The Practical Fiction of Psychoanalysis

THE PRACTICAL FICTION OF PSYCHOANALYSIS: An exegesis of the critiques and defenses of psychoanalytic modus operandi The methodology and validity of the kind of knowledge-generation produced in clinical psychoanalysis is the subject of much critical debate. What constitutes psychoanalytic ‘evidence’ and how this evidence is validated are two fundamental questions that psychoanalysts must be constantly aware of and ready to answer.

There are many different ways of looking at these issues, some of which will be addressed in this essay. Starting with Freud and his ‘medical-scientific’ search for a clinical method to relieve psychological symptoms, we find hypnosis and later, dreams and free associations as indicative of the traditional position psychoanalysts have taken with respect to the methodological constraints of their particular ‘brand’ of epistemology1. A central question in this thesis is whether psychoanalysis can be measured as an empirical science, equal in its objective verifiability to the other ‘natural’ sciences, already well established in Freud’s time and all of which dealt with material subject matter2. The immateriality of psychoanalytic data, ab initio, is of critical importance to many of the responses psychoanalysts are required to make in defence of their prized discipline. Psychoanalysis is accused of being invalid, unreliable, un-empirical, unfalsifiable, overly inductive and essentially un-scientific.

These criticisms are briefly referenced to their major proponents and the defenses made will be introduced to give the reader an overview of the status of the debate, which continues to this day, about the crisis of psychoanalysis as a science. 3 Freud was aware that his hypnotic method was vulnerable to attack and anticipated several criticisms, with characteristic austerity. Suggestion 4 was one such criticism, to which he responded in his published case materials. Anna O. 5 was described as being completely unsuggestible due to her, at times obstinate, critical common sense 6. This unsuggestible nature, which transpires to be internally consistent with the other clinical ‘facts’ of her case, is enough for Freud to rule out the possibility that

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Theory of knowledge with regards to method validity and scope // investigation of what distinguishes justified belief from knowledge 2 These scientific disciplines were all able to construct experiments; investigating relations between variables that were objectively verifiable and reliably inter-observable (sometimes with the use of microscopes), whereas psychoanalysis deals in what is immaterial, what is hidden, what is in the realm of the so-called ‘unconscious’.

3 The conclusion that psychoanalysis may never be a science, as science wants it to be, and that it nonetheless appears valid and useful is summarised under the title of this essay: the practical fiction of psychoanalysis which seems adequate enough to justify its existence, and brings light to an otherwise darkened arena where it could seem as if the ‘dead horse’ of psychoanalysis was being kicked by straw men.

4 The undeniably possibility of the suggestion of the analyst to the patient during hypnosis.

5 The patient with whom the talking-cure (later to develop into psychoanalysis) was first discovered as a method of alleviating psychological and psychosomatic symptoms.

“She had great poetic and imaginative gifts, which were under the control of a sharp and critical common sense. Owing to this latter quality she was completely unsuggestible; she was only influenced by arguments, never by mere assertions. Her willpower was energetic, tenacious and persistent; sometimes it reached the pitch of an obstinacy which only gave way out of kindness and regard for other people.”Breuer, J. & Freud, S. (1896). Studies in Hysteria, Chpt II, p. 21 6

therapeutic gains, made through the lifting of repressions 7 during Anna O’s ‘autohypnotic’ states, had anything to do with the selection bias or suggestion of the analyst. Whether this anecdotal evidence is enough to fortify the hypnotic procedure against scientific scrutiny is a central to the debate about psychoanalytic data generation. Freud asks the question: “how far the patient’s statements are to be trusted and whether the occasion and mode of origin of the phenomena were really as…presented”8, which illuminates an unavoidable aspect to the clinical validation of data in the problematic of psychoanalysis. Freud admits of the limited evidential and causal implications of symptom remission based on the ‘talking’ method, and maintains the explanans9 of suggestion for the explananda10 of remission11. However, the ‘irrational character’ of Anna O’s connections, Freud thought, spoke in favour of their reality; how could he or the patient have come up with such illogical linkages and unlikely causal hypotheses?12 Convincing as it may be, this does not immunize Freud or psychoanalysis to the imperative questions of what it is that actually constitutes data within the psychoanalytic situation and whether the methodology is scientific or valid.

Despite the uncanny usefulness of Anna O.’s ‘condition seconde’ for plumbing the depths of her repressed pathogenic material 13, Freud abandoned the clinical method of hypnosis. If hypnosis was to be the independent variable of the psychoanalytic testing ground, Freud knew many individuals would miss out because not everyone was as prone to ‘absences’ as Anna O. So he began self-analysis and developed dream interpretation and free association as the psychoanalytic modus operandi.

