Zusammenfassung
Wie eingangs und mehrfach auch in Flucht vor dem Gewissen bemerkt, hat in den letzten Jahren die die Grundlagen der Psychoanalyse in Frage stellende Kritik an Wahrheit und Wert psychoanalytischer Einsicht durch den anerkannten amerikanischen Wissenschaftsphilosophen Grünbaum sowohl Aufsehen wie auch in den Reihen der Analytiker Betroffenheit, ja Bestürzung und v. a. auch Feindseligkeit erregt. Seine durchdachte und auf eingehender Literaturkenntnis beruhende Kritik am Wahrheitsanspruch und an der Wirksamkeit der Psychoanalyse ist eine ernsthafte und machtvolle Herausforderung an uns. Folgt man seinen Ausführungen Schritt für Schritt, will es einem wirklich scheinen, daß die wissenschaftlichen Grundlagen der Analyse unterhöhlt und ihre Vernunftschlüsse schadhaft sind. Wie ich in meiner ersten Diskussion mit ihm im Frühjahr 1986 sagte: Hätte er mit seinen Behauptungen Recht und beharrte ich angesichts dieser weiterhin darauf, als Analytiker zu wirken, zu schreiben und zu lehren, so wäre ich kaum mehr als ein Betrüger, bestenfalls eine Art von Schamane und Voodoo-Priester.
„Jede große Idee, sobald sie in die Erscheinung tritt, wirkt tyrannisch; daher die Vorteile, die sie hervorbringt, sich nur allzubald in Nachteile verwandeln.“ (Goethe, Wilhelm Meisters Wanderjahre, 2. Buch, Bd.18, S.53).
„Ich will keine Überzeugungen erwecken — ich will Anregungen geben und Vorurteile erschüttern.“ (Freud, GW 11, S. 250)
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Referenzen
Dieses Kapitel begann zunächst als eine formale Diskussionsantwort auf die auf Einladung des „Departments of the Philosophy of Science“, Johns Hopkins University, Baltimore, 9. April, 1986 gegebene Vorlesung Grünbaums, „The validity of hidden motives in psychoanalytic theory“. In den folgenden Monaten gab ich meine Kommentare in mehreren Foren und hatte einen weitreichenden Austausch über die darin vertretenen Gedanken mit Grünbaum und einer Anzahl von Kollegen und Freunden (Gray, Dreyfus, Kommor, Thomä, Kachele, Paniagua, Nathanson, Schermer). Am 19. Dez. 1986 wurde der Essay als Vortrag beim Herbsttreffen der Amerikanischen Psychoanalytischen Gesellschaft gehalten und von Shapiro und Compton formell diskutiert. Allen Diskussionsteilnehmern bin ich sehr dankbar für ihre Anregungen.
„Psychoanalysis has proved a fiasco. It is by far the most costly and time-consuming of all psy-chotherapies, yet it has not been shown to be more curative than a single one of its hundred-plus rivals... I venture to say that things havechanged fundamentally — that, though the players are still on the field, the outcome of the game is no longer in doubt...“ (Crews, „The future of an illusion“, New Republic, 21. Januar, 1985).
„Investigative cogency of lifting repressions via ,free associations’“, „the purported ability of the patient’s free associations to certify causes“ (1986 a).
„... despite the appeal to the latter [the clinical evidence] by these champions of psychoanalysis the operation of hidden motives in Freud’s sense has yet to be cogently tested on an adequate scale. And until it is, the widespread belief in psychoanalytic theory in some segments of our culture is hardly well-founded’.
„The nub of his distinctivetheory of repression is notjust that we harbor repressedmemories, thoughts, desires, and feelings. Instead, it is that sexual repressions are the crucial pathogensof mental disorders, that repressed infantile wishes are the instigatorsof our dreams, and that sundry repressed, unpleasantthoughts engenderour slipsof memory, of the tongue, the ear, the eye, the pen, etc... “ (Hervorhebungen im Original).
„Once the repression etiology was thus bereft of therapeutic support the very cornerstone of psychoanalysis had been completely undermined.“
„Hie central causal and explanatory significance of unconscious ideation throughoutthe psychoanalytic theoretical edifice rests, I claim, on [those] two cardinal inductive inferences“.
Dies bedeutet auch, wie es Erdelyi in der Diskussion von Grünbaums Ansichten in dem Sonderheft von Behavioral and Brain Sciences, Juni 1986, vertritt: „... psychoanalysis has a far wider scope than the retrospective discovery of etiologies... Etiology is hardly the ubiquitous preoccupation of psychoanalysis“ (BBS, S. 234). Er fügt das Caveat, das auch den Mittelpunkt meiner Entgegnung darstellt, bei: „The issue is not either-or or all-or-none. Hie scientist is not an armchair methodologist: He must make the best of imperfect (if improvable) tools. The clinical method has not only weaknesses but also strengths“ (ebd., S. 235). Es sei hier angemerkt, daß Grünbaum auf alle Kritiken in diesem Sonderheft geantwortet hat.
