Freud's Case Studies and the Locus of Psychoanalytic Knowledge

F eud's, Case S udies and he Locus o Psychoanaly ic Knowledge (") CARL. E. PLETSCH"* INTRODUCTION: THE @TESTION OF PSYCHOANALYTIC KNOWLEDGE Reading h ough Sigmund F eud's case s udies in ch onological o de is a mos ins uc i e expe ience o anyone in e es ed in he in ellec ual his o y o psychoanalysis. One quickly sees, o example, how F eud's echnique e ol ed om he me hodical and a he in u- si e a emp s o dispel pa icula symp oms ha we obse e in S udies on Hys em'a (1 895) o he me hod o ee associa ion ha he desc ibes in his epo on he case o Do a (1905). O one sees how F eud's concep ion o he ans e ence de eloped, om he p imi i e no ion o ans e ence as some hing o be a oided o dispelled, o he ma u e concep ion o ans e ence as he in aluable cen e o analysis, he e y phenomenon ha has o be analyzed (again in he analysis o Do a). In his pape 1 shall e iew F eud's case s udies wi h s ill ano he ajec o y in mind: how F eud's sense o he signi icance o his w i en case s udies hemsel es e ol ed. 1 shall show how his ini al emba assmen o e he necessi y o desc ibing his cases in g ea de ail was e en ually supplan- ed by a con idence ha his case s udies we e impo an ehicles o psychoanaly ic knowledge. As his a i ude changed, his ini ial anxie y abou how o he medical and na u al scien i ic eade s would adjudica e his cases was displaced by a willingness o asse delica e, enuous hypo heses in his cases, la gely o he bene i o he psychoanaly ic communi y i sel . And on a mo e abs ac and pe haps less conscious le el, he posi i is ic belie in he impo an e o heo y and he objec i e e i iabili y o hypo heses ha F eud had subsc ibed o om he ime he (*) Una e sión esumida de es e abajo se ha publicado en, Pa isan Re iew, 49/1, 101-1 18, (1982). ** Depa nen o His o y, 454 Hamil on Hall 070 A, Uni e si y o No h Ca olina, Chape1 Hill, NC 27514. USA. DYNAMIS Ac a Hispanica ad Medicinae Scien ia umque His miam Illus andam. Vol. 2, 1982, pp. 263-297. ISSN: 021 1-9536. 264 CARL. E. PLETSCH had decided o s udy medicine was a leas empo a ily challenged by ano he iew o knowledge, a iew ha 1 shall y o cla i y in his pape . My examina ion o F eud's case s udies is necessa ily an in e oga- ion o only a pa o he F eudian oeu e. Bu i leads inexo ably o he ques ion o psychoanaly ic knowledge, i s locus, cha ac e , and epis- emological s a us. Fo we canno examine he cases wi hou conside ing hei ela ionship o F eud's o he w i ing. We canno help wonde ing whe he F eud w o e his case s udies o a speci ic eade ship, o example, o whe he he cases communica e o hei eade s in a unique ashion. These ques ions will lead us o delinea e an impo an issu e in F eud's hinking and o specula e upon how F eud's mos peculia ly psychoanli ic knowledge di e s om o he o ms and kinds o know- ledge. Two no ions aken om he discou se oEghilosophy o science will assis us in ou examina ion o F eud's case s udies: ((exempla sa and «pe sonal knowledge)). We mus no ei y hese no ions, howe e , o pe mi hem o dis ac us om he ques ion o psychoanaly ic know- ledge. Le i be clea om he ou se ha 1 am no ying o de end psychoanalysis o o answe he ( edious) ques ion o whe he o no psychoanalysis is a science. No am 1 ying o demons a e he alidi y o hese no ions o ( exempla )) and ((pe sonal knowledge)) in he discou se o he philosophy o science. 1 am using hese no ions in connec ion wi h F eud's case s udies o he much mo e modes heu is ic pu pose o illumina ing he place o case s udies in he discou se o psychoanalysis and specula ing upon he na u e o psy- choanaly ic knowledge, a peculia so o knowledge ha 1 belie e emains o be adequa ely desc ibed. This is no he place o elabo a e upon how he e m «exempla » has been used by desc ip i e philosophe s o science, bu 1 mus admi ha my unde s anding o he way in which F eud's (and la e psychoana- , lys s') case s udies cons i u e exempla s in psychoanalysis di e ges in one e y impo an espec om he meaning o he e m gi en by Thomas Kuhn. In his a emp o show ha sha ed heo y and co es- pondence