Conversations and Controversies between Psychoanalysis and Efficacy

Abstract

The present article intends to reflect on the current and controversial debate surrounding the possibility of evaluating psychoanalytical treatment's efficiency, efficacy, and effectiveness. Psychoanalysts have found different viewpoints on this issue. Still, we believe that, before choosing any position, we should thoroughly analyze what these evaluation parameters propose. In this article’s point of view, such debate is based on criteria established not by scientific or clinical research but by business and management fields. In conclusion, it is argued that, before establishing temporary parameters (even in science), it would be more interesting to try to delimit problems and concepts in the psychanalysis field that could set up and support an epistemological discussion.

Keywords:
psychoanalysis; epistemology; efficacy

Resumo

No presente artigo pretendemos refletir sobre o controvertido debate atual em torno da possibilidade de uma avaliação da eficiência, eficácia e efetividade do tratamento psicanalítico. Encontramos diferentes posições entre os psicanalistas a respeito deste debate, mas acreditamos que, antes de qualquer posicionamento, temos que estabelecer uma análise do que é proposto por esses parâmetros de avaliação. Defendemos a ideia de que este debate se fundamenta em critérios estabelecidos não por pesquisas científicas ou clínicas, mas por parâmetros provenientes do campo da administração. Concluímos que, antes de se estabelecerem parâmetros, que mesmo em ciência se apresentam sempre como provisórios, seria mais interessante buscar delimitar no campo da própria psicanálise problemas e conceitos que possam estabelecer e sustentar uma discussão epistemológica.

Palavras chave:
psicanálise; epistemologia; eficácia

In 1913, Freud (1913/1987a) wrote the text “Scientific Interest in Psychoanalysis” (erroneously translated as the ambiguous “Scientific Interest for Psychoanalysis”), in which he takes stock of the intersection between psychoanalysis and various sciences and how psychoanalysis may interest them. The concepts of unconscious, drive, and infantile sexuality, to mention just three established in psychoanalysis by Freud, have become topics of discussion by authors of philosophy, biology, and gender studies. In a search for citations of this text by Freud on Google Scholar, we can find 274 articles from various fields: education, gender studies, politics, sociology, philosophy, epistemology, and aesthetics, demonstrating that Freud was right in pointing out that psychoanalysis could arouse the scientific interest of different disciplines.

Thus, it is not surprising that in this debate between psychoanalysis and the other sciences, one question arises again: what is the scientific validity of psychoanalysis? This issue can arise in a variety of ways and is of interest to various fields of knowledge, as “The Black Book of Psychoanalysis” (Meyer, 2011) demonstrates. Criticism comes from neuroscience, sociology, and the clash between various psychotherapies, philosophy, and epistemology fields. Contemporary criticism of psychoanalysis asks for its efficacy based on criteria established not by scientific or clinical research but by parameters from the business and management fields. It is argued that a scientific practice would be more effective and would reduce the costs of public and private investments. To optimize efficacy, research seeks to be based solely on evidence, moving closer to the evidence-based medicine model.

Interestingly, given this scenario, observing how some psychoanalysts position themselves in this debate calls attention since they are very diverse: some psychoanalysts flatly refuse the debate because it would be a submission to the power of science; others who advocate a good coexistence with the critics due to their social capital today, and others who try to evaluate psychoanalysis according to the parameters proposed in the previous paragraph. Before any positioning, it is necessary to establish an analysis of what are the proposed psychoanalysis evaluation parameters. Then, this paper aims to discuss how we can think of an epistemic position for psychoanalysis based on psychoanalysts’ elaborations on efficacy, effectiveness, and efficiency.

The Limits of Effectiveness Criticism

We could ask - a question that is, or should be, imposed on all academic work - about the meaning behind the production of this article. Why reflect on the current proposals for verifying psychoanalytic practice’s efficacy, effectiveness, and efficiency? We know psychoanalysis has gone beyond the in-office psychoanalytic clinic's boundaries to penetrate the social universe widely. Countless community intervention, public health, and psychosocial scope projects adopt a psychoanalytic orientation. In this sense, Freire and Costa Pereira (2011) announce that it is important to reflect on evaluating the results of clinical work in psychoanalysis, as psychoanalytic practice “is increasingly becoming a challenge for mental health professionals who adopt epistemology and psychoanalytic method as a therapy, especially in public institutions” (Freire & Costa Pereira, 2011, p. 156).

