are among the It’s forms of expression, always ready for use. Consideration of these two modes of expression reveals the remarkable fact that the It never uses either of them alone, but always both at once: that is to say, no one is altogether ill, there is always some part which remains sound even in the worst illnesses; and no one is altogether well, there is always something wrong, even in the perfectly healthy. Perhaps the best comparison we could give would be a pair of scales. The It toys with the scales, now putting a weight in the right pan, now in the left, but never leaving either pan empty; this game, which is often puzzling but always significant, never purposeless, is what we know as life. If once the It loses its interest in the game, it lets go of life and dies. Death is always voluntary; no one dies except he has desired death…The It is ambivalent, making mysterious but deep-meaning play with will and counter-will, with wish and counter-wish, driving the sick man into a dual relation with his doctor so that he loves him as his best friend and helper, yet sees in him a menace to that artistic effort, his illness.
The illness, then, bears the same relation to the patient as does his handwriting, his ability to write poetry, his ability to make money; creation, whether in a poem or a cancer, was still creation, for Groddeck, and the life of the patient betrayed for him the language of a mysterious force at work under the surface—behind the ideological scaffolding which the ego had run up around itself. Disease, then, had its own language no less than health, and when the question of the cure came up, Groddeck insisted on approaching his patient, not to meddle with his “disease” but to try and interpret what his It might be trying to express through the disease. The cure, as we have seen above, is for Groddeck always a result of having influenced the It, of having taught it a less painful mode of self-expression. The doctor’s role is that of a catalyst, and more often than not his successful intervention is an accident. Thus the art of healing for Groddeck was a sort of spiritual athletic for both doctor and patient, the one through self-knowledge learning to cure his It of its maladjustments, the other learning from the discipline of interpretation how to use what Graham Howe[6] has so magnificently called “The will-power of desireless”: in other words, how to free himself from the desire to cure. This will seem a paradox only to those—and today they are very many—who have no inkling of what it is like to become aware of states outside the comfortable and habitual drowsings of the ego. We are still the children of Descartes, and it is only here and there you will find a spirit who dares to replace that inexorable first proposition, with the words “I am, therefore I can love.”[7]
It was this dissatisfaction with the current acceptance of disease as clinical entity that drove Groddeck finally to abandon, wherever possible, recourse to the pharmacopoeia or the knife; in his little clinic in Baden-Baden he preferred to work with a combination of diet, deep massage, and analysis as his surest allies. On these years of successful practice his reputation as a doctor was founded, while his writings, with their disturbing, disarming, mocking note, brought him as many pupils as patients, as many enemies as admirers. The majority of his theories and opinions, together with the It-concept on which his philosophy is based, were already worked out before he had read Freud. Yet he gladly and joyfully accepted the Freudian findings in many cases, and never ceased to revere Freud; but whereas the work of Jung, Adler, Rank, Stekel, might well be considered as modifications and riders to basic Freudian theory, Groddeck’s case is unique and exceptional. He stands beside Freud as a philosopher and healer in his own true right.
“With Groddeck,” wrote Keyserling[8] after his death,
has gone one of the most remarkable men I have ever met. He is indeed the only man I have known who continually reminded me of Lao-Tzu; his non-action had just the same magical effect. He took the view that the doctor really knows nothing, and of himself can do nothing, that he should therefore interfere as little as possible, for his very presence can invoke to action the patient’s own powers of healing. Naturally he could not run his sanatorium at Baden-Baden purely on this technique of non-intervention, so he healed his patients by a combination of psychotherapy and massage in which the pain he inflicted must have played some part in the cure, for in self-protection they developed the will-to-life, while the searching questions he put in analysis often touched them on the raw!…In this way Groddeck cured me in less than a week of a relapsing phlebitis which other doctors had warned me would keep me an invalid for years, if not for the rest of my life.[9]
For the patient Groddeck sought to interpret, through the vagaries of outward symptom and clinical manifestation, the hidden language of the It; “I do maintain,” he writes,
that man creates his own illnesses for a definite purpose, using the outer world merely as an instrument, finding there an inexhaustible supply of material which he can use for this purpose, today a piece of orange peel, tomorrow the spirochete of syphilis, the day after a draught of cold air, or anything else that will help him pile up his woes. And always to gain pleasure, no matter how unlikely that may seem, for every human being experiences something of pleasure in suffering; every human being has the feeling of guilt and tries to get rid of it by self-punishment.
