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Contribution of Hungarian Psychoanalysts

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The American Journal of Psychoanalysis, 2009, 69, (207–220)
© 2009 Association for the Advancement of Psychoanalysis 0002-9548/09
www.palgrave-journals.com/ajp/
CONTRIBUTION OF HUNGARIAN PSYCHOANALYSTS TO
PSYCHOANALYTIC PSYCHOSOMATICS
Judit Mészáros
How is psyche related to soma? What tricks does the mind play on the body—and vice-versa?
In psychoanalysis, few have probed these questions more deeply than analysts from the
Budapest school. Their work began in Hungary and was carried forward in other countries,
following their forced emigration. In this study, I touch upon common features of Ferenczi’s
and Groddeck’s thinking about psychosomatics. I explore the work of Sándor Ferenczi, Lajos
Lévy and Mihály Bálint among others, and the attraction between avant garde Hungarian
intellectuals—mainly writers influenced by Ferenczi—and Georg Groddeck.
KEY WORDS: The Budapest School of psychoanalysis; Ferenczi; Groddeck;
Bálint; early object relations; psychoanalytic psychosomatics.
DOI:10.1057/ajp.2009.11
BUDAPEST
Sándor Ferenczi, Lajos Lévy and Michael Balint
In Ferenczi’s work, body and mind form a unit; physical and psychological processes flow into one another (Pfitzner, 2005, pp. 30–31).1 The
subject of Ferenczi’s interest in psychosomatics is himself—his own body,
“my poor Konrad” (Erős, 2004)—as he describes it in the Freud-Ferenczi
correspondence, using the Swiss writer Spitteler’s term. Seeing the body
more generally as the stage on which the mind expresses itself, Ferenczi
views the body as a surface abounding in symbols whose hidden messages
can be decoded through psychoanalysis. At the same time, in Ferenczi’s
approach, the body makes it possible to demonstrate the depths of psychic
regression. This view reflects Haeckel’s theory of onto—and philogenetics,
according to which the development of the individual repeats the phases
Judit Mészáros, is a Ph.D., Training and supervising analyst, Hungarian Psychoanalytical
Society. President, Sándor Ferenczi Society, Hungary.
Address correspondence to Judit Mészáros, Szt. Istvan krt. 13, Budapest, 1055, Hungary
E-mail: [email protected]
An earlier version of this paper was presented at the clinical Sándor Ferenczi Conference,
August 2–6, 2006, Baden-Baden, Germany
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208 MÉSZÁROS
of earlier development. Ferenczi contends that this is a flexible, two-way
process in terms of the functioning of the mind: in regression we see the
very reverse of individual development. Earlier phases of ego development
can be reconstructed. In fact, as he discussed in his bioanalysis, his famous
Thalassa (1924), intercourse enables us to return to the womb and even
beyond to the very beginning of life and to the primordial soup (Thalassa).
In addition to all this, the psychosomatic phenomena in Ferenczi’s approach
appear to be appropriate to revealing any intrapsychic conflict, whether it is
a problem in adulthood or in very early mother—infant, or even prenatal,
object relations—the latter case representing nothing more than the emotional
disposition of the mother and the environment toward the pre-born child.
Let us examine two examples of the appearance of relational
disturbances.
According to Ferenczi, a frustrating relationship full of bitterness and
disappointment, but still marked by a strong bond—like his own relationship with Freud—can manifest itself in physical destruction. As we know,
his study, (1933) Confusion of tongues between adults and child written
for the Wiesbaden conference represented, by today’s assessments, a paradigm shift toward modern trauma theories, and widened the gaps between
Freud and Ferenczi.
In an October 2, 1932 entry in his Clinical Diary, Ferenczi states the
following about pernicious anaemia:
Regression in — Embryonic state during analysis (in organic disintegration)
Further regression to being dead. […] In my case the blood-crisis arose when I
realized that not only can I not rely on the protection of a “higher power” but on
the contrary I shall be trampled under foot by this indifferent power as soon as I go
my own way and not his. […] And now, just as I must build new red corpuscles, I
must (if I can) create a new basis for my personality, if I have to abandon as false
and untrustworthy the one I have had up to now? Is the choice here one between
dying and “rearranging myself”—and this at the age of fifty-nine? […] A certain
strength of my psychological makeup seems to persist, so that instead of falling ill
psychically I can only destroy—or be destroyed—in my organic depths (Ferenczi
(Ferenczi, 1933b, 212–213.
