The case for the Freud–Breuer theory of hysteria: A response to Grünbaum’s foundational objection to psychoanalysis

ABSTRACT

In his influential critique of psychoanalysis, philosopher Adolf Grünbaum has repeatedly objected that the psychoanalytic enterprise has a foundational flaw in that its fundamental claim that repressed thoughts can be pathogenic cannot be sustained. His criticism focuses on Freud and Breuer’s reasoning toward this claim in Studies on Hysteria, which Grünbaum rejects mainly on the ground that there is an alternative explanation, the placebo hypothesis, that Freud and Breuer have failed to rule out. I argue against this by showing in detail why Freud and Breuer’s claim about the pathogenicity of repressed thoughts can be sustained on the evidence presented in Studies. Providing such a detailed response to Grünbaum’s objection is important for several reasons, including that it illustrates how the possibility of the influence of suggestion that critics often bring against psychoanalysis need not be fatal, thereby offering an alternative, complementary solution to the problem of suggestion to one recently proposed.

Un plaidoyer pour la théorie de l'hystérie de Freud-Breuer : réponse à la critique fondamentale de la psychanalyse par Grünbaum. Dans sa critique influente de la psychanalyse, le philosophe Adolph Grünbaum a maintes fois émis l'objection que l'entreprise psychanalytique possédait une faille fondamentale en ce sens que son allégation quant au caractère pathogénique des pensées refoulées ne pouvait être soutenu. La critique de Grünbaum est axée sur l'argumentation de Freud et de Breuer développée en ce sens dans les Études sur l'hystérie, que Grünbaum rejette principalement au prétexte qu'il existerait une explication alternative, à savoir l'hypothèse placebo, que Freud et Breuer n'ont pas réussi à exclure. L'auteur de cet article s'inscrit en faux contre cette proposition, en montrant en détail pourquoi la thèse de Freud et de Breuer relative au caractère pathogène des pensées refoulées peut être corroborée par les preuves avancées dans les Études. Il est important d'apporter une réponse détaillée à la critique de Grünbaum, pour plusieurs raisons, y compris parce que cela permet d'illustrer comment l'hypothèse de l'influence de la suggestion que les critiques formulent à l'encontre de la psychanalyse n'est pas forcément fatidique, et d'offrir ainsi une solution alternative et complémentaire au problème de la suggestion tel qu'il a été récemment formulé.

Ein Plädoyer für die Hysterietheorie von Freud und Breuer: Antwort auf Grünbaums Grundlagenkritik an der Psychoanalyse. In seiner einflussreichen Psychoanalysekritik hat der Philosoph Adolf Grünbaum wiederholt geltend gemacht, dass die Psychoanalyse insofern ein grundsätzliches Manko aufweise, als ihre fundamentale Theorie der Pathogenität verdrängter Gedanken nicht aufrechtzuerhalten sei. Seine Kritik konzentriert sich auf die entsprechenden Ausführungen von Freud und Breuer in den Studien über Hysterie, die Grünbaum vor allem mit der Begründung ablehnt, dass es eine alternative Erklärung gäbe, nämlich die Placebo-Hyothese, die von Freud und Breuer nicht widerlegt worden sei. Ich bestreite dies, indem ich detailliert zeige, dass sich Freuds und Breuers These von der Pathogenität verdrängter Gedanken mit Hilfe des in den Studien vorgestellten Fallmaterials belegen lässt. Es ist aus verschiedenen Gründen wichtig, so detailliert auf Grünbaums Kritik einzugehen, u.a. um zu zeigen, dass die Möglichkeit eines suggestiven Einflusses, die Kritiker oft gegen die Psychoanalyse ins Feld führen, keineswegs fatal sein muss. Einhergehend mit dieser Reaktion auf Grünbaum zeichnet sich eine alternative Lösung für das Problem der Suggestion ab, die eine kürzlich vorgestellte ergänzt.

Un argomento a favore della teoria dell’isteria di Freud e Breuer. Risposta all’obiezione di Grünbaum sui fondamenti della psicoanalisi. Nella sua influente critica alla psicoanalisi, il filosofo Adolf Grünbaum ha ripetutamente obiettato che l’edificio concettuale psicoanalitico poggia su fondamenta fragili in quanto il suo assunto chiave, secondo cui i pensieri rimossi possono essere causa di patologia, non potrebbe essere convalidato. La critica del filosofo si concentra sul ragionamento che condusse Freud e Breuer a formulare questo assunto nei loro Studi sull’isteria – un ragionamento che Grünbaum rigetta soprattutto in ragione del fatto che esiste una spiegazione alternativa, l’ipotesi del placebo, che Freud e Breuer non erano giunti a poter escludere. In questo articolo argomenterò contro il ragionamento di Grünbaum mostrando nel dettaglio per quale motivo l’assunto di Freud e Breuer sulla natura patogena dei pensieri rimossi può essere sostenuto sulla base delle evidenze presentate negli Studi. Rispondere in maniera così dettagliata all’obiezione di Grünbaum è importante per diversi motivi – tra gli altri, perché mostra come la possibilità dell’influenza della suggestione (un elemento spesso posto in rilievo dai critici della psicoanalisi) non costituisce necessariamente un argomento fatale. Viene in tal modo offerta una soluzione alternativa e complementare (rispetto a un’altra recentemente proposta) al problema della suggestione.