ules a e no su icien o explain disciplina y cohe ence in ce ain na u al sciences, Kuhn used he e m ((pa adigm)) in one o i s senses o mean asha ed examples o success ul p ac ice)), which s uden s o hese disciplines lea n, and which hen se e o main ain he cohe ence o hei esea ch communi y (1). In Kuhn's la e essays, hese (1) In his la e essays Kuhn uses he e m ((exempla s)) o his sense o his o iginal e n ((pa adigm)). C : The S uc u e o dcien z i Re olu ions. Chicago, Uni e si y o Chicago P ess, F eud's Case S udies and he Locus o Psychoanaiy ic Knowledge 265 a e e med exempla s. My imp ession is ha psychoanaly ic case s udies -F eud's in pa icula -- se e he pu pose o helping psychoanalys s iden ie he p oblems posed by hei pa ien s and pe mi psychoana- lys s al1 o e he wo ld, si ing done in hei consul a ion ooms wi h hei pa ien s, o p oceed in pa allel ashion, e en hough he examples a e no always success ul. The case o Do a comes o mind once again: he ailu e o F eud's a emp s o eason wi h Do a and he ab up e mi- na ion o analysis be o e he apy could be e ec ed does no seem o de ac om he alue o he case. The p esen a ion o such an awkwa d case as an exempla migh well gi e a desc ip i e philosophe o science like Kuhn pause, o say no hing o a neo-posi i is . Bu his seems unp oblema ic he e, p ecisely because 1 am no ying o de end psychoanalysis as a science o demons a e he alidi y o he no ion o exempla s. Wha e e one hinks o psychoanalysis, i is a ac ha F eud's case s udies ha e been ex emely impo an ehicles o he adi ion o psychoanaly ic knowledge. Somehow F eud's cases s ill communica e essen ial knowledge o psychoanalys s. I is much easie , howe e , o say wha hey a e no han o speci j wha hey a e and how hey wo k in he discou se o psychoanalysis. Al hough hey a e by no means de oid o heo e ical conside a ions, o example, hey a e al1 highly de ailed in es iga ions o qui e idiosync a ic cases. F eud seldom e en claimed o hem he alue o illus a ions o heo y, and as ime wen on he ceased o make such claims al oge he . And as 1 ha e al eady sugges ed, hey a e no qui e like exempla s in ha hey ob iously do no depend upon being examples o success ul p ac ice. Many con e sa ions wi h psychoanalys s and a eading o he memoi li e a u e o psychoanalysil sugges , howe e , ha wha psychoanalys s de i e om hei s udy o F eud's cases is a sense o how F eud hough , and, mo e pa icula ly, how he hough wi h his pa ien s. E en o he non-psychoanaly ic eade F eud's case s udies seem o communica e how i eels o do psychoa+ nalysis and lea n om pa ien s. In con as o his heo e ical w i ings like he Th ee Essays on he Theo y o SexualiS, o exposi o y-didac ic ones like he In oduc o y Lec u es on Psychoanalysis, F eud's case s udies may be he locus o in e subjec i i y in psychoanalysis. I is e en emp ing o hink ha he communica ion be ween F eud and he psychoanaly ic eade s o his case s udies is modeled on he kind o communica ion ha ob ains be ween malys and pa ien in psychoanalysis p ope . I his is app oxima ely ile, i sugges s F eud's exemplq cases unc ion 1962, and mo e speci ically The Essen ial Tension: selec ed S udies in Scien z ic T adi ion and Change. Chicago, Uni e si y o Chicago P ess, 1977, pp. 306 and 318-319. 266 CARL. E. PLETSCH as a kind o ((pe sonal knowledge)), bo owing now om Michael Polanyi (2). S udying hem, psychoanalys s aci ly lea n o hink like F eud. The ques ion o emos in my mind while w i ing his pape is how he s a us F eud acco ded he knowledge deposi ed in his case s udies e ol ed in his own hinking. Bu o he ques ions can ne e be a om he su ace o inqui y: how, o example, ha e F eud's case s udies been u ilized by his ollowe s in psychoanalysis? How ha e la e psychoanalys s ein e - p e ed hese case s udies? And how ha e he new cases epo ed by o he psychoanalys s eshaped he Co pus o psychoanaly ic knowledge? Al hough 1 shall no be able o answe hese ques ions in he b ie compass o a pape on F eud's own hinking, 1 belie e my p esen inqui y is gi en g ea e signi icance by he ac ha psychoanalys s ha e indeed