To Groddeck plainly the ego is only a reflexive instrument to be used as a help in interpreting the motive force which lies behind the actions and reactions of the whole man; it is perhaps this which gives his philosophy its bracing life-giving quality. It is a philosophy with a boundless horizon, whereas the current usages of psychoanalysis plainly show it to have been built upon a cosmogony as limited in scope as that which bounded the universe of Kelvin or of Huxley.[10] If Freud gives us a calculus for the examination of behaviour, the philosophy on which it rests is a philosophy of causes; to Groddeck, however, all causes derive from an unknowable principle which animates our lives and actions. So we are saved from the hubris of regarding ourselves as egos and of limiting our view of man to the geography of his reflexes; by regarding the ego as a function we can re-orientate ourselves more easily to the strains and stresses of a reality which too often the ego rejects, because it cannot comprehend, or because it fears it. So much, then, for the basic difference between the philosophies of Freud and Groddeck; it will be evident, if I have stated my case clearly, that they complement one another, that they are not antithetical, as some have believed them to be; for Freud supplies much of the actual heavy machinery of analysis, and Groddeck joyfully accepts it. In return Groddeck offers a philosophy of orientation and humility which justifies the technocratic contributions of Freud, and allows us to understand more clearly the problems and penalties not merely of disease, for that does not exist per se—but of suffering itself. With Freud we penetrate more deeply into the cognitive process; with Groddeck we learn the mystery of participation with the world of which we are part, and from which our ego has attempted to amputate us.
And what of the It? Groddeck does not claim that there is any such thing. He is most careful to insist that the It is not a thing-in-itself, but merely a way-of-seeing, a convenient rule-of-thumb method for attacking the real under its many and deceptive masks; indeed in this his philosophy bears a startling resemblance to the Tao-concept of the Chinese. The It is a way, not a thing, not a principle or a conceptual figment. Having accepted so much, Groddeck is prepared to attempt a half-length portrait of it.
Some moment of beginning must be supposed for this hypothetical It, and for my own purposes I quite arbitrarily suppose it to start with fertilisation…and I assume that the It comes to an end with the death of the individual—though the precise moment at which we can say an individual is dead is again not so simple a matter as it seems.…Now the hypothetical It-unit, whose origin we have placed at fertilisation, contains within itself two It-units, a male and a female.…It is perhaps necessary here to comment upon the extent of our ignorance concerning the further development of the fertilised ovule. For my purposes it is sufficient to say that after fertilisation the egg divides into two separate beings, two ce
lls as science prefers to call them. The two then divide again into four, into eight, into sixteen and so on, until finally there comes to be what we commonly designate a human being.…Now in the fertilised ovule, minute as it is, there must be something or other—the It, we have assumed?—which is able to take charge of this multitudinous dividing into cells, to give them all distinctive forms and functions, to induce them to group themselves as skin, bones, eyes, ears, brain, etc. What becomes of the original It in the moment of division? It must obviously impart its powers to the cells into which it divides, since we know that each of them is able to exist and re-divide independently of the other.…It must not be forgotten that the brain, and therefore the intellect, is itself created by the It.…Long before the brain comes into existence the It of man is already active and “thinking” without the brain, since it must first construct the brain before it can use it to think with. This is a fundamental point and one we are inclined to ignore or forget. In the assumption that one thinks only with the brain is to be found the origin of a thousand and one absurdities, the origin also of many valuable discoveries and inventions, much that adorns life and much that makes it ugly.…Over and against the It there stands the ego, the I, which I take to be merely the tool of the It, but which we are forced by nature to regard as the It’s master; whatever we say in theory there remains always for us men the final verdict “I am I”.