In a sign of the truly frank relationship between Groddeck and he,
Ferenczi not only noted this in his own clinical diary, but he shared it with
his friend in the last letter he wrote to Groddeck:
The underlying psychological reason for this decline was due, apart from sheer
exhaustion, to my disappointment in Freud, about which you also know. (Ferenczi to
Groddeck, 20 March 1933. Ferenczi-Groddeck correspondence, 2002, p. 105.)
It could also be said that Ferenczi saw the body as a second system of
signals, one which has its own language to relate to the inner conflicts that
take place unconsciously, like a sort of messenger whose functioning is
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PSYCHOSOMATICS CONTRIBUTION OF HUNGARIAN PSYCHOANALYSTS 209
determined by psychological processes. Sándor Márai, one of the greatest
writers of the 20th century and a friend of Ferenczi, had this to say on the
occasion of Ferenczi’s death:
Ferenczi’s death had a completely primal effect on me: I simply couldn’t believe
it. When I put down the receiver that brought the news of his death, after a moment of reflection, I called my informant and asked if he had not made a mistake.
Later, I thought about it and realized that I was hurt and angry at the death of
Ferenczi. I had a childlike idea that he had discovered something, that it didn’t
apply to him, that he would die when he wanted to. As far as I knew, he hadn’t
wanted to and […] he looked down on death and life’s primitive structure [the
body] […] he ordered a member of his family, if she happened to find him,
dying, not to believe it straight away, but to shake him violently […] This is what
he thought of the body; it was like a faulty clock that sometimes stops and just
needs to be shaken to get it to start ticking again […] This is also why I was hurt by
his death. Perhaps he simply wasn’t shaken properly (Márai, 2000, 47–48).
Another example draws our attention to the potentially grave psychosomatic consequences of a frustrating mother--child relationship. The ideas
that Ferenczi put forth in his 1929 study The Unwelcome Child and His
Death Instinct also appear in the later works of other analysts. Whether
linked to Ferenczi or independent of him, these ideas were developed
further and made complete. They also brought about a change of perspective not only in the theory of psychoanalysis and in therapeutic practice,
but more generally in clinical work, as well as in infant care and in modern
childbirth. In 1929, Ferenczi thought that the symptoms of many patients
could be interpreted as psychosomatic expressions of the death instinct.
On this, there was complete agreement between him and Groddeck, who
also saw early deaths as unconscious suicides. Thus, Ferenczi writes the
following about a deficit in early emotional relationships:
I obtained a somewhat deeper insight into the genesis of unconscious self-destructive
trends during analysis of nervous circulatory and respiratory disturbances, especially
of bronchial asthma, but also of cases of complete loss of appetite […] not explicable
anatomically […] patients came into the world as unwelcome guests of the family,
so to speak […] In later life, relatively slight occasions were then sufficient motivation for a desire to die, even if this was resisted by a strong effort of will. Moral and
philosophic pessimism, scepticism, and mistrust became conspicuous character traits
in these patients […] I only wish to point to the probability that children who are received in a harsh and unloving way die easily and willingly. Either they use one of the
many proffered organic possibilities for a quick exit, or if they escape this fate, they
retain a streak of pessimism and aversion to life (Ferenczi, 1929, pp. 103–105).
An important part of treatment is that Ferenczi allows these patients to
be children again in the psychoanalytic process, and to enjoy early primary
love, or passive object love, and, in this case, complete acceptance by the
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210 MÉSZÁROS
analyst. Love and attention, in Ferenczi’s view, are indispensable to staying
alive (Haynal, 2002). Without love, the growing child can actually die;
indeed, early love is “equivalent to nutrition.” Winnicott said almost the
same: “A baby can be fed without love, but lovelessness or impersonal
management cannot succeed in producing a new autonomous human
child” (Winnicott, 1971, p. 127).