s udied F eud's cases as exempla y solu ions o p oblems. They ha e oo, 1 belie e, lea ned mo e and mo e consis en ly om he case s udies han om F eud's mo e adi ionally o mula ed heo e ical p oposi ions. The whole p ocess o psychoanaly ic educa ion ensh ined in he ins i u es o psychoanalysis sugges s his, al hough again i would ake a sepa a e pape o demons a e i conclusi ely. I is e y la gely he case s udies, F eud's and he cases published subsequen ly in he same spi i by his ollowe s, ha ha e enabled psychoanalysis o main ain i s g ea me hodological cohe ence o so long, and du ing a pe iod when mos o F eud's o mal heo e ical s a emen s ha e been shown o be a leas pa ially alse (3). Psychoanalys s a e o cou se no al1 ully awa e o he ac ha case s udies play such an impo an ole in hei discipline. Many i no mos psychoanalys s a e s ill consciously wedded o a posi i is ic concep ion o science, and hey place g ea s o e in he heo y o psychoanalysis when hey ep esen i o he public a la ge. I 1 am igh :, howe e , hey (2) See POLANM, M. (1958), Pe sonal Knowledge: owa ds a pos -c i ica1 Philosophy. Chicago, Uni e si y o Chicago P ess. (3) On psychoanaiy ic educa ion see: GOODMAN, S. (ed.) (1977), Psychoanaly ic Educa ion and Resea ch. New Yo k, In e na ional Uni e si ies P ess, and LEWIN, B. D.; ROSS, H. (1960), Psychoanaly ic Educa ion in he Uni ed S a es. New Yo k, In e na ional Uni e si ies P ess. Fo e idence o he ole o case s udies in main aining he cohe ence o he psychoanaiy ic discipline, one should aiso conside he pe iodicai li e a u e o psychoa- naiysis and he p ominence o case s udies in i . Two o he publica ions a e aiso in e es ing in his con ex : one, didac ic, is Hedda Bolga 's essay on The Case S udy Me hod, in WOLMAN, B. B. (ed.) (1965), The Handbook o clinical Psychology. New Yo k, McG aw-Hill; he o he , his o ial, is Ha old G eenwaid's edi ion o G ea Cases in Psychoanalysis. New Yo k, Ballan ine Books, 1959, whe e he edi o explici ly sugges s ha hese mos equen ly s udied and ci ed cases cons i u e a mo e signi ican his o y o psychoanalysis han a ecoun ing o he e olu ion o heo y o echnique. F eud's Case S udies and he Locus o Psychoanaly ic Knowledge 267 a e much mo e de ensi e abou he agili y o his body o heo y han hey need o be. Fo ~ hen hey communica e wi h hei pa ien s and wi h each o he , hey a e demons ably mo e in e es ed in he sub le ies o insigh ound in pa icula cases gene a ed by. hei me hod han hey a e in he alidi y o gene al heo e ical p oposi io is. This sugges s ha psychoanaly ic knowledge, he knowledge pecu- lia o psychoanalysis, is cons i u ed a he di e en ly han he know- ledge o a mo e ho oughly heo y-based science. In ac , 1 use he wo d «knowledge» in e e enice o psychoanalysis, ins ead o «science», p e- cisely in o de o sugges ha he e y ques ion o science is misleadding when applied o psychoanalysis (4). I so, hen he g ea ene gy expen- ded in ying o e o mula e F eud's heo e ical p oposi ions o make hem expe imen ally eis able may no -in spi e o he alue such e o s may ha e o o he pu poses- con ibu e much o ou unde s anding o wha psychoanaly ic knowledge eally is (5). A uly desc ip i e (4) Se e al o he disciplines o ques ionables scien i ici y ha e applied o he s a us o special o ms o knowledge in o de o ci cum en he ques ion o science, which seems always o en ail a compa ison wi h physics. This ac ic gi es ise o he plu al o m, aknowledges)). This seenis no el bu i could become as common as «sciences» is now. And since «knowledge» is so much less eigh ed wi h ideology han «science», his migh acili a e mo e and mo e genuine desc ip i e app oaches o he in ellec ual capi als o he anomalous disciplines o p~~choanalysis, e hnog aphy, his o y, e c. In ollowing his sugges ion, howe e , one necessa ily aises he al e na i e ques ion o «a » o cc a b, ' and ha wo will need o be di e en ia ed be o e i wiii be use ul. (5) Fo he e o s o es F eud's heo ies expe imen ally, see EYSENCK, H. J.; WILSON, G. D. (eds.) (1973), The Expe imen al S udy o F eudiam Theo ies, London, Me huen, and SARNOFF, 