By giving an historical account of the mystic, artistic and scientific models of dream-

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“that in the case of this patient the hysterical phenomena disappeared as soon as the event which had given rise to them was reproduced in her hypnosis—made it possible to arrive at a therapeutic technical procedure which left nothing to be desired in its logical consistency and systematic application. Each individual symptom in this complicated case was taken separately in hand; all the occasions on which it had appeared were described in reverse order” Ibid. p. 34 8 Ibid, p. 42 9 Statements, laws, theories, facts used to explain 10 The thing to be explained 11 “But I always found the patient entirely truthful and trustworthy. The things she told me were intimately bound up with what was most sacred to her. Whatever could be checked by other people was fully confirmed. Even the most highly gifted girl would be incapable of concocting a tissue of data with such a degree of internal consistency as was exhibited in the history of this case. It cannot be disputed, however, that precisely her consistency may have led her (in perfectly good faith) to assign to some of her symptoms a precipitating cause which they did not in fact possess” Ibid 12 “the story of the development of the illness would have remained completely unknown alike to the patient and the physician if it had not been for her peculiarity of remembering things in hypnosis, as I have described, and of relating what she remembered. While she was in her waking state she knew nothing of all this” Ibid. p. 43 I have already described the astonishing fact that from beginning to end of the illness all the stimuli arising from the secondary state, together with their consequences, were permanently removed by being given verbal utterance in hypnosis, and I have only to add an assurance that this was not an invention of mine which I imposed on the patient by suggestion. It took me completely by surprise, and not until symptoms had been got rid of in this way in a whole series of instances did I develop a therapeutic technique out of it. Ibid, p. 45 13

interpretation14 and stating that this history somehow justified the validity of dreams as worthy subject matter, Freud contributed an element that elevated his method above all previous attempts at getting to the ‘meaning’ of dreams 15. He asserted that dreams and dream-thoughts were indeed reliable sources of data. To justify his addition of the dreamer’s free association to the dream contents—as among the data available to him—Freud appeals to more anecdotal evidence from a missionary who demonstrates that dream-interpreters (from the ‘East’ 16) used the dreamers’ collaboration17 to build up their interpretations. Freud attributes his discovery of the procedure of dream-interpretation to his work with patients like Anna O. 18 who pledged to give Freud uncensored access19 to their innermost thoughts including the thoughts of their dreams. This led Freud to conclude that dreams can be “inserted into the psychical chain…[and] traced backwards in the memory from a pathological idea.”20 Thus we begin to see a method, similar to that of the treatment of hysterical and obsessive symptoms, which could be talked away in the talking cure, and depended somewhat on the patient being in a somnolent state 21.

Freud was cognizant of the possible dispute of his ‘new’ method of free-association 14

“‘interpreting’ a dream implies assigning a ‘meaning’ to it—that is, replacing it by something which fits into the chain of our mental acts as a link having a validity and importance equal to the rest”. Freud, S. (1900). Interpretation of Dreams, Chpt II, p. 95 15 “As we have seen, the scientific theories of dreams leave no room for any problem of interpreting them, since in their view a dream is not a mental act at all, but a somatic process signalizing its occurrence by indications registered in the mental apparatus” Ibid. “that neither of the two popular procedures for interpreting dreams can be employed for a scientific treatment of the subject. The symbolic method is restricted in its application and incapable of being laid down on general lines. In the case of the decoding method everything depends on the trustworthiness of the ‘key’—the dream-book, and of this we have no guarantee. Thus one might feel tempted to agree with the philosophers and the psychiatrists and, like them, rule out the problem of dream-interpretation as a purely fanciful task.” Ibid. p. 99 “to realize that here once more we have one of those not infrequent cases in which an ancient and jealously held popular belief seems to be nearer the truth than the judgement of the prevalent science of to-day. I must affirm that dreams really have a meaning and that a scientific procedure for interpreting them is possible.”Ibid 16

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“these dream-diviners do not allow a single point to escape them and only give their interpretation after they have completely mastered the replies to all the necessary enquiries.” Ibid. p. 97 18 “I have been engaged for many years (with a therapeutic aim in view) in unravelling certain psychopathological structures—hysterical phobias, obsessional ideas, and so on. I have been doing so, in fact, ever since I learnt from an important communication by Josef Breuer that as regards these structures (which are looked on as pathological symptoms) unravelling them coincides with removing them.” Ibid.

19 “We therefore tell him that the success of the psycho-analysis depends on his noticing and reporting whatever comes into his head and not being misled, for instance, into suppressing an idea because it strikes him as unimportant or irrelevant or because it seems to him meaningless. He must adopt a completely impartial attitude to what occurs to him, since it is precisely his critical attitude which is responsible for his being unable, in the ordinary course of things, to achieve the desired unravelling of his dream or obsessional idea or whatever it may be.” Ibid. p. 100 “It was then only a short step to treating the dream itself as a symptom and to applying to dreams the method of interpretation that had been worked out for symptoms.” Ibid.

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“the establishment of a psychical state which, in its distribution of psychical energy (that is, of mobile attention), bears some analogy to the state before falling asleep—and no doubt also to hypnosis” Ibid.

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and dream-interpretation. There could be no guarantee of misinterpretation or arbitrary conclusions and a complete interpretation with the attendant total meaning was rarely possible with dreams, but Freud was not concerned with these limitations: he was concerned with what things ‘meant’ to his patients, not how accurate or complete they were. An implicit understanding about the mind, that we get from psychoanalysis, is that things are not always clear, total and accurate in the mind and that there is a certain degree of fogginess that can perhaps be cleared by working through the repressed material and bringing the unconscious into consciousness, but these things are hugely difficult to measure and substantiate scientifically. This difficulty does not, however, negate the validity of psychoanalysis.