Ferenczi’s ideas on the serious psychological and psychosomatic damage
suffered by the unwelcome child, the infant that has been left on his own,
were strengthened and took a new developmental tack through the work
of people like René Spitz. Ferenczi’s deductive conclusions were borne out
through René Spitz’s own experiments and observations that it was really
true that a child can become seriously ill in an environment without love
and can actually die.
Spitz was also influenced by the early years of Hungarian psychoanalysis.
He saw Freud for a few months in 1911 for his personal analysis, earned
a medical degree in Budapest, and attended Ferenczi’s lectures, but left
Hungary in the first wave of emigration in 1919. The teachings of Freud,
Ferenczi, Balint and Klein appealed to him, and he carried on his special
interest in the early relationship between mother and child. In the 1930s,
when an ever more intensely fascist Europe forced him to escape as well,
he finally emigrated from Paris, and then settled in America. He quickly
came to understand the pragmatic way of thinking in America and the
demand for applicability. He thus observed infants placed in various institutions using the methods of experimental psychology with new techniques,
tests and other tools. He described hospitalism as a depressive symptom
in the abandoned child in the early few years. The studies Spitz conducted,
and his 1943 film, Grief: A Peril in Infancy, prompted the consensus that
early contact and the early emotional and physical relationship between
mother and child should become a developmental imperative. The results
of his research changed the theoretical background and practice of hospital
care for infants. It is well worth noting that experimental psychology demonstrated trends in line with psychoanalytic ideas in those years.
Harry Harlow’s research on primates placed the life-affirming power of
maternal care that keeps us alive in a more general context. His experiments were powerful proof of the fact that the possibility of clinging to the
mother, or the lack thereof, is a crucial issue. Later, other experiments with
animals bore this out on a much wider scale. Harlow’s greatest contribution
was his demonstration of the power of “mother love,”1 that is, the necessity
of normal development (cuddling in general and especially if they were
frightened), and the devastation that ensues when an infant is untouched,
unloved and neglected.
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PSYCHOSOMATICS CONTRIBUTION OF HUNGARIAN PSYCHOANALYSTS 211
Both René Spitz and John Bowlby had shown—before Harlow’s demonstrations—how infants raised in orphanages became ill and failed to thrive
if they were fed, but never cuddled when they were isolated or abandoned.
On the topic of clinging, it would be a mistake to omit the name of the
man who discovered the infant reflex that was named after him (the Moro
reflex). In 1918, Ernst Moro described this reflex so characteristic of infants.2
Ferenczi also discovered Moro’s research. Ferenczi wrote that he had come
across the
interesting work of a pediatrician from Heidelberg on the first trimenon, or on the
characteristic features of the first three months of an infant’s life. […] According
to Moro, if we slap a baby’s pillow with both hands, then a unique reflex motion
takes place […] the child brings both arms together symmetrically […] at the same
time the legs demonstrate a similar motor behaviour (Ferenczi, 1918, p. 225).
Ferenczi incorporated this into his study on the traumatic neuroses he
had observed in the First World War. According to Ferenczi, “Moro is
referring to a tiny sort of fright (or traumatic neurosis).”(ibid.) Ferenczi notes
that this reminds Moro of the cuddling reflex in baby animals, and in baby
monkeys in particular, with which they “cling to their mothers.” (Ibid.) It
looks, therefore, as if this “clinging phenomenon” or reflex was being
offered by Moro for the benefit of scientific thinking. Imre Hermann (1933),
also of the Budapest school, defines the infant’s early clinging movements
as a component of instinct, and thus speaks of a clinging instinct in the
mother infant relationship. Hermann assumed a tendency toward a clinging
instinct behind the Moro reflex. Perhaps these examples are suitable to
demonstrate the cycle in the complexity of somatic and psychological
components that is capable of bringing about changes in the successive
layering of physical and psychological needs in the organic depths—in a
harmony that represents satisfaction in optimal cases, but in a disharmony
of pathological reactions in opposite cases.
One more phenomenon can be added to the list of Ferenczi’s ideas on
psychosomatics: pathoneuroses. This is the expression Ferenczi uses to
describe psychological disturbances that develop in the soil of organic
abnormalities. He sees these as regressions that have come about as a result
of physical illnesses, injuries or mutilations—in fact, as narcissistic regressions that are accompanied by a withdrawal of the libido from the outside
world and a seizing by the libido of the sick body part (Ferenczi, 1917).