According to Nogueira Filho (2000), it is imperative to establish clear-cut criteria for evaluating the effectiveness of psychotherapeutic practice, which comes from the “growing regulatory fury - inspired by the North American legal system - arising from the growing economism in health services” (Nogueira Filho, 2000, p. 93). However, even though it is important to recognize the need for dialogue with the scientific community, it seems it is important to emphasize “the immediacy and practicality trait present in mass culture as one of the factors contributing to psychotherapeutic activity exhibiting the speed mark as well” (Nogueira Filho, 2000, p. 94).

Nogueira Filho (2000, p. 94) states that since its appearance, psychotherapy has received “the seal of an exotic practice [...] After all, how psychotherapies exert their efficacy is the word and does not presuppose any action of any other nature on the subject who undergoes them”. We can also mention Fontoni’s considerations when remembering that the American Psychological Association (APA) postulated that psychotherapeutic practices should not have any theoretical orientation but be based on “scientifically” proven evidence. With this, based on psychoanalysis with a Winicotinian matrix, Fontoni (2015, p. 114) will say that we could, as “psychoanalytic scientists, launch ourselves into the endeavor of conducting more studies that meet current demands”. He tells us this supported by Zeliko Loparic’s (2008) assertion that meeting this requirement would be a necessity for the survival of psychoanalysis itself.

We have here four works that do not fail to raise the problem of effectiveness and try to find ways out of the impasses that these questions pose for psychoanalysis without falling into the easy Manichaeism of refusing criticism. Nevertheless, we can ask whether this way of stating the problem is the only or the most interesting one from an epistemological perspective. Indeed, in this entire discussion, we see arguments that have been repeated since Freud’s time. The seal of exoticism attributed to psychotherapy emerges from which voice? Is the accusation of exoticism not based on a deaf speech to what is not objectively measurable regarding effectiveness, efficacy, and efficiency? Is not this discourse that prevents debate when we find the APA’s recommendation that psychotherapies should not have any theoretical orientation, as if it were so obvious that the notion and direction of cure should be established based on each treatment or the evidence of each treatment, without considering a theoretical model? We believe this is partly due to taking the notions of effectiveness, efficacy, and efficiency as given or obvious.

Firstly, as psychoanalysts, we have to say that these notions are not so obvious, just as our concepts are also unclear to those who defend this paradigm in the current debate. While questioning where they come from and their meanings, it is important to consider why the scientific validity of psychoanalysis arises with certain violence. This violence is observable, for example, in several articles in the “Le Livre Noir de la Psych-Analyse: Vivre, Penser et Aller Mieux sans Freud”, in which several authors have a single and unquestionable purpose: to demonstrate that psychoanalysis is charlatanism for not meeting the discourses of efficacy, effectiveness, and efficiency, even ignoring the letter of the text from a metonymic style of argumentation in which the arguments do not hold up, as Bracks Faria and Calazans (2015) have shown.

Let us see how we can think about these concepts of efficiency, effectiveness, and efficacy raised to evaluate psychoanalysis. According to Brotti (2004), the notion of efficiency arises in the theoretical discussions of the Classical School of Administration in the context of the emergence of the Industrial Revolution.

The definition of efficiency is linked to the idea of maximizing production and minimizing consumption of the materials used for production. In the sequence of a presentation by a series of authors, Brotti distinguishes among efficiency, efficacy, and effectiveness as follows, but always within the scope of origin that is the organizational management:

Efficiency is oriented towards optimizing the production/consumption ratio: it refers to the internal performance of the organization, achievable through a predominant orientation towards methods, norms and techniques that emphasize the faster execution of productive processes, with less effort and at lower costs [...]. Efficiency is, in short, the economic performance criterion that reveals the administrative capacity to produce maximum results with minimum resources, energy and time [...]. Effectiveness is the managerial performance criterion that reveals the administrative capacity to achieve the established goals or proposed results [...]. Effectiveness is the political performance criterion associated with the capacity to produce results that correspond to society’s expectations. The notion of effectiveness presupposes a real and genuine commitment to the social objectives and political demands of the community. (Brotti, 2004, p. 85-88)