Zum Beispiel, „that sexual repressions are the crucial pathogens“, oder: „once the repression etiology was thus bereft of therapeutic support, the very cornerstone of psychoanalysis had been completely undermined“ — beides Beispiele aus seiner zusammenfassenden Darstellung in der Johns Hopkins University.
Marmor bemerkt: „One wonders... whether the causal significance of conflict in the genesis of at least some psychopathology... does not still retain much of its validity. Grünbaum does not deal with this issue... “ (Behavioral and Brain Sciences, Bd. 9, Juni, 1986, im weiteren zit. als BBS, S. 249).
Dabei will er das von ihm gebrauchte Wort „certify“ nicht als „to make certain“ etc, sondern als „to offer evidence for“ verstanden wissen.
„At times Grünbaum pays insufficient attention to the centrality of conflictin Freudian theory“. So stellt auch Wachtel fest (BBS, S. 264).
„At Freud’s time, especially the early period of theory formation, causality was considered the only basis for science. Since that time the consensus has become that therapy is a process, an interplay between intrapsychic forces and interpersonal influences which underlie the course of treatment in the context of the patient-doctor relationship. Grünbaum treats it as the multi-variable system from which one variable can be selected for study while the others are presumed to stay invariable. This runs counter to the idea of process, an evolving system where all the parts respond to any change in one variable. The focus is on process, hence on a complex system of interaction, not on simple cause and effect relationships. This is extraneous to Griinbaum’s thinking, but strikingly convergent with the current way of thinking in physics.“
Dies entschuldigt freilich die armselige Qualität der meisten klinischen Berichte keineswegs.
1984 führte Parioff unter dem schlagenden Titel „Psychotherapy research and its incredible credibility crisis“ aus: „... the research evidence so carefully examined does not adequately represent the psychotherapies most frequently practiced“ (S. 97). „Behavior therapists were dismayed to learn that the touted superiority of their procedures over the conventional psy-chodynamic therapies had not been confirmed...“ (S.98). „In contrast to the relatively modest role of behavior therapy in overall clinical practice, psychotherapy outcome research which is limited to carefully controlled studies is based largely on the investigation of behavior therapy in clinical and laboratory settings. The inappropriateness of delegating such a dominant role to the behavior therapies is recognized by some behavior therapists, who acknowledge that psychoanalytically oriented therapies remain the dominant force in American psychiatry and clinical psychology... Of the nearly 500 studies reviewed by Smith et al., only about 13% may be classed as psychodynamic or insight therapies, even when the most flaccid criteria of classification are used (6% psychodynamic, 6% dynamic eclectic and 1% Adlerian)“ (S.101).
„The survey by Shapiro and Shapiro included so few dynamic therapies (and the quality of these was so dubious) that reliable conclusions regarding comparative efficacy based even on the restricted measures used cannot be derived. The measurement of outcome was limited to the criteria and instruments of particular interest to the behaviorally oriented investigator rather than the dynamically oriented psychotherapist“ (Parioff, S. 102).
Ich stimme völlig mit Cremerius überein, wenn er schreibt: „Es gibt bestenfalls spezifischere und weniger spezifische Operationen zur Bewußtmachung des Unbewußten. Alles, was geschieht, alles, was gegeben ist, alles, was sich verändert, alle Maßnahmen, auch das Deuten selbst, und alles, was der Patient tut oder nicht tut, ist Gegenstand in einem dynamischen Feld, das es zu verstehen gilt... Damit sind auch das Durcharbeiten und die vielen operatio-nalen Methoden, die erforderlich sind, um aus Einsicht Veränderung entstehen zu lassen, ein ebenbürtiger Partner des Deutens geworden. Wir müssen uns jetzt nicht mehr entschuldigen, wenn wir z. B. beim Durcharbeiten erzieherische Methoden anwenden, wenn wir manipulieren und provozieren. Denn wir treten damit nicht aus der psychoanalytischen Situation heraus, werden weder Pädagogen noch Nicht-Analytiker. Vielmehr dient dies dem einen und einzigen Prozeß, das dynamische Feld so zu beeinflussen, daß Einsicht undVeränderung möglich werden“ (S. 169 f.).
Shevrin kommentiert: „Moreover, if you deny reality testing to neurotic patients, you cannot maintain it for experimental subjects. If Grünbaum is altogether right about the analytic clinical method, then there is no relying on reasonableness in any context... the clinical method is the only way we can be in touch with certain phenomena“ (BBS, S. 258 f.).
