The Freud Files
Page 15
John Michell Clarke, concerning Studies on Hysteria: The necessity of bearing in mind, in studying hysterical patients, the great readiness with which they respond to suggestions, may be reiterated, as the weak point in the method of investigation may perhaps be found here. The danger being that in such confessions the patients would be liable to make statements in accordance with the slightest suggestion given to them, it might be quite unconsciously given to them, by the investigator.23
Robert Gaupp: Anyone who can give his questions a suggestive twist, whether done consciously or unconsciously, can obtain from susceptible patients any answer which fits into his system. That may be the reason why Freud’s psychoanalyses abound in material which other researchers seek in vain.24
Forel: I claim that Freud greatly exaggerates this cause of nervous troubles [traumatic reminiscence] and above all in generalising it to cases where the patient remembers nothing, often suggesting to his patients all sorts of things which are more detrimental than useful, above all in the sexual domain.25
James Jackson Putnam: When the physician is fully imbued with the belief in the sexual origins of the patient’s illness he must, by virtue of the closeness of this relationship, be in a position to impress his views, unconsciously, upon his patients and might easily draw from them an acquiescence and endorsement which would not in reality be as spontaneous as it seemed.26
Arthur Muthmann: With this process [abreaction] suggestive influences by the physician play a prominent part. A powerful suggestion which then acts auto-suggestively is especially the explanation respecting the method. The patient is informed that his illness is due to some forgotten experience. If this experience could be discovered, then his complaints would be cured. With a proper course of procedure the patient seizes at once the connection of resuscitating reminiscences with his illness, and, from its very inception, there is attached to this idea the suggestion that the respective symptoms will disappear.27
Hoche: The confirmation that the followers of the theory give for the ‘discoveries’ of complexes which have become unconscious are not surprising. The believing doctor and patient (or rather the female patient) are equally under the suggestive effect of an identical circle of ideas. The patients already certainly fully know what is expected of them . . . Above all one sees that the eventual therapeutic effect finds its explanation without having to profess to the principles of Freudian theory; essentially . . . it is the old suggestive technique in a new pseudoscientific guise.28
Moll: Moreover, I believe that the cures effected by Freud (as to the permanence of which, in view of the insufficiency of the published materials, no decisive opinion can as yet be given) are explicable in another way. A large proportion of the good results are certainly fully explicable as the results of suggestion. The patient’s confidence in his physician, and the fact that the treatment requires much time and patience, are two such powerful factors of suggestion, that provisionally it is necessary to regard it as possible that suggestion explains the whole matter.29
Bernard Hart: The preconceptions of the analyst, the particular moments at which he sees fit to intervene in the patient’s narrative, the emphasis which he directs to certain features of the narrative, the point at which he deems the flow of associations to have reached the significant element, all these are abundantly able to produce decided alterations in the subsequent functioning of the patient’s mind.30
One sees that for many of Freud’s critics, it was one and the same thing to criticise the arbitrariness of his theoretical hypotheses and to denounce the suggestive character of his technique. This was not accidental. By the 1890s, psychiatrists and psychologists were acutely aware of the demise of Charcot’s theories through the criticism of the Nancy school, and of the ease with which one could take one’s theories to be real through suggesting them to patients or to subjects of psychological experimentation. Despite (or rather because of) their positivism, they didn’t trust many of the clinical ‘confirmations’ which Freud invoked in support of his theories. In the 1920s, the young Karl Popper recalled this whilst elaborating his famous critique of the non-falsifiable nature of psychoanalytic theory.
Karl Popper: Those ‘clinical observations’ which analysts naïvely believe confirm their theory cannot do this any more than the daily confirmations which astrologers find in their practice . . . what kind of clinical responses would refute to the satisfaction of the analyst not merely a particular analytic diagnosis but psychoanalysis itself? . . . Moreover, how much headway has been made in investigating the question of the extent to which the (conscious or unconscious) expectations and theories held by the analyst influence the ‘clinical responses’ of the patient? (To say nothing about the conscious attempts to influence the patient by proposing interpretations to him, etc.) Years ago I introduced the term ‘Oedipus effect’ to describe the influence of a theory or expectation or prediction upon the event which it predicts or describes: it will be remembered that the causal chain leading to Oedipus’ parricide was started by the oracle’s prediction of this event. This is a characteristic and recurrent theme of such myths, but one which seems to have failed to attract the interest of the analysts, perhaps not accidentally.31
In psychology and psychiatry, heuristic hypotheses (‘speculations’) have a much more problematic status than in other fields, because of the role of human influence, that is, of what William Carpenter called ‘expectant attention’ or what Bernheim called ‘suggestion’. In physics, chemistry and molecular biology, there is the possibility that an erroneous conjecture will eventually be corrected through experiment or calculation, even if this is far from being necessarily and automatically the case.32 In these disciplines, as Andrew Pickering33 cogently explains, the ‘material agency’ resists the hypotheses made about it, thus obliging the investigator to rectify them accordingly (this is what Pickering calls the ‘dialectic of accommodation and resistance’). It is not the same in social psychology and psychopathology, where heuristic hypotheses are tested on ‘human agencies’ that are inevitably interested in the theories of which they are the object. In such cases, one can no longer count on the resistance of the experimental object, as human agency tends to accommodate itself to the experimental or therapeutic context. It was precisely this looping effect that Bernheim and Delbœuf recognised in hypnosis experiments under the heading of suggestion. Subjects accommodated experimenters, mirroring their explicit and implicit suggestions as well as their theoretical expectations. Meanwhile, experimenters were likewise affected by their subjects, and both were caught up in a field of reciprocal suggestions from which no external vantage point could be found.