It is interesting to go through these concepts before returning to the analysis of the most specific questions concerning psychoanalysis, at first, to demonstrate that they are notions and not operations that impose themselves: when we say that they arise in the context of the Revolution Industrial and to think about production, it is because the issue of evaluation procedures using these parameters is located directly in the capitalist discourse, which does not fail to have a specific notion of what a subject is - a worker producing for someone. If the subject does not produce for someone due to a symptom that makes him unproductive, then we have the clinic that emerges in this context to remove this symptom so that the subject can become productive again, regardless of the causality or questions that may surround the emergence of this symptom. We cannot fail to consider here the articulation we found at the end of the 19th century between neurasthenia and productivism demands, remembering that Freud did not create psychoanalysis just by dealing with hysteria but also with cases of chronic fatigue (neurasthenia) or trauma that arise from new working conditions, as Mario Eduardo Costa Pereira states:

An important aspect of Beard’s theory on neurasthenia, to which Freud was particularly sensitive, was that this 'new nervous disease' would depend on certain specific sociocultural conditions. According to Beard, this situation would be related to the American lifestyle. “Energy consumption would be at the root of this neurosis due to the American man’s hectic life, under stress by an industrial society in a development crisis” (Costa Pereira, 2002, p. 173).

Secondly, these concepts are discussed to verify that these notions reach the health field not through the impasses of the clinic itself but through the management practice of Evidence-Based Medicine. This practice aims to make the “practice of medicine more effective and efficient, consequently, more scientific, which results in better benefits for the patient, doctors, and health professionals” (Berwanger et al., 2005, p. 120). Through the meta-analysis method, research/interventions aim to reduce costs, even if the risk is to ignore what is happening to the subject. The issue becomes more complex when we move this practice into the field of the subject's suffering, where we do not have the biological markers to determine the cause of the illness and where the use of statistics to indicate the diagnosis has already been widely questioned, both by psychoanalysts and physicians, especially concerning making clinical epidemiology exist, in which the singularity of a case would be approached no longer from its specificities, but data established through population statistical treatment (Barata, 1996).

On the other hand, several authors consider that criticisms of efficiency, efficacy, and effectiveness cannot be discarded. Examples of this statement can be found in Nogueira Filho, for whom, “although it is easy to criticize this research, this does not authorize representatives of the various lines of thought to treat this issue with disdain” (Nogueira Filho, 2000, p. 94), and Freire and Costa Pereira (2011, p. 156), who make the following consideration:

It is interesting to see how pertinent and well-founded some of these criticisms are, because although the excellence of psychoanalytic work - both public and private - is seen among peers at Congresses and Symposia, for the most part this excellence within the walls does not go beyond its borders.

These authors present us Parloff’s critique of the lack of criteria for scientific proof of psychotherapeutic practices in his article “Psychotherapy research evidence and reimbursement decisions: Bambi meets Godzilla,” in which:

The researcher spared no criticism of the lack of criteria for proving the various modalities of psychotherapy because, besides the harm to patients, this absence would bring enormous economic damage to government mental health policy worldwide since spending on psychotherapeutic techniques without proof of efficacy would eventually become a huge drain on public investment, to the detriment of the population’s mental health. (Freire & Costa Pereira, 2011, p. 157)

Within this perspective, we already have psychoanalyst researchers in Brazil committed to using effectiveness parameters. In 2007, research was published on the “Assessment of Psychoanalytic Psychotherapy Outcomes” in a Psychiatry magazine in Rio Grande do Sul (Jung et al., 2007), whose authors, coming from psychology, psychiatry, and psychoanalysis, are inserted in public and private universities, as well as in institutions outside the academia (Eizirik, for example, is the IPA president). The evaluation was conducted using a questionnaire - the effectiveness questionnaire - and recorded semi-structured interviews. The DSM-IV-TR axis five global assessment of functioning scale and statistical analysis were also used to detect clinically relevant differences. So, we see all the classic procedures to respond to the criticism presented by Freire and Costa Pereira (2011) and answer whether psychotherapy is effective.

