Freud's Case Studies and the Locus of Psychoanalytic Knowledge

Freud's, Case Studies and the Locus of Psychoanalytic Knowledge (") CARL. E. PLETSCH"* INTRODUCTION: THE @TESTION OF PSYCHOANALYTIC KNOWLEDGE Reading through Sigmund Freud's case studies in chronological order is a most instructive experience for anyone interested in the intellectual history of psychoanalysis. One quickly sees, for example, how Freud's technique evolved from the methodical and rather intrusive attempts to dispel particular symptoms that we observe in Studies on Hystem'a (1 895) to the method of free association that he describes in his report on the case of Dora (1905). Or one sees how Freud's conception of the transference developed, from the primitive notion of transference as something to be avoided or dispelled, to the mature conception of transference as the invaluable center of analysis, the very phenomenon that has to be analyzed (again in the analysis of Dora). In this paper 1 shall review Freud's case studies with still another trajectory in mind: how Freud's sense of the significance of his written case studies themselves evolved. 1 shall show how his inital embarrassment over the necessity of describing his cases in great detail was eventually supplanted by a confidence that his case studies were important vehicles of psychoanalytic knowledge. As his attitude changed, his initial anxiety about how other medical and natural scientific readers would adjudicate his cases was displaced by a willingness to assert delicate, tenuous hypotheses in his cases, largely for the benefit of the psychoanalytic community itself. And on a more abstract and perhaps less conscious level, the positivistic belief in the importante of theory and the objective verifiability of hypotheses that Freud had subscribed to from the time he (*) Una versión resumida de este trabajo se ha publicado en, Partisan Review, 49/1, 101-1 18, (1982). ** Departrnent of History, 454 Hamilton Hall 070 A, University of North Carolina, Chape1 Hill, NC 27514. USA. DYNAMIS Acta Hispanica ad Medicinae Scientiarumque Histmiam Illustrandam. Vol. 2, 1982, pp. 263-297. ISSN: 021 1-9536. 264 CARL. E. PLETSCH had decided to study medicine was at least temporarily challenged by another view of knowledge, a view that 1 shall try to clarify in this paper. My examination of Freud's case studies is necessarily an interrogation of only a part of the Freudian oeuvre. But it leads inexorably to the question of psychoanalytic knowledge, its locus, character, and epistemological status. For we cannot examine the cases without considering their relationship to Freud's other writing. We cannot help wondering whether Freud wrote his case studies for a specific readership, for example, or whether the cases communicate to their readers in a unique fashion. These questions will lead us to delineate an important fissure in Freud's thinking and to speculate upon how Freud's most peculiarly psychoanlitic knowledge differs from other forms and kinds of knowledge. Two notions taken from the discourse oEghilosophy of science will assist us in our examination of Freud's case studies: ((exemplarsa and «personal knowledge)). We must not reify these notions, however, or permit them to distract us from the question of psychoanalytic knowledge. Let it be clear from the outset that 1 am not trying to defend psychoanalysis or to answer the (tedious) question of whether or not psychoanalysis is a science. Nor am 1 trying to demonstrate the validity of these notions of (texemplar)) and ((personal knowledge)) in the discourse of the philosophy of science. 1 am using these notions in connection with Freud's case studies for the much more modest heuristic purpose of illuminating the place of case studies in the discourse of psychoanalysis and speculating upon the nature of psychoanalytic knowledge, a peculiar sort of knowledge that 1 believe remains to be adequately described. This is not the place to elaborate upon how the term «exemplar» has been used by descriptive philosophers of science, but 1 must admit that my understanding of the way in which Freud's (and later psychoana- , lysts') case studies constitute exemplars in psychoanalysis diverges in one very important respect from the meaning of the term given by Thomas Kuhn. In his attempt to show that shared theory and correspondence rules are not sufficient to explain disciplinary coherence in certain natural sciences, Kuhn used the term ((paradigm)) in one of its senses to mean ashared examples of successful practice)), which students of these disciplines learn, and which then serve to maintain the coherence of their research community (1). In Kuhn's later essays, these (1) In his later essays Kuhn uses the term ((exemplars)) for this sense of his original terrn ((paradigm)). Cf: The Structure ofdcientzfi Revolutions. Chicago, University of Chicago Press, Freud's Case Studies and the Locus of Psychoanaiytic Knowledge 265 are termed exemplars. My impression is that psychoanalytic case studies -Freud's in particular-- serve the purpose of helping psychoanalysts identie the problems posed by their partients and permit psychoanalysts al1 over the world, sitting done in their consultation rooms with their patients, to proceed in parallel fashion, even though the examples are not always successful. The case of Dora comes to mind once again: the failure of Freud's attempts to reason with Dora and her abrupt termination of analysis before therapy could be effected does not seem to detract from the value of the case. The presentation of such an awkward case as an exemplar might well give a descriptive philosopher of science like Kuhn pause, to say nothing of a neo-positivist. But this seems unproblematic here, precisely because 1 am not trying to defend psychoanalysis as a science or demonstrate the validity of the notion of exemplars. Whatever one thinks of psychoanalysis, it is a fact that Freud's case studies have been extremely important vehicles of the tradition of psychoanalytic knowledge. Somehow Freud's cases still communicate essential knowledge to psychoanalysts. It is much easier, however, to say what they are not than to specifj what they are and how they work in the discourse of psychoanalysis. Although they are by no means devoid of theoretical considerations, for example, they are al1 highly detailed investigations of quite idiosyncratic cases. Freud seldom even claimed for them the value of illustrations of theory, and as time went on he ceased to make such claims altogether. And as 1 have already suggested, they are not quite like exemplars in that they obviously do not depend upon being examples of successful practice. Many conversations with psychoanalysts and a reading of the memoir literature of psychoanalysil suggest, however, that what psychoanalysts derive from their study of Freud's cases is a sense of how Freud thought, and, more particularly, how he thought with his patients. Even to the non-psychoanalytic reader Freud's case studies seem to communicate how it feels to do psychoa+ nalysis and learn from patients. In contrast to his theoretical writings like the Three Essays on the Theory of SexualiS, or expository-didactic ones like the Introductory Lectures on Psychoanalysis, Freud's case studies may be the locus of intersubjectivity in psychoanalysis. It is even tempting to think that the communication between Freud and the psychoanalytic readers of his case studies is modeled on the kind of communication that obtains between malyst and patient in psychoanalysis proper. If this is approximately trile, it suggests Freud's exemplq cases function 1962, and more specifically The Essential Tension: selected Studies in Scientzfic Tradition and Change. Chicago, University of Chicago Press, 1977, pp. 306 and 318-319. 