Daimon Publishers

Jungian Psychiatry
by
Heinrich-Karl Fierz

Introduction

Foreword by Caspar Toni Frey-Wehrlin

The fact that Jung spent the first ten years of his career working in clinical psychiatry had a decisive influence on his lifelong endeavors. Not only do we find his later discoveries foreshadowed in certain passages of the early writings which were the fruit of intensive daily contact with psychotic patients (Jung, 1907, 1914). There are also good grounds for arguing that concepts such as the collective unconscious and the archetypes, as well as the notion of their priority over the personal unconscious, could only have come out of clinical experience, bearing in mind that the fantasy of a psychotic compared to that of a neurotic or of anyone else, for that matter, is like a fresco compared to a copperplate engraving.

It is all the more surprising in view of this that so few of Jung's pupils should have followed his example. If the period of internship every doctor wishing to become a specialist has to go through is disregarded, then the number of Jungian analysts who have worked in clinical psychiatry for any length of time and published their findings can be counted on the fingers of one hand. One of them, and probably the one with the longest experience, is Heinrich Karl Fierz.

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Fierz was born in 1912 in Basle. His father, a Professor of Chemistry at the Technical University in Zurich, wrote among other things, a "History of Chemistry" (H.E. Fierz-David, 1945), in which unusual attention is given to alchemy. His mother was one of Jung's earliest pupils (cf. Linda Fierz-David, 1947). Fierz studied medicine in Basle, Zurich, Berlin and Paris and was certified in 1938. He received his psychiatric training at the Burghölzli Mental Hospital in Zurich under H. W. Maier and Manfred Bleuler. His analytical and psychological training came from C.G. Jung. It is interesting to note that this pupil of Jung wrote his doctoral dissertation in 1941 on the subject of electroshock therapy.

Though he was to specialize in psychiatry and psychotherapy, Fierz also had an excellent medical training with Professor Löffler in Zurich, which served him well in the first four years of his clinical career; they were spent, not in psychiatry, but in the medical sanatorium at Mammern. As the writings that resulted from that experience show, even in medical practice, he never lost sight of the whole person (e.g., "The Attitude of the Doctor in Psychotherapy," p. 193 of this volume).

In 1949, Ludwig Binswanger, the founder of "Daseinsanalyse," appointed him director of the clinical department of Sanatorium Bellevue in Kreuzlingen. There, alongside his busy schedule of clinical duties, Fierz extended his activities to various other fields. The following deserve particular mention:

- a series of training analyses which he gave in addition to his outpatient therapy and which were especially valuable in training the young doctors. This was important for the Jungian school as a whole because, for a variety of reasons, the recruitment of a new generation of doctors was proving difficult at that time, which meant that the school was in danger of losing touch with its roots in clinical medicine.

- his teaching at the Zurich Jung Institute, founded in 1948, which he took up at around that time and maintained until shortly before his death.

- the enduring results he achieved as an active member of the International Society for Medical Psychotherapy, serving for many years as secretary on its council. There he maintained regular contact with colleagues and through his many lectures introduced the Jungian point of view to professional circles around the world.

The resonance of this work drew a growing number of fellow doctors and therapists to Kreuzlingen where they wished to complete their professional training under the supervision of H. K. Fierz. It was there that I also came to know him and over a three-year collaboration received the benefit of his considerable experience and skill as a teacher. It was there, too, that the core of the staff came together, with which we were to open "our" Zürichberg Clinic in 1964.

This brings me to the next and, in my view, most important stage in H.K. Fierz's career, which is his work as Medical Director of the Zürichberg Clinic in Zurich.

The basis of all therapy and the factor that has priority for Fierz is the attitude of the therapist. I would like to describe what that means in words that he himself approved and which can therefore be considered accurate: "A readiness to share the patient's experience, a willingness to learn despite growing experience, an awareness of what is unchanging in human nature and a mind that is open to the discoveries of modern science - only a combination of all four of these qualities can help the patient and foster understanding in this difficult field."

