Clinical Psychoanalytic Knowledge—an Epistemological Inquiry

CLINICAL PSYCHOANALYTIC KNOWLEDGE-AN EPISTEMOLOGICAL INQUIRY EUGENE B. BRODY andJUDITH F. TORMEY* The Scientific Tasks ofPsychoanalysis Psychoanalysis is concerned with the "mind" and "how it works"; the interpretations which are its major investigative and therapeutic tools aim particularly at discovering those aspects of "mental life" that are concealed from the experiencing and sometimes self-deceiving subject. It has been, therefore, understandably difficult for biological and physical scientists to fit the theories and contributions of psychoanalysis into their scientific world view. This problem is related to the continuing contemporary debate over what the mind is. Answers to this question are not theoretically neutral but biased in favor of a preferred methodology, be it neurobiological, behavioral, or psychoanalytic. Endless arguments over the legitimacy of reductionist claims that the mind is "nothing but . . . ," filled in with the favored reductionist substitute, have left competing theories without a secure foundation on which to construct an answer to the question, How does the mind work? Despite Freud's early physicalism, psychoanalysis as a theory and an investigative-therapeutic method presupposes a nonreductionist view of mind. It assumes, furthermore , that the psychoanalytic method, which includes a special long-term relationship between analyst and subject (analysand), produces .a unique kind of knowledge that illuminates the nature of the mind and how it functions. Such knowledge enables the psychoanalyst to make scientific generalizations about other minds—minds other than his own and that of any particular patient. It also facilitates change in the patient's ways of thinking, feeling, and acting in a desired direction, one considered more compatible with "health" than "illness" and termed, therefore, "therapeutic." This inquiry is addressed to the assumption that a particular kind of knowledge does, in fact, arise from the clinical psychoanalytic re- *Department of Psychiatry, Institute of Psychiatry and Human Behavior, University of Maryland School of Medicine, 645 West Redwood Street, Baltimore, Maryland 21201.© 1980 by The University of Chicago. 0031-5982/81/2401-0217$01.00 Perspectives in Biology and Medicine ¦ Autumn 1980 \ 143 lationship. It explores the methods of acquiring psychoanalytic knowledge , its limits, and the criteria of its validity. What kind of knowledge is it? Is it the same for analyst and analysand? How is it related to observable data? What concepts of truth are relevant? Although similar inquiries have been made, most recently by Ricoeur [1,2] and Modell [3], our approaches and conclusions differ in many respects. The Psychoanalytic Situation and Relationship Psychoanalysis was defined by Freud as both a method of gathering data and a theory which aims at making human thought, feeling, and action intelligible. It can be viewed, thus, as an instrument for the construction of subjective reality. But in a manner compatible with its origins , it remains primarily a method of treatment. It developed from Freud's clinical experience with persons whose behavior was not intelligible in terms of the usual criteria for understanding others or was not compatible with the social rules of the context in which they lived. Those contemporary analysts who contribute to the theoretical literature do so mainly on the basis of their own experience with people who come to them in the role of patients, seeking help for subjective discomfort of one sort or another. They, then, must work through or ignore their potentially incompatible interests in data gathering and theory building in relation to the therapeutic problems and expectations of the patient. The analyst-patient dialogue derives from the tradition defining the ordinary relationship of physician and patient. The patient's intent is not that of a research subject, but of a sufferer seeking relief and willing, therefore, to follow the doctor's instructions. The major instruction to the patient is the basic rule requiring translation of private ideas and imagery into public language and their report without censorship to the analyst. With time the patient becomes increasingly aware ofthe fragility of such translations, the cognitive and especially the affective losses and revisions suffered by the original in the process. The analyst, sensitive to the issue, limits his own interventions to verbal statements which he considers therapeutically useful. These may be rare, and the patient may experience entire sessions with little or no analytic comment. His questions...