266 CARL. E. PLETSCH as a kind of ((personal knowledge)), borrowing now from Michael Polanyi (2). Studying them, psychoanalysts tacitly learn to think like Freud. The question foremost in my mind while writing this paper is how the status Freud accorded the knowledge deposited in his case studies evolved in his own thinking. But other questions can never be far from the surface of inquiry: how, for example, have Freud's case studies been utilized by his followers in psychoanalysis? How have later psychoanalysts reinterpreted these case studies? And how have the new cases reported by other psychoanalysts reshaped the Corpus of psychoanalytic knowledge? Although 1 shall not be able to answer these questions in the brief compass of a paper on Freud's own thinking, 1 believe my present inquiry is given greater significance by the fact that psychoanalysts have indeed studied Freud's cases as exemplary solutions to problems. They have too, 1 believe, learned more and more consistently from the case studies than from Freud's more traditionally formulated theoretical propositions. The whole process of psychoanalytic education enshrined in the institutes of psychoanalysis suggests this, although again it would take a separate paper to demonstrate it conclusively. It is very largely the case studies, Freud's and the cases published subsequently in the same spirit by his followers, that have enabled psychoanalysis to maintain its great methodological coherence for so long, and during a period when most of Freud's formal theoretical statements have been shown to be at least partially false (3). Psychoanalysts are of course not al1 fully aware of the fact that case studies play such an important role in their discipline. Many if not most psychoanalysts are still consciously wedded to a positivistic conception of science, and they place great store in the theory of psychoanalysis when they represent it to the public at large. If 1 am right:, however, they (2) See POLANM, M. (1958), Personal Knowledge: towards a post-critica1 Philosophy. Chicago, University of Chicago Press. (3) On psychoanaiytic education see: GOODMAN, S. (ed.) (1977), Psychoanalytic Education and Research. New York, International Universities Press, and LEWIN, B. D.; ROSS, H. (1960), Psychoanalytic Education in the United States. New York, International Universities Press. For evidence of the role of case studies in maintaining the coherence of the psychoanaiytic discipline, one should aiso consider the periodicai literature of psychoanaiysis and the prominence of case studies in it. Two other publications are aiso interesting in this context: one, didactic, is Hedda Bolgar's essay on The Case Study Method, in WOLMAN, B. B. (ed.) (1965), The Handbook ofclinical Psychology. New York, McGraw-Hill; the other, historial, is Harold Greenwaid's edition of Great Cases in Psychoanalysis. New York, Ballantine Books, 1959, where the editor explicitly suggests that these most frequently studied and cited cases constitute a more significant history of psychoanalysis than a recounting of the evolution of theory or technique. Freud's Case Studies and the Locus of Psychoanalytic Knowledge 267 are much more defensive about the fragility of this body of theory than they need to be. For ~rhen they communicate with their patients and with each other, they are demonstrably more interested in the subtleties of insight found in particular cases generated by.their method than they are in the validity of general theoretical propositioris. This suggests that psychoanalytic knowledge, the knowledge peculiar to psychoanalysis, is constituted rather differently than the knowledge of a more thoroughly theory-based science. In fact, 1 use the word «knowledge» in referenice to psychoanalysis, instead of «science», precisely in order to suggest that the very question of science is misleadding when applied to psychoanalysis (4). If so, then the great energy expended in trying to reformulate Freud's theoretical propositions to make them experimentally teistable may not -in spite of the value such efforts may have for other purposescontribute much to our understanding of what psychoanalytic knowledge really is (5). A truly descriptive (4) Several other disciplines of questionables scientificity have applied for the status of special forms of knowledge in order to circumvent the question of science, which seems always to entail a comparison with physics. This tactic gives rise to the plural form, aknowledges)). This seenis novel but it could become as common as «sciences» is now. And since «knowledge» is so much less freighted with ideology than «science», this might facilitate more and more genuine descriptive approaches to the intellectual capitals of the anomalous disciplines of p~~choanalysis, ethnography, history, etc. In following this suggestion, however, one necessarily raises the alternative question of «art» or ccrafb, ' and that two will need to be differentiated before it wiii be useful. (5) For the efforts to test Freud's theories experimentally, see EYSENCK, H. J.; WILSON, G. D. (eds.) (1973), The Experimental Study of Freudiam Theories, London, Methuen, and SARNOFF, 1. (1 97 l), Testing Freudian Concepts, NewYork, Springer. More recendy Seymour Fisher and Roger Greenberg have catalogued and analyzed the vast literature devoted to'experimental study of Freud's theories in their book The Scientiflc Credibility of Freud's Theories and Therafy. New York, Basic Books, 1977; the same authors have edited a book of exemplary tests of Freudian theories, entitied The Scientific Evaluation of Freud's Theories and Therapy. New York, Basic Books, 1978. On Freud's theories more generally, their genesis, their «style», and their status as science, see ELLENBERGER, H. (1970), The Discovely of the Unconscious. New York, Basic Books; various papers by Robert R. Holt, e.g, Two Influences on Freud's Scientific Thought: a Fragrnent of intellectual Biography, in: WHITE, R. W. (ed.) (1963), The Study oflives, New York, Atherton Press, pp. 364-387, Freud's Cognitive Style, American Zmago 22, 163-179 (1965), and A Review of Some of Freud's Biological Assumption and their Influence on his Theories, in: GREENFIELD, N. S.; LEWIS, W. C. (eds.) (1965), Psychoanalysis and curreni! biological Thought, Madison, University of Wisconsin Press, pp. 93-124; GEDO, J. 15.; GOLDBERG, A. (1973), Models of the Mind: a psychoanalytic Theory, Chicago, Univeriiity of Chicago Press. GEDO, J. E.; POLLOCK, G. H. (eds.) (1976), Freud: the Fusion of Science and Humanism, New York, International Universities Press; the work of Roy Schaefer, especially Action: its Place in Psychoanalytic Interpretation and Theory, The Annual of Psychoanalysis, 1, 159-1 96 (1 973) and A New Languagefor Psychoanalysis, New Haven, Yale University Press, 1976; and most recently, Frank Sulloway's Freud: Biologist ofthe Mind, New York, Basic Books (1979). 268 CARL. E. PLETSCH 1 account of psychoanalysis, 1 am suggesting, would have to pay much more attention to case studies as repositories and vehicles of this knowledge than has been the case thus far. Such a descriptive account would of course involve an extensive study of the periodical literature of psychoanalysis, its monographs, and of psychoanalytic education 'as practiced in the institutes. The present paper is only a beginning in that direction, an attempt to see how Freud came to the tentative conclusion that case studies were the genre of peculiarly psychoanalytic knowledge, and (as a corollary) to aim his more theoretical statements at the extrapsychoanalytic reader. It is of course also an attempt to pose the question of psychoanalityc knowledge as a question of discourse. Freud published his first case studies jointly with Joseph Breuer, whose patient ((Arma 0.)) had actually invented the ((talking cure)) that constituted the rudimentary psychoanalytic method that Freud practiced in the 1890's. These first case studies appeared in Studies on Hysteria in 1895. From that year until 191 5 when Freud completed his case history of the Wolf Man (From the History ofan Infantile Neurosis, which was not published until 191 8), his method was continually evolving. And especially during the later half of this period, Freud's energies were dedicated very largely to the formation of a school of disciples and institutionalizing psychoanalysis. We shall see that Freud's preoccupations with his method of investigation and with forming a community of psychoanalytic investigators governed his innovative use of case studies. 1 shall focus here in turn upon each of the case studies Freud wrote in this twenty year period. 