Romulo's formulation centers on the distinction between theory and practice. He notes that psychoanalytic theory is organized as a science whereas psychoanalytic practice is performed as an art. There is the notion that artistry creates ex nihilo whereas science discovers what can be tested and, most importantly, verified. The analyst, according to Lander, integrates both polarities. True artistry, however, is rarer than good craftsmanship, he observes.
It is certainly true that moments of creativity within the analytic relationship are often treasured for their significance to the analysand. These new discoveries leverage change and nourish the analytic identity of the analyst.
Not everyone, however, would accept these clear polarities between art and science or theory and practice for that matter. Moreover, using Romulo's example of heliocentrism and its acceptance, knowledge in science cannot be separated from human culture, tradition and belief structures. This is the hermeneutics of human knowing in which we are always historically situated and comprehended through the lens of culture and traditional ways of organizing experience. The earth always rotated about the sun but it took more than 1500 years before this would be ‘known’ even after it was discovered.
Romulo's clear definition of science as “an ordered set of knowledge that can be verified,” helps us situate psychoanalysis in what Freud called “a science of the mind” (1925, p.46) or “the science of unconscious mental processes” (p.70). Unlike Romulo, who locates psychoanalysis in the social science domain, Freud insisted that psychoanalysis was a natural
science. This began even before he founded psychoanalysis per se in his Project for a Scientific Psychology (1895). It was essential for Freud that the drive was deemed the point of intersection between body and mind. He was at home in the in-between.
This link to the body was as elemental for Freud as thoughts were to Bion. The psyche evolves, said Freud, to contend with the demand of the drives as much as it must contend with the constraints of family and society.
Those voices that refute psychoanalysis' credibility reduce science to empiricism in which it fares relatively poorly because it is so broadly explanatory and linked with therapeutic relationships. If by science, rather, we understand its roots to be in the desire to know (Latin scire), then psychoanalysis is profoundly scientific. Hypotheses are tested and verification is instrumental through the increase in rapport, ready access to other psychic material, and the self-report of the patient. Efficacy studies confirm the benefit of psychoanalytic treatment and this adds further verification that a psychoanalytic process has real value to people in their lives. Neuro-psychoanalytic formulations and imaging studies can address the brain correlates of change, which is another framework of verification. Viewing mind and brain as two essential vantage points of the same phenomena, needing each other to make sense of the person, frees both neuroscience and psychoanalysis from an artificial and limiting dualism.
Part of the problem between psychoanalysis and science stems from historical beginnings when it was unclear what was verified knowledge in psychoanalysis and what was simply dogmatic conviction. The depth of the leap that Freud fashioned in 1900 with the Interpretation of Dreams in which he listened to the patient's associations to apprehend the personal meaning cannot be underestimated. This was observational science at its best. Freud, for one, was acutely aware of the laws of evidence.
On the other hand, grand theories in his burgeoning science of the unconscious could take on a life of their own—becoming a coherent explanatory model from which there could be no deviance. Forbidden sexual wishes and an Oedipal template were often a bias that needed
to be confirmed in order for the Freudian structure to stand as well as Freudian authority over the nascent science. It was an authority that derived from men who wore the same ring and formed a tight inner council that controlled analytic truth. More than 100 years later, we are still laden with this legacy.
The analyst who listens without presupposition is very much aligned with Freud's advice if not his conflicted method. He wrote in 1912 in his Recommendations to Physicians Practising Psycho-analysis:
The correct behaviour for an analyst lies…in avoiding speculation or brooding over cases while they are in analysis, and in submitting the material obtained to a synthetic process of thought only after the analysis is concluded. (p 113)
It would seem that psychoanalysis has gradually come to embrace a science of meaning, as an alternative to any set metapsychology. Transference and occasional, disruptive countertransference have given way to a more inclusive fluid intersubjective field model where meaning is constructed in real time, subject to a dynamic après coup. It is a living, breathing psychoanalysis as compared to an archeological one founded on repression. Art and science merge in a scene of mutuality with both participants observing, testing and verifying to find a narrative truth that is truly healing.