Adolf Grunbaum attempts to level such a negating assault on psychoanalysis. Using Freud’s own criteria of hypothetic-deductive inductivism 22 against him23, Grunbaum attacks the clinical validation of psychoanalytic theory citing the failure of the free association method to provide evidence for actual events in the past that may or may not lead to hysteria. The “quest for the veiled meaning” 24, Grunbaum says, cannot succeed without causal inquiry or validation. Since causality is out of the question in psychoanalysis, Grunbaum is concerned about the ensuing danger of the “thematic affinity fallacy”25, which relates to Gardner’s “thematic coherence” proposition 26.

However, Freud himself said that the unlikely attributions made by the patient, do not speak of affinity or coherence, but of irrationality, illogicality; neither created by the patient nor the analyst, but emerging authentically from the repressed material, and that it is the meaning of these associations for the patient , that matter most. For Grunbaum however, neither the causal role of childhood seduction fantasies nor the explanatory role of meaning immunizes psychoanalysis against the “modes of explanation and validation of natural sciences”27 22

“He regarded adherence to these as the hallmark of the scientific status he claimed for his theory…In short I grant Freud his own canons of scientific status in addressing the following key question: Did his clinical arguments vindicate the knowledge claims he made for his evolving theory in labeling it “scientific”?” Grunbaum, A. (1986). Precis of The Foundations of Psychoanalysis: A Philosophical Critique. The Behavioral and Brain Sciences, 9, 217-284, p 220 23 “The clinical case for Freud’s cornerstone theory of repression – the claim that psychic conflict plays a causal role in producing neuroses, dreams, and bungled actions – turns out to be ill-founded for two main reasons: a) Even if clinical data were valid, the method of free association has failed to support the psychoanalytic theory of unconscious motivation; b) Clinical data tend in any case to be artefacts of the analyst’s self-fulfilling expectations, thus losing much of their evidential value. The hypothesis that psychoanalytic treatment is in reality a placebo poses a serious challenge to the assumption that insight is a key causal factor when therapy is successful. This challenge has yet to be met by psychoanalysts” Ibid. p. 217 24 Ibid. p. 218 25 “no matter how strong such a thematic affinity between a supposedly repressed thought and a neurotic symptom, this “meaning connection” is not enough to show that the repressed thought is the “hidden intentionality” behind the behaviour. Thematic affinity is not sufficient for causation. Even analysts who do not consider themselves hermeneuticists are susceptible to what might be dubbed “the thematic affinity fallacy” Ibid. p. 219 26 “psychoanalytic interpretation adduces meaningful connections between disparate and often apparently dissociated mental and behavioural phenomena directed by the goal of ‘thematic coherence’, of giving mental life the sort of unity that we find in a work of art or cogent narrative” Gardner, S. (????)

A Companion to the Philosophy of Mind. pp. 493-500 27 Ibid

The use of Freud’s own norm of scientific rationality bears no reflection on where Grunbaum considers the demarcation between science and nonscience to be, though it is this ‘demarcation principle’ that he argues against in light of Popper’ indictment of psychoanalysis as unfalsifiable and thus nonscientific. In order to be falsifiable, theories have to be testable and Popper went as far as to reject even the logical possibility of empirical testing in psychoanalysis 28. Grunbaum, unavoidably comes to Freud’s defence here, reminding us that for Freud it was research, not empirical testing that was to be conducted within the psychoanalytic setting 29, contending that some authors have found “viable strategies for supporting or refuting psychoanalytic hypotheses on the coach…[and] at least some parts of the Freudian corpus are in fact testable by empirical findings of some sort”.30 Which strategies, which parts of Freud’s corpus and which sort of findings, are not mentioned. Grunbaum is not aiming to back up the Freudian defence, so much as contextualise Popper’s narrow attack, before refuting it and psychoanalysis on his own terms. 31 Grunbaum postulates the ‘Necessary Condition Thesis’ (‘NCT’) 32 from the two premises of Freud’s ‘tally argument’33 to which he held until 1917 at least, but by 1926, Grunbaum says: “Freud’s own evidence conflicted with the claim that the cure… depends on the patient’s correct insight into its causes” 34 and that the possibility of spontaneous remission contradicts that claim. This meant that what--for Grunbaum-was the centerpiece of Freud’s theory of repression, was now refuted and the 28

“It is then a corollary of this thesis of nontestability that clinical data in particular cannot serve as a basis for genuine empirical tests”. Ibid. p. 220 29 Even though ethics in psychology had not yet been developed, one wonders what kind of experiments Popper would have psychoanalysts do on their patients: withhold valuable information and interpretations; give erroneous ones; traumatize them and observe the results?

