Martti Siirala on his 80th birthday by Ann-Helen Siirala and Anthony Stadlen (January 2003)

Martti Siirala
On his eightieth birthday

Ann-Helen Siirala

Copyright © Ann-Helen Siirala 2002, 2020
Copyright © Anthony Stadlen 2002, 2020
[Existential Analysis 14.1 (January 2003): 162-178]

Martti Siirala

Martti and Ann-Helen Siirala

Anthony Stadlen writes:

Dr Martti Siirala is one of the world’s great original existential psychotherapists. He and his wife, Dr Ann-Helen Siirala, honoured us by coming from Helsinki to conduct an Inner Circle Seminar on his eightieth birthday, Sunday 24 November 2002, from 10 a.m. to 5 p.m., in the Tuke Common Room, Regent’s College, London.
Thirty-nine people attended. Many people, from a number of countries, sent greetings and apologies.
The Finnish Ambassador invited all participants to a concert and reception the following evening at the Royal Festival Hall to celebrate eighty-five years of Finnish independence. Sibelius’s Luonnotar, among other works, was played.
Sibelius was buried by Martti Siirala’s brother Aarne, a theologian and pastor. It has been said that Martti writes as Sibelius composes. He himself says Sibelius’s way of composing is like the Finnish language, approaching all beings with a ‘humble but passionate’ questioning: ‘Who are you? Could it be that you might be …?’, while, according to Siirala, the German language tries to grasp and dominate. In his 1980 paper, ‘On malignant violence: Where to look for hope in reaching its roots?’, in From Transfer to Transference[1] (1983, Helsinki: Therapeia Foundation), he writes (p. 137) of the ‘violent elements in the absolutist claims for “Daseinsanalysis” to a direct access to the phenomena in an adequate, undistorted way’, but acknowledges that ‘it has however essentially contributed to the defence of the unreducibility of human bodily existing’.
Martti Siirala’s presentation and the ensuing seminar discussion in London will be reported elsewhere, as will the two-day Helsinki seminar to celebrate him, organised by the Finnish psychotherapy society, Therapeia, in Finlandia Hall later that week, on Friday 29 November (in Finnish) and Saturday 30 November (in English). The speakers on the Saturday were Professor Gaetano Benedetti, Professor Arno Gruen, and myself.
Participants in the London and Helsinki events agreed that something profound and extraordinary had taken place. Martti’s humility, depth, wisdom, generosity, and many-sidedness were moving to behold. The discussion was a true striving for shared understanding. It included the possibility of serious disagreement: serious, in that people listened to each other. Martti was open to doubts (including mine) about his central notions of ‘illness’ and ‘social pathology’, as were the other Helsinki speakers to my questioning their concepts of ‘empathy’ (Gruen) and ‘identification’ of therapist with patient and vice versa (Benedetti). There was a rare spirit of respect and loving reciprocity. As Martti wrote to me, it was an unforgettable experience.
What follows is the wonderful account Ann-Helen Siirala gave of her husband’s life and work to the Inner Circle Seminar in London. It followed my opening remarks, and introduced her husband’s presentation. Participants in the seminar included four from Finland (in addition to the Siiralas); two of Finnish origin, resident in the United Kingdom; and one from Sweden. Hence Ann-Helen’s initial greetings in Finnish and Swedish. I have reproduced her English as she wrote and spoke it, with very few changes.

Dear Anthony and Naomi,
Ladies and Gentlemen,
dear Fellowmen,
tervetuloa Martin suomalaiset ystävät,
och välkommen också på svenska!

On behalf of Martti and myself, I will start expressing our gratitude to Anthony Stadlen for arranging this inspiring event! – and to the nameless something, that offers us a space for something like this event to take place. Something that appears in itself as impossible … unrealisable.
As Martti would express it: … that here would be a real, and not only seeming, presence to the wonders of life.

Martti’s views pertaining to therapy have got their intense impact from the encounter with what he calls the situation schizophrenia and with bodily illness.