Psychoanalytic psychosomatics basically developed in Hungary through
the work of Ferenczi, Lajos Lévy and Michael Balint, but all of the physicians
of the Budapest school were of a similar mind, evidence of which include
the publications from the 1920s and 1930s. See, for example, Géza Révész’s
study Organic diseases that serve to manage the libido (Révész, 1993).
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212 MÉSZÁROS
From the Ferenczi—Lévy—Balint line, let us take a look at what we owe
Lajos Lévy, an internist and a familiar figure of the psychoanalytic movement. Although Lévy never conducted analytical therapy himself, his work
and life were closely linked to this healing trend and to the development
of a psychoanalytic psychosomatic approach. Ferenczi and Lévy’s first posts
were actually at the Rókus hospital in 1900. Lévy was an assistant physician at the neurology ward, as well as a trainee in internal medicine, while
Ferenczi began his medical career at the ward for venereal disease patients,
which he hated with a passion. Still, it was in an effort to counterbalance
his job that Ferenczi began to deal with psychological experiments, such
as automatic writing, and soon he discovered all those unconscious or
partly conscious phenomena that led him directly to psychoanalysis. It was
in this period that Ferenczi came to know Lajos Lévy and others (Mészáros,
2003). Lévy joined the psychoanalytic movement at the outset, and was
one of the founders in 1913 of Ferenczi’s Hungarian Psychoanalytical
Society. Ferenczi turned to Lévy for his physical ailments, and Lévy treated
him for pernicious anemia. At the same time, Lévy maintained a close
relationship with the Freud family, and, after his late emigration and arrival
in London in 1954, he became Anna Freud’s physician. His charismatic
personality and amazing diagnostic talents made him legendary among
internists. Lévy was happy to try new trends as well; he was the first in
Hungary to establish an ECG laboratory. He was also the first internist in
Hungary to treat patients using the psychoanalytic—psychosomatic
approach.
The finest example of the approach to patient and illness in Lévy’s
psychoanalytic—psychosomatic paradigm was his piece Anamnesis of
Heart Patients (1933). It was intended that this study should be dedicated
to Ferenczi’s sixtieth birthday, a surprise collection of the writings of
his followers and colleagues, but it was published posthumously after
Ferenczi’s sudden death. In many respects, Lévy’s medical history would
meet the requirements of the first interview in today’s dynamic psychotherapy sessions: for example, one must listen to and observe the patient,
including his or her every gesture and facial expression and even the
parapraxis he or she makes. According to Lévy,
we should not begin an anamnesis by asking the patient for his name, age and
occupation […] There is nothing with which we can frighten off the patient more
than if we put on an official face […] write down his every word and overwhelm
him with a stream of questions. We need be patient and attentive and let the
patient speak (Lévy, 1993, p. 304). […] we must get to know the physical and
psychological personality of the patient. After all, the physician’s task is to cure
the sick person, not the sickness. […] We need to know from the patient […] how
he views the illness (ibid., 301).
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PSYCHOSOMATICS CONTRIBUTION OF HUNGARIAN PSYCHOANALYSTS 213
One must also pay attention to the patient’s unconscious expressions.
A patient who forgets something at the physician’s—a watch, a ring or an umbrella—
is leaving a token there and that is a sign of satisfaction, as opposed to the patient who
keeps on thanking the physician but forgets his prescription (ibid., 305).
Lévy recognizes the well-known unconscious relationship of mutual
reflectivity in the doctor—patient relationship, which we describe with the
expression transference–countertransference, and he draws our attention to
the fact that the physician must be capable of making his own unconscious
vibrations serve the healing:
… the subtle play of the facial expressions that accompany complaints […] give
rise to an unconscious resonance (ibid., 305).
It was through Lévy’s generosity that several generations of physicians
were trained in psychoanalytic psychosomatics. For example, Lévy headed
the department of internal medicine at the Pest Jewish Community Hospital
(as of 1928) and developed it into one of Central Europe’s most modern,
600-bed medical facilities as of 1938. His therapeutic approach affected
the operation of the hospital, and the psychoanalytic psychosomatic
perspective was integrated into the thinking of his students.