1. (1 97 l), Tes ing F eudian Concep s, New- Yo k, Sp inge . Mo e ecendy Seymou Fishe and Roge G eenbe g ha e ca alogued and analyzed he as li e a u e de o ed o'expe imen al s udy o F eud's heo ies in hei book The Scien i lc C edibili y o F eud's Theo ies and The a y. New Yo k, Basic Books, 1977; he same au ho s ha e edi ed a book o exempla y es s o F eudian heo ies, en i ied The Scien i ic E alua ion o F eud's Theo ies and The apy. New Yo k, Basic Books, 1978. On F eud's heo ies mo e gene ally, hei genesis, hei «s yle», and hei s a us as science, see ELLENBERGER, H. (1970), The Disco ely o he Unconscious. New Yo k, Basic Books; a ious pape s by Robe R. Hol , e.g, Two In luences on F eud's Scien i ic Though : a F ag nen o in ellec ual Biog aphy, in: WHITE, R. W. (ed.) (1963), The S udy o li es, New Yo k, A he on P ess, pp. 364-387, F eud's Cogni i e S yle, Ame ican Zmago 22, 163-179 (1965), and A Re iew o Some o F eud's Biological Assump ion and hei In luence on his Theo ies, in: GREENFIELD, N. S.; LEWIS, W. C. (eds.) (1965), Psychoanalysis and cu eni! biological Though , Madison, Uni e si y o Wisconsin P ess, pp. 93-124; GEDO, J. 15.; GOLDBERG, A. (1973), Models o he Mind: a psychoanaly ic Theo y, Chicago, Uni e iii y o Chicago P ess. GEDO, J. E.; POLLOCK, G. H. (eds.) (1976), F eud: he Fusion o Science and Humanism, New Yo k, In e na ional Uni e si ies P ess; he wo k o Roy Schae e , especially Ac ion: i s Place in Psychoanaly ic In e p e- a ion and Theo y, The Annual o Psychoanalysis, 1, 159-1 96 (1 973) and A New Language o Psychoanalysis, New Ha en, Yale Uni e si y P ess, 1976; and mos ecen ly, F ank Sulloway's F eud: Biologis o he Mind, New Yo k, Basic Books (1979). 268 CARL. E. PLETSCH 1 accoun o psychoanalysis, 1 am sugges ing, would ha e o pay much mo e a en ion o case s udies as eposi o ies and ehicles o his knowledge han has been he case hus a . Such a desc ip i e accoun would o cou se in ol e an ex ensi e s udy o he pe iodical li e a u e o psychoanalysis, i s monog aphs, and o psychoanaly ic educa ion 'as p ac iced in he ins i u es. The p esen pape is only a beginning in ha di ec ion, an a emp o see how F eud came o he en a i e conclusion ha case s udies we e he gen e o peculia ly psychoanaly ic knowledge, and (as a co olla y) o aim his mo e heo e ical s a emen s a he ex apsychoanaly ic eade . I is o cou se also an a emp o pose he ques ion o psychoanali yc knowledge as a ques ion o discou se. F eud published his i s case s udies join ly wi h Joseph B eue , whose pa ien ((A ma 0.)) had ac ually in en ed he (( alking cu e)) ha cons i u ed he udimen a y psychoanaly ic me hod ha F eud p ac i- ced in he 1890's. These i s case s udies appea ed in S udies on Hys e ia in 1895. F om ha yea un il 191 5 when F eud comple ed his case his o y o he Wol Man (F om he His o y o an In an ile Neu osis, which was no published un il 191 8), his me hod was con inually e ol ing. And especially du ing he la e hal o his pe iod, F eud's ene gies we e dedica ed e y la gely o he o ma ion o a school o disciples and ins i u ionalizing psychoanalysis. We shall see ha F eud's p eoccupa- ions wi h his me hod o in es iga ion and wi h o ming a communi y o psychoanaly ic in es iga o s go e ned his inno a i e use o case s udies. 1 shall ocus he e in u n upon each o he case s udies F eud w o e in his wen y yea pe iod. 1. STUDIES ON HYSTERIA I S udies on Hys e ia is one o he leas cohe en wo ks in he F eudian Co pus. Fo one eason, i was w i en by wo au ho s who did no ag ee en i ely on i s subs ance. Fo ano he , he p incipal au ho had no ye comple ed his so-called sel -analysis o e en begun he syn hesis o his ideas ha he would publish as he In e p e a ion o D eams in 1900. Thus S udies on Hys e ia emained a se ies o agmen s, bu i s agmen a y and en a i e na u e pe mi s an unhinde ed iew o he au ho s' anxie y abou he case s udies hey epo in i . ~ eud's' and B eue 's conce ns we e no unlike wha any la e nine een h-cen u y na u al scien is s would ha e el when, s ill caugh in he h oes o gi ing bi h o a new kind o knowledge, hey