Today, eighty years ago, this Martti Olavi Siirala was born.
The first time I congratulated him personally was twenty years ago, on his sixtieth birthday – and since 1986 we have been a married couple.
Martti’s father, having the same Christian name, proudly wrote in his diary, that his fourth child and third son was born. He noted the son’s ‘long fingers and quite an impressive nose’ (‘paljon nenävärkkiä’)!
After Martti, a fourth son was born seven years after him.
Today two of the five Siirala-siblings have passed away: the theologian-thinker brother Aarne and the lawyer-brother Erkki.
Martti became MD in 1947 and wrote his neurological thesis in 1949 – at the age of twenty-six.
Three years later, 1952, he and his musician wife and two little sons went to Switzerland, to Zürich, for studying psychoanalysis.
There they stayed for five years, until 1957. A daughter had been born in Zürich, 1956.
Since 1952 Martti has been practising psychotherapy and since 1968 working also as a senior lecturer in psychiatry at the University of Helsinki.
The vision for founding Therapeia (the name is the Greek word for therapy) emerged in Martti’s mind during his stay in Zürich. That course there was centrally led by Medard Boss, who, inspired by the philosophy of Martin Heidegger, had developed existential analysis. That signified a radical renovation into a non-reductionist, phenomenological direction.
In Martti’s vision the medical anthropology and social pathology also played an essential role. These were founded by Viktor von Weizsäcker (1886–1957). He was an internist and neurologist, who did pioneering studies in sense-physiology, and above all he was a developer of deeply human understanding of the sick man and that side of man‘s fate as man, experienced by his physician in hospitals and private practice. His challenging views in his large production were in their way systematic but did not form a system. His friend and pupil Wilhelm Kütemeyer (1903–72), a bold anti-Nazi, developed further both the medical anthropology and the social pathology, writing even a book The Illness of Europe (Die Krankheit Europas, 1951).
In 1958 Martti could get his vision provisionally realised, when the Therapeia Foundation and Institute became founded. His vision was even explicitly contained in the rules. The aim of Therapeia was stated to be the training and practice of psychoanalytic therapy in the spirit of existential analysis and anthropological medicine. In the practice of therapeutic training each student’s own basic way of experiencing was respected, and the therapeutic literature used in the process of training was meant to be treated in the spirit of freedom. Such had been the constellation and spirit in Zürich. Two of Martti’s Finnish colleagues got their training in the same circle a few years later and joined him as ideators and instructors in the work during Therapeia’s early years.
Participants in the founding process in 1958 were also Martti’s theologian brother Aarne, and from Basel, Switzerland, Martti’s companion in the psychoanalytic training in Zürich, Gaetano Benedetti, already then a pioneer in the psychotherapy of schizophrenia. A Finnish firm had donated the legally demanded founding capital.
Therapeia happened that time to be the first established psychoanalytic institute in Finland, one offering analytic psychotherapy to psychotic, neurotic and bodily ill patients. Training in psychoanalysis by Therapeia took place in all these clinical dimensions. A number of Finns had received their training with the International Psychoanalytic Association (IPA) in different countries, but their group had not yet received its acceptance as a membership organisation. This constellation, IPA–non-IPA (since the 1970s, IFPS), created some problems, but did not lead to any serious conflicts. An encounter of Martti with D. W. Winnicott on his lecturing trip among the IPA people in Helsinki, on which occasion he spontaneously sympathised with our basic approach in Therapeia, had a favourable effect on our IPA-relations.
Therapeia as such spontaneously signified many-dimensional questioning, a phenomenological research, opening itself up in an unorthodox and not hierarchically controlled way, even in a spirit open to renovations concerning theory, method and conception of knowledge. Martti came to write a most extensive manuscript, Therapy and Conception of Knowledge, an epistemological treatise, one from challenging, generally-human perspectives. Not only he and the two colleagues mentioned above, but also other members of Therapeia, finished works on psychopathology and psychosomatics, some of them appearing as academic dissertations and others as books and papers published in international journals.
The Therapeia Institute became run by the Foundation. It offered professional training programmes in psychoanalytic therapy, got such therapies approved by the Finnish National Board of Health as competent to receive social funding by the National Pension Institute – this, however, only after quite some efforts.
