The Role of the Case Study Method in the Foundations of Psychoanalysis

In my 1984 book on The Foundations of Psychoanalysis, I addressed two main questions: (1) Are the analyst’s observations in the clinical setting reliable as ‘data,’ and (2) if so, can they actually support the major hypotheses of the theory of repression or psychic conflict, which is the cornerstone of the psychoanalytic edifice, as we know? In the book, I argued for giving a negative answer to both of these questions. Clearly, if the evidence from the couch is unreliable from the outset, then this defect alone suffices to jeopardize the very foundations of the clinical theory. But, as I strongly emphasized, even if clinical data were not contaminated by the analyst’s influence, the inability of the psychoanalytic method of clinical investigation by free association to warrant the required sort of causal inferences leaves the major pillars of the theory of psychic conflict ill-supported (1984, 172). Thus, I see a two-fold threat to the psychoanalytic case-study method as a means of scientific inquiry.It is an immediate corollary of my challenge that it applies not only to Freud’s own original hypotheses, but also to any and all post-Freudian versions of psychoanalysis that rely on his clinical methods of validating causal inferences, though the specific content of their theories of psychic conflict is different. After all, the alteration in the content of the hypotheses hardly makes their validation more secure. Therefore, as Morris Eagle documented in a recent publication (1983), those analysts who have objected to my critique as anachronistic have simply not come to grips with it. For example, such inadequate engagement is present, in my view, in the recent Freud Anniversary Lecture ‘Psychoanalysis as a Science: A Response to the New Challenges,’ given by Robert Wallerstein (1986), the current president of the International Psychoanalytical Association. As he tells us (1988, 6, n.1), ‘The Freud Anniversary Lecture was intended primarily as a response to Grünbaum.’ Yet he does not come to grips at all with the gravamen of my challenge: Even if clinical data could be taken at face value as being uncontaminated epistemically, the inability of the psychoanalytic method of clinical investigation by free association to warrant causal inferences leaves the major pillars of the clinical theory of repression ill-supported.