could only epo hei agmen a y insigh s in case s udies. In his s udy o Anna O., o example, B eue el obliged o «excuse» himsel o eci ing he de ails o he case by d awing an analogy F eud's Case S udies and he Locus o Psychoanaly ic Knowledge 269 be ween Anna 0. and he cla i y o he p o oplasm o he eggs o he sea- u chin which enable he his ology s uden o see wha happens in he eggs o o he species whose egg-p o oplasm is opague: «The in e es o he p esen case seems o me abo e al1 o eside in he ex eme cla i y and in elligibili y o i s pa hogenesis)). B eue 's analogy was la e used by F eud oo, as he edi o s o he S anda d Edi ion o his w i ings poin ou . And his gene al a gumeni ha pa hology may illumina e he wo kings o he heal hy pe sonali y became an impo an jus i ica ion o he alue o psychoanaly ic esea ch. Bu i is in e es ing o no e ha bo h o hese ideas a ose in esponse o B eue 's (and F eud's) anxie y abou epo ing in such de ail on a single unusual example. S angely enough, he sea-u chin analogy is ac ually inapp op ia e in his mos impo an espec , since Anna 0. did no cons i u e a ypical exa nple o a di e en species bu an indi idual o he same species whose pa hology migh ha e made he wholly idiosync a ic. Thus he analogy se es p incipally o mask he p oblem which na u al scien is s o he ime would ha e ound mos unse ling (6). The S o y o Anna O. -now hough o ha e been Be ha Pap- penheim in eal li e: he social wo ke , philan h opis and ounde o he Jüdische F auenbund- was he i s and mos ex ao dina y o he cases epo ed in S udies on Hys e ia. Hen i Ellenbe ge desc ibes F eud's lea ning o he s o y o B eue 's pa ien , along wi h his expe ience wi h Cha co a he Salpe ie e in Pa is, as one o he wo pe sonal expe ien- ces ha led him o de ise a new heo y o he neu oses (7). B eue had ea ed Anna O. in he ea ly 1880's and o se e al easons was uncom- (6) STRACHEY, J., e al. (eds.), The S anda d Edi ion o he Comple e Psychological Wo ks o Sigmund F eud, London, Hoga h, ol. 2, p. 41. The analogy may seem imp obable oday, bu in he in ellec ual clima e o physiological psychia y ha p e ailed in he 1890's i was no unusual-see SULLOWAY, F'. (1 979), op. ci . (7) ELLENBERGER, H. (1970), op. ci ., p. 480. Ellenbe ge dis inguishes hese wo pe sonal expe iences om he la ge ends in neu ology and psychia y ha also con ibu ed o F eud's hinking abou he neu oses. The w i ings o la e psychoanalys s on Anna O. / Be ha Pappenheim a e oo nume ous o lis . A ew o he mo e i npo an : ELLENBERGER, H. F., The S o y o Anna O.: a c i ical Re iew wi h new Da a, Jou nal o he His o y o he Beha io al Sciences, 8, 267-269 (1972); JENSEN, E. M., Anna O. - a S udy o he la e Li e, Psychoanaly ic Qua e ly, 39, 269-293, (1970); MEISSNER, W. W. A S udy on Hys e ia: Anna O. Redi i ia, The Annual o Psychoanalysis, 7, 17-52 (1979); POLLOCK, G. H., The Possible Signi icance o Childhood Objec Loss in he Jose B eue -Be ha Pappenheim (Anna O.)- Sigmund F eud Rela ionship, Jou nal o he Ame ican Psychoanaly ic Associa ion, 16, 7 11-739 (1968), Be ha Pappenheim's pa hological Mou ning possible E ec s o Childhood Sibling Loss, Ibid., 20, 476-493 (1972), and Be ha Pappe-eim: Addenda o he Case His o y, Ibid., 21, 328-332 (1973); and mo e-gene ally, S. REICHARD, A Re-examina ion o "S udies on H~s e ia", Psyckoanaly ic Qm edy, 25, 155-177 (1956). 270 CARL. E. PLETSCH o able abou e u ning o he case. As Ellenbe ge no es, he case (( adically di e [ed] om o he cases o hys e ia [ epo ed] a ha ime, bu [was] analogous o he g ea exempla y cases o magne ic illness in he i s hal o he nine een h cen u y, ... » The case o Anna O. seems o ha e appea ed o be a e e sion o an ea lie and os ensibly p e- scien i ic psychology. As Ellenbe ge epo s, To he olde magne ize s, Anna O.'s s o y would no ha e seemed as ex ao dina y as i did o B eue . I was one o hose cases, so equen in he 1 8201s, ye so sca ce in he 1880's, in which he pa ien dic a ed o he physician he he apeu ic de ices he had o use, p ophesied he couqse o he iiiness, and announced i s e minal da e. Bu in 1880, when au ho i- a ian