Researching the Unconscious

Principles of Psychoanalytic Method

Michael Rustin

• Publisher: Routledge
• Year: 2019
• eBook ISBN: 9780429670497
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Researching the Unconscious provides an exposition of key issues in the philosophy and methods of the social sciences that are relevant to psychoanalysis, both as a clinical practice and as a human science.

These include the debates initiated by Thomas Kuhn's theory of scientific revolutions, the "actor-network theory" of Bruno Latour, the ideas of philosophical realism, distinctions between "meaningful" and "causal" explanation, and the relevance of complexity theory and "part–whole analysis" to psychoanalysis. The book goes on to discuss specific forms and methods of psychoanalytical research, including the role of case studies, of outcome research, and of "grounded theory" as a key methodological resource, of which it provides a detailed example. The book concludes by outlining principles and methods for psychoanalytic research in the wider contexts of infant observational studies, society, and culture.

Michael Rustin provides a unifying account of the methodological principles that underlie the generation of knowledge in psychoanalysis, in the light of recent developments in the philosophy and sociology of science. In doing so, it provides a coherent rationale for psychoanalytic investigation, which will be of value to those pursuing research in this field.

Researching the Unconscious is unusual in its being based both on a deep understanding of and respect for psychoanalytical clinical practice and on its author's wider knowledge of the philosophy and sociology of science. It is unique in its comprehensive approach to the principles of psychoanalytic research.

CHAPTER ONE

Introduction

The central presupposition of this book is that psychoanalysis has constituted itself as a research programme from its beginnings in Freud’s early work, and as such has, during its history, achieved a remarkable development of theories, clinical techniques, and applications. These make up one of the most substantial paradigms of knowledge to have been created in the human sciences during the last 100 or more years.

The argument will be made that none of this development would have happened, nor would psychoanalysis have achieved its large influence in Western culture, if it had not always been a theoretically coherent and empirically grounded form of knowledge. Its methods of research have enabled new discoveries to be made, significant theoretical developments to take place, and valid and productive hypotheses to be distinguished from invalid and unproductive ones. The purpose of this book is to explicate and justify the methods of research on which psychoanalytic knowledge is based and to clarify its principles in order to further research in this field.

The advance of psychoanalytic knowledge and understanding has not been of a unified and linear kind, parallel to the triumphal progress that some attribute to the natural sciences. From the very beginning, in the work of Freud and his immediate circle, differences of approach were apparent, some of them leading to the enrichment of the central tendency of Freudian work, others to divergence and the development of separate schools of thought. Psychoanalytic work, since it is based on the study of and interaction with human subjects, has always been located in particular historical and social contexts. The different tendencies of psychoanalytic thought—for example, the Freudian, Object-Relations, Relational, and Lacanian schools—have been specifically shaped by their cultural and national locations. But such a diversity of theoretical approaches, values, and methods is also to be found in other fields of human knowledge—for example, in historiography, philosophy, sociology, and anthropology. By contrast, economics and psychology, in their dominant contemporary forms, are exceptional in the social sciences in the claims they make for the universal scope and applicability of their explanatory schema, which they sustain by excluding social particularities and differences from their modelling. The universalization and homogenization of their fields of study, as constituted by their rational, interest-seeking ideal-typical individuals, is perhaps more the prosecution of an ideological world view than a genuinely universal human science that is truly universal in its scope. This does not, of course, deny the power of neoclassical economists’ and cognitive psychologists’ theories and methods to explain the particular fields of phenomena that their models capture.

During most of its existence, psychoanalysis has been under attack as non-scientific, as “pseudo-scientific”, or as largely out of touch with the mainstream of the social sciences. It has developed as a field largely outside the academic and university system, within the context of its practising professions. These have evolved their own systems of training, international conferences, and publication in scientific journals and books, which follow many of the norms and protocols of other scientific disciplines. It is through this substantial knowledge infrastructure that psychoanalysis has developed. Nevertheless, there is no doubt that the relative detachment of the psychoanalytic field from other fields in the academic human sciences has had its costs. Psychoanalysis has been unable to learn sufficiently from research in the psychological, biological, and social sciences, and these human sciences have found it difficult to take account of the reality and significance of unconscious phenomena for the mental lives of individuals and groups.

In recent years there has been some increased dialogue between some “mainstream” human sciences and psychoanalysis. One such bridge lies in the field of “attachment theory” developed by John Bowlby and his successors (Holmes, 2014), which, while absorbing some of the central insights of the psychoanalytic theory of infant development, nevertheless developed laboratory-based procedures to test and validate its hypotheses. It seems clear that the split that developed at one stage between attachment theory and psychoanalysis had limiting effects on the development of both fields. Its consequence was that psychoanalysts became further removed from empirical scientific procedures, and the attachment tradition lost contact with the subtleties of psychoanalytic theories and techniques and their relevance to clinical practice.

