Psychoanalysis Is Scientific

This is a philosophy of science paper. I will summarize the emergence of psychology, psychiatry and psychoanalysis from the Western philosophical tradition, and use Bacon’s (1620/1993) definition of science and the contemporary philosophy of “Critical Realism” to argue that excluding psychoanalysis from science rests on an erroneous valorization of subjectivity or a constricted definition of science.     My axiomatic assumptions:  1) I am real and I have some degree of will power; 2) You are real and, similarly, have will power.  To believe otherwise would suggest “depersonalization,” “derealization,” and “abulia,” impairments of mental functioning. Subjectivity is real and worthy of scientific study, but is not the sole reality for a scientific psychology.  Descartes’s “Cogito ergo sum” is, despite post-Cartesian argument, correct; Berkeley’s “Esse est percipi” is not.

Exploring the world starts at birth, perhaps some few weeks earlier.  Neonates have immediate sensations that slowly become organized, forming a core subjectivity that will be present throughout life.  Toddlers begin to develop a theory of mind, an accurate belief that others also have a subjective core.  Such recognition gradually leads (under supportive conditions) to “I am not the center of the universe; reality exists beyond my perception and will.”  Reality-testing – the differentiation of internal and external – is a basic, though imperfect ego function.  This is a cursory ego-psychoanalytic description of early development.

That psychoanalysis is scientific has been disputed for decades; the debate remains heated.  Recent issues of Psychoanalytic Psychology (2015) and the International Journal of Psychoanalysis (2015) were largely devoted to psychoanalytic research, and an extensive discussion played out on Division 39’s listserv.  Science advances from argumentation as well as data.

Healing, Science and Philosophy

I’ve proposed (2013) that the discipline of psychoanalysis, like Freud’s ego (1923), serves three masters: healing, science, and the history of ideas.  These domains have different standards and methods.  Many conceptual problems in psychoanalysis stem from attempts to meet the conflicting standards.  Epistemology is the philosophical context for psychoanalysis as science, with Ethics, the philosophy of values, also relevant.  Science, philosophy, and history are intellectual domains. Clinicians must respect ideas while attending to the pragmatics of helping patients; in a treatment situation, therapeutic intent should have priority over scientific aims (Stone, 1954).

History

Psychology emerged by addressing three central philosophical issues: the problem of knowledge (cognitive psychology), the problem of action (behavioral psychology), and the problem of evil (clinical psychology). Psychiatry advanced from demonology through humane caregiving to become part of scientific medicine that itself emerged just a bit more than a century ago.  Psychoanalytic treatment addressed the clinical phenomena of neurotic suffering.  Freud advanced propositions and a method for exploring the dark side of human nature, a dynamic unconscious.  “Social” sciences emerged: sociology, anthropology, economics and politics, each developing validity criteria and methods fitting its subject matter.

Philosopher Francis Bacon (1561-1626), called the father of empiricism, defined science as “an attitude toward the universe in which observations are made using the best methods available; logic is employed; and contradictions or magical, supernatural, and ad hoc solutions are rejected.”  Brenner noted that all sciences are inferential and influenced by the observer’s psychology, but facts rule (2006).  Experimentation may be employed but is not required (e.g., Galileo’s astronomy); quantification is a tool of science, not its essence.  Two principles to add to Bacon’s and Brenner’s: scientific conclusions are tentative, and although “psychological reality” is rife with contradiction and paradox, its methods are rational and empirical.

Science was first called natural philosophy; epistemology asks how we know.  Plato’s answer: look inward, using “the mind’s eye” rather than easily-deceived senses.  Aristotle declared otherwise: observation is primary.   Descartes followed Plato: we know only what our minds can grasp; we think, we doubt.

The British Empiricists, especially Berkeley, extended Aristotle’s program: perception defined reality.  Perception enhanced by technology: the telescope, microscope, fMRIs , remains subjective. Science requires replication and consensus to validate perception; psychoanalysis attends to counter-transference.  Renik’s “irreducible subjectivity” (1993), suggests that subjectivity is altogether irreducible, rather than not reducible to zero.  That we are imperfect instruments rules out neither scientific activity nor reality-testing.   Physicians rely on subjectivity, asking patients to rate their pain; self-report and lab tests together validate treatment.