„Aufgrund der bisherigen Ergebnisse der prozessual orientierten Therapieforschung kann für die zukünftigen verfeinerten Untersuchungen die Voraussage gemacht werden, daß sich die Omnibusbegriffe Suggestion und Einsicht in ein breites Spektrum kommunikativer Prozesse auflösen werden“ (Thomä u. Kachele 1985, S. 381).
„So little is known about the effects of suggestion or the power and nature of the placebo effect that devout Freudians might be poorly served by following Grunbaum’s suggestion that this technique [the analysis of transference] has not stood the test of empirically based research“ (Caplan, BSS, S.229).
„... the element of ,suggestion’ is neither the exclusive nor even the most salient aspect of the nonspecificity hypothesis“ (Parloff, S. 107).
„In science, as in most other affairs, we should first try to keep what we already have — cultivate the land that has been cleared and guard it against a return of the jungle and against corrosion — and then try to improve on it or to enlarge it“ (Waelder 1960, S.X).
Masling kommentiert: „My only disappointment with Griinbaum’s book is its failure to make explicit how much experimental evidence relevant to the merit of the theory is already available... Psychoanalytic theory has proved, perhaps unexpectedly, to be extraordinarily heuristic“ (BBS, S. 250). Kline weist auf die „more than 1000 objective studies of psychoanalytic theories“ hin und tadelt Grünbaum dafür, er habe „a poor grasp of experimental psychology“ (BBS, S. 246). Grünbaum antwortet auf diesen Einwand, ich glaube, wiederum pars pro toto, mit dem Hinweis auf seine divergente Bewertung einzelner Forschungsergebnisse in bezug auf die Psychodynamik der Paranoia and die Traumtheorie.
„The inadequate status of epidemiological data concerning therapeutic efficacy in most areas of medicine should give the defenders of the Freudian enterprise pause before they yield to Griinbaum’s critique of this element of the tally argument“ (Caplan, BSS, S. 229).
Unsere Evidenzfindung ist der archäologischen sehr ähnlich, wie sie vom Staatsarchäologen von Florida, Miller, beschrieben wird: „Truth in archeology is usually an accumulation of supporting evidence“(New York Times, 19. Mai, 1987, C 3).
„According to the history of science, the long-term rewards of successful speculation have been the setting-up of new frameworks with fundamental ideas and the integration thereby of apparently disconnected branches of science. Men such as Newton, Maxwell, Darwin and Einstein are known primarily not as great experimenters or observers, but as critical and imaginative creators of new intellectual systems. This group, of course, also includes Freud“ (Guttman, 1965, S. 132).
„The general theory of relativity seems herein to be only the ultimate consequence of an intellectual movement which receives its decisive motives equally from epistemological and physical considerations. The working together of the two points of view has always come to light with special distinctness at the decisive points in the evolution of theoretical physics“ (S. 353).
„Even after some 60 years of intense scrutiny, experimentation and debate, the quantum physicists concerned with answering such questions (about ,reality’) seem no closer to conclusive agreement than ever.“
„We have come to two logically certain and completely opposite conclusions. Each photon goes around both ways; each photon goes around one way only.... the object in question is a ghost.... In other words, the picture of an ,external world4 that each of us builds up from our daily observations is a fraudulent one. There is no objectively existing external world; there are simply our observations themselves, and patterns among those observations... Elucidating the nature of the patterns in the observations is the business of physics, and of biology, and of science in general...“ (S. 13).
„... time and space are modes by which we think, not conditions in which we live... Most fields of pioneering endeavor are not well enough surveyed to be entirely accessible to logical analysis. In such fields, as Charles Kettering... once put it, ,Beware of logic. Logic is an organized way to go wrong — with confidence.’ One has rather to call on another human faculty, judgment — which generally has to call intuition to its help... May the universe in some strange sense be ,brought into being’ by the participation of those who participate?... The vital act is the act of participation... What choice we make has an irretrievable influence on what will happen from then on. We have been promoted from observers to participators. There is a strange sense in which this is a participatory universe“ (1985, S. 31 f.).
Edelson definiert diese epistemologische Richtung wie folgt: „Eliminative inductivism is a name for the view that evidence shall count as support for a hypothesis, shall confer scientific credibility upon a hypothesis, only if: a) the evidence is entailed by, is deducible from, or is a positive instance of, the hypothesis (that the evidence confirms the hypothesis is necessary, but not sufficient, for it to count as support for the hypothesis); b) the evidence justifies preferring the hypothesis to some other rival hypothesis (that is, justifies believing the hypothesis rather than this rival); c) the evidence has been obtained in a way that eliminates from consideration plausible alternative explanations, which otherwise might have been held to account for it“ (1984, S. 4 f.). In dieser Formulierung scheint mir die an die Wissenschaftlichkeit gestellte Forderung durchaus annehmbar und mit psychoanalytischer Forschung im Prinzip vereinbar zu sein.
