Editorial

I

One of Freud’s important but elusive thoughts was there is a bond or conjunction (ein Junktim) between the clinical work and the theoretical activity of an analyst. In German, ‘ein Junktim’ is a term that is used above all in jurisprudence, meaning a particular connection of two legal norms that may be applied only together so that there cannot be one without the other. Freud writes, in Strachey’s translation:

In psycho-analysis there has existed from the very first an inseparable bond between cure and research. Knowledge brought therapeutic success. It was impossible to treat a patient without learning something new; it was impossible to gain fresh insight without perceiving its beneficent results. Our analytic procedure is the only one in which this precious conjunction is assured. It is only by carrying on our analytic pastoral work that we can deepen our dawning comprehension of the human mind. This prospect of scientific gain has been the proudest and happiest feature of analytic work. Are we to sacrifice it for the sake of any considerations of a practical sort? (1978, Standard Edition XX, 255)

The question remains, however, what does Freud actually mean with the Junktim-conjunction between cure and research and, and even more importantly, how should we conceive of this connection within the present day psychoanalysis. I want to formulate a few thoughts on this burning issue.

II

Already the fact that Freud uses the term Junktim may indicate that he does not have in mind any obvious relationship between the two instances, clinical work and acquiring psychoanalytic knowledge through research, one that would be easy to spell out and teach for everyone involved. Freud was acutely aware that here lies a key problematic for psychoanalysis, whose justification and general acceptance depend on the Junktim, and he worked with it all through his career, without formulating any definitive account.

Freud’s guiding thought was that clinical work and theoretical activity of an analyst influence each other, i.e., that new encounters in one have consequences in the other. He paints a picture of clinical experience and psychoanalytic knowledge fertilizing each other. Even though Freud followed research and discussions in several scientific fields, he wanted to establish that psychoanalysis is a discipline that stands on its own, and the Junktim is supposed to lay the foundation for it. Thus, the research within psychoanalysis and by the analysts themselves is fundamental for the discipline, rather than the research on psychoanalysis by external authors or other disciplines. In Freud’s time, there was yet no research of psychoanalytic process or of the efficacy of psychoanalysis in the contemporary sense. But anyhow Freud maintained, importantly, that psychoanalysis is a clinical praxis and a research praxis at the same time, a discipline with its own research object, key concepts and theoretical structures.

What kind of knowledge does psychoanalytic research generate, and how? Freud repeatedly defined psychoanalysis as a psychology of the unconscious and likened its research process with that of natural sciences like physics and biology. Like in those sciences, in psychoanalysis takes place inductive generalisation, Freud maintained, and conceptual models and theories are supposed to explain the empirical findings. He himself was very creative in generating psychoanalytic concepts, models and theories that are supposed to carry psychoanalytic knowledge. And he very much emphasized this generation as a process, as a continuous and self-critical questioning of the existing concepts, models and theories that contradict clinical experience. Thus, the clinical experience may give reason to make changes in the conceptual structure, which the analyst uses in thinking of the clinical process. In this sense, there is conjunction between the two.

III

The present day psychoanalysis differs fundamentally from Freud’s creation, because today there exists not one but a great number of different psychoanalytic theories and conceptual models that are used by the analysts in their clinical thinking. This fact obviously has influence on the Junktim between psychoanalytical knowledge and clinical experience. The picture drawn by Freud, in which some clinical observations may give reason to reformulate existing concepts and theories, does not hold in the same sense any more. Today, analysts may listen to their patients and think of the analytic process by applying several concepts, models and theories that may not cohere with each other. Rather than having a single body of knowledge in their mind, they try to find a suitable approach for each particular case, or for a particular phase of a process. Thus, there exist a plurality of concepts, models and theories, which certainly changes the whole picture of the field – and which seems to threaten the idea of psychoanalysis as a science. R.D. Hinshelwood remarks critically:

The problem of a permissive view of truth and the means to achieve it, is that we can slip into a simplistic relativism, in which meaning for the sake of it is sufficient. Gadamer’s “intentional community” implies a relativism which scientific experimentation avoids. The scientific demands for validity and reliability no longer apply to meaning generation. Without that rigour we could enter “an anything goes” territory. And indeed psychoanalysis exemplifies that, being pushed apparently helplessly towards such a Tower of Babel. (Hinshelwood, 2013, p. 84)

In other words, there does not exist any more a psychoanalytic theory, which could be assessed critically with the help clinical experience, but many such theories. Freud’s hope at certain point of his career was that the theory of Oedipus complex would be the common frame that is shared by all psychoanalysts, but that theory too is highly contested today. The same is true of most of Freud’s theoretical formulations, and not only his, but of those of other thinkers in the field as well. This state of conceptual and theoretical plurality necessarily changes our conceptions of psychoanalytic knowledge. Generally, by knowledge we mean well-enough justified true beliefs. Empirical knowledge consists of perceptions or experiences and concepts that are dependent on theories. But if there prevails a plurality of very different theories and models, how is it possible to justify one’s psychoanalytic beliefs well enough?