1. STUDIES ON HYSTERIA I Studies on Hysteria is one of the least coherent works in the Freudian Corpus. For one reason, it was written by two authors who did not agree entirely on its substance. For another, the principal author had not yet completed his so-called self-analysis or even begun the synthesis of his ideas that he would publish as the Interpretation ofDreams in 1900. Thus Studies on Hysteria remained a series of fragments, but its fragmentary and tentative nature permits an unhindered view of the authors' anxiety about the case studies they report in it. ~reud's' and Breuer's concerns were not unlike what any late nineteenth-century natural scientists would have felt when, still caught in the throes of giving birth to a new kind of knowledge, they could only report their fragmentary insights in case studies. In his study of Anna O., for example, Breuer felt obliged to «excuse» himself for reciting the details of her case by drawing an analogy Freud's Case Studies and the Locus of Psychoanalytic Knowledge 269 between Anna 0. and the clarity of the protoplasm of the eggs of the seaurchin which enable the histology student to see what happens in the eggs of other species whose egg-protoplasm is opague: «The interest of the present case seems to me above al1 to reside in the extreme clarity and intelligibility of its pathogenesis)). Breuer's analogy was later used by Freud too, as the editors of the Standard Edition of his writings point out. And his general argumenit that pathology may illuminate the workings of the healthy personality became an important justification for the value of psychoanalytic research. But it is interesting to note that both of these ideas arose in response to Breuer's (and Freud's) anxiety about reporting in such detail on a single unusual example. Strangely enough, the sea-urchin analogy is actually inappropriate in this most important respect, since Anna 0. did not constitute a typical exarnple of a different species but an individual of the same species whose pathology might have made her wholly idiosyncratic. Thus the analogy serves principally to mask the problem which natural scientists of the time would have found most unsettling (6). The Story of Anna O. -now thought to have been Bertha Pappenheim in real life: the social worker, philanthropist and founder of the Jüdischer Frauenbundwas the first and most extraordinary of the cases reported in Studies on Hysteria. Henri Ellenberger describes Freud's learning of the story of Breuer's patient, along with his experience with Charcot at the Salpetriere in Paris, as one of the two personal experiences that led him to devise a new theory of the neuroses (7). Breuer had treated Anna O. in the early 1880's and for several reasons was uncom- (6) STRACHEY, J., et al. (eds.), The Standard Edition ofthe Complete Psychological Works ofSigmund Freud, London, Hogarth, vol. 2, p. 41. The analogy may seem improbable today, but in the intellectual climate of physiological psychiatry that prevailed in the 1890's it was not unusual-see SULLOWAY, F'. (1 979), op. cit. (7) ELLENBERGER, H. (1970), op. cit., p. 480. Ellenberger distinguishes these two personal experiences from the larger trends in neurology and psychiatry that also contributed to Freud's thinking about the neuroses. The writings of later psychoanalysts on Anna O. / Bertha Pappenheim are too numerous to list. A few of the more irnportant: ELLENBERGER, H. F., The Story of Anna O.: a critical Review with new Data, Journal ofthe History ofthe Behavioral Sciences, 8, 267-269 (1972); JENSEN, E. M., Anna O. - a Study of her later Life, Psychoanalytic Quarterly, 39, 269-293, (1970); MEISSNER, W. W. A Study on Hysteria: Anna O. Redivivia, The Annual of Psychoanalysis, 7, 17-52 (1979); POLLOCK, G. H., The Possible Significance of Childhood Object Loss in the Josef Breuer -Bertha Pappenheim (Anna O.)- Sigmund Freud Relationship, Journal ofthe American Psychoanalytic Association, 16, 7 11-739 (1968), Bertha Pappenheim's pathological Mourning possible Effects of Childhood Sibling Loss, Ibid., 20, 476-493 (1972), and Bertha Pappe-eim: Addenda to her Case History, Ibid., 21, 328-332 (1973); and more-generally, S. REICHARD, A Re-examination of "Studies on H~steria", Psyckoanalytic Qmrtedy, 25, 155-177 (1956). 270 CARL. E. PLETSCH fortable about returning to the case. As Ellenberger notes, the case ((radically differ[ed] from other cases of hysteria [reported] at that time, but [was] analogous to the great exemplary cases of magnetic illness in the first half of the nineteenth century, ... » The case of Anna O. seems to have appeared to be a reversion to an earlier and ostensibly prescientific psychology. As Ellenberger reports, To the older magnetizers, Anna O.'s story would not have seemed as extaordinary as it did to Breuer. It was one of those cases, so frequent in the 1 8201s, yet so scarce in the 1880's, in which the patient dictated to the physician the therapeutic devices he had to use, prophesied the couqse of the iiiness, and announced its terminal date. But in 1880, when authoritarian use of hypnosis had supplanted the former bargaining therapy, a story such as that of Anna O. could no longer be understood (8). The anxiety of the two authors, therefore, must have been based on the kind and quality of case study they were reporting, and not only on the fact of reporting case studies. Case studies were common enough in medicine and neurology at the time. Just two years befores publishing Studies on Hystiera, Freud had published a conventional case history illustrating how effective hipnotism could be in clearing up symptoms in a case of hysteria (9). This was quite unproblematic since the case merely illustrated a relatively common medical procedure and appeared to validate a theory. In Studies on Hysteria, however, Freud and Breuer were admitting the lack of medical and physiological authority over hysteria and, by implication, attributing to the patients the knowledge and power to cure themselves. As Freud noted, their cases also had more of a literary than a scientific character (10). And that, taken in conjunction with the fact that Freud and Breuer were using their cases to illustrate yet non-existent theory, was what made Studies on Hysteria an anomalous book on an anomalous subject. Of course Studies on Hysteria consisted of more than merely case studies. The first chapter was a paper that Freud and Breuer had previously. published, a ((Preliminary Communication)) on hysteria, defi- (8) ELLENBERGER, H. (1970), op. cit., p. 484. This gives iníeresting relevance to a remark of Robert Darnton in his book, Mesmerism and the End of the Enlightenment in Frunce, Cambridge (Mass.), Harvard University Press, p. 173: «Works by nonmesmerists usudly honor Mesmer as a misunderstood and sometimes heroic prophet of modern psychology. It may be that psychoanalysis developed from a line of occult scientists, linking Freud, Charcot, and Braid with Bertrand, Puysegur, and Mesmer, just as chemistry emerged from alchemy.)) (9) A Case of a successful Treaunent by Hypnosis in: STRACHEY, J. et. al. (eds.) (1966), Standard Edition, vol. 1, London, Hogarth, pp. 1 15-128. (10) See below, p. 27 1. Freud's Case Studies and the Locus of Psychoanalytic Knowledge 27 1 ning their place on the frontier of research and distinguishing their approach from that of other investigators. And the book concluded with a ((Theoretical)) chapter by Breuer and a paper on catharsis as the essential ingredient of (tl'he Psychotherapy of Hysteria)) by Freud. Thus the two authors carefully bracketed their detailed case studies by theoreticd statements, giving their case studies the formal appearance of mere illustrations. But. this was an obligatory formality dictated by the norrns of scientific reporting, norms to which Breuer and Freud naturally subscribed. Nevertheless, the theoretical portions of Studies on Hysteria were the profoundly tentative portions and the case studies the real substance of it. OnXy in the case studies could the authors speak comfortably in the indicative mood -only there were they really sure of their ground. And there were good reasons for this, that Freud at least recognized. In his discussion of the case of Frau Emmy von N., also published in Studies ofHysteria, Freud noted the