Research on the Couch

Single-case studies, subjectivity and psychoanalytic knowledge

R.D. Hinshelwood

• Publisher: Routledge
• Year: 2013
• Print ISBN:
  9780415625203
• eBook ISBN:
  9781136693113
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Is psychoanalysis knowledge? Is psychoanalysis a science, or is it hermeneutics? Can clinical material be considered research data?

Psychoanalysis is ambiguous about whether it is about meaning or about truth, and the relations between these two compelling experiences. Psychoanalysts often think of their work as closer to the humanities than to medical and natural science. The wider the gap between science and psychoanalysis appears, the more psychoanalysts feel pulled to something that respects subjectivity, the humanity of their patients themselves, and move away from the procedures of natural science.

Research on the Couch is a relevant and timely contribution to the current debate about both the nature and validity of psychoanalysis and its body of knowledge. Freud always regarded his clinical material as his research data. In this book R.D. Hinshelwood aims to explore that view and defend Freud's claim whilst acknowledging the criticisms of single case studies and the inevitable problems for research into human subjectivity and personal experience. To this end the book reviews Freud's own methods of disseminating his discoveries, discusses the problem of evaluating different claims to psychoanalytic knowledge, and presents a cogent logical model for testing psychoanalytic theories clinically.

This book evolves a model for the generation and justification of psychoanalytic knowledge, a 'parascience' just as rigorous as natural science, and one that addresses the subjectivity of meaning. Research on the Couch will be of interest to psychoanalysts of all schools, academics, clinicians, students and those keen to further their knowledge of psychoanalytic studies.

Part I

Introduction

The centrality of the psychoanalytic method within the psychologies has been increasingly displaced by instrumental (behavioural) approaches of one kind and another that objectify (and often quantify) personal experience. Psychoanalysis is the prime psychology still concerned with human experience itself and, as such, it necessarily relinquishes the instrumental approach. Psychoanalysis may claim to discover valid and reliable knowledge. But, our knowledge is also the ‘instrument’ of change, the change agent. The ‘act’ of knowing is not the beginning of change – first to know and then to make the change. Knowing something is the beginning and the end. New knowledge is an added element to the state of mind, and re-arranges everything else. This is what is meant by ‘insight’ – a new vista on the self is a new self. That is a crucial element of working with a mind. Psychoanalysts have been disheartened by the advance of practices based on instrumental action, and we have often avoided engagement with them. This book starts by addressing the core criticisms that have contributed to the decline in confidence in psychoanalysis in the last half-century.

Because of the unique nature of our knowledge and operational methods, doubt has been cast on the possibility of rigorous research that reaches the standard of other medical and scientific disciplines. Without comparable research, uncontested claims can be made for more or less any theory – a situation referred to as ‘anything goes’ (Tuckett 1994a, p. 865). Much of the predicament of psychoanalysis today is that the core problems of focusing on experience severely restrict the strength of the claim to be scientific. Freud’s authoritative opinion won’t protect us now. We are living in ‘a post-apostolic era’ (Arlow 1982, p. 18). Nor is this contemporary scepticism towards our theories helped by the fact that so often we criticise each other within the world of psychoanalysis, often without the empirical and logical rigour of the physical sciences.

There are no doubt multiple reasons of a personal kind that inhibit necessary rigour in our discussions; problems of unresolved transferences, excessive group dynamic loyalties, the effects of uncontained counter-transference, and intersubjective pressures arising within the work itself. However, the starting point for this book is that there are also significant epistemological reasons why consensus among ourselves is hard to reach. Though the more personal aspects can no doubt exploit the intellectual ones, it is valid to address the key epistemological issues themselves. They are:

• that the material we work with is the subjective experiences of our patients, rather than more objectively observed and measured data;
• that theory-building is uncontrollably and wildly liberated by our inability to test and compare psychoanalytic theories; and
• that the uniquely personal quality of our material makes single-case studies suspect.

Chapter 1 will give an account of how these problems mount to almost insuperable obstacles, and show the scale of the problem to be tackled. Because psychoanalysis is difficult to defend as a science, various reactions can be seen:

• Outcome studies: Under financial pressures, research has turned towards measuring outcome and effectiveness of whole treatments (see for instance Richardson, et al. 2004).
• Process research: Focusing on the clinical setting has addressed many detailed aspects of psychoanalysis itself using quantitative measures and qualitative evaluations (often using audio/video recording) of the psychoanalytic process in treatment (e.g. Luborsky 2001; and Chapter 2).
• Extra-clinical research: Another response turns to experimental methods outside the clinical setting (see Rubenstein 1976).
• Social science methods: There has been a turn to the methods of social science which Rustin (1989) has strongly advocated, noting the correspondence between clinical observation and naturalistic observation, or fieldwork. Tuckett (1994b) applied grounded theory (Glaser and Strauss 1967) to the psychoanalytic process; and more recently (Tuckett et al. 2008) he commenced a project resembling ethnographic fieldwork with groups of psychoanalysts (see Chapter 2).
• Hermeneutics: Another strategy admits psychoanalysis is not a natural science, and then immediately re-erects psychoanalysis as something else; as a hermeneutic discipline (Strenger 1991; and Chapter 10).
• Meanings are causes: Others (e.g. Davidson 1963; Hopkins 1982), acknowledging that psychoanalysis is about meanings, have tried to argue the epistemological point that meanings effectively function as causes.