use o hypnosis had supplan ed he o me ba gaining he apy, a s o y such as ha o Anna O. could no longe be unde s ood (8). The anxie y o he wo au ho s, he e o e, mus ha e been based on he kind and quali y o case s udy hey we e epo ing, and no only on he ac o epo ing case s udies. Case s udies we e common enough in medicine and neu ology a he ime. Jus wo yea s be o es publishing S udies on Hys ie a, F eud had published a con en ional case his o y illus a ing how e ec i e hipno ism could be in clea ing up symp oms in a case o hys e ia (9). This was qui e unp oblema ic since he case me ely illus a ed a ela i ely common medical p ocedu e and appea ed o alida e a heo y. In S udies on Hys e ia, howe e , F eud and B eue we e admi ing he lack o medical and physiological au ho i y o e hys e ia and, by implica ion, a ibu ing o he pa ien s he knowledge and powe o cu e hemsel es. As F eud no ed, hei cases also had mo e o a li e a y han a scien i ic cha ac e (10). And ha , aken in conjunc ion wi h he ac ha F eud and B eue we e using hei cases o illus a e ye non-exis en heo y, was wha made S udies on Hys e ia an anomalous book on an anomalous subjec . O cou se S udies on Hys e ia consis ed o mo e han me ely case s udies. The i s chap e was a pape ha F eud and B eue had p e iously. published, a ((P elimina y Communica ion)) on hys e ia, de i- (8) ELLENBERGER, H. (1970), op. ci ., p. 484. This gi es iníe es ing ele ance o a ema k o Robe Da n on in his book, Mesme ism and he End o he Enligh enmen in F unce, Camb idge (Mass.), Ha a d Uni e si y P ess, p. 173: «Wo ks by nonmesme is s usudly hono Mesme as a misunde s ood and some imes he oic p ophe o mode n psycho- logy. I may be ha psychoanalysis de eloped om a line o occul scien is s, linking F eud, Cha co , and B aid wi h Be and, Puysegu , and Mesme , jus as chemis y eme ged om alchemy.)) (9) A Case o a success ul T eaunen by Hypnosis in: STRACHEY, J. e . al. (eds.) (1966), S anda d Edi ion, ol. 1, London, Hoga h, pp. 1 15-128. (10) See below, p. 27 1. F eud's Case S udies and he Locus o Psychoanaly ic Knowledge 27 1 ning hei place on he on ie o esea ch and dis inguishing hei app oach om ha o o he in es iga o s. And he book concluded wi h a ((Theo e ical)) chap e by B eue and a pape on ca ha sis as he essen ial ing edien o ( l'he Psycho he apy o Hys e ia)) by F eud. Thus he wo au ho s ca e ully b acke ed hei de ailed case s udies by heo e icd s a emen s, gi ing hei case s udies he o mal appea ance o me e illus a ions. Bu . his was an obliga o y o mali y dic a ed by he no ns o scien i ic epo ing, no ms o which B eue and F eud na u ally subsc ibed. Ne e heless, he heo e ical po ions o S udies on Hys e ia we e he p o oundly en a i e po ions and he case s udies he eal subs ance o i . OnXy in he case s udies could he au ho s speak com o ably in he indica i e mood -only he e we e hey eally su e o hei g ound. And he e we e good easons o his, ha F eud a leas ecognized. In his discussion o he case o F au Emmy on N., also published in S udies o Hys e ia, F eud no ed he di icul ies a ising om he ac ha hys e ia was a diagnos ic ca ego y wi hou igo ous o commonly accep ed de ini ion: «UnXess we ha e i s come o a comple e ag eemen upon he e minology in ol ed, i is no easy o decide whe he a pa icula case is o be eckoned as a hys e ia o some o he neu osis.)) O cou se he ac ha hys e ia was a poo ly unde s ood bu no o ious class o ne ous diso de s is p ecisely wha in e es ed F eud. One migh say ha hys e ia was an acknowledged ca ego y o anomalous men al diso de s in he 1890's. Anyone who could unde s and and de ine he na u e o his diso de would clea up many mys e ies in neu opa- hology. As F eud pu i , «we ha e s ill o awai he di ec ing hand which shall se up bounda y na ks in he egion o he commonly occu ing neu oses and which shall b ing ou he ea u es essen ial o cha ac e- iza ion.)) In he mean ime, howe e , (we a e s ill accus omed o diagnosing a hys e ia, ... om i s simila i y o amilia ypical cases.)) Thus F eud explained he necessi y o epo ing case s udies o himsel by emembe ing ha hys e ia was no hen a well unde s ood disease, bu an icipa ed ha sonie g ea scien is -and in he e y ac o his w i ing upon he subjec we can see ha he al eady an icipa ed he possibili y ha he migh be ha ((di ec ing hand»- would clea up he con usion by de ining he dis inc i e ea u es o hys e ia. Then hys e ia would come in unde he umb ella o medical science and case s udies would no longe be necessa y (1 1). (1 1) S anda d Edi ion, ol. 2, p. 85. We also no e ha F eud exp eses he ge m o an idea o ( scien i ic e olu ions)) in his passage. 