difficulties arising from the fact that hysteria was a diagnostic category without rigorous or commonly accepted definition: «UnXess we have first come to a complete agreement upon the terminology involved, it is not easy to decide whether a particular case is to be reckoned as a hysteria or some other neurosis.)) Of course the fact that hysteria was a poorly understood but notorious class of nervous disorders is precisely what interested Freud. One might say that hysteria was an acknowledged category of anomalous mental disorders in the 1890's. Anyone who could understand and define the nature of this disorder would clear up many mysteries in neuropathology. As Freud put it, «we have still to await the directing hand which shall set up boundary rnarks in the region of the commonly occurring neuroses and which shall bring out the features essential for characterization.)) In the meantime, however, (we are still accustomed to diagnosing a hysteria, ... from its similarity to familiar typical cases.)) Thus Freud explained the necessity of reporting case studies to himself by remembering that hysteria was not then a well understood disease, but anticipated that sonie great scientist -and in the very fact of his writing upon the subject we can see that he already anticipated the possibility that he might be that ((directing hand»- would clear up the confusion by defining the distinctive features of hysteria. Then hysteria would come in under the umbrella of medical science and case studies would no longer be necessary (1 1). (1 1) Standard Edition, vol. 2, p. 85. We also note that Freud expreses the germ of an idea of (tscientific revolutions)) in this passage. 27 8 CARL. E. PLETSCH possibility of an orderly recounting of a patient's life (25). Furthermore, Freud recognized that there were several stories to be told that could hardly be told simultaneously. In the Dora case he distinguished only between the narration of his interpretive technique and the reconstrvcted biographic story in which the patient's pathology had developed. But he no longer felt that he could weave these stories together as he had in Studies on Hysteria. i have in this paper left entirely out of account the technique, which does not at al1 follow as a matter of course, but by whose means done the pure metal of valuable unconscious thoughts can be extracted from the raw material of the patient's associations. This brings with it the disadvantage of the reader being given no opportunity of testing the correctness of my procedure in the course of this exposition of the case. 1 found it quite impracticable, however, to deal simultaneously with the technique of analysis and with the internal stmcture of a case of hysteria: 1 could scarcely have accomplished such a task, and if 1 had, the result would have been almost unreadable (26). Freud had learned a great dela about the epistemological status of the knowledge he was deriving from hysterical patients in the years since 1895. Paradoxically, what he had learned made him both more and less sanguine about the prospects of communicating this knowledge. He was much more aware of'the difficulties of demonstrating the validity of his observations and hypotheses to the medical world at large, but he had begun to see that other initiates and especially practitioners of psychoanalysis were in a peculiarly advantageous position to appreciate his case studies. Ernest Jones writes that we do not know why Freud hesitated so long to publish the Dora case, and strictly speaking that is true, but the way his thinking had changed since 1895 suggests a very strong reason. He simply,took his reservations about the case's incompleteness very seriously. And in view of the still almost complete lack of a psychoanalytic community in 1901, it is no wonder that he did not publish it then. In 1905 things looked different and the illustrative value the case held for other psychoanalysts outweighed his reservations about the possibility of its being appreciated by the uninitiated. (25) Standard Edition, vol. 7, pp. 16-18. (26) Ibid., vol. 7, pp. 12-13 and 112. Cited passage appears on p. 112. On p. 13, Freud writes that «Apart from the dreams, therefore, the technique of the analytic work has been revealed in only a very few places. My object in this case history was to demonstrate the intimate srructure of a neurotic disorder and the determination of its symptoms; and it would have led to nothing but hopeless confusion if 1 had tried to complete the other task at the same time.» This is an even more explicit recognition of the impossibility of reconciling the naturalistic narrative with the work of anaiysis. Freud's Case Studies and the Locus of Psychoanalytic Knowledge 279 Anyone seeking to understand what psychoanalytic knowledge is should try to understand Freud's dilemma at this juncture. 1 believe that if we cannot appreciatt: Freud's motives in considering whether to publish the Dora case, we may be reasonably sure that we do not understand the way in which psychoanalytic knowledge developed and how it is constituted. 111. LITTIE HANS AND THE RAT MAN When Freud finally decided to publish his account of Dora's case it was after four years of temporizingj as 1 have already pointed out. In fact, the paper had beeri accepted for publication as early as January, 190 1 by Ziehen, the editor of the Monatschrift für Psychiatrie und Neurologie, the same journal in which it actually appeared in 1905 (27). But this was the last of Freud's. case studies that was to appear in a medical journal not directly associated with the psychoanalytic movement. (Jones notes that Freud gave his last lecture before a medical audience in 1904.) Of course in 1900 when Freud worked with Dora and wrote the history of her case, he couldn't be expected to have had disciples or a journal devoted e~rclusively to psychoanalysis. It was only in late 1902 and 1903 that the first meetings of what was to become the Vienna Psychoanalytic Society were held in Freud's waiting room, and only in 1908 that the first ((internationa.1)) meeting of psychoanalysts was held in Salzburg. It was at the Salzburg meeting that the decision was made to publish a psychoanalytic periodical (28). As one might suppose, the Jahrbuch was founded in order to give the group its own forum in which to further develop psychoanalysis without the interference of the uninitiated -a step taken by the practitioners of virtually every emergent discipline or subdiscipline (29). Thus in 1909 Freud was able to publish his next two case histories in the first two numbers of the first psychoanalytic periodical, the Jahrbuch fUr psychoanalytische und psychopathologische Forschungen. These were his reports on the cases commonly known as Little Hans, Analysis of a Phobia in a Five-Year-Old Bay, and the Rat Man, Notes upon a Case of Obsessional Neurosis. In view of the circumstances in which they were (27) See the ((Editors Note)), Standard Edition, London, Hogarth, vol. 7, pp. 3-5 (1953). (28) See JONES, E. (1955), The Life and Work off-igmund Freud, vol 2, pp. 38-45. (29) See also Jung's prefatory statement in the first volume, and Jone's account of Freud's letter in which he expressed satisfaction at being rid of outside interference and able to communicate with his disciples in their own publication, ibid., p. 45. It is significant that this important step in creating a disciplinary matrix should have been marked on Freud's part by the contribution of two case studies (and no other communications) to the first volume of the Jahrbuch. 