The Age of Reason led to the Age of Enlightenment, with observation and reason superseding revelation for comprehending the world.  John Dewey’s pragmatism (knowledge is what works), and Sartre’s choice (of what to believe) are 20th Century contributions to scientific epistemology. Contemporary science rejects supernaturalism, and is uncomfortable with a radical relativism of choice.  Post-modernism treats subjectivity as a spur to scientific inquiry, with certainty always beyond reach.   Scientific disputes focus on methodology.   Science is better served by “both/and” rather than “either/or” approaches to method.  Aristotle promoted empiricism without rejecting Plato’s rationality.

Critical Realism

Philosopher-Psychoanalyst Charles Hanly, a former IPA president, described the central tenets of this epistemology (2014, pp 903 ff): A real world exists, independent of our senses.  Appropriate scientific methods of observation can help us know reality to a degree, as can unaided observation that allows commonsense knowledge of other persons and other things.  Following Freud (1927), Hanly goes on: Evolution has enabled the human mind to “develop precisely in the attempt to explore the external world (p 55).”  Children learn to assess reality with degrees of accuracy.  Freud asserts that the human mind is part of nature, knowable just as any natural object only in a mediated way, and that mind is determined not only by its own structure, but by the objects (i.e., people) that affect it – an early relational idea.

Freud’s arguments support my critique of the distinction between “social” and natural sciences that implies lesser status.  For Descartes and the empiricist philosophers, subjectivity was the basis for knowing, while naysayers see mind as unable to judge reality, leaving it only with constructions.  Critical Realism sees subjectivity as a limiting factor, requiring continuous scrutiny of the reliability of observation, rather than dismissal or mushy relativism.  Hanly states: “there is no end to observing and correcting our clinical observations (p 904).”  [Ongoing debate about “truth” and the nature of evidence in psychoanalysis is addressed by Levine (2016) and others in a recent special issue of the Psychoanalytic Quarterly.] Psychoanalysis has abandoned the idea of a godlike analyst with immaculate perception.   Busch’s (2015) IPA Congress plenary address underscored tentativeness in clinical psychoanalysis as a major change from the approach of earlier generations.

There is hard science – and harder (not lesser) science that must contend with the problem of subjectivity.  Rogers (2014), reviewing Stanislas Dehaene’s “Consciousness and the Brain” (2014), supports this position.  Dehaene acknowledges that subjective reports can mislead, but states that the subjective report of the viewer in the lab is exactly what is meant by conscious awareness.  “Subjective reports are the key phenomena that a cognitive neuroscience of consciousness purports to study. They are primary data (p. 42)… along with …psychophysiological observations.”   And: “The Self is “a statistical deduction from observation…” Every self is different from all other selves, and differs from itself over time” (p. 113).

Reality-testing, an ego-psychoanalytic concept and emergent property of mind, is essential despite imperfect perception.    For Plato, Descartes, the empiricists, and we healers who inquire about thoughts and feelings, subjective consciousness is a natural phenomenon subject to scientific exploration.  Freud deepened the understanding of human subjectivity by focusing on meaningful unconscious mental processes (psychological reality), also natural phenomena.

Reductive Causality vs. Emergence

Reductive causality declares mind to be brain, brain to be chemistry, chemistry to be physics and physical particles and sub-particles to have their character determined ultimately by the Big Bang.  A consistent reductionism would claim our universe is not only determined, it is predetermined; if we can state necessary and sufficient antecedents, everything follows.  That seems as predetermined as the notion of an all-powerful god whose omniscience must include immutable knowledge, even of the future.   Contra this radical determinism, scientific domains develop methods of study of phenomena not adequately understood by their contingent precursors.  There is no dispute about proximal causality or causal chains; free association relies on such chains.  Despite the claims of Churchland (2013), emergent phenomena cannot be radically reduced.

“Emergence” is a conceptual alternative to reductionist determinism.  Particles come together to form atoms and molecules with properties different from the particles; these come together over a vast time span in which life emerges with reproductive abilities not present in earlier material forms.  Evolution generates new forms by variation and mutation.  Life evolves toward complex nervous systems and the human brain.  The brain’s properties include consciousness, self-consciousness, language, a procedural unconscious that allows walking and riding bikes thoughtlessly, and a dynamic, meaningful unconscious.  At each level, the properties are natural phenomena – not epiphenomena – around which scientific disciplines develop.  Each discipline focuses on phenomena within its domain, developing methods specific to their study.  Humans continue to evolve to create groups, economies, polities and cultures.   Each emergent form can be studied scientifically.  Social, political and economic realities exist; science itself must be funded to survive.  Borderline disciplines address transitions.  The brain is the hardware of mind.  Lesions and other hardware differences (variations, mutations) have effects studied by brain science.  When neural hardware seems intact, psychology, psychiatry and psychoanalysis become relevant; philosophy’s Problem of Evil will not be solved by biology alone.

