In an article, “Psychoanalysis as Art and Science,” Bowlby (1979b) draws attention to two very different aspects of the discipline of psychoanalysis: the art of psychoanalytic therapy and the science of psychoanalytic psychology. In so doing, he emphasises on the one hand, the distinctive value of each and, on the other, the gulf that divides them, states Prof. Ashoka, in the final and tenth part of his erudite research, in the weekly column. A Different Truths exclusive.
If we consider the development of psychoanalysis over the past nine decades, we find that new discoveries have rarely led to consolidation, let alone to critical discussion. Indeed, the extreme subjectivism of many psychoanalysts generates one quarrel after another. Psychoanalysts avoid rational methods of discrimination between rival hypotheses. It seems that any interpretation can be supported from within the terms of any one theory. Relationships between analysts are not usually built on the pursuit of a common, though tricky, endeavour, but on loyalty to a particular faith. Does such and such an analyst believe in Freud, Jung, or Klein? Does this analyst practice “real” analysis?
And yet, the whole edifice of psychoanalysis—its theory of development and its theory of cure —depends upon the assumption that adult pathology stems from problems, real or phantasied, in infancy. An outsider might then assume that psychoanalysts would keep up with the findings of those disciplines to which their field is most closely related-in particular, cognitive and developmental psychology and human biology. Surely, analytic research would benefit from the study of infants and children in natural settings. Instead, psychoanalysts tend to fall back on so-called veridical reconstructions of infancy gathered from the clinical material of adults. The paucity of observational studies diminishes the number of independent variables with which to correlate analytic reconstructions. Inevitably, the psychoanalytic theory of normal personality development has remained weak and open to criticism
By contrast, a minority of psychoanalysts, such as John Bowlby, James Robertson and Christoph Heinicke, are attuned to the methodological limitations of retrospective research. As a result, they have undertaken various prospective studies that follow the behaviour of children about to undergo experiences of separation from their mothers. Since analysts of all orientations seem to agree that separation in childhood plays an undeniable role in adult pathology, one might expect that the observation of separation behaviour in a variety of settings could offer a fertile ground for intergroup study. In my opinion, those analysts who have undertaken such studies manifest greater agreement over their findings, show less of a propensity for schisms, and have found it easier to maintain a more open and scientific attitude towards the work of their colleagues. An analyst’s views of infancy crucially affects his interpretations of unconscious material. It makes a great deal of difference to the patient whether the analyst sees him or her as a bundle of id impulses, a raging orally fixated infant, a frustrated narcissistic self, a thinking and curious creature, or a victim of a broken attachment.
In an article, “Psychoanalysis as Art and Science,” Bowlby (1979b) draws attention to two very different aspects of the discipline of psychoanalysis: the art of psychoanalytic therapy and the science of psychoanalytic psychology. In so doing, he
- Focus of study. The practitioner aims to take into account as many aspects as possible of each and every clinical problem with which he must deal. This requires him to draw on any scientific principle that may appear relevant and also to draw on his own personal experience of the condition in question. The research scientist must have a very different outlook. He aims to discern the general patterns underlying individual variety and, therefore, ignores the particular and strives for simplification. He also tends to concentrate on a limited aspect of a limited problem.
- Modes of acquiring information. In his role of giving help, the practitioner is permitted access to information of certain kinds that are closed to the scientist. He is permitted to intervene and privileged to observe the consequences of such interventions. The research scientist, however, has the advantage of enlisting new methods to cross-check on observations made and on hypotheses born of older methods.
- Mental attitudes — scepticism and faith. If he is to be effective, a practitioner must have faith. He must be prepared to act as though certain principles and certain theories were valid. He is likely to choose between various theories on the basis of his own experience. As Bowlby points out, such faith is not a bad thing in clinical practice. A great majority of patients are helped by the practitioner’s faith and hope. The very lack of these qualities may make many excellent research workers ill-suited to be therapists. The scientist, on the other hand, must exercise a high degree of criticism and self-criticism. In his world, neither the data nor the theories of a leader, however much personally admired, may be exempt from challenge and criticism.