280 CARL. E. PLETSCH published, it should come as no surprise that Freud's accounts of these two cases should be devoid of that defensive sensitivity vis 6 vis nonpsychoanalytic readers which marked his account of the Dora case. The cases published in 1909 were clearly aimed at a readership of psychoanalysts, a readership which had only emerged in the time since the writing of the Dora case (30). The case of Little Hans especially gives the impression of a contribution entre nous, and it became the very first item in the first issue of the Jahrbuch. The sense of familiarity derives in part, of course, from the fact that the raw materials for the report were supplied by the little boy's parents, who were, according to Freud, ((among my closest adherents)) (3 1). According to Freud, too, he had «for many years been urging my pupils and my friends to collect observations of the sexual life of children)) in order to compare the data of such observations to hypotheses about early sexual life derived from the analysis of adults, e.g., those that he had published in the Three Essays on the Theory of Sexuality (1905). The case of Little Hans is the most obvious fmit of this request, something the parents of the child shared with Freud, and which Freud then shared with his other disciples. But there were important and positive theoretical reasons for sharing this case with psychoanalysts. Freud acknowledged that the hypotheses in the Three Essays, seem as strange to an outside reader as they seem incontrovertible to a psycho-analyst. But even a psycho-analyst may confess to the wish for a more direct and less roundabout proof of these fundamental theorems. Surely there must be a possibility of observing in children at first hand and in al1 the freshness of life the sexual impulsed and wishes which we dig out so laboriously in adults from among their own débris -especially as it is also our belief that they are the common property of al1 men, a part of the human constitution, and merely exaggerated or distorted in the case of neurotics (32). Here we see that Freud continued to regard the case study as somewhat inferior in significance to theoretical formulations, but accorded it an irnportant role in the confirmation of hypotheses, i.e., in the validation (30) The two cases constitute vol. 10 of the Standard Edition. (3 1) The father was Max Graf, a music critic and member of Freud's early circle who attended the ((Wednesday meetings)). It is interesting that this relatively simple case that Freud published for didactic reason done, and not because it illustrated any new complexities of technique or marked out any new territory of diagnosis, has been very little the subject of later psychoanaiytic investigation or writing. This would seem to confirm Freud's statements about the greater value of the cases on the frontiers of knowledge, even if they cannot be completely resolved, given in his account of the case of the Wolf Man. See below, p. 290. (32) Standard Edition, vol. 10, pp. 5-6. Freud's Case Studies and the Locus of Psychoanalytic Knowledge 28 1 process (33). It is also interesting to note that he seems no longer worried about the fact tlhat this is only one case. Working now in the context of what he was later to cal1 athe psychoanalytic movement)), Freud discovered another use for the case history -the pedagogical. In his conclusion to the Analysis ofa Phobia in a Rve-Year Old Boy he wrote that, Strictly speaking, 1 learnt nothing new from this analysis, nothing that 1 had not already been able to discover (though often less distinctly and more indirectly) from other patients analysed at a more advanced age. But the neuroses of these other patients could in every instance be traced back to the same infantile complexes that were revealed behind Hans's phobia. 1 arn therefore tempted to claim for this neurosis of childhood the significance of being a type and a model, ... (34). This is a particularly initeresting passage, in view of the tremendous irnportance that case studies, and particularly Freud's case studies, have occupied in the curriculum of the psychoanalytic institutes. The account of Little Hans's phobia and its removal constitutes the first psychoanalytic case study written largely for didactic reasons (35). Of course Freud had called his account of Dora's analysis ((suitable as a first introductory publication)), but with the scientific reading public at large in mind. In the case of Dora Freud wanted to demonstrate his understanding of hysteria; in that of Little Mans he wanted to show psychoanalysts how psychoandysis proceeds and that the sexual aetiology of adult neuroses could be confirmed in the analysis of a child. The different audience that Freud envisioned is crucial to the evolution of his thinking about the value of his case studies. Freud's report on his analysis of the Rat Man, Notes upon a Case of Obsessional Neurosis, confirms this impression about the intended readership to which Freud now directed his case studies (36). The case of (33) Ct JONES, E. (1955), The Life and Work ofSigmund Freud, vol. 2, pp. 258-262. (34) Standard Edition, vol. 10, p. 147. (35) It was also the first child arialysis, a practice later developed along slightly different lines by Melanie Klein. See her Psychoanalysis of Childra (London, Hogarth, 1932) and especidy her Narrative of a Child Analysts (London, Hogart). (36) The post-Freudian psycheoanalytic literature on the case of the Rat Man is abundant. See KANZER, M. (1952), The Transference Neurosis of the Rat Man, Psychoanalytic Quarterly, 21, 181-189; ZETZEL, E. 11. (1966), 1965: Additional Note upon a Case of obsessional Neurosis: Freud 1909, InternationalJournal ofPsycho-Analysis, 47, 123-129; MEYERSON, P. G. (1966), Comments on Dr. Zetz~l's Paper, ibid., pp. 139-142; LIPTON, S. D. (1971), Freud's Analysis of the Rat Man considered as a technical Paradigm, abstracted in Builetin ofthe Philadeiphia Associationfor Psychoanalysis, 21, 179183; CEDO, J. E.; GOLDBERG, A. (1973), Models ofthe Mind, pp. 11 1-1 14; and BEIGIER, J. S. (1975), A Commentary on Freud's Treatment of the Ilat Man, The Annual ofPsychoanalysis, 3, 27 1-286. 282 CARL. E. PLETSCH the Rat Man is less an illustration of a theoretical hypothesis than the case of Little Hans, and more an attempt to explore new ground, but it is therefore even more directly oriented to the psychoanalytic readership of the Jahrbuch. In noting the incompleteness of his account of the case, Freud explained that he had «not yet succeeeded in completely penetrating the complicated texture of a severe case of obsessional neurosis)). Furthermore, Freud noted that obsessional neuroses were far less easy to understand than cases of hysteria. This was paradoxical, since obsessional neuroses constitute not only «a dialect of the language of hysteria)), but ((a dialect in which we ought to be able to find our way about more easily, since it is more nearly related to the forms of expression adopted by our conscious thought than is the language of hysteria)). He suggested that the difficulty was due to the fact that fewer cases of obsessional neurosis had presented themselves for analysis, such neurotics finding it possible to ((dissimulate their condition in daily life)). In any case, obsessional neuroses constituted a pathology on the frontier of psychoanalysis, 'much like hysteria had been an anomaly in neuropathology when Freud began to study it. This is what made Freud feel justified in communicating his insights to the psychoanalytic community. In these circumstances there is no alternative but to report the facts in the imperfect and incomplete fashion in which they are known and in which it is leeitimate to communicate them. The crumbs of knowle~de offered " " in these pages, though they have been laboriously enough collected, may not in themselves prove very satis5ing; but they may serve as a startingpoint for the work of other investigators, and common endeavour may bring the success which is perhaps beyond the reach of individual effort (37). With this 1 believe we begin to see another pattern in Freud's thinking about his case studies: they are exemplary investigations, not necessarily solutions, to problems of psychopathology. He now thought of his case studies as parts of a scientific research literature to which other psychoanalysts would obviously contribute. Even his imperfect and incomplete case studies served to mark out the territory of future psychoanalytic investigations. In his conclusion to the sarne case, he expressed his wish that (([allthough my communication is incomplete in every sense, it may at least stimulate other workers to throw more light upon the obsessional neurosis by a deeper investigation of the subject)). Freud may have been given to false modesty on occasion, but this is not one of those (37) Standard Edition, vol. 10, pp. 156-157. Freud's Case Studies and the Locus of Psychoanalytic Knowledge 283 