27 8 CARL. E. PLETSCH possibili y o an o de ly ecoun ing o a pa ien 's li e (25). Fu he mo e, F eud ecognized ha he e we e se e al s o ies o be old ha could ha dly be old simul aneously. In he Do a case he dis inguished only be ween he na a ion o his in e p e i e echnique and he econs c- ed biog aphic s o y in which he pa ien 's pa hology had de eloped. Bu he no longe el ha he could wea e hese s o ies oge he as he had in S udies on Hys e ia. i ha e in his pape le en i ely ou o accoun he echnique, which does no a al1 ollow as a ma e o cou se, bu by whose means done he pu e me al o aluable unconscious hough s can be ex ac ed om he aw ma e ial o he pa ien 's associa ions. This b ings wi h i he disad an age o he eade being gi en no oppo uni y o es ing he co ec ness o my p ocedu e in he cou se o his exposi ion o he case. 1 ound i qui e imp ac icable, howe e , o deal simul aneously wi h he echnique o analysis and wi h he in e nal s mc u e o a case o hys e ia: 1 could sca cely ha e accomplished such a ask, and i 1 had, he esul would ha e been almos un eadable (26). F eud had lea ned a g ea dela abou he epis emological s a us o he knowledge he was de i ing om hys e ical pa ien s in he yea s since 1895. Pa adoxically, wha he had lea ned made him bo h mo e and less sanguine abou he p ospec s o communica ing his knowledge. He was much mo e awa e o ' he di icul ies o demons a ing he alidi y o his obse a ions and hypo heses o he medical wo ld a la ge, bu he had begun o see ha o he ini ia es and especially p ac i ione s o psychoa- nalysis we e in a peculia ly ad an ageous posi ion o app ecia e his case s udies. E nes Jones w i es ha we do no know why F eud hesi a ed so long o publish he Do a case, and s ic ly speaking ha is ue, bu he way his hinking had changed since 1895 sugges s a e y s ong eason. He simply, ook his ese a ions abou he case's incomple eness e y se iously. And in iew o he s ill almos comple e lack o a psychoana- ly ic communi y in 1901, i is no wonde ha he did no publish i hen. In 1905 hings looked di e en and he illus a i e alue he case held o o he psychoanalys s ou weighed his ese a ions abou he possi- bili y o i s being app ecia ed by he unini ia ed. (25) S anda d Edi ion, ol. 7, pp. 16-18. (26) Ibid., ol. 7, pp. 12-13 and 112. Ci ed passage appea s on p. 112. On p. 13, F eud w i es ha «Apa om he d eams, he e o e, he echnique o he analy ic wo k has been e ealed in only a e y ew places. My objec in his case his o y was o demons a e he in ima e s uc u e o a neu o ic diso de and he de e mina ion o i s symp oms; and i would ha e led o no hing bu hopeless con usion i 1 had ied o comple e he o he ask a he same ime.» This is an e en mo e explici ecogni ion o he impossibili y o econciling he na u alis ic na a i e wi h he wo k o anaiysis. F eud's Case S udies and he Locus o Psychoanaly ic Knowledge 279 Anyone seeking o unde s and wha psychoanaly ic knowledge is should y o unde s and F eud's dilemma a his junc u e. 1 belie e ha i we canno app ecia : F eud's mo i es in conside ing whe he o publish he Do a case, we may be easonably su e ha we do no unde s and he way in which psychoanaly ic knowledge de eloped and how i is cons i u ed. 111. LITTIE HANS AND THE RAT MAN When F eud inally decided o publish his accoun o Do a's case i was a e ou yea s o empo izingj as 1 ha e al eady poin ed ou . In ac , he pape had bee i accep ed o publica ion as ea ly as Janua y, 190 1 by Ziehen, he edi o o he Mona sch i ü Psychia ie und Neu ologie, he same jou nal in which i ac ually appea ed in 