Advances in neuroscience have proved to be another source of interdisciplinary connection. They are bringing new kinds of evidence to support psychoanalytic conjectures derived from clinical inference—for example, regarding the functions of the affective centres of the brain and of dreams in shaping mental life. The demands of “evidence-based medicine”, now widely imposed by public health systems on psychoanalytic practitioners, although often putting unduly restrictive pressures on the provision of good clinical services, have had positive as well as negative effects. They have required psychoanalysts and psychotherapists to provide empirically accountable answers to the crucial question, does psychoanalytic psychotherapy work? And if so, for whom, and at what cost, compared with other forms of treatment? Valuable work has followed from this, in empirical trials of psychoanalytic therapies, although it should be noted that the outcomes of these have often given quantitative validation to what psychoanalysts believed they already knew qualitatively from their clinical experience. Many researchers—philosophers, psychologists, psychoanalysts, and neuroscientists (for example, Antonio Damasio, 2000; Gerald Edelman, 1992; Peter Fonagy, 2001; Peter Fonagy & Mary Target, 2002; James Hopkins, 2004; Jaak Panksepp, 1998; Mark Solms, 2015; Allen Schore, 1994; Daniel Stern, 1985)—have contributed to this bridge-building, which greatly enhances the possibilities for psychoanalysis to take up its justified place within a more inclusive scientific discourse.

Nevertheless, this more active interchange between “mainstream” human science, with its accredited methods of research, and psychoanalytic practice is not without its risks. It could be that psychoanalytic practitioners and researchers will, in their pursuit of conventional scientific legitimation (and of authorization of their services by health commissioners), lose sight of the distinctive kinds of knowledge that their own psychoanalytic research tradition can produce. Psychoanalysts need a systemic understanding of their own established methods of knowledge-generation, and of its particular criteria of sense and validity, if their relationship with other human sciences is to take the form of dialogue and not become a mere surrender to positivism. The risk in the embrace of the conventional measures of empirical measures characteristic of mainstream psychology is that they will find themselves measuring something other than the essential objects of psychoanalytic study.

Plan of the book

Psychoanalysis as a distinctive form of knowledge

The argument of chapters 2 and 3 draws upon seminal works in the recent literature of the philosophy and sociology of science to establish the view that psychoanalysis constitutes a distinctive field of knowledge, with its own research methods and its own means of representing its findings. The developments in these fields that have been most essential in establishing the ontological and epistemological foundations of psychoanalysis are those of the historian and philosopher of science, Thomas Kuhn, and the anthropologist and sociologist of science, Bruno Latour: their relevance for the understanding of the psychoanalytic field is examined. Crucial in Kuhn’s work (chapter 2) is his recognition of the diversity of scientific paradigms and the research methods on which their development is based. The misconception that there is but one scientific method, exemplified by physics, has provided influential but mistaken grounds for the rejection of psychoanalysis as a valid scientific practice. The significance of Bruno Latour’s research (chapter 3) is his demonstration of the central importance of the laboratory as the location of transformative discoveries. When one recognizes that the clinical consulting room has some of the attributes of the scientific laboratory, one understands why this setting has been so productive of psychoanalytic knowledge.

Realism and social science

The science of the unconscious is, more or less by definition, a study of phenomena that lie beneath the surface of everyday perception and understanding. It is argued in chapter 4 that psychoanalysis is by no means unique as a form of knowledge in postulating underlying depths of phenomena that must be understood if the life-world of everyday experience is to be understood. This chapter draws on the “realist” theories of knowledge developed by Rom Harré, Roy Bhaskar, Russell Keat, and John Urry to locate psychoanalysis in a conception of scientific knowledge that recognizes the need for the understanding of deep structures and their causal powers, including those located in the unconscious mind.

Cause, meaning, and interpretation

The project, still influential, to assimilate the psychological and social sciences to the methods of the natural sciences has struggled with the fact that human experience is constituted through “subjective meanings”—that is, through the meanings assigned to phenomena by human persons. The natural sciences do not need to be concerned with dimensions of consciousness or “subjective” explanation in investigating their objects of study. A problem for the social sciences is to reconcile the idea that social phenomena must be conceived not only as entities in causal relations to the material world and to each other, but also as agents who interpret the world and act through their own understandings of it. If social behaviour is understood only in its “objective” aspects, the essence of human subjectivity and consciousness is lost. If, on the other hand, human life is understood only in the dimension of subjective meanings and intentions, causal relations and their determinations vanish from sight. Progress has been made in the social sciences in bringing together these two necessary forms of understanding—the “nomothetic” and “idiographic”—for example, in sociology, through the duality of structure and agency (Archer, 2003; Giddens, 1979, 1984).