30 Ibid 31 “When Popper claims that his falsifiability criterion excludes psychoanalysis from the pantheon of the bona fide empirical sciences, his principle concern is not with Freudian theory as such, important though psychoanalysis is. In Popper’s earlier works (1962, pp. 156-57;255-58) we find psychoanalysis playing a role not so much as itself the prime target of his charge of nonfalsifiability, but rather as a centerpiece for his critique of inductivism as a method of scientific theory-validation or a criterion of demarcation between science and nonscience. For…Popper (pp. 33-38), inductivism does accept the claims of abundant empirical confirmation made by adherents of Freud’s theory…

Indeed Popper (pp. 35-37) seems to have become convinced of the unfalsifiability of psychoanalysis partly because he thought it was always confirmed inductively, come what may. Thus, by 1919 he had persuaded himself both that inductivism does not have the methodological resources to challenge the scientific status of psychoanalysis and that Freud’s theory…was in fact empirically refutable. On this basis, Popper argued that the inductivist method of confirmation and its criterion of demarcation are unacceptably permissive.” Ibid 32 “1. Only the psychoanalytic method of interpretation and treatment can yield or mediate for the patient correct insight into the unconscious causes of his neurosis.

2. The patient’s correct insight into the conflictual cause of his condition and into the unconscious dynamics of his character is in turn causally necessary for the durable cure of his neurosis” Ibid. p. 221 33 “After all, his conflicts will only be successfully solved and his resistances overcome if the anticipatory ideas [i.e. psychoanalytic interpretations] he is given tally with what is real in him. Whatever in the doctor’s conjectures is inaccurate drops out in the course of the analysis; it has to be withdrawn and replaced by something more correct.” Freud, S. 1917, ?? 16: 452) 34 Grunbaum, A. (1986). Precis of The Foundations of Psychoanalysis: A Philosophical Critique. The Behavioral and Brain Sciences, 9. p. 222

justification for Freud’s tautology35: ‘therapeutic success is the same things as support for causal inferences’, could no longer be made. By 1937, Grunbaum reports, Freud had “confined the prospects of psychoanalysis to palliation…[and] of his tally argument…Freud gradually renounced or significantly weakened both of them” 36.

Grunbaum identifies some compelling flaws in Freud’s theoretical construction of psychoanalysis, which seem to hold a lot of sway post facto, but in reality, these are essentially interpretations of Freud that want to keep him in stasis; as if to deny the notorious dynamism and flux of his brilliant mind37. Just because Freud abandoned the propositions he realized as incorrect, psychoanalysis does not suddenly become worthless or unscientific. Grunbaum argues that without his ‘NCT’, Freud has only his free-association method to support his conclusions, but since this very method is in question, the evidential value of psychoanalytic data is left in disrepair 38.

Freud’s failed attempt to ameliorate the opprobrium of the evidential value of clinical data39 is a central thesis to Grunbaum’s appraisal. Moreover, even if Freud succeeded in his mitigation, his theory of repression, Grunbaum says, is fundamentally wrong. 40 Yet psychoanalysts continue, according to Grunbaum to “maintain that free associations are crucial for the validation of both their etiologic hypotheses about the causes of neuroses and the psychoanalytic theory of dreams.” 41 Freud’s final defence of the probative value of clinical data culminates in what Grunbaum coins “the pseudoconvergence of clinical findings”42 – adding insult to injury43. For Grunbaum, the 35

“In other words, the hypothesis that therapeutic success is caused by the removal of repressions is to this day the sole justification for assuming that free association show repressions to be causes” Ibid. p.

224 36 Ibid 37 A mind who’s dynamism and flux has fallen upon some of the most timeless and intuitive perceptions regarding the workings of the human psyche, by its nature immaterial and unverifiable.

38 “there appears to be no way to free clinical data from the possibility of contamination by suggestion… this left the evidential value of clinical data in serious doubt” Ibid. p. 223 39 “the failure of free association to ensure that repressed ideation emerges without contamination by suggestion. Although mindful of this problem, Freud kept offering further reasons for his belief that free association “guarantees to a great extent that…nothing will be introduced into it by the expectations of the analyst” (1925, 20:41). In this vein, he assures us of the analyst’s ability to distinguish the patient’s bona fide memories from imagined.” Ibid p. 226 40 “the gains made by their hysterics to the resurrection of buried painful memories. They also thought that this hypothesised process of producing therapeutic success was evidence that an original act of repression was necessary to maintain it. It then followed that the removal of the repression would eliminate the neurosis…The pattern of relapses, additional treatment, temporary remissions, and further relapses made it doubtful that removing the repressions of adult traumas was therapeutically effective. Freud began to be haunted by the triumph of the placebo hypothesis over his therapeutic hypothesis…without therapeutic support for the causal role of repression, the very cornerstone of PA was completely undermined. Hence at that point, the new clinical psychoanalytic structure tumbled down and lay in shambles. So also did free association as a method of establishing causation.” Ibid. p.