However, even agreeing with the argument that we cannot treat the issue with disdain, we partially disagree with Freire and Costa Pereira’s propositions for three reasons. The first is that the authors take the concepts on which the critique of the validity of psychoanalysis is based as obvious, even though the critics of psychoanalysis do not bother to go beyond their field of work and find out what is going on in the psychoanalytic field as well. Perhaps this is more a discussion related to questions of power than knowledge: there is a hegemony of university discourse which, while imposing this agenda of validity, obscures the meaning of what is being discussed, as previously mentioned, based on the argument that the ideas of efficiency and efficacy are also articulated in a speech and, therefore, cannot be placed as universal parameters for all discourses. To whom are extramural about taking our signifiers? Certainly not to the supporters of evaluation, who do not even intend to study what psychoanalysis has to say, and much less are open to a debate, except for their terms, which implies not accepting to understand any other concept. The extramural would be the lay public, for whom the notions of efficacy and efficiency are as unfamiliar as those of desire or unconsciousness.

The second reason is that procedures for evaluating efficacy, effectiveness, and efficiency in the clinical field of subjective suffering can bring the most varied results, allowing us to question the application of these procedures in the problems in question here. When performing a meta-analysis to determine which therapies are the most effective, Leichsering and Rabung (2008) concluded that psychoanalysis would be more effective than short-term therapies and that its positive results are independent of age, sex, subgroups, or subjects’ previous experiences with therapies. They also concluded that psychoanalysis would have more noteworthy results in isolation than psychotropic drugs. However, as they claim to be a fact of reality, these arguments about the efficacy of the results of a psychotherapeutic process can be used in any discourse, which hinders them from being taken here as evaluation parameters.

The third reason is the argument to analyze the efficacy issue well. A comparison should be made with the results of a medicinal intervention. This is because it is implied that descriptive psychopathology is only possible because of incipient research into the investigation of biological causes, which does not allow us to avoid the indiscriminate use of drugs for illnesses whose causes are unknown. The question of efficacy always undermines this matter of the biological cause of subjective suffering. As Pignarre (1999, p. 15) tells us, “In the end, the question of efficacy is most often observed by tautological reasoning, and the criteria by which we choose to determine efficacy are never neutral”.

Thus, a new question arises: in the field where we operate with the subject and desire, can we reduce it to an organism and operate only based on medication? Or, more precisely, is a drug a pure producer of subjectivity, and can it operate without the suggestion device? What is a drug so we can operate from it without the subjective relationship, only technically? These are the issues that two epistemologists, François Dagognet and Phillipe Pignarre, one of whom is also a doctor, have been asking since the 1960s.

A first definition that can bring us closer to the issue is through an important differentiation: a molecule that acts on an organism is not the same thing as a drug. A molecule has biologically identifiable effects; medicines, conversely, “constitute a way of linking the biological to social” (Pignarre, 1999, p. 15). In this connection, we can consider why the drug takes many aback: it does not cease to have a libidinal value, which means that use and, especially, abuse occur more due to the place they can occupy in a subjective dynamic than due to the possibility of having a molecule operating under experimental conditions.

Another criticism of psychoanalysis efficacy is the failure to use the “double-blind” experimental procedure. This procedure is characterized by dividing the research subjects on the medicine efficacy into two groups, one receiving the drug itself and the other just a simulacrum, popularly known as a placebo. The big question in this type of research is determining whether a medicine intends to cure what it intends to cure and the proportion of only suggestive effects. In short, the goal of this procedure is to isolate the strictly objective factor of a medication. However, this experimental procedure in pharmacology only began to be widely used after the Second World War. So, we can wonder whether the yesteryear medicines were ineffective. “Western medicine defined itself as modern and scientific long before this proof existed and was the subject of a prescribed and rigorous methodology” (Pignarre, 1999, p. 18).