occasions. He was concerned here with the very difficult problem of demarcating obsessional neuroses from cases of hysteria, as we see from the same passage where he also states very vaguely that «What is characteristic of this neurosis -what differentiates it from hysteriais not, in my opinion, to be found in instinctual life but in the psychological field)) (38). This postulate remained to be further specified by other workers who would analyze cases of obsessional neurosis. Thus we see that Freud's diminished anxiety about the incompleteness of his cases and his confidence in the cooperation of his psychoanalytic followers go hand in hand. The case history had by this time achieved the status of a genre peculiarly suited to communication among psychoanalysts. Freud clearly saw both of his cases published in 1909 as a part of a ongoing process of psychoanalytic resebch. They were not merely places where acquired insight and knlowledge could be deposited (for the benefit of the world at large), buu a genre which fomented further research by investigators who had already gained ..a conviction of the value of psychoanalysis. Freud said little enough about the transference in these two case studies piiblished in 1909, but that may be precisely because these are cases written for psychoanalysts and psychoanalysts understood this matter by then. There is good evidence in remarks he made for nonpsychoanalysts on the subject of transference in the sarne year, that he believed that experience in analysis was a prerequisite for the appreciation of the validity of insights derived from psychoanalysis. In his Five Lectures on Psychoanalysis given at Clark University in 1909, Freud stressed that the experience of ti-ansference plays a decisive part in bringing conviction not only to the patient but also to the physician. 1 know it to be true of al1 my followers that they were only convinced of the correctness of my assertions on the pathogenesis of the neuroses by their experiences with transference; and 1 can very well imderstand that such certainty of judgement cannot be attained before one has carried out psycho-analyses and has oneself observed the workings of transference (39). This conviction that his followers had verified the value of his insights by their own experience with the transferences of their own patients must be seen as an important part of the basis of his new attitude about case studies. The experience of transference that Freud now began to presuppose in the readers of his case studies can be viewed with extreme skepticism (38) Zbid., vol. 10, p. 248. Cf: JQNES, E. (1955), The Life and Work ofSigmund Freud, vol. 2, p. 264. (39) Zbid., vol. 11, pp. 51-52. 284 CARL. E. PLETSCH or it can be casually accepted as specialized training. It can be viewed as no more than the psychoanalytic analogue of the prerequisite training presupposed in the scientific reports of every other specialized discipline, from psychics to statistical demography. Or, experience with the transference in the prospective psychoanalyst's own analysis and in the supervized analysis of his first patients can be taken as a rite of initiation bound to produce believers and thus a highly unscientific community of investigators. It seems to me that there is at least a modicum of truth in both of these positions, and futhermore, that there is little prospect of resolving the issue to the satisfaction of al1 those who adopt the opposed attitudes. This much must be admitted. In fact, the two positions form the parameters that give rise to the question of psychoanalytic knowledge. For if psychoanalytic training, analysis, etc., is both scientific training and religious rite of initiation, then psychoanalysis is neither simply science nor religious pseudo-science. What strikes me as more interesting, however, is that this experience with the transference in the analytic situation that Freud prescribed might be the complement of the case studies in defining the peculiar nature of psychoanalytic knowledge. For 1 began by noting that psychoanalitic knowlegde seemed anomalous in being located in case studies. Now in the process of demonstrating the evolution of Freud's own thinking toward this view, we have discovered that experience with the transference is a prerequisite to understanding the cases Freud reported. The transference seems to be the particular kind of ((personal knowledge)) required of the psychoanalyst. But unlike the many examples of personal knowledge given by Polanyi in his book by that name, the transference is only useful when the psychoanalyst is acutely conscious of it. Unlike the many skills that we learn without being able to describe them adequately or explain them theoretically, and by definition unlike tacit knowledge, transference is a kind of knowledge that depends upon the psychoanalyst's ability to articulate it. Thus it may be that the transference is more thoroughly ((personal knowledge)) than the skills that other scientists learn by empathy and imitation from their teachers. It seems to constitute a form of intersubjectivity that can only be defined as articulated ((implicity)), or, in psychoanalytic terms, the unconscious made conscious. This would seem to be what makes it both highly subjective and yet a shared medium of communication that constitutes the basis of the psychoanalytic community of investigation. IV. THE SCHREBER CASE Freud's analysis of Daniel Paul Schreber's delusion was published in the Jahrbuch für psychoanalytische und psychopathologische Forschungen in 19 1 1. Freud's Case Studies and the Locus of Psychoanalytic Knowledge 285 This essay, Psychoanalytic Notes on un Autobiographical Account of a Case of Paranoia, is not a case study in the same sense as the others i am considering here, inasmiich as Freud had no personal contact with Schreber, nor did Schreber himself have any experience with psychoanalytic therapy (as even Little Hans had). Schreber had, however, written an elaborate account of his mental illness, and published it as his Memoirs ofa Mental Patient (40). Freud used these published memoirs as the basis of his analysis. Nonetheless, the case is again presented primarily to psychoanalysts rather than to the medical world at large. Thus we may note that by this time Freud's thinking on his case studies had progressed so far that he made no rhetorical use of the fact that the patient's autobiographicd account was in the public domain. He might have argued that this would give his analysis an objectivity that his earlier case studies did not possess, opening it to the review of other professionals interested in paranoia. But he was no longer concerned in his case studies with establishing his greater capacity to deal therapeutically with a particular form of mental illness. He was still very much concerned that other psychoanalysts should read the case and assimilate his analysii; of it, however. In this respect, Freud's case history of Schreber bears some similarity to his treatment of Wilhelm Jensen's story ((Gradivm, which also verged upon becoming a case study of its author (41). Freud's most general aim in writing his acount of Schreber's illness was to establish the nature of paranoia and its location among other psychoanalytically understood mental disorders. As he had been at pains to distinguish obsessional neuroses from hysteria in his account of the analysis of the Rat Man, in his essay on Schreber Freud wanted to establish paranoia as a diagnostic category by penetrating to its defining features too (42). Al1 of this ought to remind us, 1 think, of his original anticipation in Studies on Hysteria, of «the directing hand which shall set up boundary marks)) among the various mental disorders. But the difficulties in the area of paranoia were particularly grievous and led to the fact that Freud was compelled to base his discussion of this disorder upon a written account rather than an analysis. People suffering from paranoid delusions were not apt to submit to psychoanalysis, a process (40) Denkwurdigkeiten eines Nenienkranken (Leipzig, Mutze, 1903), an English traslation was made by Ida Macalpine and Richard Hunter and published with an introduction as Memoirs of my Nenious Zllness (London, Dawson, 1955). (41) ((Delusions and Dreams in Jensen's Gradivm (1907), Standard Edition, vol. 9, pp. 7-95. (42) On which, see chapter three of the essay, «On the Mechanism of Paranoia)), Standard Edition, vol. 12, pp. 59-79. 