224 41 Ibid 42 “Freud appealed to converging evidence, contending that other clinical data can cross-validate a patient’s acceptance or rejection of his analyst’s interpretations. All clinical evidence, however, whether corrobative or not, is suspect, because it depends on the method of free association with its potential suggestive effects” Ibid 43 1)Insofar as the evidence for the psychoanalytic corpus depends on data from the treatment setting,

mere existence of repression44 (the discovery of which he attributes to Schopenhauer) is not a necessary condition for the causal role Freud assigned it. In the end, Grunbaum raises some critical questions45, the answers to which contain the future prosperity of the psychoanalytic mode of investigation.

According to Milton et als.46 concise chapter on the broad levels of critique against psychoanalysis we can position Grunbaum’s criticisms within the categories of i) philosophically challenging the truth and scientific status of psychoanalysis and v) globally criticizing Freud’s methodological, theoretical and therapeutic techniques. 47 Questioning the truth value and explanatory power of psychoanalysis is definitely manifest in Grunbaum but Milton et al., make a good rebuff when they state that ideas about the self, naturally evade the rigour of ideas about nature, placing psychoanalysis within “the border between science and the humanities.” 48 So there is still this question about where psychoanalysis stands among the sciences: is it natural science or on the border between natural science and the humanities? Furthermore, there is the question of the role of the psychoanalyst: genetic archeologist or here-andnow hermeneutician?

this support is remarkably weak.

2) In view of the methodological shortcomings of clinical psychoanalytic inquiry, a proper test of Freud’s central hypotheses calls for well-designed extraclinical studies, either epidemiologic or experimental…For the most part, such studies have yet to be performed.

3) Despite the poverty of the clinical support, it could still conceivably turn out that Freud’s brilliant theoretical imagination was actually serendipitously right in some respects. But whereas psychoanalysis may thus be said to be scientifically alive, it is currently hardly well, at least insofar as its clinical foundations are concerned.

44 “in the psychoanalytic sense of banishing a thought from consciousness or denying it entry.” Ibid 45 “Does free association indeed bring out repressed wishes, or anger, or guilt, or fear, and so on, without contamination by other influences? If unconscious thoughts surface, by what criteria does the analyst decide when, during the investigation of parapraxes and dreams, to call a halt to the flow of associations…how does the analyst avoid a selection bias in the face of the thematic variety of associations, particularly since imposing some limit on duration is unavoidable?” Ibid 46 Milton, J., Polmear, C. & Fabricius, J. (2004). A Short Introduction to Psychoanalysis. Chpt V, (‘Critiques of Psychoanalysis’) pp. 79-99 47 The intervening categories are less relevant to the critical methodological approach, though interesting in their own right. It is not within the scope of this essay to go into all of these and the two categories chosen represent a fair overview of the course. The other critiques are: ii) Contextual challenges to Freud’s originality such as Ellenberger’s (1970) relegation of Freud’s stature as the rightful heir to ‘dynamic psychiatry’, to which he asserts Janet and Adler as having a greater claim; iii) Political and ideological critiques (Feminism/Marxism) discussing the inimical or federated effects of Freudian theory on women’s liberation and capacity of psychoanalysis (as a bourgeois doctrine) to look beyond the class interests that delimit its ideological horizon; iv) Patient critiques, including reports of abusive treatment and professional misconduct (Masud Khan). The reader is referred to Milton’s chapter for more detail and references.

48 “at once empirical and hermeneutic: it works by deciphering clues…fossil remains of extinct species – in order to reveal hidden reality…evidence of dreams, slips and neurotic symptoms to reveal the hidden reality of the unconscious…Science is in fact a continuum with psychoanalysis occupying an honoured place toward the Darwinian end.” Ibid. p. 85

Hermeneuticists like Ricoeur49, Schafer50 and Will51, try to assert psychoanalysis as a purely interpretive discipline: “concerned with…plausible meaning and reasons rather than mechanisms and causes.”52 This evasion of the scientific dispute of psychoanalysis’ status within the ‘bone fide’ sciences gives “Tacit acceptance of Popper’s narrow view of science”53 and demonstrates an aversion to the investigation of objective truths within the realm of subjectivity 54. It is clear, I think, that the critical approach to psychoanalytic methodology sees the hermeneutic evasion as an example of a wolf in sheep’s clothing. The ‘quest for the veiled meaning’, Grunbaum says, cannot succeed without causal inquiry or validation, yet hermeneuticists declare inquiry and validation to be inappropriate outside the natural sciences. Simply saying that psychoanalysis is an interpretive discipline and denying its palpable scientistic tendencies does not save psychoanalysis from the imperative questions addressed in this thesis.