However, the big issue here is that the double-blind procedure aims to eliminate from the field what we can call empiricism: what does not have full experimental control. In this sense, we see with increasing clarity that we have here a research procedure that, in the specific case of drugs and the larger case of medicines, applied to cases of subjective suffering, with an epistemological perspective that always affirms a specific method to the detriment of others, which is simply a huge epistemological mistake. As Pignarre explains to us regarding medicines:

Does modern medicine progress by moving away from empirical practices? Is it not this same word, empiricism, used to explain discoveries made in traditional societies or those of our ancestors? How can we talk about scientific medicine's uninterrupted progress and redefine it around a practice representing the triumph of empiricism? (Pignarre, 1999, p. 14)

Nevertheless, how is empiricism reintroduced in this field? Once again, Pignarre answers us, suggesting that there is no unequivocal relationship between what would be considered objective simply because of medication and knowledge about the processes of becoming ill.

This proof poses a problem to our desire to do science: on the one hand, it records the brutal separation between the existence of effective drugs and, on the other, our knowledge of the mechanisms involved in pathologies. It is important to recognize that the two things do not coincide and that no order of predominance is legally imposed here (Pignarre, 1999, p. 21).

How can we establish the healing structure without knowing the structure of becoming ill? This problem is greater than the double-blind issue. Introducing the notion of placebo prevents itself from answering as objectively as it claims. This is because, in seeking an effective object that would be proof against charlatanism, he reveals the impossibility of doing so by trying to extract the suggestion immaterial from the scene, or rather, from what Freud describes under the concept of transference. On the contrary, as Dagognet points out, “the history of pharmacy and panaceas that highlights archetypes and supreme quintessences can then help to establish and verify the maximum of the immaterial efficacy” (Dagognet, 2011, p. 27).

However, how can this happen? Due to the realist illusion that presupposes having the drug an authentic reality independent of the production procedures of that reality. It is the search for objectivity in which all contingencies are ruled out.

We must insist on this: the substitutive proof that the use of the placebo authorizes sins due to its naivety, its unfortunate substantialism. It inspires the illusion that the equation (x = a-y) will finally give us the medicine and its naked authenticity. Through it, one could reach the ultimate realitas, the foundation of medical matter, freed from everything accidental, from subjectivity, which is at the height of the costly variations that relativized it, from the surprising disturbances that prevent all control and systematization (Dagognet, 2011, p 30).

Therefore, it is important to debate what we find in this placebo equation. If x is the supposed drug, the molecule in its purity, and y the suggestion effect, ideally, the medicine to be described by the equation is the molecule minus the suggestive effect. The double-blind placebo effect would be discarded, and the drug's efficacy index would be found. However, here we have a contradiction pointed out by Dagognet: if in one experiment we found in the control group that took the placebo a 30% cure rate and in the other group we found a successful 70%, We still cannot say that the drug would have this high relevance rate since we cannot know whether, in the 70% group, we did not also get a cure by the suggestive effect. For Dagognet, in the first analysis, the 30% of the control group that took the placebo should also be removed from the group that took the drug, bringing the relevance index down to 40%. However, even among this 40%, we would never be sure their cure was effective because of the drug since this subtraction operation will never eliminate the contingency under application conditions. The suggestive effect would, therefore, be ineliminable. “There is no real cure entirely free of its magic or individual nuances” (Dagognet, 2011, p. 35). Through this reasoning, “the remedy is nothing but probability, in no way reality and even less necessity. Its power is connected to the possible and the eventual, in no way to the certain” (Dagognet, 2011, p. 30).

Now, is it not the illusion of the efficacy of medicine that many - not all - of those who criticize psychoanalysis claim when trying to evaluate it by these parameters? The search for a reality without a contingency in which all issues can be controlled to avoid costs or produce profits? Nevertheless, are questions always posed in this way in discussions in the epistemological field? Furthermore, especially when it comes to psychoanalysis, should we not first ask ourselves what the matter is so that it can be submitted to resource management procedures as parameters for evaluating treatment? These questions are what we will evaluate in the next section.