(I myself, being a psychologist, got my own training in analysis there, and Martti has been one among several teachers during the, at that time, six years programme. Today it is five years. Since 1998, I’m also a training analyst.)
The theory outline in Therapeia includes studies in classic and modern theory of psychoanalysis, phenomenological philosophy and theory of Daseinsanalysis, social pathology and developmental theories.
Martti’s basic views did not appear just in one push or during just a short period of his life, but have developed themselves during quite some period of his life, and continue to do so. Sure, that process also has been centred around some significant events, encounters, and coincidences.
From his autobiographical, unpublished notes I quote:
‘Ideas that engage a person’s thinking processes always have their genesis in a struggle with problems that are personal and near, which is shown, e.g., by Erik Homburger Erikson, in his work Young Man Luther. How widely such a struggle can be spread depends on the significance of the ideas and on the historical situation, its particular constellation. In a way, this historical situation comes to serve as a midwife to the ideas becoming born. Formation of ideas works in this way on all levels, so also in the case of my own.’
The contemporary academic philosophical views appeared to Martti rarely really relevant in the encounter with man’s predicament in the actual historical situation.
One weighty reason for this lies in the domineering practice in our scientific culture of dividing life into primarily separated domains and spheres, each one obeying just its own laws – and thus their mutual interconnections remain unobserved.
These matters were the subject of his first major work – in German – the title of which would be translated: The Schizophrenia of the Individual and of All of Us (Die Schizophrenie des Einzelnen und der Allgemeinheit, 1961).
Martti’s formation of ideas must also have to do with his own childhood family situation. He sees it as a source of his interest in psychodynamics and for developing the concept of collective delusion.
One thing affecting his identity obviously was the particular constellation of sibling rivalry in the family into which he was born.
For the boy Martti it seemed that the brothers and the sister were those who made the decisions in the group; he was an outsider. He felt a need of capturing an ultimate correct image of what happened between him and his siblings – in order to estimate what was right and what was unjust in the treatment he received from the side of his elder siblings.
Another kind of problematics has to do with his parents. On the mother’s side there was an influence of the social pathology of the Swedish-speaking upper class, with power both in matters of language and economics, though in this case no big fortune. In addition, some of the ancestors of his mother had made a military career in the service of the Russian tsar. The mother was a nurse, but did not work professionally.
On the father’s side there were priests in many generations, their language was Finnish and they did not possess any significant fortunes. What kind of micro- and macrosocial motivating agents drew these two to join into matrimony?
Martti Siirala senior, a gynaecologist and obstetrician, was a pioneer in the field of social medicine, an originator of maternal care and active in founding different healthcare systems in the underdeveloped parts of Eastern Finland, along the Finnish-Russian border. There wasn’t time and psychic space to devote real attention to the being of this son. Besides, they had wanted a girl! Thus his position as the very object of murderous hatred from the side of his two-years-elder brother did not become noticed by either one of them.
At the age of forty-four Martti’s father creepingly became severely ill. The diagnosis was never set – not even today. It was some kind of neurological illness, hinting at degeneration of nervous connections between the cerebellum and the spinal cord. The symptoms were: difficulties in coordination, difficulties to swallow, strongly varying moods, and at last apparent arteriosclerosis.
At the age of fifty he had to stop working. Martti has told that his father could think about his illness as an incomprehensible punishment. For what? Between the age of fifteen to twenty-five, four of the five years of the wartime exempted, Martti read aloud ingenious anecdotes written by a physician in Rauma-dialect. Both Marttis enjoyed this very much! Martti jr. was twenty-five when his father died.
Afterwards Martti has thought that his parents could not have been very much aware of the burdens – in micro- as well as in macrosocial milieu – that were passed over to the offspring. Such unidentified burdens, the nature of which Martti later came to study, seemed to have obstructed many channels between the parents.