One of the common strands within the global critiques on display in Milton’s chapter is the profound worry that psychoanalysts cannot be trusted with the mind but I find Hinshelwood’s poignant statement to be of use in this matter. He states that psychoanalysis actually seeks to alter and rebalance the inequality it appears to foster through encouraging the patient to achieve new independence as disowned or misattributed aspects of the self are reclaimed.55 What comes out clearly is that critiques of psychoanalysis (global or philosophical) reflect “an odd mixture of despair…and idealistic naivety”56 and that this is something psychoanalysis too, has to manage in its response.57 On the defending line, Tuckett tries to reset the psychoanalytic testing ground within more empirical parameters and argues for the generation of clear and specific predictive hypotheses within the session as well as working orientations and ‘grounded hypotheses’ without.58 The ‘grounded hypothesis’ approach to the question 49

Schafer, R. (1999). Recentering Psychoanalysis: From Heinz Hartmann to the Contemporary British Kleinians. Psychoanalytic Psychology, 16: 339-354 50 Will, D. (1986). Psychoanalysis and the New Philosophy of Science. International Review of Psycho-Analysis. 18: 153-173 51 Ricouer from last year 52 Milton. P. Will 86 just before #2 53 Ibid 54 The putative goal of psychoanalysis 55 Hinshelwood, B (1997) Therapy or Coercion? London: Karnac pp. 1-209 56 Milton et al (2004) p. (near end of chapter V) 57 In the end, if psychoanalytic research and treatment is so flawed, the question begs to be asked, what would the critics have it replaced with, if at all? Milton covers a number of responses to this question, which summarise the global critiques quite well. Some believe we are better off with nothing; others believe social and psychological Darwinism will come to the rescue; others believe the very idea of psychoanalysis is wrong and advocate groups of fellow sufferers as an alternative to formal psychotherapy; and others, who we will briefly visit in the penultimate section of this essay believe there are other options for psychoanalysis.

58 I want to suggest the need to comprehend different aspects of a psychoanalytic process in terms of what is known as Grounded Theory, a form of hypothesis development which starts by attempting to make sense of situations through a process of comparing them with each other and which, its adherents argue, permits theory development that is closely fitted to the situations it is trying to know and, being experience-based, is practically useful”Tuckett, D. (1994). Developing a Grounded Hypothesis to

of validity involves concepts like ‘clinical facts’59; ‘clusters’60; ‘working orientations’ and ‘grounded hypotheses’61 being taken as read.62 Tuckett also introduces the potential of extra-clinical ‘macro-validation’63 in addition to the ‘micro-validation’64 that goes on within the session.65 The work of psychoanalytic data generation is analogized to the ‘theoretical sampling’66 of ‘immediate sessional data’, which Tuckett believes: “illuminates a wider field of events…has proved practically useful in the sessions, and… has been predictive”67. Grounded hypotheses, as described by Tuckett, respond to the inimical problem of theory-testing within the social sciences. The immaterial nature of psychoanalytic data requires rigorous inductive processes of theory-building which relies on a stronger faith in the immanent reliability of the epistemophilic trend understand a Clinical Process: The Role of Conceptualisation in Validation. International Journal of Psycho-Analysis, 75:1159-1180. p. 1159 59

“if psychoanalysis is being undertaken, the occurrences noted by the analyst in the session, provided they are apprehended within the framework of free-floating attention and free association, are what is to be regarded as the psychoanalytic data. In this sense, I argue that if there is a reasonably detailed clinical account intended to describe what has actually gone on in the session, then that account is usefully considered as providing the clinical facts. The account will include information about what the analyst has noticed and also, through hints that other analysts will quite probably notice, can even provide significant information about what was noticed unconsciously but not immediately apprehended, or even what was completely ignored” Ibid. p. 1160 60 “Gradually, analysts expect to sense what they think is the patient's unconscious concern at that moment. As the session progresses, memories of past material from the patient or all kinds of ideas, including apparently irrelevant ones, will impinge on the analyst more or less consciously and become linked with what is being heard and experienced. This is how I try to work, and in this way what I have come to think of as clusters of psychoanalytical clinical facts emerge in each session” Ibid. p. 1159 “In so far as analysts reflect on the sessions outside their participation in them, however, I consider the process to be significantly different. After the session an analyst is at least somewhat outside the transference–countertransference matrix and less of a participant. To reflect on the validity of what is being done, the analyst can engage in a more systematic effort to see what is being learned and not learned and be able to assess its evidential base. The time framework is stretched, and distinctions and patterns not seen in the heat of the moment can be discerned and their generalisability and interconnectedness considered. It is, therefore, outside the session that I find useful the two other concepts that I have mentioned: working orientations and grounded hypotheses.”Ibid.

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“My several conceptual distinctions are intended to suggest a gradient in focus from the first, rawest possible level of basic data (clinical facts), to a second, more conceptualised level of collections of linked facts (clusters), to a third level of more focused selections (working orientations), and to a fourth, still more focused and organised level of grounded hypotheses, characterised by their linking of observations in a more generalisable causal model.” Ibid. p. 1160 63 “Macro-validating activity refers to activities conducted outside the session aimed at questioning what has happened in it…Macro -validation shifts the perspective and, by providing an alternative viewpoint to that of the session, entails a small but significant step towards validation: an underlying principle in all scientific work is to compare situations from different points of view and to reflect on the resulting differences.” Ibid. p. 1161 64 “Micro-validating activity, questioning what we and the patient have selected to know and not know and how and why, goes on all the time in most ordinary analyses, particularly as we seek the patient's responses to the interpretations we make.” Ibid. p. 1160 65 “my current confidence in these hypotheses is built on two separate levels of activity, which I want to introduce: the micro-validating activity of my work in each individual session, and the macro-validating activity of seeking to explore and to think outside the sessions about the pattern of development within them. These two activities can and probably should be mutually reinforcing, and, no doubt, form part and parcel of many analyses. They are certainly very much part of the oral tradition in psychoanalysis and psychoanalytic education.” Ibid.