Psychoanalysis and its Relationship with the Scientific Field

To demonstrate how psychoanalysis approaches this issue of evaluating its praxis, it is worth remembering that Freud had to deal with it at the very beginning of his work, which is observable in the author’s efforts to make a good presentation of his proposal to the scientific community:

On the other hand, you should not assume that what I am presenting to you as a psychoanalytic concept is a speculative system. On the contrary, it is empirical - either a direct expression of observations or a consistent process of working on them exhaustively. I have never been able to convince myself of the truth of the maxim that controversy is the mother of all things. It derives from the Greek sophists and fails to overvalue dialectics like them. It seems to me, instead, that what is known as scientific controversy is, in its entirety, very unproductive, besides the fact that it is almost always conducted according to highly personal motivations. You will assure me that nothing like psychiatric work can oppose psychoanalytic research. What opposes psychoanalysis is not psychiatry but psychiatrists. Psychoanalysis relates to psychiatry in the same way histology relates to anatomy: one studies the external forms of organs, and the other studies their structure in tissues and cells. It is not easy to imagine a contradiction between these two types of study, being one the continuation of the other. As you know, anatomy is considered by us as the foundation of scientific medicine. Even if psychoanalysis proved so ineffective in any other form of nervous and psychic illness as it does in delusions, it would be fully justified as an irreplaceable instrument of scientific investigation. (Freud, 1913/1987b, p. 290)

Still in defense of a position in which the psychoanalytic clinic dialogues with the criteria for evaluating the results of the “positive” sciences, Costa Pereira and Laznik (2008) affirm that the place in which “Freud, from the beginning to the end of his work, situated the epistemological field of psychoanalysis in the territory of Naturwissenschaft (science of nature); therefore, of an empirische Wissenschaft, an empirical science” (Costa Pereira & Laznik, 2008, p. 9). Still, it is necessary to emphasize that Freudism’s relationship with the paradigm of natural science is paradoxical because, as Assoun (1983) states, the Freudian theory is marked and crossed by an epistemological ambiguity.

On the one hand, we know that one of Freud’s ambitions was to turn psychoanalysis into a science and thus share in the prestige of the science of his time. Freud’s scientific ideal began with his work in the anatomy and physiology laboratory, and the creator of psychoanalysis linked himself to the physicalist project. According to Assoun, Freud was “a late-born child of an obstinate physicalist current” (Assoun, 1983, p. 53). Freud’s masters in the field of physiology, Helmholtz-Brücke and Du Bois-Reymond, for example, made a solemn oath, which said, “Brücke and I [Du Bois-Reymond] will solemnly undertake to impose this truth, namely that only physical and chemical powers, to the exclusion of all others, act on the organism” (Assoun, 1983, p. 53).

On the other hand, Darian Leader (2010), in the text “Freud's Scientific Formation”, demonstrates two important aspects: the first is that even the so-called physicalist authors of this quote greatly relativized the point of view due to an epistemological necessity: not everything achieved prove through physical-chemical powers; the second is that this passage, more than an affirmation of a school’s principle, was just a letter between friends. Furthermore, Darian Leader demonstrates that Helmoltz’s Physicalist School never existed: it was an invention of Bernfeld and is not proven either by Helmholtz’s writings or the historiography of German science. Thus, it is unlikely that Freud followed an epistemological tradition that never existed, even though he was formed in an environment where a mechanistic point of view often took science. However, as Wolf Lepenies (1996) demonstrates, even in this scenario, in the so-called human sciences, every movement towards a strictly scientific analysis was immediately opposed in the field of what we might call the disciplines of sense and meaning.

That is why we can say that the young Freud also showed a fascination for philosophical speculation, literature, and mythology. Even though his university education occurred in a positivist environment, the fascination for philosophy he experienced in his youth continued to produce effects, which can be attested to by Freud’s attendance at Brentano’s lectures. Furthermore, it is worth mentioning that the choice of medicine occurs through overdetermination. Freud reveals that reading the text attributed to Goethe, “On Nature”, or “Über die Natur”, in German (Robert, 1964, p. 58-59), led him toward medicine.

Goethe is considered one of the pioneers of romanticism in “Naturphilosophen”, whose speculative romanticism is opposed to the scientific positivism of the “Naturwissenschaft” masters. However, the Goethe that influenced Freud bears a double inscription, being, to use Assoun’s expression, a “Darwinized Goethe” (Assoun, 1983, p. 202). So, the mentioned Goethe’s poem can be classified as a romantic apology for nature, as it exalts the powerful and mysterious beauty of this divine creation.