There was another member of the psychoanalytic generation that thought
similarly to Lévy about the physician, the patient and the illness. This was
Michael Balint. He was a student of Ferenczi, worked with Ferenczi at the
psychoanalytic Polyclinic in Budapest and was its head after Ferenczi
(1933) died and until Balint emigrated (1939). Everything that Lévy introduced in Hungary, Balint brought to fulfillment in London. Michael Balint
left Hungary twice for political reasons. After the first time he emigrated in
1920, to Berlin, he returned to Budapest in the mid-1920s, and, together
with his wife Alice Balint, completed his training analysis with Ferenczi.
Michael Balint published his study Psychoanalysis and Internal Medicine
at the age of 30 in 19263 (Bálint, 1926)—in which he devoted serious
attention to the phenomenon of transference, which even pervades the
relational dynamic between a doctor and a patient in somatic healing: the
pains of seriously ill patients stop, for instance, as he writes, if their physician enters the room. This is why the patient asks for the doctor so often.
… the visit, which, “objectively”, is so rarely necessary […] This art that a good
physician feels intuitively is what psychoanalysis uses to attempt to turn the
unconscious into the conscious and an intuitive feeling into a learnable science
(Bálint, 1926, p. 442).
Balint already mentions Groddeck in this study, who “speaks about a
whole series of cases, in which serious circulatory disturbances, for which
every cardiacum and diureticum have failed, have been cured with
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214 MÉSZÁROS
psychotherapeutic intervention” (ibid., 442). In his brief summary of 1926,
Balint sees the short history of psychoanalytic psychosomatics as follows.
Adler was the first to work out the relationship between organic diseases
and psychoanalysis,
the actual research, however, did not start down the path he had envisaged, but
the one seen by Ferenczi. It is interesting that Ferenczi’s theoretical report was
published at about the same time as that short account of so many years of practical
results that was put out by Groddeck, who was working completely independently
of him. Somewhat later and under some influence from Groddeck and Ferenczi,
Simmel and Deutsch began dealing with this topic (Balint, 1926, p. 444).
BUDAPEST—BADEN-BADEN
It is clear that once Ferenczi came to know psychoanalysis, he worked to
make it accessible and usable in the broadest possible cross-section of society,
not only as a theory and as a therapy, but also as a new approach to the way
people operate. He used a number of forums in Hungary to reach the medical
community, the educated middle-class and the young avant-garde. It is due
to these efforts that psychoanalysis found its way among representatives of
literature and the arts in Budapest, only 10 years after Freud and Ferenczi
had met. It is due to these quiet, intensive popularizing efforts that psychoanalysis earned its own department at the Budapest medical university in 1919
and became a part of regular medical training, if only for a short time. As the
first professor of psychoanalysis, Ferenczi opened the door to the psychoanalytic way of thinking in medical training. What is this then if not the early
victory of the introduction of psychoanalytic psychosomatics, which, however,
was soon swept away by Hungary’s socio-political changes? It provided an
example that became engraved in the common knowledge of the psychoanalytic movement (Mészáros, 2008a). And as soon as an opportunity was
granted, the innovation of the Hungarian analysts who had taken part in the
establishment of a department of psychoanalysis in Budapest was realized
once more. This took place through the person of Sándor Radó, who, in 1944,
exactly a quarter century later, managed to win acceptance for psychoanalysis
at Columbia University Medical School.
Ferenczi, Groddeck, the Hungarian writers and psychoanalysts
We learned much about the relationship between Ferenczi and Groddeck
with the publication of their correspondence in French, German and
English. Thanks go to the editors, among them Pierre Sabourin, Judith
Dupont (French), Joachim Frank (German) and Christopher Fortune (English).
We now have a special opportunity to learn more about their ideas on
psychosomatics.