Joseph Delbœuf: Finally I give the explanation of the phenomena exhibited at the Salpêtrière: they are due to training and suggestion. The operator will have regarded the characteristics presented by his first subject to be essential for all individuals, rather than purely accidental. Unconsciously using suggestion he will have transformed them into habitual signs. He will be attached, without knowing it, to obtaining them with other subjects who will have produced them by imitation, and thus the master and his pupils, reciprocally influencing each other, will not cease to feed their error.34
Hippolyte Bernheim: When one has seen how suggestible hysterics are, even during their fit, how much they easily realise the phenomena which one expects or that they have seen produced in others, one cannot stop oneself from thinking that imitation, working by auto-suggestion, plays a great role in the genesis of these manifestations . . . I thus believe that the grand hysteria which the Salpêtrière presents as classical, unfolding in clear and distinct phases like a chain hysteria, is cultivated hysteria.35
Bernheim and Delbœuf spoke of hysterical and hypnotic phenomena, but the implication of their analyses went far beyond the limited frame of therapeutic and experimental hypnotism, particularly as they reduced these to one effect among others of suggestion. The production of psychological artefacts which they highlighted in the hypnotic and ps
ychotherapeutic relation was precisely what the hypnotic specialist Martin Orne rediscovered seventy years later at the centre of experimental psychology laboratories under the name of ‘demand characteristics of the experiment’.36 Orne showed how experimentation in psychology was inevitably affected by the reaction of its subjects. Far from being purely passive objects, the subjects are perfectly aware of being observed, they wonder what the experimenter wants to prove and do their best to validate what they take to be his hypotheses. This simple observation, which extends and generalises what Bernheim and Delbœuf had remarked concerning hypnotised subjects, hasn’t ceased to haunt experimental social psychology. A multiplicity of procedures has been designed to allay this problem, without much success. Indeed, it is not simply a question of what had been called the ‘personal equation’ of the investigator,37 nor even the inevitable distortion introduced by his or her subjectivity (the ‘principle of indetermination’ which characterises the human and social sciences, according to Georges Devereux).38 More fundamentally, what is in play here is the degree to which psychological experimentation provokes real modifications in the behaviour and self-awareness of its subjects, insofar as they adapt to the theories and hypotheses applied to them, not unlike the manner in which the rat of the behaviourists or the drosophila of the geneticists adapts to laboratory conditions.39 One could well say that the theory produces its ‘object’, not only in the Kantian sense of organising it conceptually, but much more literally, in the sense in which the subject of experimentation transforms itself to adapt to the theory. It is the ‘Oedipus effect’ which Popper described: the hypotheses of the psychologist provoke what they claim to describe or predict, transforming reality instead of merely reflecting it.
Wohlgemuth: The Psycho-analyst in looking for ‘complexes’ is like an agent provocateur. He stirs up trouble where there was none before, and then says he discovered a plot.40
It was this subtle production (or rather, co-production) of psychological artefacts which Freud’s peers saw when they spoke of ‘suggestion’ and ‘auto-suggestion’, rather than, as Freud claimed, direct suggestions of command, such as ‘You will now sleep’ or ‘Your symptoms will disappear tomorrow.’ Freud frequently protested that analysis was a non-directive method which had nothing to do with the crude hypnotic suggestion of its beginnings.
Freud: It is not only in the saving of labour that the method of free association has an advantage over the earlier method. It exposes the patient to the least possible amount of compulsion . . . It guarantees to a great extent that no factor in the structure of the neurosis will be overlooked and that nothing will be introduced into it by the expectations of the analyst.41
Freud to Jung, 7 October 1906: For reasons of principle, but also because of his personal unpleasantness, I shall not answer Aschaffenburg’s attack . . . He is still taking up arms against the hypnotic method that was abandoned ten years ago.42
But Freud’s peers, thanks to their familiarity with the work of the Nancy school, saw clearly that the replacement of direct hypnotic suggestion with the method of so-called free association by no means settled the problem of suggestion understood as creation of artefacts.