66 “Theoretical sampling is the process of data collection for developing grounded theory whereby the

operating within the human mind, than either Grunbaum or Popper conceive 68.

Tuckett relies on this faculty being employed in the explorations of hypotheses derived from micro-, and macro-validation, to strengthen the case that psychoanalytic data gathering is possible and testable69. Whether Tuckett succeeds in nullifying all of the critiques launched at psychoanalytic methodology by reframing psychoanalysis as a social science, is neither here nor there, since it was not intended to validate any particular hypothesis other than the potential of grounded hypotheses to make the work of validation within psychoanalysis possible. The palliative intention of Tuckett’s thesis is overwhelmingly gratified in his cogent defence but it does not address all of the wounding done to ego of psychoanalysis by its global and philosophical critics.

Another defence—based on Ezriel’s re-analysis of the role of the analyst in his therapeutic quest—distinguishes between the ‘genetic-archeological’ orientation and the ‘here-and-now’ orientation to data retrieval in clinical psychoanalysis, as natural science70. Psychoanalysis, Ezriel reports, has erroneously been conceptualised as a genetic process, akin to that of the archeologist, and it has been ignorant to the potential of a more scientific field of experimentation by grasping the transferential ‘here-and-now’ phenomena that arise within the session, which undoubtedly contribute to the genetic view but surpass these unverifiable relics in their testability. 71 By recording sessions and identifying pre-interpretation and post-interpretation material, Ezriel devises the psychoanalytic experiment, with the analyst’s intervention as the experimental variable. This again, relies on an almost blind faith in the analyst’s sensitivity to the unconscious object relationships underlying the transferencecountertransference matrix, and their causal role in the manifest expression of interpersonal behaviour. Psychoanalytic interpretations represent hypotheses for Ezriel. The analyst predicts movement in the patient’s response on the basis of the analyst jointly collects, codes and analyses his data and decides what data to collect next and where to find them, in order to develop his theory as it emerges. This process of data collection is 'controlled' by the emerging theory” Ibid. p. 1174 67 Ibid. p. 1175 68 The mind is itself an instrument, capable of recognizing, decoding, remembering, questioning at many levels and attributing meaning where it is due.

69 When we consider validation in psychoanalysis apropos the grounded hypothetical approach along with the concomitant ‘gradient in focus’ that allows the analyst to build grounded hypotheses and make specific predictions, psychoanalysis sighs a little sigh of relief.

70 “The customary method of investigation in the natural sciences is to observe events in the 'here and now', i.e. while they are taking place in front of the observer, either spontaneously or under experimental conditions set up by him. It is then possible to identify 'dynamic, ahistorical' causes…In contrast with this, the historian or archaeologist, using a 'genetic' method, reconstructs particular past events and so is able to explain how present-day conditions have been brought about in a particular case.” Ezriel, H. (1956) Experimentation within the Psycho-Analytic Session. The British Journal for the Philosophy of Science, 7:29-48, p. 30 71 “It has commonly been assumed among analysts that psycho-analysis is a purely genetic method.

Indeed, Freud compared the analyst with an archaeologist who ' digs up ' the patient's past. This was in keeping with his original view that what constituted the dynamic source for the thoughts and feelings which the patient expressed during a session (his so-called ' free associations ') were his unconscious memories of unresolved conflicts of his childhood, and that the psycho-analytic method enabled the analyst to use the material produced by the patient in the session to reconstruct significant events in his past life and so the historical genesis of his symptoms and, by putting this reconstruction to the patient to remove these symptoms.” Ibid.

hypothesis. Procedurally, interpretations include three specific predictions of movement in the patient’s response (i) towards a required relationship, felt to be indispensable to (ii) the avoidance of another sort of relationship, which the patient feels would result in (iii) a calamity72. On the basis of these interpretations, the pre-, and the post-interpretational material, Ezriel believes that the central proposition of psychoanalysis – that correct insight brings repressed material into consciousness— can be tested experimentally, flying in the face of Grunbaum’s critique of Freud’s supposed ‘NCT’. Ezriel, in the tradition of Freud, also nullifies the objection that analysts’ interpretations can be incorrect because within the ‘here-and-now’ approach the accuracy of the interpretation is immaterial; it is the patient’s responses being studied and assessed.

From blind faith to belief, we conclude our overview of the prominent debates surrounding the validity and scientific status of psychoanalysis as an epistemological technique. How do we know, what we think we know in psychoanalysis, to be the truth? Can we test and verify data from the session and if so which data are empirical?

These questions still must be asked for there is no possibility of escape. In his chapter on belief, Britton73, finds that in his later papers Freud posits anxiety--not repression-as central to psychoanalysis; this alone makes Grunbaum’s thesis redundant.