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PSYCHOSOMATICS CONTRIBUTION OF HUNGARIAN PSYCHOANALYSTS 215
Milán Füst, Zsófia Dénes, Dezso” Kosztolányi and Georg Groddeck
Literary circles were also attracted to the works of Groddeck through
Ferenczi. After Groddeck and Ferenczi met, Groddeck’s sanatorium became
something of a household name among those of Hungary’s writers, who were
open to psychoanalysis. On a postcard written to István Hollós on August 8,
1921, Ferenczi first makes mention of meeting Groddeck. “I am going to
Groddeck’s sanatorium in Baden-Baden, for some recovery and to see the
‘plant’ there.” And from then on he became a regular visitor at that sanatorium,
and, beyond the treatments, became a dear friend of Groddeck. It was through
Ferenczi that Zsófia Dénes came in contact with Groddeck, as well as two
of Hungarian literature’s outstanding figures, Dezso” Kosztolányi and Milán
Füst. Zsófia Dénes, who was the niece of Ferenczi’s wife Gizella, and Milán
Füst were both treated by Groddeck. All three dealt with Groddeck in their
writing; indeed, he had a great impact on all of them. Like Ferenczi, Groddeck represented the complete unity of the body and the mind.
In 1917, Groddeck wrote, “… the mind and the body form a unified
whole, which conceals a primal thing/Id […] In other words, I reject the
separation of physical diseases and psychic diseases, I have attempted to
treat the whole person, the primal thing/Es/Id inside” (Groddeck’s letter to
Freud, May 17, 1917, cited by Vég, 1996, p. 126).
In 1920, Ferenczi devoted a section of his book A pszichoanalízis
haladása [The Progress of Psychoanalysis] to Organikus állapotok pszichoanalízise [Psychoanalysis of Organic States], and to Groddeck, mentioning
of Groddeck’s 1917 booklet.4 Ferenczi writes of Groddeck:
He claims to have succeeded in demonstrating in numerous cases of purely
organic illnesses—inflammations, tumors and constitutional irregularities—that
the disease arose by way of insurance against unconscious ‘sensitivities’ …
(Ferenczi, 1920, p. 198).
Milán Füst was a great writer and aesthete, whose life was embittered
by a constant dissatisfaction with everything around him. Naturally, he thus
had an ambivalent attitude toward the thinking of Freud, and it was precisely
this ambivalence that tied him to psychoanalysis for a lifetime. There was
actually only one figure in this long relationship — in which he was in
search of some balm to soothe his own somatic symptoms — who managed
to avoid Füst’s contemptuous and belittling narcissism, and that exceptional
figure was Groddeck. A decade after Groddeck’s death, Füst says the
following in his diary.
One of the most profound areas of study throughout my life has been aesthetics.
I am Theodor Lipps’s follower in that and George Groddeck’s in psychology (Füst,
cited by Szilágyi and Fazakas, 2002, p. 478).
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216 MÉSZÁROS
Groddeck also features in the correspondence among Hungarian writers.
For example, Füst wrote the following to Kosztolányi from Baden-Baden
on May 28, 1928:
Groddeck,—yes,—truly a great mind.—Probably the most outstanding man I have
ever seen. Extraordinary intellect and extraordinary power […] He is so intelligent
that it is frightening. (He is not a psychoanalyst, not at all, he’s a worker of wonders, his science cannot be learned) […] He is not a doctor—he is the only doctor,
someone born once in a few centuries.—Still, unfortunately, he does nothing for
me for the time being (Füst, cited by Szilágyi and Fazakas, 2002, pp. 168–169).
It can be said that Füst was swept up by his own attitude of transference
to Groddeck, and this certainly holds true, but there was also in Groddeck
a mix of many things: suggestion, empathy, the transference–countertransference dynamic, the interpretation of unconscious processes and the representation of the reality principle.
Zsófia Dénes, the young writer and a relative of Ferenczi’s wife, was
sent to Groddeck from Vienna, because of her depression caused by losses
suffered during her emigration. Crying all day, cowering motionlessly in
the most beautiful room at the Groddeck sanatorium surrounded by the
trees of the Black Forest, concealed in her black hospital gown, she heard
Groddeck say the following one day in 1923:
Yes, yes, the regret, the sadness, and indeed the great beauty. Man gets lost in
it, in the pure joy. But afterwards he reaches the point where it is destructive
because it stands in the way of life. And then the clever man steps outside it […]
His clothes remain on the ground […] like skin that has been shed that he no longer needs. Because he already has some new skin on his body. And man goes on.
