I thank Austin Ratner for his thoughtful and stimulating paper, and also Daniel Benveniste and Arnold Richards for having invited me to join this discussion.
Reading the paper by Austin Ratner also stimulated me to read his recent book, The psychoanalyst's aversion to proof, and thus better understand both his critical approach to Freud and to psychoanalysis, and the nature of his preoccupation for the future of our field. Freud and his followers' allergy to the empirical confirmation of psychoanalysis as a theoretical body makes it hard for Austin Ratner to see any future for psychoanalysis.
But let me now come to the paper under discussion. Reading it not only reminded me of Saul Rosenzweig's attempts to empirically confirm psychoanalysis in the 1930s and of Freud's lack of interest for such a work, which Austin Ratner does deal with in his book. It also reminded me of a similar preoccupation which Harry Stack Sullivan (1892-1949) had expressed already in the 1930s, in terms of the necessity to find empirical and even statistical confirmation of our clinical work. As far as Georg Groddeck (1866-1934) is concerned, it is true that he founded psychosomatic medicine not in terms of controlled clinical trials, as Franz Alexander and Florence Dunbar would start doing in the 1930s, but in terms of using his creative imagination to explore the pathogenesis of a whole series of organic and physical symptoms and illnesses. From this point of view, it is true that he was as one-sided as many other pioneers have been. But we do have to be still thankful to him for such a pioneering contribution as The book of the It, that is, for having tried to describe the ways in which our psychological life and conflicts influence
our bodily functions.
As to the question “Art versus Science,” we of course have to do with a false dichotomy. As a medical doctor and a psychoanalyst, I see myself as working with my patients as an “artist,” committed to working in a very individual way with every one of them, and, at the same time, as a “scientist,” applying to the work a whole series of theoretical principles and scientific laws discovered and formulated by Freud and by the following generations of psychoanalysts. For example: working with a hysteric patient, I can see how the general law of psychic repression (formulated by Freud and Breuer in 1895) plays a role in the genesis of her particular and unique symptoms. The scientific law according to which a symptom is the result of a failure in our memory system is still valid!
From this point of view, we can even say that Freud was very much inclined to offer to his patients, in every single session, more than one proof of the way of functioning of their unconscious mind.
In other words, from this point of view I would more clearly distinguish—as Austin Ratner does not seem to me to do in his book—between what I would call “clinical proof,” on the one hand, and “empirical” or “experimental confirmation,” on the other hand. From this point of view, I do not believe that we can talk of an “aversion to proof” on Freud's side, but only of his aversion vis-a-vis the second meaning which I am giving to the word “proof.”
At the same time, it is true that if we go back to Freud's presentation of his way of working in an article such as his 1912 article “The beginning of treatment,” we can see that he seems to take for granted that patients will want to work with him because of his fame rather than only once he will have demonstrated to them “the power of the unconscious.” On the other hand, not having the chance of inducing in their patients the kind of transference that Freud seems to have been able to produce in his patients from the very beginning, post-Freudian authors ranging from Sullivan to Bion are very preoccupied to show to their patients “the unconscious in action” from the very first session. In other words, from this point of view, we can say that most post-Freudian authors did not share Freud's apparently minor interest in showing to his patients the way of working of psychoanalysis from the very beginning of the treatment.
This is why he could use the first session talking about time and money, that is, something which we can not allow ourselves to do any more. At variance with him, we have to prove that psychoanalysis works from the very first contact with our patients—otherwise, why should they come back?
Last but not least, we cannot allow ourselves to forget the fact that the pressure toward empirical and experimental confirmation of psycho-analysis is much bigger in our time than in Freud's time, because of the different Zeitgeist. Not to talk about the fact that many of the patients who avail themselves of our experience and competence are still—at least in my country—people psychologically predisposed to the kind of work we do, as opposed to them being people who come to us only after having read a piece of empirical research confirming the quality of our work. The relative scarcity of such studies might influence social media and the opinion-makers, but this is mostly a problem in the sociology of knowledge and influence. In my experience, any patient who sees the connection between words, emotions and relationships is a potential patient of ours—under the condition that we know how to do our work.
Munich