Evolution is progressive because a few hardware changes increase adaption and survival.  Inbreeding produces fewer changes; variety in a genetic pool advantages survival.  Social evolution works in historical, not geological or cosmic time.  Evolution has accelerated since the 1890s: through technology (built on science), social equality (built on evolving value systems), and the population explosion (built on agricultural and medical advances).   Science has become an industry with space-age applications that generate new questions and better answers.

In addition to the personal investment we have in our own offspring, every baby represents a potential Copernicus, Darwin, Freud or Einstein.  The population explosion creates a new set of environmental conditions – not all beneficial, but every baby (including identical twins) is different from every other.

The complex phenomenology of humanity therefore extends itself indefinitely, as long as we do not destroy ourselves and the planet.  Each baby is unpredictable.  Individuals interact based on proximity, creating different cultures, political and economic systems, and now global connectivity.  These phenomena are worthy of scientific study, not to be restricted (as was anatomy by religious bans on dissection), or demeaned by a “scientism” strangled by its narrowness.

The study of individuals addresses commonalities as well as uniqueness.  No generalization fully describes an individual. Intensive individual study will be incomplete, but essential for understanding anyone.  Individualized medicine assumes the same stance as clinical psychoanalysis.

Over-determination, “Multiple Function,” Parsimony

Freud (1895) asserted that a “convergence of several factors” is required to generate a hysterical symptom; human behavior is not based on simple causality. The search for causes is replaced in psychoanalysis by a search for multiple motives operating together and sometimes in conflict; conscious intent is never a single or even necessarily dominant factor.  A depth psychology is posited in which personal history, imperfectly remembered, contributes to thoughts, wishes, fears, symptoms and behavior.  Waelder (1930) described “multiple function” as behavior serving several aims at once. Science eschews teleology in principle, but human minds conjure possible futures or fantasies that motivate behavior.

Over-determination and multiple function are concepts analogous to interactions in statistical analysis of variance and covariance, where outcomes result from single variables and interactions among them.  Psychology is multifactorial and loosely assembled; rarely does simple causality help to understand people.

Parsimony is a scientific principle; it does not overrule actual complexity.  Though I admire its elegance, I find Brenner’s parsimony inadequate for my own clinical work.

Free Will

Philosophy of science discussions are often sidetracked by semantic issues.  Free Will is an issue that appears to contradict science.  The seeming paradox of the psychoanalytic “free association,” which we know is not at all free, is resolved by semantic precision.

“Freedom” is a concept, applicable in several domains: statistical, political, and psychological among them.  For traditional science everything is determined (unfree).  Contemporary science recognizes emergence as a property of evolution. Statistics uses “degrees of freedom” to measure indeterminacy.  Political science measures freedom by rating elections, independent judiciary and press freedom to compare nations.  Natan Scharansky felt he had more freedom in the gulag than did his guards: freedom of thought.  Freedom in any domain is a relative matter; it is a Platonic Idea.  Enhanced agency is a primary aim of psychoanalytic treatment, freeing people from inhibitions, symptoms and anxieties.

Modesty, Ambition and Progress in Science

Scientists focus on specific phenomena to fit their methods.  Dissertations conclude with a section on limitations of the study that may limit generalization (e.g., sample size and population).  Research programs address limitations with further research.  Scientists must be modest in their claims.

Scientists are also expected to be ambitious.  Research does aim for generalization, and for applications.  Freud was ambitious, attempting a complete understanding of the human mind.  His range came to include humor, art, literature, and the psychopathology of everyday life.   Darwin’s propositions have become the overarching paradigm for life sciences.

Ambition leads to error; Freud made many.  The subtitle to his Narcissism paper (1914), “an introduction, could apply to much of his writing.  Freud is chided for having no summary.  This omission may be his recognition that his system, like Darwin’s, was incomplete.  Freud’s view of psychosis is questionable; his psychology of women is undermined by its phallocentric viewpoint.  “Anatomy is destiny!” was publicly challenged in 1951 by Christine Jorgenson, recently by Caitlin Jenner, following a 40-year political movement by the transsexual demographic.  Freud’s “bedrock” (penis envy in women, castration anxiety in men) was a leap of faith.  His rejection of other-than-clinical research promoted an isolation that still hampers scientific progress.