And the next day I stepped out of my clothes. I went up to the Black Forest […]
He wanted it that way, the doctor (Dénes, 1979, p. 133).
Groddeck was there among the literary intellectuals of Budapest.
Dezso” Kosztolányi interviewed him in 1925. We may see this exchange
as Groddeck’s essence:
G.: […] I say that the results of psychoanalysis can nowhere be used as fruitfully
as in healing.
K.: Even for physical illness?
G.: Physical illness … psychic illness … Aren’t the two the same? […]
My functioning is nothing more than a reaction to 19th century medicine,
which mostly saw the human organism as a machine and tried to repair it […]:
it oiled its bolts, cleaned it, but it forgot about the hidden electricity which actually drives the machine […] because it is primarily the mind which makes it go.
Disease itself is a secret confession […] so that we can find shelter from the adversities of life […] Every early death is a suicide. […] If a sick person still goes
to see the doctor, he says by this fact that he doesn’t want to be sick. This is a
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PSYCHOSOMATICS CONTRIBUTION OF HUNGARIAN PSYCHOANALYSTS 217
pivotal inner contradiction. […] This is when the battle between patient and
doctor begins […] [the doctor] clears away all those stumbling blocks towering
before the patient’s self-healing (Kosztolányi, 1925, pp. 388–390).
Michael Balint
Budapest took Groddeck in, but soon expelled the finest of its intellectuals when it passed the anti-Jewish laws in 1938. Michael Balint was there
at the same time at the Budapest school, and then continued the work that
he had begun in Hungary during his forced exile first in Manchester and
later in London, and developed new innovations. Balint influenced psychoanalytic psychosomatics in Budapest and abroad. Balint’s work and personal
experience symbolizes the development of the Budapest school, and the
sudden blow it received while in full bloom (Mészáros, 2008b). The societies in Berlin and Vienna felt it also—in the period between 1933 and
1938—their lifeblood drained from them as the analysts fled fascism.
Completing his training with Ferenczi in 1926, Michael Balint joined
the Hungarian Psychoanalytical Society, and became a training analyst in
the same year. In 1930, he co-founded the Hungarian society’s psychoanalytic outpatient center, of which he was a deputy director between 1931
and 1933, taking over the leadership after Ferenczi’s death in 1933.
He launched seminars for practicing physicians at this Polyclinic.
In the 1930s, he gathered a number of physicians around him in order
to integrate psychotherapeutic perspectives into medicine. This gathering
became the precursor to casework groups set up by Balint for general
practitioners right after he settled in London. The origin of the Balint groups
can be traced back to three sources. The first is work on case-work seminars developed for social workers, to which Eichholtz had introduced Balint
in the late 1940s. The second is the group analysis that he learned about
through Wilfred Bion in 1947. The third source is Ferenczi’s life’s work.
Ferenczi, who did everything to fashion analysis into an invincible clinical
weapon, spoke as early as 1921 about the indispensability for general
practitioners of the understanding they gain from psychoanalysis. Ferenczi
gave a lecture “Psychoanalysis at the service of the practising physician,”
in 1923 to a large audience at the Košice Medical Association in today’s
Slovakia.
Michael Balint’s activity is well known in the field of psychosomatic
treatment, research and training. In the 1950s, he set up the case study
group for family doctors, the so-called “Research cum training seminars”
known popularly as the “Balint groups.” He published his popular book
The Doctor, his Patient and the Illness (Balint, 1957). There is a funny part
in an interview he gave Bluma Swerdloff5 in 1965, which represents well
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218 MÉSZÁROS
how Balint worked with general practitioners, and what he thought about
medicine.
Balint: “No formalities, no lectures, no demonstrations, nothing. Each doctor
brings up the cases that he finds difficult in his practice. He reports the case. Then
we discuss the case, discuss the doctor-patient relationship […]
Swerdloff: In the psychological field, is there a problem […]
Balint: Sh! No! This is medicine; medicine […]
Swerdloff: He doesn’t come to you with a problem in diagnosing a specific illness,
or does he?