Farrell äußert einen ähnlichen Einwand: Grünbaum „seems to be controlled by a picture of epistemic relevance and legitimacy, in which the concepts of falsification and demonstration play central roles. Such a picture is quite inappropriate when we try to get to grips with the character of psychoanalytic work“ (BBS, S. 237).
„... the material produced by psychoanalytic method is perspective- and method-dependent ...“ (Farrell, BBS, S. 237).
In „The Problems of Philosophy“, Kap. 12. Ich verdanke diesen Hinweis, wie überhaupt die hier verkürzt dargestellte Einführung zu den 3 Wahrheitsbegriffen, Herrn Prof. Stephen Vic-chio (der Russellhinweis stammt aus seinen Vorlesungsnotizen, 1987 b).
William James spricht von „the truth’s cash value in experiential terms“ (in: Pragmatism, zitiert nach Vicchio, Vorlesungsnotizen). John Dewey führt dazu aus: „That which guides us truly is true — demonstrated capacity for such guidance is precisely what is meant by truth ... The hypothesis that works is the true one; and truthis an abstract noun applied to the collection of cases, actual, foreseen and desired, that receive confirmation in their works and consequences“ (Dewey: Reconstruction in Philosophy, S. 156 f.; zit. nach Titus et al. 1986, S. 248 f.).
Titus et al. sprechen von der „coherence, or consistency, theory“:„A judgment is true if it is consistent with other judgments that are accepted as true. True judgments are those logically coherent with other relevant judgments“ (S. 245 f.).
„Systematic coherence is not only the criterion we use for truth; it is what in the end we mean by truth“ (Nature of Thought, Kap. 27; zit. nach Vicchio 1987 b).
„... .1 am uneasy about the Rorty option: I think it is 1) a self-dissolving skepticism, and 2) it does not do justice to a fact that I take as an almost primitive datum, namely, the wonder of science. Like the existence of pain, if that isn’t accepted to begin with, I find it hard to care what clever doubts can be raised“ (zit. nach persönlichem Brief).
Wèi zhi si? y?. Fú k? yü?n zhi y?u?
Der folgende Abschnitt stützt sich ganz besonders auf Diskussionen mit Stephen Vicchio.
R. Wiehl, persönliche Mitteilung; s. auch Grassi; s. oben Kap. 9.
„... we need less methodology and metaphysics — less philosophical reinterpretation of the activity of psychoanalysis“ (Freud, morality, and hermeneutics, 1980, S. 185).
Eine deratig radikale Differenz findet sich im Beitrag von Caws zur BBS-Diskussion von Grünbaums Arbeit: „... the natural domain of which it [psychoanalysis] is the science is the idiosyncratic world of the individual patient, not the class of human beings over which the natural science of psychology applies. In other words, I think that clinical findings cannot reliably be extrapolated beyond the case from which they are drawn. Every new patient who walks into the analyst’s office is a new world to be explored ... and the task of analysis is the establishment of causal connections that hold withinthe complex structure of that patient’s cognitive and emotional life“ (BBS, S.230f.; ich habe mich darauf schon in Kap.l von Flucht vor dem Gewissenberufen).
Rubinstein (1983) zitiert aus einem 1907 von Breuer an August Forel geschriebenen und von Sulloway zitierten Brief: „Freud was a man given to absolute and exclusive formulations: this is a psychical need, which, in my opinion, leads to excessive generalization“ (S. 174). Rubinstein sieht darin den wirklichen Grund für Breuers Distanzierung von Freud und fügt hinzu, Freud habe „a striking penchant for quick generalizations which more than once turned out to be ill founded... [He] had an overblown belief in the power of inductive inference as he practiced it“ (S. 180). Er schließt daraus: „It is the clinical part of psychoanalysis that is really disturbing. It is top-heavy with theory but has only a slim evidential base“ (S. 187). Holt betont denselben Punkt: „Freud believed that one made a generalization into a scientific law by stating it in the most universal and dogmatic terms“ (BBS, S. 243).
„Xiié ér bù si?, zé w?ng. S? ér bù xüé, zé da?.“ (Lun Yü, II, 15). Einen ganz ähnlichen Gedanken zitiert der konservative politische Kommentator George F. Will während der „Iran-contra“ Hearings: „In one of his plays, Tom Stoppard writes:,Skill without imagination is craftsmanship and gives us many useful objects such as wickerwork picnic baskets. Imagination without skills gives us modern art/ Modern art, and foreign policies such as arms sales to Iran. Where were the senior conservatives in whom skill and imagination are supposed to be joined?“ (Baltimore Sun, 12. Juli, 1987, 7E).
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© 1989 Springer-Verlag Berlin Heidelberg
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Wurmser, L. (1989). Gedanken zum Problem des wissenschaftlichen Absolutismus. In: Die zerbrochene Wirklichkeit. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-00919-2_10
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