In Madness and Civilization Foucault saw psychoanalysis as a part of the power game with patients. He argued that the shift from virtual incarceration of mental patients in asylums, to the treatment of mental illness, was merely a revision in the power relationship between doctor and patient, but not a real change in attitude. The physician was still the dominating figure in the relationship, the omnipotent and omniscient participant in their interactions. In Foucault's very convincing presentation, this dominance was depicted as a virtual apotheosis of the physician.
Lorenzer disagrees with Foucault and feels that he did not note the major differences in Freud's approach, and the way Freud diverged from Janet, Charcot, and Liebeault. He points out that in the pivotal case of Anna O. came a major shift in the doctor-patient relationship. This time the patient led the way, both in showing the physician how the treatment should be conducted and in setting the theme and topic of their interaction. Now the doctor simply sat by and listened, and it was the patient's feelings and recollections, not physical complaints, that were of utmost importance.
But the question arises whether Freud's accomplishment cannot be reduced to his readiness to recognize the nature of the subject. Was Freud's decisive contribution to the new "science of understanding" merely his sensitivity? Certainly not, as a comparison with the equally sensitive Breuer will show. The proclivity to sensitivity and the willingness to learn were alone not enough to solve the riddle of the unconscious. As a comparison, Lorenzer considers the devotion of Clemens Brentano to Anna Katharina Emmerich, who occasionally exhibited the stigmata; or the interest of the physician, Justinus Kerner, in the visions of the psychic, Fredericke Hauffe, about whom he wrote the book, The Prophetess of Prevorst.
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In a 1932 letter to Stefan Zweig, Freud commented that Breuer failed to recognize what he had before him because of the lack of anything "Faust-like" in his character. Perhaps it is this Faust-like aspect that enabled Freud to deal with the irrational. It had its dangers, as the relationship to Fliess showed, but Freud's scientific nature was a strong antidote to any foolhardiness. Perhaps Freud's greatness lay in his ability to change his orientation, to shift from biological studies on planaria, from his many and quite excellent neurological publications, to his novel-like case histories, from being a researcher to becoming an interpreter of lives. Habermas has referred to this as "scientific self-misunderstanding." Freud proposed understanding the patient, but what was understood he construed in scientific terms. There was a paradoxical effect to Freud's search for the origins of the phenomena he was investigating. He did not find them, but instead delineated the structure of the unconscious, formulated the mechanism of the unconscious process, and sketched the scaffolding of metapsychology. The sufferings of humanity were wrested from ecstasy and were not regarded as manifestations of otherworldly beings, but as dynamic and energic forces organized in a structure. Had Freud's scientific orientation not prevailed, we might have a psychoanalysis consisting of mandalas and mythologies.
Was Freud's lifelong dedication to a scientific understanding of psychoanalysis not, in the last analysis, a relic from the time of his work on planaria? A study of the metapsychological works of 1915-1917 is thought-provoking. There is an undeniable identification of the basic psychoanalytic statements with clearly neurophysiological formulae from the 1891 study of aphasia. But a deeper look at Freud's mode of thinking indicates that in spite of his merciless pursuit of science, he established a new paradigm that Lorenzer calls the "hermeneutics of the body." The two viewpoints—of the science of culture and of the natural sciences—cannot be reduced to each other, but they intersect in the metapsychological concepts introduced by Freud. The decisive metapsychological concepts have a striking capacity to be read in either direction: to reflect the natural sciences and physiology, as well as to reflect psychological and sociological meaning. And while they have these strong links with both types of science, they are not reducible to either, but maintain their own discourse. Psychoanalysis is a natural science, yet at the same time an analysis of the structure of meaning. In the words of Ricoeur, psychoanalysis is the combination of hermeneutics and energy.
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Wilson, E., Jr. (1994). Psyche. Zeitschrift Für Psychoanalyse Und Ihre Anwendungen. XL, 1986. Psychoanal. Q., 63:401-402