286 CARL. E. PLETSCH which would naturally elicit al1 their fears of persecution and cause them to ascribe the persecutions to the psychoanalyst. Having virtually no paranoid patients, therefore, and retaining those that he did encounter for only the very briefest periods, Freud found himself forced to fely upon the serendipitously published account of Schreber. Thus his apologies for the fact that under these circumstances he was not able to analyze the transferences .of the patient in the now well established analytic context (43). In view of al1 of these dificulties, it is al1 the more interesting and revealing that Freud should have chosen to convey his insights on paranoia in the form of a case history. The Schreber case seems to demonstrate the significance of case studies as the privileged genre of psychoanalytic knowledge in a negative way. Freud found it natural to make his arguments about paranoia in the context of this case study, even without transference, free association or even any personal contact with the subjetct, because no other mode of reporting constituted a plausible alternative. To be sure, the inclination Freud obviously felt to anchor his thinking on paranoia in Schreber's memoirs may stem as much from the unusually florid nature of the pathology of this particular case as from the impossibility of giving a convincing account of paranoia in a more abstract mode. But whatever the mixture of motives, the incontestible fact is that Freud's report on the Shreber case has remained the cornerstone of psychoanalytic thinking on paranoia to this day (44). In his ((Attempts at Interpretation)), the second chapter of the essay on Schreber, Freud noted that his readers would ((only follow him as far as their own familiarity with analytic technique will allow them)) (45). But the case is a good illustration of how Freud's psychoanalytic colleagues did in fact follow him and by their own attention to Schreber's memoirs amplie the conclusions that could be drawn from a single case study. A year after his publication of the essay on Schreber, Freud noted that, By a happy chance the same issue of this periodical [the Jahrbuch] as that in which my own paper appeared showed that the attention of some other contributors had been directed to Schreber's autobiogaphy, and made it (43) Standard Edition, vol. 12, p. 9. (44) Of the enormous literature on the Schreber case, see especially the book by NIEDERLAND, W. G. (1974), The Schreler Case psychoanalytic Profile of a Paranoid PersonaliQ, New York, Quadrangle, which contains good bibliographies of earlier work on Schreber. There was, for instance, a Symposium on the case, papers from which were published in the Znternational Journal of Psycho-Analysis, 44 (1963), edited by Philip M. Kitay. Other recent work on Schreber is represented by CEDO. J. E.; GOLDBERG, A. (1973), Models of the Mind, pp. 125-134; and MEISSNER, W. W. (1979), Schreber and the Paranoid Process, The Annual of Psychoanalysis, 7, 3-40. (45) Standard Edition, vol. 12, pp. 36-37. Freud's Case Studies and the Locus of Psychoanalytic Knowledge 287 easy to guess how much more material remains to be gathered from the symbolic content of the phantasies and delusions of this gifted paranoic (46). Of course Ernest Jones and other writers since him have suggested that Freud's remarks about paranoia in his account of the Schreber case sowed the seeds of the soon to be accomplished disassociation of Carl Jung and his followers from Freud, and the eventual disaffection of Sandor Fernczi (47). But so far from suggesting that Freud's essay failed in its role of exemplar to help maintain the coherence of the psychoanalytic community of investigation, this demonstrates the power of the case study to define the boundaries of the nascent discipline. Reading Freud's case studies, it seems, not only guided and educated Freud's willing followers, but could also serve to separate less orthodox analysts from the movement. In fact, Freud's next case study would be even more important in separating errant analysts. V. THE WOLF MAN Freud's analysis of the case of the Wolf Man, his last lengthy case study, was written in the winter of 19 1415, entitled From the History ofan Infantile Neurosis (1 91 8), and published in his Kleine Schriften, since the war had interri~pted the publication of the Jahrbuch for which it was intended. It quite elaborately illustrates the fact that Freud had come to use his case studies to educate and influence the thinking of his fellow psychoanlysts rather than the medical world at large. In fact, Freud used the case of the Wolf Man to arbitrate his differences with Adler and especially with Jung. As he noted in regard to the context of his writing the case, At that time 1 was still freshly under the impression of the twisted reinterpretations which C. G. Jung and Alfred Adler were endeavoring to give to the findings of psychoanlysis. This paper is therefore connected with my essay "On the History of the Psycho-Analytic Movement" which was published in the Jahrbuch der Psychoanalyse in 1914. It supplements the polemic contained in that essay, which is in its essence of a personal character, by an objective estimation of the analytic material (48). It should not escape our notice that in linking this essay «On the History of the Psychoanalytic Movement)) to the case of the Wolf Man here, Freud calls the latter ((objective)) and implies that the former is more (46) Ibid., vol. 12, p. 80. (47) JONES, E. (1955), Tke Life and Work of Sigmund Freud, vol. 2, pp. 268-269. (48) Standard Edition, vol. 17, p. 7. 294 CARL. E. PLETSCH knowledge par excellence. Not that they constituted the only kind of psychoanalytic knowledge. As a first distinction, one might contrast this knowledgeforpsychoanalysts deposited in the case studies with the knowledge ofpsychoanalysis that Freud purveyed in his more expository and theoretical works (62). A detailed investigation would undoubtedly yield many further distinctions based upon differences in the ways in which psychoanalytic knowledge is transmitted and the uses to which it is put (63). There are, in other words, many discourses of psychoanalysis. But we do not need to begin by knowing everything; i.e., we do not need to make an exhaustive study of al1 the differing discourses of psychoanalysis before we can begin to distinguish psychoanalytic knowledge from other forms of knowledge. if case studies are indeed the genre of peculiarly psychoanalytic knowledge -the kernel of Knowledgeforpsychoanalystswe should begin our description of psychoanalysis and psychoanalytic knowledge here. Freud's oeuvre opened the discourse of psychoanalysis, but it seems that all the fissures that have developed in psychoanalytic discourse since Freud are prefigured in the fissures of Freud's writing. 