Question. Dr. Hinshelwood, your coming in Rome the next 3rd and 4th of October, will open a debate around a question nowadays always more important for the psychoanalytical field: Could psychoanalysis be considered a science?
In your book, “Research on the Couch: Single Case Studies, Subjectivity and Psychoanalytic Knowledge” (Routledge, 2013), you point to that Freudian attempt that lasts from more than a century and has its only decisive key in the clinical practice.
What is the reason why you moved your interest to develop a discourse on the features of the psychoanalytical research?
R.D. Hinshelwood. Well, perhaps I was always interested in human minds, and what we can know about each other, and about the mind in general. But, during clinical training from about 1970 onwards, it was the practice of psychoanalysis which dominated my interest. I was also working in the public service, in psychiatry, and interested in how psychoanalytic ideas could contribute to improving the life of the most seriously disabled psychiatric patients.
But I was a doctor before I trained as a psychoanalyst, and medical science is of great importance to all of us – we will all need the benefits of it at some point. I did take an interest in how science worked, and during that time one of my Professors was a neuroscientist, one of the earliest – J.Z. Young. He was a great inspiration to me, and as I went on to become a psychiatrist I was curious about the mind as something connected with the body and the brain. I wondered a lot about how they connect. That is a problem that has never been solved. As I developed as a psychoanalyst it became obvious that the kind of knowledge we have about the mind is different from the knowledge we have of the brain and the body, and the way we get our knowledge is different in each case. There is a lot of good reasons for comparing psychoanalysis with the natural sciences, and a lot of good reasons for finding that they are a bit different – although a bit the same.
When Breuer hypnotised Anna O and found that if she expressed feelings about her symptoms, then the symptoms disappeared, he was doing something like any scientist, or medial scientist, does. He made an experimental intervention (hypnotic abreaction) and observed the result of his intervention. But when Freud analysed his dreams he began something quite different. Maybe he did not realise how different it was. But he became interested in constructing meanings. His criterion was no longer like a scientist. He did not make an interpretation of his dream and then observe what happened. His criterion was to pick out themes. These themes then constituted the meaning, or meanings, of the dream. And the specific criterion was coherence of meaning. If he could find a theme which ran through all the elements of the dream this created a coherent meaning, and was the interpretation of the dream. This process is quite different from the experiment of a scientist where the specific criterion is a significant change.
Perhaps this contrast (between causes and meanings) became most apparent when clinicians, especially in America, such as Roy Schafer, and Donald Spence specifically talked about the hermeneutic tradition. It seemed to have the backing of top-level philosophers such as Habermas. They went right against Freud’s belief that psychoanalysis was a natural science like any other. I found myself uncomfortable about having to decide between the two. I began to realise that one could see how both approaches – scientific, and hermeneutic – could come together. I think this was particular stimulated by work I read by the British philosophers, Jim Hopkins and Richard Wollheim. They asked the question whether meanings could also be causes. And it became obvious that finding a meaning in a session is equivalent to making an intervention in a scientific experiment. We expect the meaning in a psychoanalytic session to have an effect – it causes a degree of insight that is lifting repression, or integrating a split, etc.
So, I became interested in how this could be formulated in more strict logical terms, like a scientific experiment. But it is only like a scientific experiment. Because meanings are not physical causes in the physical world, and so one has to be careful to respect the difference.
Question. In the recent times, short-term psychotherapies have seen a strong diffusion: there is a kind of conformity between the way to read sufferance and solve symptoms and the imperative of the technique promoted by the discourse of our society. Nevertheless, psychoanalysis is still surviving thanks to the importance recognized to subjectivity that in your work lives in the space given to the psychoanalyst’s interpretation and his presence with the patient, in a safeguard of the single case embodied by each one and each session, as a standard that has to be considered not more as a limit but as what make possible a research in this field.
Freud wrote in Turnings in the Ways of Psychoanalytic Therapy (1918) about the need with which “the pure gold of psychoanalysis should be mixed up with the copper of direct suggestion”, if it wants to guarantee a future for itself.
What do you think about the present time of psychoanalysis and what is it necessary to do for keeping it alive?
R.D. Hinshelwood. I believe Freud was right in saying that there could be benefit in fairly ordinary interventions which did not take much direct notice of the unconscious. There is experimental evidence that beneficial effects occur with simple forms of psychological treatments. In fact, they are the principles of empathy, warmth and genuineness according to Truax and Carkuff in 1967. I guess that these will inevitably have a beneficial impact – and not just in therapy, but probably in most encounters in life. The psychoanalytic view is that a factor of understanding is important as well; and moreover an understanding at the level of the unconscious.