The atomic physics of the 1940’s gave way to nuclear physics and to strange entities; even to “quantum weirdness.”  Nobel Laureate physicist David Gross sees ignorance – and new questions – as driving science.   Scientists must be ambitious and modest.  Ambition expands the frontiers of knowledge; modesty limits premature claims. Scientists devise more refined methods to make progress.  Popper led a philosophical assault on the scientific standing of psychoanalysis over 50 years ago; Grunbaum continued the assault more recently.  Responding to Grunbaum, Howard Shevrin conducted a series of increasingly refined studies.  The philosopher cried “Uncle;” acknowledging Shevrin’s (2012) work as a valid demonstration of psychoanalytic hypotheses.

Best Evidence; Convergent validity

“Best evidence” is a complex concept,” determined – always provisionally – by social, cultural, even political consensus; the FDA recently approved a new pill for enhancing female desire by a vote of 18-6.

Despite Meehl’s (1954) finding statistical prediction superior to clinical judgment, the latter is standard for individual decisions in all health care practice; cases also remain the primary source of psychoanalytic data.  Experimental findings don’t readily translate to individuals; operational definitions and exclusion criteria limit generalizability, and patients may be statistical outliers. Statistical significance often falls short of practical significance, experimental conditions differ greatly from those of clinical practice, and contamination and fraud are not unheard of.    Failure to replicate is common for all areas of scientific research.  Randomized controlled trials (RCTs) are considered a “gold standard” for empirical research, but a close look at RCTs comparing drugs or psychotherapies frequently shows results to be tarnished (Wachtel, 2010), leading to “fool’s gold” claims (Shedler, 2015). It is understandable that practitioners are critics of controlled research; Hoffman’s (2009) rejection of quantitative studies drew a standing ovation at his invited APsaA address.  I read summaries of research papers, often finding full articles dull reading and rarely directly relevant to my practice.

Yet I must admonish fellow clinicians that an art whose claims are more than aesthetic needs more than claims for affirming its value. A google search shows nearly 500,000 listings for psychoanalytic research; with significant support for treatment effectiveness, as well as clarification of therapy concepts and process.  Many studies use quantitative methods to provide normative data; social policy research is scientifically respectable. “The Authoritarian Personality” (Adorno, et al, 1950) initiated political psychology.  Clark, Chein and Cook (1952) were cited in the Supreme Court’s 1954 decision outlawing school segregation.

Scientific method begins with systematic observation, and correlation; clinical evidence may be limited to these methods.  Psychoanalysis is not unique in this regard (e.g., meteorology, astronomy), nor is it unusual for much of health care practice. Scientific judgments are based on current empirical evidence and best rational arguments.   “Convergent Validity” – a preponderance of observation, correlation, relevant experimentation, and findings from related disciplines – is a proper standard for “best evidence.”  Life forms evolve; subjectivity seems to have infinite potential for variation.  Lest we find ourselves in the hatchery of Aldous Huxley’s dystopic “Brave New World,” individuals must be treated as unique.  Science corrects its findings with changing consensus over time.  There can be no complete theory of everything (Critchley, 2015). Researchers and clinicians should stop fighting: “The farmers and the cowboys should be friends” (Hammerstein, 1943).

Epistemophilia and its Discontents

The urge to know motivates infants.  Freud spoke of an epistemic drive.  Panksepp’s recent work (2012) supports this idea.  Curiosity is basic to science and to the future evolution of our species.  Knowing is resisted because knowledge can be painful.  Weaning requires accommodation to a reality beyond personal need; toilet training inhibits urges; the Oedipus complex redirects and defers desire; mortality leads to adaptations, from depression and despair to the search for meaningful lives.  The Western creation myth forbids tasting the fruit of the Tree of Knowledge; Biblical knowing is a synonym for sex.  What Freud made explicit has been in plain sight since Eve met the serpent.   Science aims to discover realities. Psychoanalysis focuses on subjectivity and approaches its task with the best methods available.

Daily headlines demonstrate the failure to solve the Problem of Evil.  Science is not alone in its efforts; by evoking personal engagement, the humanities provide a second path.  Freud was as inspired by Sophocles, Shakespeare and Goethe as he was by Brucke and Meynert.  Psychoanalysis bridges C.P. Snow’s (1959) “Two Cultures.”  The study of superego phenomena exemplifies a psychoanalytic approach.  Religion may provide comfort to multitudes, but its “side effects” – intolerance, fanaticism, cultism and holy war (common expressions of a punitive superego) – undermine its claims. Freud’s genius allowed him to create from his efforts to heal a new science that has become a permanent contribution to the history of ideas. This science, a disciplined curiosity based on a set of ideas, continues to address the challenges of the Problem of Evil.

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