Since the early 1950s epistemological matters have occupied Siirala’s mind.
The texts about psychoanalysis that he came into contact with as a young physician were average ones, but they and other readings gave him the insight that illnesses/diseases are something very human – that there is an appeal and a message in them. They can be met and understood differently than what mostly happens in traditional medical practice.
So he started to listen to the patients’ life-histories and found an actual and historical network of misery in the family.
Not only the studying of Sigmund Freud’s theories, but also studying Martin Luther was decisive for Siirala’s thinking.
The theologian brother Aarne made his academic dissertation on Luther – and the two brothers then became engaged in discussions about the split between scientific/philosophic and religious thinking. What are the consequences of such a split?, they asked. Man was not any more aware of his responsibility for the oneness in life.
The rapid development in medicine had lost the basic wisdom of the oneness of life – and so the split continued.

Planning this presentation, I happened to come across a seminar work, written by a student in Sweden, who attended a course in psychotherapy. She wrote about Siirala’s views on man’s illness-predicament. This text helped me to approach the subject from my own angle and experience.
In the following, I will briefly present some concepts, some in the form of a thesis, that have emerged to him and which refer to something in our existence as men.
Such concepts do not primarily mediate any command or control over human challenges. Their central function is one of articulating our fundamental experience, to help us to open ourselves to our life addressing itself to us, to accept to listen to its messages.
Here the formation of concepts does not so much promote doing and techniques, but rather our readiness to become more and more open to receive insight and encouragement given by it.
Man’s distress, also in the form of manifest illness, signifies a new chance to receive a message.

I. The patient is really injured.
His/her wounds and traumas are not only intrapsychic; there is not only question of an ‘intrapsychic reality’. The first ‘reception-world’ (family, society, culture) has damaged him by its inhuman traditions and practices, restricted his rights and chances for development. Such inhuman traditions and models figure without exception on all levels of life.

II. Illness has a vicarious character.
The damage takes place in a way that the challenges of life do not become met responsibly within the person’s reference surroundings and instead become split out. This leads to transformation into burdens, landing on vicarious goal-persons or -groups. Those burdens (existential problems and challenges) become more and more anonymous, ever more difficult to become identified, to the extent the common responsibility concerning them becomes reduced. They just continue their passage between individuals, generations and their society and culture. Within the individual one meets his burden situated in his personality structure and/or in his bodily and psychic functions and their regulation systems. Finally the burden may get its expression as an identifiable particular illness.

III. Illness has the character of appealing.
The illness appeals for getting the burden recognised as something alien to the character of the befallen person and alongside with this for getting it shared through becoming taken into common responsibility in life. Life and the sick man appeal for becoming again membered and remembered as forming organically part in the common life. The anonymous burden contains hitherto not lived parts of life, both individually and socially, as potentialities for development, talents and creativity.
The appealing from the side of the sick one for remembering again and for getting insight is ambivalent. Life strives, in contrast to the ambivalence, for development and for realised possibilities. These dimensions have not become noticed enough within therapies and research.
However, if the message does not become denied but becomes received, then therapy becomes born, and there is possibility of recovery or improvement for the sick. The process from transfer to transference[2] can begin, because a readiness for sharing the burden meets the sick and the illness. Old patterns start getting the character of interaction, of reciprocity within a relation different from the one in the first reception-world. This fact can remain unobservable for a long time. That process may end so that the help-seeking one finally becomes responsible for his liberated possibilities as well as for the cross which always comes to belong to his personal life-history.
This process always contains resistance. It appears within the therapeutic frame; within the patient, and between him and the therapist. Besides, resistance takes place in the final phase of therapy within the human surroundings. There it lies far away from simply welcoming the change or improvement in the patient. This occurs both in the close and in the more distant surroundings, because people there prefer to see the patient continuing to carry his burden, to be the vicarious one, since otherwise the unresponded challenges from earlier in life would threaten again. Within family therapy this has been noticed, but not enough in other forms of therapy.