Although this book will not take any of these positions, and will seek to defend psychoanalysis as a rigorous and evidenced body of knowledge in its own right, we can place the present study in relation to the range of major studies of process research which we will turn to in Chapter 2.

Chapter 3 will be a brief resume of the logical model, which will eventually be developed in Part III. The development of this logical model is the main product that attempts to face the numerous issues that we encounter in claiming psychoanalysis as valid knowledge.

After these three introductory chapters, Part II will address the epistemological issues and problems in developing a rigorous approach to human subjectivity. Part III is the nub of the argument, developing a logical model for psychoanalysis without relinquishing the specificity of psychoanalysis, or the unique experience of the subjects we work with every day. Perhaps Chapters 17, 18 and 19 are the crucial core of this book’s contribution, and that to which the earlier part of the book leads.

In Part IV we will test examples of published clinical cases fed into the logical model.

Chapter 1

Holding the Centre

Criticism of psychoanalysis and psychoanalysts is not new. In the early years, Freud thought that emotionally toned criticisms were inevitable. As a Jew he expected blind dismissal. Kraft-Ebbing viewed Freud’s (1896) aetiology of hysteria as ‘a scientific fairy-tale in public’ (Jones 1953, p. 289); and David Eder, in 1911, rendered a meeting of the British Medical Association totally silent in response to his address on psychoanalysis (Jones 1955). Around the same time, the British Medical Journal in 1907 thundered outrage in a leader: ‘[Psychoanalysis] usurps the confessional . . . [and is] in most cases incorrect, in many hazardous, and in all dispensable’ (BMJ 1907). Based on a credulous assessment of the alleged comment by the Wolfman that this man is a ‘Jewish swindler, he wants to use me from behind and shit on my head’ (Freud’s letter to Ferenczi, 13 February 1910; Brabant et al. 1993, p. 138; see also Obholzer 1982), Fish’s (1989) critique confirms the fascination for wild allegations to substitute for calm judgement.

Ad hominem criticism has continued to flourish happily in later years (Masson 1984; Crews 1993, 1998; Fish 1989, and Webster 1995). Cioffi (1970) argued there is no evidence of psychoanalysis as an effective treatment therefore Freud was a liar, an argument based on that of Eysenck and Rachman (1965). Another categorisation is that of Crews, a prominent critic who regarded psychoanalysis as failing on three important counts: (a) psychoanalysis is no use as therapy; (b) it fails as a scientific body of knowledge; and (c) Freud mischievously posed as an intrepid and path-breaking reporter of new discoveries, when he was not. Psychoanalysis appears to be multivalent in attracting criticism from so many different angles, as it is equally multivalent in attracting interest. Though no criticism can be accepted simply at face value, our defensiveness cannot either. Despite being often fervent and emotionally toned, some criticisms may at times be realistic, and should give us pause for thought.

The demand ‘physician, heal thyself’, appears to be applied to people in the psyche professions much more freely, and harshly, by both the general population and uninformed professionals. High-achieving people are not immune from personal idiosyncrasies, and some are frankly insane, without it invalidating their academic and creative achievements: for example, the ‘beautiful mind’ of John Forbes Nash who won the Nobel Prize despite suffering from schizophrenia (Nasar, 1998; and see Kay Jamison’s (1993) Touched with Fire, a psychiatric study of artists and writers (including Byron)). Of course, this is not to recommend an insane psychoanalyst, just that out-of-the-ordinary achievement is not necessarily incompatible with mental disturbance, even psychosis. Nevertheless, it appears that an extreme standard of mental health is often expected of psychoanalysts, and a special suspicion is visited upon us if we are just ordinary. So, the poison pen seems more readily applied when it comes to Freud and psychoanalysis. The myth is that all psychological workers will be honed to psychic perfection, and anyone who is not should expect to be discounted. The extraordinary persistence of personalised argument that sidesteps the normal conventions of scientific and philosophical criticism was remarked on by Forrester: ‘The one thing historians of science don’t usually do is spend much time in print . . . doubting the trustworthiness of scientists. There are deep and profound reasons why this is so’ (Forrester 1997, p. 218).

There is no reason why dishonest scientists should not be exposed (e.g. Cyril Burt;¹ see Joynson 1989), but when it comes to psychoanalysis, such criticism has been inventively promoted.