Forel: Since the introduction of the doctrine of suggestion one reads at the end of the praises of a large number of vaunted new remedies, ‘Suggestion is excluded.’ It is in just such cases that a purely suggestive action is most probable.43
Prince: I would point out, however, that the method employed by Freud in fact makes use of the principles of hypnosis; for the state of abstraction, in which the so-called free associations of the subject are obtained, is in principle hypnosis . . . I say so-called free associations, because when the attention is concentrated on a particular theme the associations are determined by this fact. There is no such thing as free associations under these conditions.44
One could very well suggest without hypnosis, and it was for this reason that, in his psychotherapeutic practice, Bernheim dispensed with trance induction and turned towards suggestion in a waking state. Consequently nothing guaranteed the fact that Freud’s method of free association would be any less suggestive than other psychotherapeutic methods, or that his theories would be more objective than his master Charcot’s.
Benjamin Logre: From the school of the Salpêtrière, so brilliant in so many respects, Freudianism retained, enriched and systematised, what was least fortunate: the culture of hysteria.45
Hart: A lengthy investigation of a patient’s mind means that one is no longer examining at the end of the investigation the object one set out to observe, but an object which has progressively altered during the course of the investigation, and altered in a way which may have been largely determined by the investigation itself. This was the circumstance which vitiated absolutely and completely the painstaking conclusions drawn by Charcot and his school of the Salpêtrière. A perusal of the literature of double personality suggests strongly the existence of a similar vitiating factor . . . It is not easy to avoid the conclusion that the method of psychoanalysis contains potential sources of distortion at least as great as those in the instances just mentioned.46
R. S. Woodworth: Psychological experimenters (as Messer and Koffka) have frequently observed that it is very difficult to secure a really free association . . . It is rather strange that the Freudians . . . should assume that the subject is really passive in the process of the analysis, and should omit to inquire what sort of tendency or control may be exerted on the movement of thought. If we ask ourselves this question, we notice that the psychoanalyst instructs his subject to be passive and uncritical, and to give expression to every thought that comes up, no matter how trivial or embarrassing it may be. The subject is warned time and time again that he must keep back nothing if he wishes the treatment to succeed. It is easy to see that such instructions tend to arouse a definite set of mind towards that which is private and embarrassing; and this easily suggests the sexual. Certainly one cannot be in the hands of a Freudian for long without becoming aware that sexual matters are of special interest and concern, and thus, if at all responsive, getting a strong mental set in that direction.47
Jastrow: The so-called ‘free association’ is not free, not completely, not convincingly so. It is altogether too prone to be guided by the analyst’s attitude, questions, known views, personal relations to the analysee. The opportunities for suggestion are abundant; they intrude subtly, however much one is on one’s guard. I do not refer to the cruder forms of suggestion in the same physician–patient relation which deceived so astute a psychiatrist as Charcot in the ‘discovery’ of three distinct hypnotic states . . . I do imply that the probing may readily have a suggestive effect, if there is . . . an anticipatory theory behind it and a knowledge on the part of the patients of what is expected of them.48
Even the so-called ‘resistances’ of patients prove nothing, as how could one exclude the possibility of ‘resistance’ as obliging (by ‘transference love’), or as a form of trained behaviour, to conform to theories of the analyst? From the 1880s onwards, it was quite common to suggest to hypnotised patients not to remember something, or not to respond to suggestions. Delbœuf, however, pointed out that the hypnotic amnesia demonstrated by Bernheim was simply trained behaviour. On what grounds, then, could one establish that the situation was radically different in analysis?
Freud: In every analytic treatment there arises, without the physician’s agency, an intense emotional relationship between the patient and the analyst which is not to be accounted for by the actual situation. It can be of a positive or of a negative character and can vary between the extremes of a passionate, completely sensual love and the unbridled expression of an embittered defiance and hatred . . . We can easily recognize it as the same dynamic factor which the hypnotists have named ‘suggestibility,’ which is the agent of hypnotic rapport and whose incalculable behaviour led to difficulties with the cathartic method as well.49
As Aschaffenburg and Hoche argued, patients knew in
advance what was expected of them. Hence it would be no surprise if patients exhibited all the manifestations of resistance or negative transference as portrayed in psychoanalytic theory. For Freud, such manifestations attested to the existence of an objective, non-dissimulating unconscious, as it resisted his suggestions and theoretical hypotheses.50 But in the eyes of his colleagues, this resistance to the theory could itself be suggested by the theory. For such experienced hypnotic researchers such as Forel, Moll and Janet, the contrast which Freud established between the long and difficult ‘working-through’ of analysis and the deceptive facility of hypno-suggestive therapies was simply fallacious.51 Paradoxically, the insistence that psychoanalytic therapy did not operate by suggestion heightened its suggestive effects.
Jerome Frank: Viewed solely as methods of persuasion, evocative therapies may paradoxically heighten the therapist’s incentive and ability to influence the patient through their stress on his neutrality and objectivity. This tempts him to induce the patient to express material that confirms his theories, because he can regard it as independent evidence for them; and the patient is induced to accept the therapist’s formulations because he believes them to be his own.52
Freud: It is perfectly true that psycho-analysis, like other psychotherapeutic methods, employs the instrument of suggestion (or transference). But the difference is this: that in analysis it is not allowed to play the decisive part in determining the therapeutic results. It is used instead to induce the patient to perform a piece of psychical work – the overcoming of his transference resistances – which involves a permanent alteration in his mental economy.53