…We cannot get away from it, and even while I assert the proposition is false I am obliged to act as if it were true. Yet I am, by no means, I, but only a continuously changing form in which my “It” displays itself, and the “I” feeling is just one of its ways of deceiving the conscious mind and making it a pliant tool.…I go so far as to believe that every single separate cell has this consciousness of individuality, every tissue, every organic system. In other words every It-unit can deceive itself, if it likes, into thinking of itself as an individuality, a person, an I. This is all very confusing but there it is. I believe that the human hand has its I, that it knows what it does, and knows that it knows. And every kidney-cell and every nail-cell has its consciousness just the same…its “I” consciousness. I cannot prove this, of course, but as a doctor I believe it, for I have seen how the stomach can respond to certain amounts of nourishment, how it makes careful use of its secretion according to the nature and quantity of the material supplied to it, how it uses eye, nose and mouth in selecting what it will enjoy. This “I” which I postulate for cells, organs, etc, like the general-I (or the ego-awareness of the whole man) is by no means the same thing as the It, but is produced by the It, as a mode of expression on all fours with a man’s gestures, speech, voice, thinking, building, etc…About the It itself we can know nothing.
At this point the orthodox objections of the Rationalist deserve to be stated and considered. They are questions which Groddeck himself did not bother to answer, believing as he did that no hypothesis could be made to cover all the known facts of a case without special pleading or sophistry, and being unwilling to strain for interpretations which might appear to cover the whole of reality and yet in truth yield only barren formulae. Groddeck believed that whatever was posited as fact could sooner or later be disproved; hence his caution in presenting the It-hypothesis not as a truth, but as a method. Yet a critic of the proof-of-the-pudding school would have every right to ask questions along the following lines:
That a case of inoperable cancer, say, which defies every other form of treatment, can be made to yield before a Groddeckian attack by massage and analysis, is within the bounds of belief. Even the It-hypothesis might be conceded as a useful working tool in this case. Freud has so far altered the boundaries between the conscious and unconscious intention that we are inclined to respond to suggestions which fifty years ago would have seemed fantastic. But if a thousand people contract typhoid from a consignment of fruit are we to assume that the individual It of each and every one of them has chosen this form of self expression in a desire for self punishment?
It is the sort of question to which you will find no answer in Groddeck’s books; yet if he seems content to present the It as a partial hypothesis it is because his major interest is in its individual manifestation. Yet there is nothing in the hypothesis as such to preclude a wider application. Had he addressed himself to such a question he might very easily have asserted that just as the cell has its It-ego polarity, and the whole individual his, so also could any body or community develop its own. The conventions of the logic that we live by demand that while we credit the individual with his individuality, we deny such a thing to concepts such as “state,” “community,” “nation”—concepts which we daily use as thought-counters. Yet when our newspapers speak of a “community decimated by plague” or a “nation convulsed by hysteria” we accept the idea easily enough, though our consciousness rejects these formations as fictions. Yet in time of war a nation is treated as an individuality with certain specified characteristics; politicians “go to the nation”; The Times discusses the “Health of the Nation” with the help of relevant statistics. This unity which we consider a fiction—could it not reflect, in its component parts, the shadows of the individual unity, which is, according to Groddeck, no less a fiction? If a national ego why not a national It? But I am aware that in widening the sphere of application for the It-hypothesis I am perhaps trespassing: for if Groddeck himself remained silent on the score he no doubt had his reasons.