Criticisms aside, for a moment, Britton brings us back to the simple matter of the practical role of belief74 within the psychoanalytic process. To believe, presupposes the possibility that you may be incorrect, whereas knowledge equates to an assertion of incontrovertible truth75. Britton thinks that we are all prone to treat beliefs as facts, particularly when they arise unconsciously. All is not lost, however, for the realisation that we have a belief and not knowledge is emancipating76. In any case, Britton says, 72

“'What makes this patient say and do these things in front of me at this moment?' I make my interpretative comments as soon as I think I can distinguish in the material three kinds of object relations which, though ostensibly independent of one another, can be linked up into a rational pattern by assuming that the patient feels compelled to adopt a certain course of behaviour and to avoid another because he fears the latter's supposedly disastrous consequences.' The three kinds of object relations are thus: first, one which the patient tries to establish with the analyst and which I call the required relationship, since he requires it in order to avoid the second, which I accordingly call the avoided relationship ; this he feels he has to avoid in external reality because he is convinced that if he gave in to his secret desire of entering into it this would inevitably lead to the third relationship, a calamity.” Ibid. p. 39 73 Britton, R. (1998) Belief and Imagination: Explorations in Psychoanalysis. London: Routledge, pp.

8-18, Chpt I (‘Belief and Psychic Reality) Belief, according to Britton: is to psychic reality what perception is to material reality; rests on probability not certainty; produces an emotional state akin to certainty; is necessary for action and reaction; operates in the absence of knowledge and therefore is not the same as knowledge 74 Belief is (in philosophy): the epistemic attitude of holding a proposition p to be true where there is some degree of evidence, though not conclusive…for the truth of p…while knowing p would generally be considered to entail…that p is true, believing p is consistent with the actual falsity of p (Flew, 1979) or Gardner, S. (????) A Companion to the Philosophy of Mind 75 Britton is anti-Platonic in his notion of belief, since the Platonic dictum says that knowledge is justified belief.

76 According to Britton such psychic emancipation (bringing the unconscious into consciousness) is a function of psychoanalysis. Psychic development leads to recognition of belief instead of fact and recognition is the first stage in relinquishment of redundant beliefs as it admits the possibility of doubt.

Cognitive, scientific and cultural development is not just about the acquisition of new ideas but emancipation from pre-existing beliefs and involves bringing together subjective experience with

all objective evaluation or reality testing requires a subjective belief and may use external perception or internal correlations with pre-existing beliefs or facts (theory) where direct perceptual confirmation is unavailable (such as in the clinical setting of psychoanalysis). It is possible to extract an epistomological model out of Britton’s chapter on belief that appears inseparable from the process of psychoanalysis itself, though he doesn’t present it as such77. Finally, Britton presents some thoughts on the disorders of the belief function that can appear in clinical cases; unbeknownst to him, he neatly provides a conclusive and over-arching analysis of some of the critics, their critiques and of the psychoanalytic defence, with an almost comical effect. 78 In analysis, Britton thinks of the patient as being in a state of interpretation, which is the analyst’s belief, or in a state of insight, which is his own belief. Both parties’ belief amounts, at most, to a practical fiction, thus useful but not truthful. With this is mind, it is important to entertain the paradoxical theorem that some fiction is true whilst other fiction is false, or better still, that fiction is both true and false. 79 To sum up, a few of the major critiques and responses to the scientific validity of psychoanalysis have been presented, in this brief exegesis. The wish for some concrete resolution to the palpable crisis facing psychoanalysis qua Scientia was not sufficient to achieve its desired effect and there are still many questions facing the discipline.

There is much progress to be made before essays such as this will be able to take on a narrower mien. It is hoped, however, that some of the attacks against psychoanalytic methodologies have been neutralized through a scholarly, if a little incisive, review of the major areas of dispute. Woven into this thesis has been an attempt to do justice to the critical methodological approach to an appraisal of the psychoanalytic modus operandi as well as the alternative proposals defending the discipline, whilst maintaining that, many of the criticisms and defenses fail to notice the value of what is ineluctably and irrefutably the practical fiction of psychoanalysis.

objective self-awareness so that one sees oneself in the act of believing something.

77

UNCONSCIOUS • IDEAS • BELIEF • KNOWLEDGE

(unknowable, uncontaminated by belief about the outside world) (which may become objects of belief) (requires reality testing through perception of external world or internal correlation with preexisting facts or other beliefs before it becomes…)

(whereby subsequent experience and knowledge can discredit and relinquish erroneous belief which sometimes requires mourning if it was important) 78 Britton mentions the: psychotic ‘annihilation of the function of belief’ which would accurately describe Grunbaum and Popper’s prescription; non-psychotic ‘suspension of belief’ which allows for practical fictions as would seem to be Britton’s stance on psychoanalysis; ‘counter-belief’ which reiterates the possibility that some fictions are true whereas others are false, and; ‘failure to relinquish belief’ whereby everything is probable and nothing is possible or certain and also has relevance to the work of psychoanalysts and their critics, Freud and Popper being the most obvious examples.

79 What the patient says is both true and not true; his unconscious phantasies are both real and unreal; the analysts interpretations are both accurate and inaccurate etc.