpiece of psychoanalytic literature” (p. 163). Furthermore, Rudnytsky wrote, “It is not an overstatement to say that The Ego and the Id has become a book of the past, whereas The Book of the It—like Ferenczi's Clinical Diary – remains a book for the future” (p. 143).
Groddeck and Ferenczi's works are still being researched by the Groddeck Gesellschaft and the International Ferenczi Society, respectively. Each has international conferences and numerous valuable publications. Freud's works also stimulate ongoing discussion and debate, albeit marginalized from medicine and saddled with the baggage related to the political power structure that Freud created, just as Bleuler predicted. That's where I agree with Ratner that a scientific basis for testing and pruning would be useful. But beyond the historical political barriers, the objective study of an intersubjective process remains a daunting task. When Freud ventured into the realm of psychology, he understood that his efforts would, at best, build a scaffolding for others later to build upon. Ratner's call is consistent with Freud's wish.
Mark F. Poster, MD
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