Clinical facts

One of the most significant methodological debates to have taken place in the psychoanalytic field in recent years concerns the nature of “clinical facts”, which was the subject, in 1994, of a special seventy-fifth-anniversary double issue of the International Journal of Psychoanalysis, edited by David Tuckett. This debate was a response to a number of overlapping anxieties about the scientific status of psychoanalysis. One concern was why there were such apparently irresolvable differences between schools and perspectives in the psychoanalytic movement. ¹ There were issues of translation to consider too—how had the sense and meanings of Freud’s writings in their original German been seriously modified through, for example, their translation into the English Standard Edition (Steiner, 1994)? There were the problems of evidence, and issues of validation of hypotheses and theories. Critics within psychoanalysis, such as Robert Wallerstein (Wallerstein & Sampson, 1971), Donald Spence (1982, 1993, 1994, 1998), and David Tuckett (1993), have pointed out the problems of reliance on analysts’ reports of clinical sessions. It was pointed out that it was often virtually impossible to differentiate between theoretical formulations and the imputed evidence for them. The clinical vignette, standard in psychoanalytic writing, was deployed more often as an illustrative or persuasive device than as systemic evidence, which could validate or invalidate a theory, according to a scientific procedure. Spence put it thus:

Whereas we would not take seriously any paper on art history that did not present reproductions of the painting or art object in question, we deal constantly in hearsay reports of clinical happenings that are undoubtedly influenced by the author’s need to sharpen his point, or improve the fit between evidence and theory. Our clinical literature can be described, from one point of view, as doing art history without present the slides, and what is remarkable is that, to date, no one has pointed to the problem of presenting the missing data. [Spence, 1994, p. 918]