The question is, then, how to think of the Junktim between clinical experience and psychoanalytic knowledge under the condition of conceptual and theoretical plurality, which threatens to become an ‘anything goes’ relativism. Such a state of relativism would be very problematic, because then experiences, concepts and theories would be intertwined with each other in a way that would make any critical discussion concerning either experiences or knowledge generated from them impossible. Hinshelwood is not the only writer who thinks that psychoanalysis today is actually not far from such an unfortunate state.

IV

But we can take a somewhat different perspective to the issue at hand. We may ask, how strong concepts, models and theories are needed in psychoanalysis. What kind of knowledge does the research in conjunction with clinical work bring about? Freud seemed to presuppose that psychoanalysis is a science comparable to natural sciences in the sense that there has to exist a general conceptual structure that makes it possible to understand and explain what takes place in the clinical process. This was the task of the metapsychology. This presupposition of Freud has been widely contested, however. It may turn out that psychoanalysis can live as a discipline and do also scientific research without strong metapsychological theory.

In his posthumously published book Thinking in Cases, John Forrester, a prominent historian and philosopher of sciences, maintains that psychoanalysis is a discipline whose mode inference is ‘thinking in cases’. He writes:

So psychoanalysis combines two unlikely features: it promises a new way of telling a life in the twentieth century, a new form for the specific and unique facts that make person’s life their life. And at the same time, it attempts to render that way of telling a life public, of making it scientific. The bridge between these two aims is the case history, along with the curious and distinctive narratives of transference and countertransference phenomena that increasingly came to dominate ‘clinical writing’, as it is called

For Forrester, the question, is psychoanalysis a science, is comparable to the question, is jazz serious music. In one sense of ‘serious’ it may be not, but in another sense jazz certainly is serious business. The whole question may be mistaken. And this is the case with psychoanalysis too, Forrester maintains. More accurate would be to ask, was psychoanalysis a science hundred years ago, when Freud worked for its conceptual foundations. At that time, psychoanalysis was a unique attempt to formulate a Junktim between clinical experience and conceptual knowledge in scientific terms. It was a very particular attempt, according to Forrester, because so far the sciences had followed either the principles of Aristotle, according to whom scientific research always concerns something universal, or those of John Stuart Mill, according to whom sciences begin with the individual instances and proceed inductively to general claims. The Aristotelian sciences of species and essential structures are outmoded, however, and the modern sciences use statistical methods that do not apply to psychoanalytic research. Psychoanalysis studies individual lives in the form of case histories and claims to be a science, which was a unique project in Freud’s time. The situation has changed however.

According to Forrester, instead of asking whether psychoanalysis is a science and what sort of science, more relevant today is to ask what sort of reasoning psychoanalysts use in their research activities. He distinguishes, following Ian Hacking, six styles of reasoning – postulation and deduction; experimental exploration; hypothetical construction of models by analogy; ordering of variety by comparison and taxonomy; statistical analysis of regularities of populations; historical derivation of genetic development, and adds a seventh, i.e., reasoning in cases, which characterises the style of reasoning in psychoanalysis and related disciplines. Those related disciplines include medicine, jurisprudence, and human sciences, which all study individual cases and try to establish more general knowledge concerning the phenomena at hand (see Forrester 2017, Ch. 1). There are significant differences among those other disciplines, into which I cannot go here, but medicine, law and studies of literature for instance are generally accepted as scientific fields of their own kind. Why should this not apply to psychoanalysis as well?