IV. Sharing burdens and the responsibility is the true ground for therapy.
That ground offers a better ‘second reception-world’, capable of correcting damages. Empathy is a too narrow concept for sharing[3], just as the uncovery of the unconscious material only represents a part within the sharing. Both of those alone do not form a sufficient ground for a healing therapy. Gaetano Benedetti says that the first step in the psychotherapy of schizophrenia is constituted by the therapist identifying[4] himself with his patient, and that the counteridentification of the patient then can take place on that ground. This readiness for listening to the appealing of the illness, and for recreating the sharing of the situation, is rare.

V. The healing process inescapably contains suffering.
This is because the damage which has encountered the patient is real. The suffering is not an end in itself, but has the character of a crossing or a way through.
The pain and discomfort under the burden represent an attempt to flee from pain and threatening suffering. He must flee as long as there is not any sharing in sight. Within a dialogical sharing the burden can become distinct and communicative. The birth of hope is a precondition for true, meaningful suffering, for a passage from darkness via a desert towards light. Therapy contains suffering for both parties.
The source of the patient’s pain contains three things:
(a) gradual re-creation of the childhood’s damaged patterns for getting through some way possibility of experiencing them behind all layers of defence;
(b)  a painful encounter with the neglected life-possibilities;
(c)  last but not least, to relinquish the hopeless security-system.
The ‘first reception-world’ exists as the individual and his ‘first reception’, i.e., fertilisation, living in th womb, birth, the surroundings of childhood and youth. Within this ‘first reception-world’ all the time through his life-history a ‘reception-religion’, a system of trust and distrust, hope and hopelessness, basic expectations, images of man and existence, time and eternity, etc., are being formed. The god of this religion may become reflected in one or several faces, existing in different religions. The relation to a confessional surrounding is just one of its features. Even where that relation is consciously neutral or atheistic, it all the same is a re-ligio, one existentially given relation to each man’s individual and general roots. (Religio = rootedness!)
The ‘second reception-world’ becomes realised in the ‘second reception’ by therapy, a dialogical reception, containing overtaking of responsibility in a vicarious sense, contrary to the first reception-world. The goal in the second reception is that the patient in the future shall accept responsibility.
Something on the patient’s side tries to get the therapeutic space identical with the first reception-world and so prevent the possibility of the second reception from becoming a living dialogue. Sometimes, not only during psychotic outbreaks, the repeating compulsion of the patient, to re-create the first reception-world, takes the expression of a religion, the idol of which must become defended ragingly against the threat of becoming transformed to a living God, who is the god of true reception and love. Harold Searles describes how the contradictory expectations of the patient sometimes do not leave almost any space for something new in his life. The therapist can then feel how the damage produced by the parents to the patient engraves into himself.
Martti has, time and again, come to try to articulate the basic human situation to which therapy as a faithful sharing process within man’s illness predicament takes place with the fellowman, in the form of dialogue as a second reception.
Taking such exposure of us therapists to the illness predicaments of man within an utter solitariness in our societies and cultures, even in the midst of its health-care institutions, living with such a professional fate as being a therapist represents the impossible becoming somehow possible. No wonder that most of the psychoanalytic institutions with which Martti has been in touch have undergone severe crises. ‘Thanks to our Creator’s mercy, something really healing all the same takes place here and there,’ he is used to saying. One dimension vitally needed, opening itself up more and more for us therapists, seems to him to be the social pathology. Good through bad, hope through to receiving light through humble and passionate therapeutic encounter: that takes place, as we know, as wanderings in human solidarity through darknesses and deserts. According to Dostoyevski the kernel of life is JOY.

Notes (by Anthony Stadlen)

[1] In Martti Siirala’s terminology, ‘transfer’ means ‘alienation’ or ‘displacement’, which he also calls ‘social pathology’ (see my introduction), while ‘transference’, starting from but transcending Freud’s term, means a restoring of the wholeness and holiness of human relatedness and ‘being-with’, a healing of ‘social pathology’.

[2] See note 1.

[3] Ann-Helen Siirala here indicates that Martti Siirala, too, is dissatisfied with the notion of ‘empathy’, which in Helsinki became the subject of a friendly dispute (see my introduction) between Arno Gruen and myself.

[4] See my introduction.

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