La defensa de la teoría de la histeria de Freud y Breuer: Una respuesta a la objeción de Grünbaum a los cimientos del psicoanálisis. En su influyente crítica al psicoanálisis, el filósofo Adolf Grünbaum argumenta repetidamente que la empresa psicoanalítica tiene una falla de partida: su afirmación fundamental de que las ideas reprimidas pueden ser patogénicas no se sostiene. Su crítica se centra en el razonamiento de Freud y Breuer en torno a esta afirmación en Estudios sobre la histeria, razonamiento que rechaza principalmente debido a que hay una explicación alternativa, la hipótesis del placebo, que Freud y Breuer no han logrado descartar. El autor de este artículo argumenta en contra de esto, mostrando en detalle por qué la afirmación de Freud y Breuer sobre la patogenicidad de los pensamientos reprimidos puede sostenerse sobre la evidencia presentada en los Estudios sobre la histeria. La respuesta detallada a las objeciones de Grünbaum es importante por varios motivos, entre ellos, ilustrar cómo la posibilidad de la influencia de la sugestión, idea a la que recurren a menudo los críticos contra el psicoanálisis, no es necesariamente fatal, lo cual ofrece una solución complementaria y alternativa al problema de la sugestión recientemente propuesto.

KEYWORDS:

• hysteria
• philosophy of science
• Adolf Grünbaum
• suggestion
• placebo
• unconscious memory
• Inference to the Best Explanation

Acknowledgments

I would like to express my sincere thanks to Tim Fuller and the reviewers for IJP for their helpful comments on drafts of this paper.

Notes

1 Misra (2016) goes into more detail. However, although Misra responds to Grünbaum’s criticism that Freud does not rule out the placebo effect, she does so at a general level, taking in psychotherapy as a whole, rather than specifically focusing on the evidence described in Studies on Hysteria. Brakel (2015) also offers an interesting response, drawing on empirical research, although without addressing in detail the underlying epistemological issue.

2 In my view, other aspects of Breuer’s comments, in particular that of “surprise,” are more important than the ones Grünbaum focuses on. Breuer’s argument is best understood in historical context: he is calling to attention disanalogies with a subsequent method of cure—developed in the late 1880s—based on suggestion. So, although he fails to rule out suggestion as the means of cure, he nevertheless provides pertinent reasons against the most contemporaneously plausible alternative explanation of the facts.

3 Grünbaum is dismissive about IBE, but elsewhere (2015) I discuss why his dismissal is problematic.

4 Freud and Breuer write, “our investigations reveal, for many, if not for most, hysterical symptoms, precipitating causes which can only be described as psychical traumas” (1893–1895, p. 6; my emphasis).

5 P is a competing explanation insofar as it is not supplemented by FB. It is possible that the true explanation is a combination of FB and P, but that is an argument for FB.

6 I give an abbreviated version of this argument in Michael (2015).

7 Although the events were associated with strong emotion, they were in themselves ordinary enough occurrences. Where the event was unusual, it was not so because of its fancifulness, but because of its idiosyncratic details—for example, Anna O.’s being so terrified upon hallucinating a snake while nursing her sick father, that, upon trying to pray, she could do so only through English verses (1893–1895, pp. 38–39). As Breuer puts it, the “very insignificance of so many of those causes, the irrational character of so many of the connections involved, argue in favour of their reality” (ibid., p. 43). Here “irrational character” refers, not to any lack of internal consistency of the memories, since Breuer reports that they were remarkably internally consistent (ibid.), but to the peculiarity and self-incomprehensibility of Anna’s reactions—another example being her coughing upon hearing dance music—which would be unexpected in a false memory. In sum, we have memories that are realistic, coherent, and replete with idiosyncratic details, and, whenever checked, are fully confirmed. Especially in the absence of any obvious planted suggestions, these facts seem better explained by the true memory hypothesis than by the false memory hypothesis.

8 It is possible that the emotion was added by the patient after the event. However, this seems unlikely, given that the emotion expressed was spontaneous, specific, and cohered intimately with the details of the event. The better explanation of these facts is that the emotion arose at the time of the event, even if it was not expressed then.

9 Elsewhere I mount a similar argument in relation to dream interpretation (Michael 2008, 2015).

10 A similar point can be brought against an alternative hypothesis that Grünbaum presents, namely, that it was the traumatic experience itself that caused the symptom, while the repressed memory merely maintained it. This hypothesis is not essentially different from FB, varying only in that it is more complex and denies that the repressed memory was a cause of the coming-to-be of the symptom. Such a hypothesis may be preferable in explaining symptoms that arose at the time of the traumatic event, but not in explaining symptoms that arose some time after it. See also Misra (2016).

11 Modern studies show that the neurophysiological mechanisms underlying such hypnotically produced “symptoms” are similar to those involved in hysteria (Halligan et al. 2000; Bell et al. 2011).

12 The Bayesian brain hypothesis is a possibly groundbreaking overarching theory of the brain and mind which is gaining much attention among cognitive neuroscientists and philosophers (Clark 2016; Hohwy 2013).

13 See Freud (1893b, p. 35) for evidence in support of this suggestion.