It is amazing: a romantic text seduces Freud and illuminates the path of medicine. Is the choice of medicine associated with romantic medical practices? We cannot rule out this possibility, even because the historical work by Ellenberger (1970), in pointing out the ancestors of dynamic psychotherapy, unveils its romantic roots. The very choice of the dream as an object of study denounces Freud’s ties to the romantic ideology. On the other hand, the proposal of interpretation as a deciphering of signs distances Freud from the romantic poetics that works from the perspective of totalizing meaning insofar as the Freudian method of dream interpretation constitutes an opening to the infinity of singularities: Freud works in the dimension of differences. Hence, the study of oneiric phenomena reveals, according to Birman (1993, p. 17), “Freud’s association to the mythopoetic tradition to oppose the canons of natural science” but, on the other hand, marks its difference, indicated by the particularity of psychoanalytic interpretation, the specificity of the psychoanalytic method of dream interpretation.

Therefore, Freud began his career marked by a double determination: on the one hand, the science represented by Darwin and the physiology experts, and on the other, Goethe’s romanticism.

Nevertheless, what could be interpreted as an idiosyncrasy of Freud has roots, in fact, in the very nature of the field in which he is located: that of the clinic of psychological suffering or simply the clinic. As François Ansermet (2003) reminds us, the clinical field develops from the tension between the singularity of the clinical case, which we can only know one by one from the subject’s narrative, and the universal of clinical structures, which are always open to modifications depending on the singularity of the case.

Therefore, we believe that the relationship between Freudian psychoanalysis and the ideal of modern science is at least controversial. Following this line, we can quote Figueiredo (1996), who states that the so-called human sciences’ request for epistemological recognition and legitimation is pathetic. It is as if epistemology should establish a court where the different disciplines would humbly deposit their law titles to be judged according to predetermined rules. A notion already contradicted by epistemologists of different orientations, such as Gaston Bachelard, Paul Feyerabend, and Thomas Kuhn. There would be a criterion of truth, and from this, the scientific value of a piece of knowledge would be decided. For Figueiredo, historically, psychology differs from epistemology projects in a powerful sense. The “old epistemology” seeks truth guarantees in subjectivity, excluding finitude, desires, and failures. The epistemic subject is purified and incompatible with the worldly perspective.

According to Figueiredo (1996, p. 23), “The field of psychology itself is the one that, from an epistemological point of view, would have the status of the waste from the purge operated by the method in the process of constituting a purified subject”. From this perspective, we should not abandon the task of the epistemological foundation of psychology. Still, we should start from the idea that each scientific domain has its contour and specificity, making establishing a unitary science ideal pointless. Thus, we should think of a “weak epistemology, that is, an epistemology whose task would be limited to elucidating the conditions of possibility of the different theories, looking for these conditions in their implicit assumptions” (Figueiredo, 1996, p. 23).

However, an epistemological question arises before asking about its scientific validity: to which field of problems does psychoanalysis and its object, namely the unconscious, belong? Freudian theory has as its object an alteritarian principle par excellence, namely, the unconscious. In this concept, we find a dimension of otherness that continually escapes us through dreams, and failed acts that scandalize us, thus revealing a strange closeness to ourselves. Nevertheless, we can find other figures of otherness in Freudian texts beyond this dimension. From a rigorous reading, Philippe Julien draws our attention to a distinction in the field of alterity made by Freud in the text “Project for a Scientific Psychology”, written in 1895 but published posthumously in 1950 (Freud, 1950/1987). The author reveals that Freud presents two sides of the other: the first is made in our image and likeness - similar other; and the second is beyond the likeness - als Ding - is the other close, strange, and foreign (Julien, 1996, p. 42). We do not follow the author’s conclusions from this distinction, so we will look to Freud himself for reference to obtain our own. In the seventeenth item of the Project... (1950/1987), Freud seeks to understand judicial thinking and its differences from reproductive thinking, revealing that the objective of every thought process is the establishment of the state of identity. Judicial thinking arises when perception does not coincide with the desired mnemic image, giving rise to the interest in knowing. To explain the process, Freud (1950/1987, p. 447) uses an example: “Let us suppose that the object that makes up the perception resembles the subject - another human being”. By choosing the problem of perceiving others as an example, Freud offers us the possibility of cutting out this passage, considering it as a small exposition on the problem of recognizing others.