Balint: Please, really listen! Medicine… Medical students go around the wards,
and they are clerks there and so on. So they come and say: “I have a patient who
has”—let’s see, what? […] Now, let’s see what the woman is like? And how her
personality and her problem with her marriage and her children are connected
with her illness. This is medicine.
Swerdloff: You assume a connection.
Balint: I do not “assume”! This is medicine! This is medicine! … we see … how
these things are connected” (Swerdloff, 2002).
It is safe to say, then, that the efforts of Ferenczi, Lévy and Balint to
introduce the experience of psychoanalysis into the practice of healing in
general represents the legacy of the Budapest School.
Franz Alexander
Finally, I would like to mention Franz Alexander, the farthest removed from
the Hungarian link to psychoanalytic psychosomatics, who became a physician
in Hungary, but was trained as an analyst in Berlin. Alexander left Hungary
in 1920 because of the first enactment of the anti-Semitic laws there, and
became the first student at the newly formed Psychoanalytic Institute in Berlin.
Later he became an outstanding member of the Berlin Society and was invited
to Chicago in 1931, where he established the Chicago Psychoanalytic Institute
and devoted his work to psychoanalytic psychosomatics.
He differed from Ferenczi’s point of view in his psychoanalytic perspective. Alexander no longer saw the body as a carrier of symbols. He saw the
body as a reactive system, which may react with symbols, but may also
express itself through a vegetative nervous system, which does not correspond directly to symbols. Alexander distinguished sharply between a
conversion symptom and a symptom, such as an ulcer, which was a response
by the autonomic nervous system and the vegetative organs, such as the
stomach, to emotional states. A conversion symptom symbolically expressed
unconscious psychological content through neuromuscular or sensoryperceptive systems, for example hysterical paralysis or hysterical blindness.
A vegetative symptom did not “express” anything, but was the physiological
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PSYCHOSOMATICS CONTRIBUTION OF HUNGARIAN PSYCHOANALYSTS 219
response of the organ to “constant or periodically returning” emotions. Thus,
the peptic ulcer had no psychological significance in itself, but reflected a
reactivated and chronic conflict over dependency.
As we can see, the theoretical and therapeutic innovations of psychoanalytic
psychosomatics represented as much a part of the way of thinking of the
Budapest school as, for example, relationship in psychoanalysis, the transference–countertansference dynamic, the early object relations model and the
recognition of the mother—child relationship. Their ideas on psychoanalytic
psychosomatics were present from the 1910s, and developed further through
the later work of the émigré analysts, work that still enriches our knowledge
today.
NOTES
1. He took infant monkeys away from their real mothers, giving them instead two artificial
mothers, one model made of wire and the other made of cloth. The wire model was
outfitted with a bottle to feed the baby monkey. But the babies rarely stayed with the wire
model longer than it took to get the necessary food. They clearly preferred cuddling with
the softer cloth model, especially if they were scared. (When the cloth model had the
bottle, the babies did not go to the wire model at all.)
2. Ernest Moro (1874–1951) was an Austrian physician and pediatrician, who discovered the
infant reflex that was named after him (Moro reflex). The Moro reflex, also known as the
startle reflex is one of the infantile reflexes. This reflex is a response to unexpected loud
noise or when the infant feels as if it is falling. It may be observed in incomplete form in
premature birth after the 28th week of gestation, and is usually present in complete form
by week 34 (third trimester). It is normally lost by the sixth month of life post-partum.
It was discovered and first described by the Austrian pediatrician. Reference: http://en.
wikipedia.org/wiki/Moro_reflex#column-one#column-one
3. A lecture was given at the Budapest Medical Circle on January 25, 1926.
4. Dr. Georg Groddeck: Die psychische Bedingtheit und psychoanalytische Behadlung
organischer Leiden. Verlag von S. Hirzel, Berlin, 1917.
5. Swerdloff’s interview was published with small corrections as part of a series of Special
Issues on the Life and Work of Michael Balint, guest edited by Judith Dupont. American
Journal of Psychoanalysis, 2002, Vol. 62/1+4 and 2003, Vol. 63/3
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