On Studying Freud's Classic Cases: Another Point of View

All psychoanalysts are indebted to Jacob Arlow for his service to clinical psychoanalysis and psychoanalytic education. Many also have personal reasons to be grateful. My own experience is, I suspect, quite typical: he granted the gift of time and thought by reading a paper sent by someone whose only request was that he verify an idea attributed to him. His comments were generous, erudite, and most helpful and ended with his statement that I should use them as I wished.

Now, as so often in the past, an essay of his has helped me to think through a problem that is most immediate. My own institute is in the process of evaluating its curriculum, and we must grapple with the complicated issues of examining the old and the new in psychoanalytic education within a firm context of commitment to Freudian theory and practice.

The American Psychoanalyst [25/1] has reprinted Dr. Arlow's address to the graduating class of the San Francisco Psychoanalytic Institute. In that address, he creates an imagined contemporary response by a committee on certification rejecting Sigmund Freud's application to be a full member of The American on the basis of four case histories: Dora, Little Hans, Wolf Man, and Schreber. Dr. Arlow presents the committee's statement of rejection and summarizes why these cases “are major historical documents, but they do not represent modern psychoanalytic thought and practice.” He asks whether “there [is] really any need to continue studying them as if they were the holy writ of psychoanalytic science …” What matters most, he says, is that a “scientific spirit of free enquiry, of readiness to change, should be the center of our professional heritage and psychoanalytic education …”

It seems to me that Freud's cases, including even those in the Studies on Hysteria, demonstrate vividly precisely that last point: the need for free inquiry, a readiness to change, and a flexibility of mind and spirit within the matrix of discipline and judgment that Dr. Arlow seeks in a curriculum.

Perhaps if we can articulate what Freud's cases do teach and how they teach, we may come to the conclusion that they do, in fact, remain a unique and irreplaceable part of a curriculum of psychoanalytic education. “Holy writ,” no. But that, after all, is one of the things we hope to teach: that there is no holy writ. As Jung said, “The errors of the teacher become the dogma of the students,” and we must be always wary on that account. It is for that reason that I believe the case histories, or any of Freud for that matter, should be taught, not simply read, so that we can bring a critical scrutiny to what is being presented and make informed clinical comparisons. Evaluation of the cases then becomes a particularly rich source of discriminating judgment; what has been left behind is as informative as what has proved lasting and salient.

We are not trying to teach “facts.” Rather, we seek to imbue a particular way of thinking about observations. That vital, sudden, indirectly expressed meanings exist and can be abstracted from unexpected sources is a basic principle of our work. A drawing of wolves in a tree, a memory of thumb-sucking while one pulls at an earlobe, the periodic appearance of a cough, the symbolic meaning of the content of a child's irrational fear—we teach that these are incalculably rich sources of information, never to be degraded, although we are not necessarily capable always of understanding. Such observations are now the stuff of most clinical case material; but the range, intensity, and special fecundity of Freud's case presentations seem fairly to inundate the mind and to provide a particularly strong stimulation to speculation by the reader. It seems to me that the combination of the actual presentations and the very complex effect of all the fantasies about the author tend to evoke an active, rather than passive-receptive attitude in the student, an attitude that is not so consistently experienced when one reads other authors.

Since what analysts must be taught is so much better learned by a kind of infusion and absorption, an authentic acceptance rather than an imposition, whatever positive fantasies exist about Freud may especially facilitate the learning process. Further, it may be that the special transference place he occupies leads to some combination of identification and a counteridentificatory struggle for autonomy that is fertile territory indeed for the seeds of knowledge: an openness to new ideas coupled with a questioning spirit.

On the other hand, writings must be taught carefully and with a special sensitivity to the problems of identification, counteridentification, and transference. The very existence of those tendencies that, as Dr. Arlow suggests, can make for abuse of creative thinking can perhaps be made especially useful. Freud's cases demonstrate the capacity to describe, vivify, explain, and convince. Certainly there are other analysts who write extraordinarily well; they, too, should be, and are, read. But to deprive candidates of guided reading of the most profound examples of literary facility in the service of psychoanalytic explication seems a real loss of an opportunity to learn, not just what to write, but how to write it.

That the case material presented by Freud includes significant failures and flaws by no means diminishes their educational value. If anything, modern work can suffer from success. It is important to give our candidates the opportunity to discuss the therapeutic failures, the wonderful ideas that turned out to be incorrect, the inadequacies of technique, and the problems connected with the impossibility of Freud himself experiencing the extraordinary privilege of an extensive, well-conducted analysis by another.

Dr. Arlow stresses the importance of emulating Freud's “open-minded, endless curiosity, the priority he afforded the facts of clinical observation …” It seems to me that the case histories are also unique in the possibility of teaching this most important lesson of all: that we must truly listen. In a very special way, Freud's clinical work demonstrates that dispassion, disinterest, open-mindedness, a conviction of the meaningfulness latent in apparent chaos, and, most important, a willingness to attend respectively are the real tools of the clinician. Accompanying Freud once again on the creative leap from data to theory reminds us all that data are first and can mobilize in the student a deep conviction that if sufficient attention is paid, description can become understanding and latent meaning can be uncovered.

Reading Freud's early and later case material underscores the extent and depth of his contribution to universal understanding, simply because we can see how much he had to explain. Those who study to join the profession he established can not only learn from his case histories a special attitude and a special skill, but also experience a very special pride. It seems to me that just those values for which Dr. Arlow pleads in psychoanalytic education are precisely those that can be facilitated by a study of the case histories.