The idea that psychoanalysis too is a scientific field that is based on thinking in cases is shared by a group of Swiss authors, two analysts and two philosophers, in their important new book (Guggengeim, Hampe, Schneider, & Strassberg, 2016). They maintain that psychoanalysis is neither a natural science nor a pseudoscience, nor a hermeneutical science, but a discipline that stands on its own by thinking in cases. In psychoanalytic knowledge, the general does comprise neither of law-like generalisations, like in natural sciences, or in medicine based on them, nor of theory, like often in human sciences, but of cases in the form stories. In psychoanalysis, there are exemplary or paradigmatic cases, especially those presented by Freud, as well as stories taken from mythology or literature, which enclose more general truths. The myth of Oedipus has been the most important paradigmatic story for the analysts.

By founding psychoanalytic knowledge on paradigmatic fictions, Freud radically distinguished psychoanalysis from medicine (Guggengeim et al., 2016, p. 31–32). Whereas in medicine, an individual case is judged and treated by appealing to the general knowledge of similar symptoms and their background mechanisms, in psychoanalysis it is rather the deviation from the general pattern which matters most, Guggenheim et al. maintain. Psychoanalytic couch is not a laboratory in which an individual could be measured in order to test hypotheses and theories, nor is it a courtroom, or X-ray hall in which an individual case could be studied against the existing knowledge about general processes. Instead, it is a field in which exemplary stories are interpreted again and again and used together with the clinical experience in the form of cases histories as the foundation for psychoanalytic knowledge.

This picture of psychoanalysis as a unique field thinking in cases also sets the idea of a Junktim between clinical work and acquiring knowledge into a different perspective. The centre of psychoanalysis in this picture is clearly clinical work. There is no general knowledge comparable to medicine or psychiatry. Instead, there are paradigmatic stories that are used in presenting individual case histories and reflecting on them. They together contain the body of psychoanalytic knowledge, which then is used by the analysts in their clinical work – not by subsuming the individual case under the general, but rather by using the general in order to see how this particular case deviates from the general experiences. The role and the significance of general concepts and theories are weakened in this picture of psychoanalysis as compared to a more traditional picture.

V

Let me still come back to the worry of R.D. Hinshelwood, which is shared by many writing in the field. If there is no way of critically comparing different concepts and models on which the analysts base their work, we enter into a situation in which ‘anything goes’ and there are no rational criteria for choosing one approach rather than another. If one builds on the presupposition that psychoanalysis is, or should be, one scientific discipline of some kind, as Hinshelwood obviously does, then such a situation is notoriously problematic. But if one gives up this presupposition and confines to the idea that psychoanalysis is thinking in cases and thus necessarily exists in plural, then the worry is not so heavy. Guggenheim et al. argue that even though psychoanalytic models and theories exist in plural, it does not follow from this that anything goes and psychoanalysis would be a pseudoscience. The demarcation problem should be thought in a new way, they maintain, without attempting to justify the discipline against a natural scientific type of criticism (see Guggengeim et al., 2016, p. 11–32).

R.D. Hinshelwood would not perhaps agree with this. He makes a very interesting attempt in constructing a model along which one may proceed in weighting rationally different approaches within an analytical process. He too maintains that psychoanalysis is a discipline that stands on its own and in which the research of the cases by the analyst themselves is most important, but he insists that we have to be able think critically of those concepts, models and theories on which we base our interventions in the process. In order to accomplish this, Hinshelwood carefully constructs a research model in which a metapsychological theory may be tested within an analytical process. The key idea is to develop from that theory a clinical approach and observe what follows in the patients associations when an interpretation based on that approach is made. In analysis, such an experiment can be repeated. Different clinical approaches may be tested in this way, he maintains, and material for rational comparison of different metapsychological theories is gained (see Hinshelwood, 2013, part III and IV).

This is another kind of view on the Junktim between cure and research in psychoanalysis. Hinshelwood maintains that both clinical theories and metapsychological theories are necessary, and that critical discussion of different metapsychological theories is both necessary and possible by testing them empirically. One may doubt whether this is a too optimistic view concerning the possibility of reducing the plurality of theories, but Hinshelwood has construed a model that may give empirical answers to such doubts. One may also argue, as do Guggenheim et al., that such a comparison is hardly necessary, because the rationality of psychoanalysis lies much closer to the particular cases that are presented in a form of narratives. In their picture, theories cannot be tested because they are not independent of the clinical process. This is obviously an important discussion concerning the Junktim in the present day psychoanalysis. Like in other scientific disciplines, different positions concerning the fundamental issues prevail side by side and are supported by rational arguments for and against.

Disclosure statement

No potential conflict of interest was reported by the author.