This is a good place to mention something that is fundamental to H.K. Fierz's nature, namely, the wealth of opposites it embraces, or rather the ability to endure the tension of opposites without sliding off into comfortable one-sidedness. For Fierz, one of the cornerstones of the treatment of psychotic conditions was analytical psychotherapy in the Jungian style. In practical terms that meant that every patient received an average of three hours of individual psychotherapy per week. It also meant that, in group therapy, milieu therapy and "body work," the spontaneity of the unconscious was always respected. But then that cornerstone was complemented, qualified and dialectically challenged by the second approach which Fierz, no doubt ironically, referred to as "normal psychiatry." This meant that the discoveries of modern psychiatry, primarily in the field of pharmacology, were applied to the full, but also that no irresponsible risks - of the sort often wrongly termed "psychotherapeutic" risks - were taken. Fierz's expectations regarding the environment of the clinic could also be described in terms of opposites: it should be friendly, but not false! His way of dealing with colleagues, as the expression of his leadership role, was not harmlessly predictable either. He was always available, his advice was practical and his criticism was constructive, though it could be aimed as much at the individual as at the facts and his interventions could be painful at times. He was a man of his generation in that his style was distinctly authoritarian, but - and here we see the opposite - at the same time he showed great tolerance and ability to delegate. In public he always took complete responsibility for those working under him.

A further outstanding quality was his correctness. His word was absolutely reliable, a fact recognized by all of the authorities who had dealings with the clinic. Whenever he managed to find a way out of a seemingly impossible situation, it was never by trickery. Instead one was left with the impression of having overlooked a perfectly obvious solution. This dependability, predictability almost, was counter-balanced, however, by his capacity for unexpected, lightning-quick reactions in which his superior function, intuition, came to the fore.

I do not wish to reveal what is to come in the essays that follow, but I would like all the same to draw attention to two passages from the chapter, "Psychotherapy and the Shadow," which are particularly characteristic of Fierz's way of thinking. They are the remark about the abandonment of professional principles as a sign of the transference situation and the statement that, in cases of psychosis or near psychosis, dreams should be "understood directly from the images they contained, rather than interpreted."

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Looking back now on more than twenty years as a pupil, colleague and friend, I can say that being together with this richly endowed, exceptional and many-sided, even contradictory person was always enriching, often enjoyable and sometimes difficult. In an account of Jungian psychology published in German many years ago, Fierz described individuation in the following words, which surely can also be understood in an autobiographical sense:

"If someone really faces up to the problems he meets in the encounter with his own unconsciousness, he sets out along the path of progressive development which Jung called individuation. The encounter with the unconscious leads first of all to the differentiation of the ego from other psychic contents. I have to recognize how little 'ego' and how much of various other factors goes into making me what I am. The basis of that differentiation is the confrontation with one's own affectivity. This confrontation is a challenge. Again and again, one is struck by how shocked patients are to discover that something else apart from their ego is at work within them. Yet, assuming the person does not try to avoid the problem, he will constantly be coming up against questions which introduce him to the world of the unconscious. The archetypal situations he encounters will demand a new sort of typical response from him, and that often faces him with very subtle conflicts of duty which demand a sharper conscience. He will have to adapt his persona accordingly, not in the sense of becoming 'deeper,' but rather of becoming more of an individual and thus, in the eyes of the majority - which loves collective uniformity - almost an impossibility, though he is accepted in the end, still with some suspicion, but not in an unfriendly way. Being an individual, he will find, can easily cause offense."

(H.K. Fierz, 1976, p.76)

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The publication of these collected essays would not have been possible without the generosity of Mrs. Cara Denman of London, who recognized the particular importance of these works for the English-speaking world and financed their translation. To her, therefore, we owe a special debt of gratitude. Thanks are also due to the Zürichberg Clinic which honored a promise I made in my earlier capacity as managing director of that institution, with a financial contribution of its own. Frau Dr. Antoinette Fierz-Monnier has supported the project from the outset and made available the copyright on her late husband's work.