Bowlby (1979b) believes that it is only by recognising these differences that the strengths of each role can be used to fullest advantage “or that any person can occupy both of them with any hope of success”. The repercussions of Bowlby’s view are serious because it calls for a reversal of the set adopted by a great number of psychoanalysts—namely, unquestioning faith in a theory and scepticism in their practice. Bowlby’s cross-checking of the reports of adult patients with observations of young children should reduce the analyst’s scepticism of his patient’s memory. For example, Bowlby takes very seriously the reported threats of separation made by parents to their children. Not only should the analyst cross-check his findings with those of neighbouring disciplines, but he must be able to review his work critically outside his consulting room, either by taking notes or by detailed discussion of case notes or tape recordings with his colleagues. Bowlby proposes that analysts might keep a detailed record of the responses of their patients before and after each weekend, each vacation, and each unexpected interruption of the sessions, with an equally detailed record of how the analyst dealt with them. This would enable the analyst to check the repertoire of responses a given patient presents on these occasions, and also the changes in response the patient presents over time.
In my view, the medical bias in psychoanalysis has led not only to neglect of the two roles required of the research psychoanalyst, but also to an underestimation of the art of psychoanalysis. Fearful of his emotional responses to the patient and of his imaginative powers, the analyst, aiming to maintain a “scientific” attitude, may remain aloof, neutral and dissociated from the interactions with his patient. The art of psychotherapy, according to Bowlby (1979b) requires “all the intuition, imagination and empathy of which we are capable. But it also requires a firm grasp of what the patient’s problems are and what we are trying to do.” For instance, analysts who are not prepared to meet the heavy burdens of dependence should be careful about their choice of patients. In order to have such a firm grasp of the patient’s problems, questions of etiology and psychopathology should be clarified and the practitioner should be informed of the whole range of family experiences that evidence shows affect the development of the child. Although medical science is competent to deal with this area of psychopathology, it eschews the use of imagination, and psychoanalysis has suffered accordingly. In addition, analysts have followed Freud in his equation of imagination with phantasy and the creative process with sublimation. Like Freud, many analysts continue to regard art as an anarchic process motivated by sublimation. They continue to ignore the skills and rules that are involved in every creative process.
Bowlby’s work is a testimony to the skills of imagination, immersion and objectivity. Not only does his trilogy present a simple point of view based on the distillation of a vast array of research, it also portrays the extraordinary depth of feeling of a unique individual. Few psychoanalytic books evoke the utter grief, despair and loneliness that bereaved persons, particularly children, have suffered. Most psychoanalytic texts prefer to discuss the stereotyped defenses against feeling— aggression, projection, denial, and so forth. One might conclude that few psychoanalysts are themselves capable of suffering the depths of anxiety and sadness that are only too painfully obvious to all those who have worked with young children.
…Dick…told him about his own father’s death, which had happened when Dick was a child at Dublin, not quite five years of age. “That was the first sensation of grief,” Dick said, “I ever knew…. I remember I went into the room where his body lay, and my mother sat weeping beside it. I had my battledore in my hand, and fell a-beating the coffin, and calling papa; on which my mother caught me in her arms, and told me in a flood of tears papa could not hear me, and would play with me no more…And this,” said Dick kindly, “has made me pity all children ever since and caused me to love thee, my poor fatherless, motherless lad.” (Thackeray, H. E., in Bowlby, 1980)
Prof. Ashoka Jahnavi Prasad
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Ashoka Jahnavi Prasad is a physician /psychiatrist holding doctorates in pharmacology, history and philosophy plus a higher doctorate. He is also a qualified barrister and geneticist. He is a regular columnist in several newspapers, has published over 100 books and has been described by the Cambridge News as the ‘most educationally qualified in the world’.