The perceptual complexes emanating from this likeless being will then, in part, be new and incomparable - such as its features in the visual sphere, but other visual perceptions - those of the movement of the hands will coincide in the subject with the memory of very similar visual impressions, emanating from his own body, [memories] which are associated with memories of movement experienced by himself. Other perceptions of the object - if, for example, it screams - will also awaken the memory of [the subject’s] own scream and, simultaneously, of its own experiences of pain. (Freud, 1950/1987, p. 447-448)

We can highlight three points in this passage. Firstly, we realize that the subject recognizes the other by identifying the other with the self - the hand movements are decoded from the subject's body. In this case, a mirror game reduces the other to the same. On the other hand, perception based on the scream goes beyond mirroring, as it requires recognition of the castration truth. In other words, there is recognition of the other because his pain screams at him. Finally, the perception of the other's features, the other's face, inscribes the indecipherable dimension of the other. In the field of alterity, there is an element that escapes all possibility of decipherment. Freud concludes:

Thereby, the complex of the similar human being is divided into two components: one produces an impression by its constant structure and remains united as a thing, while the other can be understood by memory activity - that is, it can be traced back to information about [the subject’s] own body. (Freud, 1950/1987, p. 448)

Why present this long passage on recognizing others in a discussion about investments in research that prove the scientific criteria of psychoanalytic clinical practice? A first response would be that there is no way to think about the social and political dimensions and conduct an epistemological reflection without fundamentally examining its ethical implications. Moreover, we believe that working on ethics invites us to think about the issue of alterity. Something that we cannot forget when criticizing a praxis is to situate the field of problems in which it is located, and psychoanalysis, as Lacan (1964) reminds us in his seminar 11, is ethical and not ontic. We believe that evaluating the psychoanalysis field with instruments used to evaluate organizational management is proof of effectiveness and efficacy.

The idea is to think of the relationship between paradigms of positive science and clinical practice as a relationship between alterities. Thus, we can establish a devouring relationship where one field is annihilated by the other. The other is reduced to the same, that is, reduced to a single sphere that determines the rules. However, we believe it is possible to establish other types of relationships in which the figure of the other is protected, and its indecipherable field remains preserved. This radical otherness that escapes deciphering represents the ethical limit that fundamentally guarantees dialogue. This belief is our commitment to building relationships between the specificity of psychoanalytic practice and the demands of the scientific criteria of natural sciences.

Final Considerations

The debate on the evaluation of psychoanalysis, as discussed at the beginning of this paper, dates to Freud’s time. The question arises for us in what terms this debate can be framed: whether there are unique parameters for an assessment. We have demonstrated that the logic of efficacy, efficiency, and effectiveness, although it may be salutary in the administration of public and private resources, may find limits when it comes to expanding their methods beyond their origin. The issue becomes more complex when we encounter the problem of the psychoanalytic field: the ethical field and the relationship between alterities. Before setting parameters that, even in science, are always provisional, would it not be more interesting to seek to delimit the problems and concepts that underpin the nature of praxis in psychoanalysis and, above all, to question what supports the efficacy, effectiveness, and efficiency parameters in the contemporary social bond?

Considering these impasses, we believe that the debate is still open and that psychoanalysis’ attempt to subordinate itself to certain parameters without first analyzing them may result in losing its greatest power: the openness to otherness and the search for strategies to sustain it without the need to submit entirely to the Other and with the avoidance of the temptation to refuse the Other’s alterity.

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• Data availability statement

  The author does not authorize the disclosure of research data.

Edited by

Responsible editor:

Mônica Medeiros Kother Macedo

Data availability

The author does not authorize the disclosure of research data.

Publication Dates

• Publication in this collection
  19 July 2024
• Date of issue
  2024

History

• Received
  06 Sept 2019
• Accepted
  11 Nov 2022