Universität KonstanzExzellenzcluster: Kulturelle Grundlagen von Integration

Reflex and Interpretation

A Genealogy of Psychoanalysis and the Neuro Disciplines, ca. 1850–1950

Prof. Dr. Dr. Katja Günther

Abstract

My project Reflex and Interpretation – A Genealogy of Psychoanalysis and the Neuro Disciplines, c. 1850-1950 attempts to recast the relationship between neurosurgery/ neurology and psychoanalysis, by analyzing their common use of the reflex principle. These disciplines all trace their history back to the neuropsychiatry that dominated the field in nineteenth-century Germany, and which used the reflex as one of its central conceptual and practical tools. An examinination of this history allows us to think these different fields alongside each other and recognize unexpected parallels in their development. Reflex and Interpretation then is a history of the mind-body connection more broadly, in a range of institutional, social, and national contexts: I follow the path of the reflex paradigm through Theodor Meynert’s Viennese University Clinic in the 1860s and 70s, via Carl Wernicke’s city asylum in late nineteenth-century Breslau, Sigmund Freud’s private practice in Vienna, the privately-practiced neurology and physical therapy in the Swiss Kurort, which impacted upon Otfrid Foerster’s neurology and developing neuro-surgery in Breslau, Paul Schilder’s psychoanalytic work in the Vienna of the 1920s and then in New York hospitals, and Wilder Penfield’s neuro-surgical work in mid-century Montreal.

My analysis is founded upon the insight that for much of the modern period the reflex paradigm existed in productive tension with the localization of function tradition. In the mid-nineteenth century, as exemplified by the work of Theodor Meynert, the reflex served to rejuvenate and legitimize an antiquated and disreputable localization paradigm, that hoped to find cerebral centers for psychic function. The alliance between localization and the reflex was, however, an uneasy one and in Meynert’s work, the localization project was tempered by an insight informed by the reflex tradition: that the brain was a fragmented organ unified through fiber connections, whose functioning could be understood through social metaphors.

The tension between the reflex and localization traditions came to the fore in the clinical work of Carl Wernicke, Meynert’s most important student. Though Wernicke’s work on sensory aphasia is often regarded as the apogee of the nineteenth-century localization tradition, his clinical practice tells a different story. I focus my analysis on a number of original patient files from Wernicke’s clinic as well as the stenographed transcripts of Wernicke’s clinical demonstrations in Breslau at the turn of the century. This shows how the application of sensory-motor physiology to the examination of living patients complicated the idea that psychic functions could be simply located in parts of the brain. Rather, Wernicke detached the reflex from the task of locating lesions, and presented it instead as a hermeneutic principle, able to bring out the patient’s subjectivity in its richness.

The corrosive effect of the reflex paradigm on the localizationist project is at the heart of my book, and I follow it in two parallel stories, looking how its connective model came to recast Meynert’s understanding of nervous action and contributed to the formation of the two new disciplines of psychoanalysis and neurology.

The tension between reflex and localization was central to Freud’s criticism of neuro-psychiatry and the emergence of psychoanalysis. Looking at Freud’s pre-1900 writings, I show how he turned the connective properties of the reflex model against what he saw as the psychological idea that sensory impressions could be located in particular areas of the brain. For this reason, though psychoanalysis has often been presented as a psychological break from physiology, I show that it rather emerged from a radicalization of physiological principles. Freud’s concept of the unconscious in particular, I propose, grew out of this internal critique of the neuropsychiatric tradition. With respect to psychoanalysis as practice, I show how Freud’s criticism of the neuropsychiatric tradition opened up new possibilities for re-casting the reflex exam as a form of therapy. Like Wernicke, Freud presented it first and foremost as a hermeneutic principle.

A very similar process of internal criticism can be seen in the emergence of neurology and neurosurgery. Breslau neurologist and neurosurgeon Otfrid Foerster picked up on a second strand within Meynert’s work – the conceptualization of the nervous system as a social entity, with nerves cooperating with each other. This provided the rationale for his newly developed neurosurgery and its complementary Übungstherapie (lit. exercise therapy). Like Freud, Foerster used the reflex both therapeutically and as a hermeneutic. In contrast to Freud however, who performed his reflex testing verbally, to access a hidden truth underlying the patients’ slips of the tongue, dreams, and speech, Foerster drew on a wide arsenal of devices to help him “listen” to the moving nervous system in his own way. He used his scalpel, as well as film and photography, to manipulate and document the moving nervous system.

In treating Freud and Foerster’s innovations as a conceptual unit, I am able to show that despite disciplinary and theoretical differences they both came to develop a concept of subjectivity as fragmented, non-transparent and requiring concerted interpretative effort to be understood.

After the disintegration of the localizationist paradigm in the work of Freud and Foerster, I examine its re-emergence in the final two chapters. Following two strands into the mid twentieth century, I show how the movement away from the reflex – foregoing its hermeneutic richness – allowed for the reintroduction of a transparent subject. By examining how the émigré psychoanalyst Paul Schilder and the neurosurgeon Wilder Penfield in North America in their clinical practice “cut the reflex in half,” I show how both of them were compelled to take their patients’ words at face value. For Schilder, this entailed a number of revisions of psychoanalytic orthodoxy, not least the rejection of the unconscious. Looking in particular at the changing visual representations of the brain used to document his stimulation results, I show how, over time, Penfield too re-introduced the category of “mind.”

A history of the brain and mind sciences, guided by their use of the reflex both as a theory and a practice, reshapes our understanding of the disciplines that have been most influential in the construction of modern theories of subjectivity. It suggests that the categories of brain and mind, which inform those theories just as much as they have structured the history of psychoanalysis and the neuro disciplines, serve to obscure the rich history of their interactions, and it provides new ways to understand the complex of forces that have helped construct the modern self.

Publication

Cover

Katja Guenther: Localization and Its Discontents. A Genealogy of Psychoanalysis and the Neuro Disciplines Chicago: University of Chicago Press 2015.