Psychoanalysis brings an additional dimension to problems of causal and interpretative explanation of mental life. Central is the idea of unconscious meanings and intentions. These are states of mind and feeling that are influential in shaping human consciousness and action, but which cannot readily be recognized by their subjects. Unconscious meanings in the psychoanalytic sense do not go unrecognized merely because people have too little cognitive capacity to keep everything in mind. Implicit beliefs and rules of behaviour of this “ordinary” kind are the frequent field of study of historians and anthropologists. The psychoanalytic meaning of the unconscious—the “dynamic unconscious”—refers to states of mind understanding of which is resisted, through the operation of processes such as repression, splitting, and projective identification, as Freud, Klein and Bion described these. The problem for psychoanalysis has been to show how these unconscious dimensions of meaning can be captured, through observation and in transference–countertransference interactions, and theoretical inferences from these shown to be valid. Chapter 5 examines these issues.

Classifications and kinds

Psychoanalytic approaches are sometimes differentiated from those of medicine and psychiatry by their avoidance of schematic diagnostic categories, conventionally arrived at through clinical assessments that take place prior to treatments designed by reference to the problems they define. Psychiatric classification commonly takes the form of diagnostic categories, schematic differentiations of kinds of psychopathology, formulated in manuals intended to guide their practice, such as the Diagnostic and Statistical Manual of Mental Disorders–5 (DSM–5) published by the American Psychiatric Association (APA, 2013), or the ICD–10: Classification of Mental and Behavioural Disorders, produced by the World Health Organization (WHO, 2016). By contrast, psychoanalytic therapy is usually particularistic and individual-centred in its approach. Psychoanalysts and psychotherapists often believe that useful diagnoses emerges mainly from what is learned during therapeutic practice itself, and that its agendas cannot be set in advance of its actual experience.

However, as chapter 6 shows, psychoanalysis has evolved elaborate forms of classification of its own, different from—though overlapping with—the diagnostic models of psychiatry. The structure of psychoanalytic theory depends on the classifications that it has itself evolved, which identify, for example, “kinds” of mental function, personality organization, developmental pathways, and psychopathology. The DSM diagnostic categories are largely a typology of symptoms, with little theoretical or explanatory rationale. The classifications of psychoanalysis, by contrast, derive from, and condense, the theoretical findings of its field. Clinical psychoanalytic practice involves a constant interchange between the meanings and patterns that are discerned in flows of clinical material, in their specificity, and in the concepts that locate such particulars within the frames of psychoanalytic theories. The specific nature and function of classification in psychoanalysis is considered.

Cases and case-study methods

The clinical case studies, which have been the most common form in which psychoanalysts have obtained and presented their findings, are sometimes dismissed as an inferior kind of research. There is a conventional hierarchy of scientific methods, in which the “double-blind randomized controlled trial” is positioned at the summit and the single clinical case study is relegated to the base. The argument of this book is that research methods need to be appropriate to their objects of study, and in this domain “one size does not fit all”. Randomized controlled trials of the treatment outcomes have an essential value. But researches have more than one purpose. The principal objects of psychoanalytic investigation have been, for example, personality structures, psychopathologies, and therapeutic techniques, accomplished through the study of phenomena revealed principally in the context of the transference relationship. This constitutes a form of fundamental scientific research and is more than the study of the effects of specified treatment interventions, or “technologies”.

Human minds have the attributes of both complexity and variety. For most purposes, they cannot be reduced to interactions between small numbers of uniform “variables”, if one is to grasp the attributes of the individuals who are the centre of psychoanalytic inquiry. Case-study methods, discussed in chapter 7, have evolved to investigate entities that possess high degrees of both idiosyncrasy and complexity, such as the objects of inquiry of psychoanalysis.

Parts and wholes

What do we do when we seek an explanation in psychoanalysis? What is it to understand an aspect of behaviour? One common-sense idea is that what we do is to identify a phenomenon as the effect of a cause. Thus it is often appropriate, for example, to causally link the difficulties of patients with disturbances in their early life. But although such causal connections are well established and provide the context for the treatment of, for example, deprived children, they are insufficient to guide psychoanalytic practice.

Psychoanalysts understand specific states of mind in their patients by identifying patterns that give them meaning. Particular aspects of thought and behaviour are understood psychoanalytically with reference to a larger holistic structure of patients’ minds. For sufficient ...

Table of contents

• Cover Page
• Praise
• Half Title
• Series Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Series Editors’ Preface
• Acknowledgements
• Preface
• 1 Introduction
• 2 Psychoanalysis as a Scientific Paradigm
• 3 The Consulting Room as the Psychoanalytic Laboratory
• 4 Philosophical Realism and its Relevance
• 5 Meanings and Causes in Psychoanalytic Explanation
• 6 On Classification
• 7 Case-Study Methods in Psychoanalysis
• 8 Parts and Wholes: Different Kinds of Explanation
• 9 Complexity Theory and Psychoanalysis
• 10 Clinical Facts
• 11 Grounded Theory in Psychoanalysis and Child Psychotherapy
• 12 Grounded Theory in Child Psychotherapy: An Example
• 13 Outcome Studies
• 14 Observational Research Methods
• 15 Socio-Psychoanalytic Research
• 16 Psychoanalytic Cultural Methods
• References
• Index