In Memoriam Marianne Springer-Kremser

o. Univ-Prof. Dr. Med. Marianne Springer-Kremser (11.11.1940 – 26.02.2023)

It is with great regret that we have to inform you about the sudden and unexpected death of Marianne Springer-Kremser. With her we have lost the most important pioneer of psychosomatics in gynaecology and obstetrics in Austria.

Marianne Springer-Kremser founded the Austrian Society for Psychosomatics in Gynaecology and Obstetrics in 1982 together with Peter Kemeter, Beate Wimmer-Puchinger, Marianne Ringler and Hans Neumann, and held its presidency for 16 years. She was active in the extended board of the Society until her death.

In 1974, with the foundation of the Psychosomatic Women’s Outpatient Clinic as a liaison outpatient clinic of the University Clinic for Psychoanalysis and Psychotherapy (then: Institute for Depth Psychology and Psychotherapy) at the II Women’s Clinic, she took the first step, which was followed by a far-reaching commitment to women’s psychosomatics in various organisations such as the Austrian Society for Family Planning, the International Planned Parenthood Federation (where she was on the Governing Council for many years) and the Committee on Women and Psychoanalysis of the International Psychoanalytic Association.

Since 1991 she was a member of the Working Group for Equal Treatment of the University of Vienna and, since the foundation of the Medical University, its chairperson. From 1987 she succeeded Prof. Hans Strotzka as head of the University Clinic for Psychoanalysis and Psychotherapy at the Medical University of Vienna. After 11 years as assistant director, she was appointed full professor in 1998 and led the clinic until her retirement in 2009. Through her tireless and determined work in research, teaching and clinical practice, as well as through her political commitment, she played a decisive role in ensuring the clinic’s continued existence.

Her scientific work is diverse and covers all areas of women’s psychosomatics, sexuality, but also psychoanalytical topics and questions of treatment and training of medical students and psychotherapists.

As early as 1974, she published her first papers together with her husband Alfred Springer on the subject of sexual dysfunction. In their work ‘Symptomatic Spiral’, the two described a successful treatment of couples with sexual dysfunction using a modified method according to Masters and Johnson – a work that prompted Prof Strotzka to bring Marianne Springer-Kremser to his Institute for Depth Psychology and Psychotherapy. In the following years, she dealt with sexual problems with regard to various phases of psychoanalytical developmental psychology.

Already in these early works she pointed out the importance of interdisciplinary cooperation in the treatment of sexual dysfunctions. She pointed out not only the psychodynamics of the individual and the interaction in the couple relationship, but also the importance of the social situation for the positive experience or development of sexual disorders. She understood that sexuality can be something pleasurable for every woman in every stage of life, to which the woman has a right. And so Marianne Springer-Kremser has contributed significantly to sexuality being taken into account in psychosomatic medicine.

Marianne Springer-Kremser’s contributions in the field of psychosomatics are so diverse that only a few can be mentioned.

In 1979, together with Peter Kemeter, she wrote a paper on conflict analysis and gynaecological/endocrinological examination in secondary amenorrhoea. The interdisciplinary cooperation between gynaecologists and psychotherapists and the necessary psychosomatic competence of gynaecologists are particularly emphasised in this work. Based on a primarily gynaecological/endocrinological treatment of a young patient with secondary amenorrhoea, it is shown how the patient was able to develop ovulatory cycles due to the parallel psychotherapeutic treatment. Various conflict situations in connection with the attachment to primary caregivers and the associated difficulties in the development of a female identity are elaborated. Secondary amenorrhoea represented a compromise between the inner conflicts and offered her a way out, shifting them to a bodily-organic level that was easier for the patient to bear.

Marianne Springer-Kremser’s habilitation thesis, which was published as a book entitled “Psychosexuality and Gynaecology”, contains a theoretical review of psychoanalytic concepts on psychosomatic pathogenesis and a detailed presentation of psychoanalytic theories of femininity as well as considerations on the aetiology, psychodynamics and treatment in various clinical pictures from psychosomatics.

The modified psychoanalytic initial interview, described in detail in this book, with the aim of a structural diagnosis, as introduced by Marianne Springer-Kremser, is still the core of the psychoanalytic working method in the Psychosomatic Women’s Outpatient Clinic today. An evaluation study carried out in 1997 showed that this initial interview has a triage function for the indication of a certain type of psychotherapy and that the patients can actually use the recommended therapies. The relation to reality, the motivation for psychotherapy and the individual suffering pressure are identified as relevant criteria for the indication.