So, there is probably a complex multi-factorial matrix of influences going on all the time in any therapy or analysis. My own view is that we should not be competitive, and that we need to grant the effectiveness of methods that do not access the unconscious. But in some cases it may be necessary to access the unconscious impulses or phantasies – these cases may be the so-called treatment-resistant ones, often today called borderline personalities or severe personality disorders. However, if we wish to explore the unconscious in these difficult cases, and of course for the purposes of training, then psychoanalysis is probably the best method we have.
One of the problems however, with psychoanalytic knowledge is now the plethora of different theories. The collection of all the psychoanalytic theories has been called a Tower of Babel. And claims are made by different psychoanalysts on the basis of a few illustrations of these theories. If we know that some non-psychoanalytic factors cause some benefit, then how do we know that the beneficial claims of a particular theory of the unconscious are not caused by one of these other non-insight-directed factors. We need to know when a psychoanalytic insight into unconscious meanings is effective, and when something else is effective. So, as a result, I thought that we should develop a rigorous method for addressing this distinction – a distinction between insight into the unconscious on one hand, and the benign factors of empathy, warmth and genuineness, on the other. That has been the work of the recent book, Research on the Couch. I try to show how we may make a distinction between the effect of an interpretation of the unconscious, and the effect of some other factor.
Question. At last, Dr. Hinshelwood what should we expect from your lecture that will happen in Rome between few weeks? I’m asking to you some previews, only for the readers of Funzione Gamma. And I would like to thank you for having accepted to grant this Interview as a way to introduce your visit. See you soon in Rome.
R.D. Hinshelwood. I mentioned above that some psychoanalysts think that if they illustrate a theory, then the illustration is also evidence for the theory. I think that is not the case. We can illustrate all sorts of things: the shape of the clouds looks like a dog – but it has no significance. A constellation of the stars looks like Orion, the hunter – but it is not in fact what it looks like. We can say that the square of one side of a triangle equals the sum of the squares of the other two sides – and we could illustrate that with a certain triangle. But it is not an illustration that proves the statement. There are certain conditions that must be applied – the triangle must have one angle of 90o. I think that we need to be clear in psychoanalysis that we need more than an illustrative example. To gain ‘evidence’ we need to be much clearer about what data will count as evidence. So the talk I want to give in Roma in October is about how we chose data from the process of a psychoanalytic session.
It is difficult when our field of study is a subjective one. That is we observe a patient’s subjective experience, which is largely unmeasurable. Not only that but to observe his experience, we have to use our own subjective experience to be able to identify what he is experiencing.
The problems of subjectivity are twofold: the field is the subjective experience of the patient, and moreover, the ‘instrument’ for observing it, our own minds and experiences, are also subjective. I hope to be able to show how it is possible to overcome these difficulties and select sections of material that serve as relevant data. Using the logical model, which is similar to a scientific one, I suggest we can show when the material indicates that the interpretation is correct, and the theory it is based on is relevant. And moreover, using that model it is possible to show when the theory behind the interpretation is not correct. And we can show it may be incorrect even when the patient changes in some way – a kind of false positive.
Thank you for the opportunity to answer some of your questions even though these issues are complicated and I cannot make as thorough a discussion as is really necessary. Nevertheless I hope these matters interest some of the readers of Funzione Gamma, because as I have tried to convey, it is a matter of urgency that psychoanalysis discovers better methods of comparing all its theories.
R. D. Hinshelwood, is a psychiatrist and a psychoanalyst, Fellow of the Royal College of Psychiatrists, Full Member of the British Psychoanalytical Society, and previously was Clinical Director of the Cassel Hospital in Richmond. He currently holds the post of Professor of Psychoanalysis at the Centre for Psychoanalytic Studies, University of Essex.
R.D. Hinshelwood has written extensively on psychoanalysis and some of his most important works are: Research on the Couch: Single Case Studies, Subjectivity, and Psychoanalytic Knowledge (Routledge, 2013); Observing Organisations: Anxiety, Defence and Culture in Health Care (Routledge, 2000); What Happens in Groups: Psychoanalysis, the Individual and the Community (Free Association books, 1987).