The construction of meaning itself has also undergone transformation from a study of repressed ideas and unconscious conflict to the formation of thought itself. Bion's notion of the thinking apparatus as a necessity of thoughts turned the science of psychoanalysis decisively towards the way that mind itself evolves. The intrapsychic and interpersonal have merged into the intersubjective and, with this inflection, psychoanalysis has taken a decisive hermeneutic turn.
Using this model then, it would be unclear who is the scientist and who is the artist in the analytic couple. Even the notion of interpretation has deflected towards the mutuality of the process—two artists engaging scientifically with each other. There is not much room anymore for Cartesian dualism, the cogito of conscious thought and positivism that sets art in opposition to science.
It was a psychology lecture offered to senior secondary school students that nudged me in the scientific direction. The lecturer presented data from an experiment in which flat worms learned a skill, were sacrificed, ground up and fed to other flatworms. These untrained worms somehow acquired the skill. The lecturer spoke of “Messenger RNA” and I was transfixed.
This was likely not long before my parents requested that I convince my younger adolescent sister that “free love” might not be the optimal way to express herself. They were confident that I could master the art of persuasion. In the end, I suppose, both aspects were indispensable to my becoming a psychoanalyst.
Consider for a moment the caricature of the analyst, the dream reader, as compared to the stage hypnotist and mind-reader. The analyst stereotype is the reasoned doctor who has assiduously learned the roadmap of the mind, especially the avenue to the unconscious. This is the scientist. The other is the mental manipulator who sows confusion, disorientation, and within the agnosia of the moment achieves a sleight of hand. This is the artist. Of course, the stereotype sorely underestimates the artistry of the analytic practitioner whose empathy and attuned listening, skilled understanding of the mind, and well-timed interpretations foster change. In turn, the mind-reader is certainly an artist who uses the subject's mind as a tableau while relying on a precise fund of knowledge and techniques. Art and science describe two indispensable sides in a holistic equation. It is how we make essential contact with patients and how we work to understand. Sometimes it can feel like magic.
It is not clear to me though that, as Romulo states, psychoanalysis is very much a “social science.” It certainly has had cross-disciplinary applications in studies of literature, mythology and cultural history but it is optimally suited more to understanding individuals in their own terms than society at large. It was the overreach of psychoanalysis, its excessive confidence and blurring of distinctions between individual and society, that eventually diminished its reputation.
Psychoanalysis does not fare any better if it tries to position itself as a biological science. What might be correlative with brain function and
neurophysiology will not likely help the practitioner very much, although it could definitely support the discipline's stature. Psychoanalysis is best served when it is allowed to occupy a transitional arena, somewhere between brain and psyche, art and science, conscious and unconscious, self and other, known and unknown. In my view, this transitional status, made explicit by Winnicott, is the most extraordinary Freudian discovery.
As a science of the transitional, there is no analysand without the analyst, and the analyst is implicated in everything that the analysand comes to know. This underscores that science in psychoanalysis includes subjectivity and the mutual construction of meaning. The art of psychoanalysis is thus also tied up closely with mutuality. Every session like every treatment is its own canvas that needs to be created anew. When Bion articulated his advice to practitioners to meet the patient without memory or desire, he was speaking to the creative element (see Tobias, 2013). There has to be a freshness to the process that allows for creativity and surprise. The analyst's desire is no less potentially oppressive than metapsychology, imposing on the patient what the analyst wants, expects, demands, believes or needs in order to make sense of the patient's discourse.
Art and science are two sides of the same coin. My impression is that the further we advance as a profession in our knowledge and its application, the less theory-bound we will become, the more confident in understanding the patient's discourse in the patient's own terms. This does not mean that we will stop theorizing or seeking more powerful explanatory models. It just means that we will have the confidence not to put these theories between us and the patient in a way that distorts the process and limits our capacity to listen. Of course, this is the art of the métier as well as its science—how to know and not know, how to interpret and still inquire, how to form common cause through human mutuality while guiding a process that is distinctly psychoanalytic.
Finally, I would like to thank Romulo for his stimulating thoughts and the clear writing for which he has always been known.
Respectfully submitted
Arthur Leonoff