In 1991, the book on female psychosomatics “Patient Frau”, which is still current today, was published by Marianne Springer-Kremser together with Marianne Ringler and Anselm Eder.
Another of her focal points was the gender-related approach to understanding female problems, which she examined primarily in relation to the life cycle. The different psychological needs, fears and problems in the individual life cycles of women are related to physical and hormonal changes and specific indication recommendations result from this. To this end, she has linked issues of gynaecology with those of psychiatry and thus made significant contributions to the women-specific view of psychological problems.

Exemplary for this is: “Depression treatment: What do women need?” from 2006. In this work, the content and aetiology of depressive disorders are examined in relation to biogenetic, psychological and social conditions of women. The development of depression is understood as embedded in the female life cycle. In contrast to the male life cycle, the normal female life cycle is associated with significantly more frequent losses. Moreover, pregnancy, childbirth and the puerperium are accompanied by a constant threat of loss. The losses in the female life cycle are centred around the woman’s reproductive function. They begin in preadolescence with the change in sexual characteristics and body schema, as well as monthly blood loss. In the reproductive phase, the woman is confronted with the change in her body schema in pregnancy, the loss when the umbilical cord is cut, weaning and finally the loss of fertility in menopause. According to – Springer-Kremser – the complex interaction between female corporeality and its psychological representation with critical events in the female life cycle, as well as socio-cultural factors such as violence and discrimination, must be taken into account when creating treatment plans for women with depressive disorders. Together with Alfred Springer, she summarised and updated her findings in this regard in her book “Die Depressionsfalle” (The Depression Trap), published in 2013.

The central concern of all psychosomatic work is networking between the various professional groups, without which individual psychosomatic work cannot lead to success. From the beginning of her involvement with psychosomatics, M. Springer-Kremser has been concerned with the development of therapy and care concepts. She has passed on her knowledge in various further education curricula. In her elective subject: ‘Psychotherapeutic therapy of female psychosomatoses with consideration of ethical questions’, she has for many years offered students the opportunity to experience clinical psychosomatic work within the framework of participant observation at the Psychosomatic Women’s Outpatient Clinic. In addition, she has passed on her experience in countless lectures on women’s psychosomatics in various medical disciplines and in the context of her supervisory work. Her commitment to psychosomatic further education and training was dedicated to the psychosomatic curriculum of the Medical Association, which she designed and implemented with Peter Gathmann. Her advocacy of ethics in medicine, the co-founding of the Institute for Ethics in Medicine, as well as her work on difficult ethical issues, her work in the Ethics Committee of the Medical University of Vienna and her long-standing membership in the Bioethics Committee of the Federal Chancellor, are also part of her demand for the consideration of a psychosomatic perspective.

Marianne Springer-Kremser further developed psychoanalytic theories on femininity, as well as psychoanalytic teaching and research. She is credited with establishing and fighting for the consolidation of psychoanalysis as an essential building block in medicine. It is to her credit that psychoanalysis is now a fixed component of medical studies at the Medical University of Vienna.

Marianne Springer-Kremser’s commitment to psychoanalysis and psychoanalytic therapy as a method of treatment, both within the framework of the Austrian Medical Association and in the Psychotherapy Advisory Board, should also not go unmentioned.

Marianne Springer-Kremser was not only committed to psychoanalysis and psychosomatics, but above all to women themselves. This commitment was determined by the conviction that women can determine their sexuality, their reproductivity and their bodies themselves. In this stance, she campaigned for the exemption from punishment of abortion within the first 12 weeks in the debate on the period solution. She has fought for women’s advancement in equal treatment bodies and contributed to the recognition of women as empowered patients in her clinical work and lecturing activities. In 2007, she received the City of Vienna Prize for Medical Sciences and Popular Education for her life’s work. In 2009 she was appointed honorary senator of the Medical University of Vienna.

As a teacher, supervisor, mentor and boss, she supported and promoted many of us. Her attitude, which she always maintained even against conservative opinions, places her in the ranks of those women who have made a significant difference.

We will never forget her.