And what of the domain of pure accident or misadventure? A man hurt by a falling wall? The victim of a railway accident? Are we to assume that his It has made him a victim of circumstances? We know next to nothing about predisposition—yet it is a term much used by medical men to cover cases where the link of causality appears obvious, the effect related satisfactorily to the cause; thus the victim of hereditary syphilis satisfies the syntax of our logic, while the victim of a railway accident seems simply the passive object of fate. And yet we do unconsciously recognise predisposition in individuals, in our friends, for how often when the news of the accident reaches us do we exclaim “But it would happen to someone like X!”? The truth is that all relations between events and objects in this world partake of the mystery of the unknown, and we are no more justified in covering one set of events with words “disease” or “illness” than we are of dismissing another with words like “accident” or “coincidence.” Groddeck himself was too wily a metaphysician to put himself at the mercy of words. “I should tell you something,” he writes,
of the onset of diseases, but the truth is that on this subject I know nothing. And about their cure…of that, too, I know just nothing at all. I take both of them as given facts. At the utmost I can say something about the treatment, and that I will do now. The aim of the treatment, of all medical treatment, is to gain some influence over the It.…Generally speaking, people have been content with the method called “symptomatic treatment” because it deals with the phenomena of disease, the symptoms. And nobody will assert that they were wrong. But we physicians, because we are forced by our calling to play at being God Almighty, and consequently to entertain overwhelming ideas, long to invent a treatment which will do away not with the symptoms but with the cause of the disease. We want to develop causal therapy as we call it. In this attempt we look around for a cause, and first theoretically establish…that there are apparently two essentially different causes, an inner one, causa interna, which the man contributes of himself, and an outer one, causa externa, which springs from his environment. And accepting this clear distinction we have thrown ourselves with raging force upon the external causes, such as bacilli, chills, over-heating, over-drinking, work, and anything else.…Nevertheless in every age there have always been physicians who raised their voices to declare that man himself produced his diseases, that in him are to be found the causae internae.…There I have my jumping-off point. One cannot treat in any way but causally. For both ideas are the same; no difference exists between them.…In truth I am convinced that in analysing I do no differently than I did be
fore when I ordered hot baths, gave massage, issued masterful commands, all of which I still do. The new thing is merely the point of attack in the treatment, the one symptom which appears to me to be there in all circumstances, the “I”.…My treatment…consists of the attempt to make conscious the unconscious complexes of the “I”.…That is certainly something new but it originated not with me, but with Freud; all that I have done in this matter is to apply the method to organic diseases, because I hold the view that the object of all medical treatment is the It: and I believe the It can be influenced as deeply by psychoanalysis as It can by a surgical operation.
If we have spent much time and space in letting Groddeck, as far as possible in his own words, define and demarcate the territory of the It, the reason should by now be apparent. Not only is the ego-It polarity the foundation-stone upon which his philosophy is built, but without an understanding of it we cannot proceed to frame the portrait of this poet-philosopher-doctor with any adequacy; since his views concerning the function and place of the ego in the world are carried right through, not only in his study of health and disease, but also into the realms of art-criticism and cosmology, where his contributions are no less original and beautiful. Groddeck, like Rank,[11] began as a poet and writer, only to turn aside in middle life and embrace the role of healer; lack of first-hand acquaintance with Groddeck’s poetry, his one novel, and what his translator describes as “an epic,” prevents me from saying anything about this side of his activities;[12] but in his one incomplete volume of art-criticism, published here under the title of The World of Man, the reader will be able to follow Groddeck’s study of painting in terms of the It-process—for he believed that man creates the world in his own image, that all his inventions and activities, his science, art, behaviour, language, and so on, reflect very clearly the nature of his primitive experience, no less than the confusion between the ego and the It which rules his thoughts and actions. Unfortunately, his death in 1934 prevented him from carrying out more than the groundwork of his plan, which was to review every department of science and knowledge in terms of this hypothesis; but in the fragments he has left us on art, language, and poetry, the metaphysical basis of his philosophy is carefully illustrated and discussed. The humour, the disarming simplicity and poetry of his writing cannot be commented upon by one who has not read his books in the original German, but it is sufficient to say that enough of Groddeck’s personality comes through in translation to make the adventure of reading him well worthwhile, both for the doctor and for the contemporary artist—for the knowledge and practice of the one supplements the ardours and defeats of the other; and art and science are linked more closely than ever today by the very terms of the basic metaphysical dilemma which they both face. All paths end in the metaphysics.
From the Elephant's Back: Collected Essays & Travel Writings Page 18