1 have traced only one of these fissures, showing that behind the explicit difference between the genres of Freud's writing intended for different audiences there lay a tension between the positivistic notions of science that Freud had imbibed with his medical education, in which theory predominated, and another notion of knowledge that arose out of or was produced by the psychoanalytic mode of knowing itself. The view of knowledge implied in Freud's increasing reliance upon case studies, the view that can be compared to a combination of Kuhn's exemplars and ; Polanyi's personal knowledge, never fully triumphed over Freud's ; commitment to theory and its veracity. But even though this view never came to predominate in Freud's mind, we are justified in according it the status of a distinguishing feature of psychoanalytic knowledge. For it represents the most radical departure from the tradition of positivistic scientific discourse in Freud's oeuvre, and we may assume that Freud (62) 1 do not allude to Clifford Geertz's distinction between ((model of~ and ((model for» here. That is quite different. (63) As far as the knowledge of psychoanalysis that is had among non-psychoanalysts is concerned, psychoanalysis is obviously one thing for the psychoanalytic patient who has come to know psychoanalysis through his or her own experience in analysis and another for the academic student of psychoanalysis who has read Freud's treatises by not experienced analysis. And similarly, the psychoanalytic knowledge acquired by psychoanalists has many other components than mere ly the case studies, e.g., what they learn from their own training analyses, what they appreciate about the concerns of their fellow analysts, what they read about analysis, etc. Fraud's Case Studies and the Locus of Psychoanalytic Knowledge 295 would not have permitted himself to be drawn into such a departure if his rnethod and the exigency of communicating with his followers had not pulled him in that direction. Ironically, this story of how Freud came to view his case studies as the locus of peculiarly psychoanalytic knowledge -in spite of himself and his positivistic trainingis a story that could appear in an unreconstructed history of science. Without much exaggeration, we can say that the data forced Freud to this view. But Freud's data were not the inert data. of the nineteenth century physical science. His data were patients, their dreams, their slips of the tongue, and ultimately their transferences and Freud's countertransferences. Freud's ambition to solve the problem of hysteria gradually led him to transform the instrusive hypnotic therapy he learned from the French into a method of intersubjectivity. In this he allowed himself to be instructed by the patients, starting with Anna O. But this method of intersubjectivity -analyzing transferencesyielded knowledge that Freud found it difficult if not impossible to convey to readers in the usual genres of scientific communication. He found himself organizing a community of investigators who experienced transference in their own analyses (often with Freud) and in their analyses of patients. For this community, the case study proved the ideal genre of communication. Thus Freud was forced to his novel view of knowledge by two strictly social configurations: his relationships with his patients and with the scientific communities, first of medicine and physiology and later of psychoanalysis. This brings us squarely back to the asertion that the question of psychoanalytic knowledge is a question of discourse. For the two relationships that pulled Freud toward his view of psychoanalysis as personal, exemplary knowledge in the case studies turn out to be the irreducible axes of psychoanalytic discourse. The discourse of analyst and pa.tient is psychoanalysis in the sense of a practice, and the discourse of analyst and fellow analysts is psychoanalysis in the sense of a discipline. Without these two levels of discourse any other is unthinkable. Every other discourse of psychoanalysis derives ultimately from one or both of these. Freud's case studies (and the case studies published since) are of course not identical with these two levels of discourse. But of al1 the writings of Freud and his followers, it is in the case studies that the discourses of analystlanalysand and analystlfellow analyst are most fully precipitated. The discourse of analystlanalysand cannot by its very nature be replicated for a reader. As Freud noted in his report on the case of the Wolf Man, a verbatim transcript of the words exchanged in a 296 CARL. E. PLETSCH whole analysis would be completely inadequate for representing that analysis to a third party (64). But rather than transcribe analyses, Freud gradually devised the case study as the vehicle and nearest approximation of the intersubjectivity that obtains in an analysis. This approximation can be deciphered by other analysts who have experienced trahsference in the analytic situation. Thus the discourse of analystlfellow analyst is much more clearly reflected in the case studies, but again, the relationship is not one of equivalence. The case studies are a sediment of this discourse, whereas they are translations of the discourse analystlanalysand. But in the case studies we hear only one voice in the discourse between analysts, the voice of Freud. And we can only attempt to infer and extrapolate from that voice the nature of the discourse arnong psychoanalysts. With these reservations we can still conclude that the case studies constitute the most characteristic and specifically psychoanalytic knowledge in the Freudian oeuvre (65). Looking back then, what does the evolution of Freud's attitude as he wrote the case studies reveal? Freud's awareness of the significance of the case study emerged hand in hand with his realization that psychoanalysis cg>nstituted a new kind of knowledge. Early in his career as a psychoanalyst, when Freud thought his insights and discoveries to be valuable merely as increments of familiar scientific knowledge, he was still oblivious to the importance of his reports on particular cases, even embarrassed by them. Only when he began to realize that his new insights might constitute a new kind of knowledge did he begin to realize that they required a novel sort of reportage. Thus the case studies lead ' us not only to an appreciation of an important fissure in psychoanalysis -the distinction between knowledge for psychoanalysts and the knowledge of psychoanalysisthey lead us to an awareness of the fissures in knowledge in general. In its most characteristic form, psychoanalytic knowledge cannot be adequately described as science or pseudoscience. As a discourse, one discourse or set of discourses among many others, it must be described as one of many kinds of knowledge. To confront the question of psychoanalytic knowledge, we must bracket the question of science. (64) Standard Edition, vol. 17, p. 13. (65) The tensions between the discourse of the anaiyst with himself, the anaiyst with the pauent and anaiyst with fellow analyst consutute fissures within the discourse of the case studies itself. To examine these a specifically literary method would be necessq. The place to start would be with Gerard Genette, (#rontieres du recitr, Figures 11 (Paris, Seuil, 1969), pp. 49-69, and ((Discours du recio, Figures 111 (Paris, Seuil, 1972), pp. 67-282. Freud's Case Sfudies and the Locus of Psychoanalytic Knowledge 297 Early in his career Freud was positively intoxicated by the aura of natural science and his highest ambition was to make his mark as a scientist. As he noted in his Autobiogfaphzcal Study, and other places, Freud had never been motivated by inclination to be a heder or therapist. Curiosity and ambition led him to science (66). The role of scientific ambition is especially clear in The Inteqretation of Dreams where he put forward such pseudo-theories as that every dream must be the fulfillment. of a wish. Formulae of this sort have enabled philosophers of science like the neo-positivist Karl Popper to categorize psychoanalysis as a ((pseudo-science)). Popper claims that ((no description whatsoever of any logically possible human behavior can be given which would turn out to be incompatible with the psychoanalytic theories of Freud)) (67). Thus many of Freud's theories appear to be untestable and unscientific. This is a criticism that psychoanalysts find difficult if not impossible to answer. But 1 have tried to show that it is an inappropriate criticism. Certainly it is an uninteresting one (68). If 1 have been right in showing that the case study gradually emerged in Freud's work as the locus of the most specifically psychoanalytic knowledge, then criticism that supposes psychoanaly-sis to-be located in theories is surely misplaced. That is not to suggest that psychoanalysis is immune to criticism, of course. A knowledge located in exemplary case studies and communicated as personal knowledge may have grave problems of its own, but they are different problems than those of theoretical sciences. -- (66) See ((Autobiographical Study)), Standard Edition, vol. 20, pp. 8 and 71-72, and «Th Question of Lay Analysis)), Standard Edition, vol. 20, pp. 253-254. (67) POPPER, K. R. (1972), Objective Knowledge: an evolutiona~y Approach, Oxford, Clarendon, p. 8. '68) That may be why Popper has not pursued the matter further than in a few snide remarks about psychoanalysis in passing.