Caspar Toni Frey-Wehrlin

Zurich, Summer 1989

Preface by Dr. Joseph B. Wheelwright

I first met Heiner Fierz at the Burghölzli Clinic in 1938. At that time he was what in America is called a psychiatric resident. I was working with C.G. Jung and with Toni Wolff, and was a part-time extern, as it was called then, at Bleuler's clinic. Both Heiner and I had worked with Jung for considerable periods of time, which created an immediate connectedness between us. We were also brought together by our psychiatric duties, particularly in regard to a new treatment for schizophrenia that had just been devised, namely, insulin shock. It was discovered by accident because somebody gave a patient suffering from diabetes an overdose of insulin. The patient happened to be schizophrenic, and when he came out of his convulsions, he was as clear as a bell. This treatment spread all over the place with amazing speed and was being used very often at Burghölzli, so that Heiner and I had to attend some of these shock therapy sessions together. I shall never forget the patients going into what the doctors call opisthotomy. Every muscle in the body goes into spasm, the back is arched and all the back muscles are in spasm, and you could hear the vertebrae grinding on each other; it was not uncommon to have lumbar fractures in the lower back from the treatment. Because of our connection through Jung and through our experiences at the clinic, Heiner and I were able to talk about things like animuses and animas and introverts and extroverts and shadows and all those good things. And so that started our friendship.

Then the war intervened, and when I returned to Switzerland, Heiner was working together with Ludwig Binswanger, so-called young Binswanger, at Sanatorium Bellevue in Kreuzlingen. Their collaboration was a very nice blending of existentialism and Jungianism, and I think Heiner and Binswanger got along pretty well. That clinic became a place where some of the early trainees at the Jung Institute (which was founded in 1948) made their first acquaintance with psychosis under the tutelage of Heiner by accompanying him on rounds, attending conferences, etc.

I did not get back to Switzerland again until years later, at which time the then-Jungian Klinik am Zürichberg was under way with Heiner as clinical director, assisted very ably by his successor, Toni Frey. I attended some of the weekly conferences there run by Heiner, and they were always a joy, because Heiner not only had an ever-ready supply of wit, but he was also very wide-ranging and didn't let silly little barriers interfere with his freedom of thought. The result was that he was very creative, and was by then becoming in the Jungian world what in English we call a gadfly. This isn't meant to be a term of disparagement; a gadfly is a person who activates and challenges others, which Heiner did several times a minute. It was incredible. So that was a very important experience, sitting there watching Heiner run those meetings.

Not too long after that, Heiner came over to the United States for a memorable two-week visit in San Francisco. He and his wife Antoinette stayed with us, and I set him up for a lecture - I was on the staff of the University of California Medical School - in Langley Porter Clinic, which is the medical school's equivalent of the Burghölzli. He gave a very well-received lecture, again sparkling with wit, and then he gave a public talk which also went over very well. Many of our trainees wanted to go and have an hour with him, presumably so that they could boast, "Oh yes, I've just had an hour with Dr. Heinrich Fierz; perhaps you've heard of him."

In the meantime, Heiner had not been idle with the pen. He was writing articles and turning out a lot of material which is now at long last being translated into English. This means that those of us who didn't hear him delivering some of his papers can now enjoy them.

Heiner's personal qualities strongly reflected his Swiss nationality. While he was staying with us over the weekend at our house north of the Golden Gate, I took him for a walk on Mount Tamalpais, which is a state park and therefore a wilderness. It was evident that this walk in the wilderness delighted him, and that, like all good Swiss, he felt renewed and grounded by it. In a country where being trilingual is not unusual, Heiner was one of the leading exponents of trilingualism. Every three years at our international congress, he used to delight his audience with a speech given in three languages that had the entire room rocking with laughter, and sometimes shouts of indignation when he said something particularly blasphemous. But everybody always looked forward to these occasions as a special treat.

And so with Heiner's death, we lost one of our pioneer analysts and one of our most gifted friends.

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