At the same time, there has been adulation from early on. Leonard and Virginia Woolf, under the influence of the Stracheys, set out to become Freud’s publisher in English. And W.H. Auden’s poetic eulogy at the time of Freud’s death in 1939, told us ‘he is no more a person / now but a whole climate of opinion / under whom we conduct our different lives’. Freud was noted by a whole range of different segments of Western intellectual and professional culture (for an account of the diffusion into British culture, see Hinshelwood 1995).

Maybe this intellectual sport is directed towards psychoanalysis because it is the most personal of ‘sciences’, and in fact the most personal of psychologies. Psychoanalysis, as Sebastian Gardner (1993) has argued, is only an extension of ordinary ‘folk psychology’. As human beings, we are all psychologists and we make our own assessment of other people’s thoughts, feelings and mental states all the time; ‘Not everyone is bold enough to make judgements about physical matters; but everyone – the philosopher and the man in the street alike – has his opinion on psychological questions’ (Freud 1938a, pp. 283–4). If psychoanalysis is a science, it also displays intimacy, passion and rhetoric. It may therefore be perfectly understandable that criticism also strays from the rational to the passionate.

Despite this, more thoughtful criticisms have developed since the 1950s, and have engaged the attention of a number of philosophers of science (Stengel 1951; Pumpian-Mindlin 1953; Popper 1959; Hook 1959; Nagel 1959; Grunbaum 1959). Erich Fromm in 1970 started his book, The Crisis of Psychoanalysis, by stating that ‘Contemporary psychoanalysis is passing through a crisis which superficially manifests itself in a certain decrease in the number of students applying for training in psychoanalytic institutes’ (Fromm [1970] 1973, p. 9).

However, the doubts thrown on psychoanalysis have been more substantive than this superficial manifestation, Fromm himself regarded the problem as the mechanistic and scientistic direction ego-psychology had been heading. Perhaps Sydney Hook’s symposium in 1958 in New York (Hook 1959) started the serious challenge. Despite the respect for psychoanalysis, that symposium failed to convince of the scientific respectability of psychoanalysis partly because of the laconic performance of the psychoanalysts presenting (notably Hartmann who gave the opening address), as well as the new view of science emerging in the 1950s (see Chapter 7).

The multiple strands of criticism by a very broad spectrum of people do need careful attention. Milton et al. (2004, pp. 79–98) classified them according to their core arguments – (a) critics of the truth and knowledge claims of psychoanalysis: Popper, Cioffi and Grunbaum; (b) critics who question Freud’s stature and originality (contextualisers): Roazen, Ellenberger and Sulloway; (c) critics from political and ideological perspectives: Millett, Timpanaro, Szasz and Rycroft; (d) patient critics: Sutherland and Sands; and (e) general critics: Webster, Crews and Masson.²

This is not the only categorisation. Gomez (2005), taking up only the first of Milton’s categories, found exemplars of three different kinds (Grunbaum, Nagel and Habermas), philosophical critiques which, despite their reservations, do retain respect for facets of psychoanalysis. Many other philosophers have taken a look at psychoanalysis, because it promises understanding of the nature of mind. These include Sartre (1943), who believed psychoanalysis dubious for promulgating a bad faith by normalising the inauthentic state of being driven by an unknown self (the unconscious). Wittgenstein ([1942] 1966) also thought Freud was wrong and that apparent unconscious drives were merely those forces concealed in speech acts. Wollheim (1984), on the other hand, as well as some of his students (Gardner 1993, Hopkins 1982), fully supported Freud, though in one of psychoanalysis’ derivative forms, Kleinian object-relations. Psychoanalytic theories have dispersed and now fan out with unrestrained abandon into numerous competing varieties and subvarieties. This state is now termed Babel, ‘where: (1) the same words name different concepts; (2) the same concepts are named by different words; (3) there are a number of words only validated within the context of a given frame of reference’ (Aslan 1989, p. 13). Others have also used this term, Babel (Tuckett 1994a; Steiner 1994; Gabbard and Williams 2002), and it has led some (for instance, Eagle 1997) to recall Yeats’s prophetic poem:

Things fall apart; the centre cannot hold;

Mere anarchy is loosed upon the world,

The blood-dimmed tide is loosed, and everywhere

The ceremony of innocence is drowned;

The best lack all conviction, while the worst

Are full of passionate intensity.

(‘The Second Coming’ 1921)

The ‘centre’, as Freud might have conceived it, has not held. Because psychoanalysis is a discourse, it can vary under social, cultural and linguistic influences; even national schools of psychoanalysis are noticeable. Moreover, as Sandler (1983) described, psychoanalysts’ theories are not always explicit, and so in use ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright
• Contents
• Foreword
• Foreword
• Preface
• Part I: Introduction
• Part II: Basics: what is belief, what is science?
• Part III: Justifying psychoanalytic knowledge
• Part IV: Testing the test
• In conclusion
• Notes
• References
• Index