1905 (27). Bu his was he las o F eud's. case s udies ha was o appea in a medical jou nal no di ec ly associa ed wi h he psychoanaly ic mo emen . (Jones no es ha F eud ga e his las lec u e be o e a medical audience in 1904.) O cou se in 1900 when F eud wo ked wi h Do a and w o e he his o y o he case, he couldn' be expec ed o ha e had disciples o a jou nal de o ed e~ clusi ely o psychoanalysis. I was only in la e 1902 and 1903 ha he i s mee ings o wha was o become he Vienna Psychoanaly ic Socie y we e held in F eud's wai ing oom, and only in 1908 ha he i s ((in e na iona.1)) mee ing o psychoanalys s was held in Salzbu g. I was a he Salzbu g mee ing ha he decision was made o publish a psychoa- naly ic pe iodical (28). As one migh suppose, he Jah buch was ounded in o de o gi e he g oup i s own o um in which o u he de elop psychoanalysis wi hou he in e e ence o he unini ia ed -a s ep aken by he p ac i ione s o i ually e e y eme gen discipline o subdisci- pline (29). Thus in 1909 F eud was able o publish his nex wo case his o ies in he i s wo numbe s o he i s psychoanaly ic pe iodical, he Jah buch U psychoanaly ische und psychopa hologische Fo schungen. These we e his epo s on he cases commonly known as Li le Hans, Analysis o a Phobia in a Fi e-Yea -Old Bay, and he Ra Man, No es upon a Case o Obsessional Neu osis. In iew o he ci cums ances in which hey we e (27) See he ((Edi o s No e)), S anda d Edi ion, London, Hoga h, ol. 7, pp. 3-5 (1953). (28) See JONES, E. (1955), The Li e and Wo k o -igmund F eud, ol 2, pp. 38-45. (29) See also Jung's p e a o y s a emen in he i s olume, and Jone's accoun o F eud's le e in which he exp essed sa is ac ion a being id o ou side in e e ence and able o communica e wi h his disciples in hei own publica ion, ibid., p. 45. I is signi ican ha his impo an s ep in c ea ing a disciplina y ma ix should ha e been ma ked on F eud's pa by he con ibu ion o wo case s udies (and no o he communica ions) o he i s olume o he Jah buch. 280 CARL. E. PLETSCH published, i should come as no su p ise ha F eud's accoun s o hese wo cases should be de oid o ha de ensi e sensi i i y is 6 is non- psychoanaly ic eade s which ma ked his accoun o he Do a case. The cases published in 1909 we e clea ly aimed a a eade ship o psychoa- nalys s, a eade ship which had only eme ged in he ime since he w i ing o he Do a case (30). The case o Li le Hans especially gi es he imp ession o a con i- bu ion en e nous, and i became he e y i s i em in he i s issue o he Jah buch. The sense o amilia i y de i es in pa , o cou se, om he ac ha he aw ma e ials o he epo we e supplied by he li le boy's pa en s, who we e, acco ding o F eud, ((among my closes adhe- en s)) (3 1). Acco ding o F eud, oo, he had « o many yea s been u ging my pupils and my iends o collec obse a ions o he sexual li e o child en)) in o de o compa e he da a o such obse a ions o hypo- heses abou ea ly sexual li e de i ed om he analysis o adul s, e.g., hose ha he had published in he Th ee Essays on he Theo y o Sexuali y (1905). The case o Li le Hans is he mos ob ious mi o his eques , some hing he pa en s o he child sha ed wi h F eud, and which F eud hen sha ed wi h his o he disciples. Bu he e we e impo an and posi i e heo e ical easons o sha ing his case wi h psychoanalys s. F eud acknowledged ha he hypo heses in he Th ee Essays, seem as s ange o an ou side eade as hey seem incon o e ible o a psycho-analys . Bu e en a psycho-analys may con ess o he wish o a mo e di ec and less oundabou p oo o hese undamen al heo ems. Su ely he e mus be a possibili y o obse ing in child en a i s hand and in al1 he eshness o li e he sexual impulsed and wishes which we dig ou so labo iously in adul s om among hei own déb is -especially as i is also ou belie ha hey a e he common p ope y o al1 men, a pa o he human cons i u ion, and me ely exagge a ed o dis o ed in he case o neu o ics (32). He e we see ha F eud con inued o ega d he case s udy as somewha in e io in signi icance o heo e ical o mula ions, bu acco ded i an i npo an ole in he con i ma ion o hypo heses, i.e., in he alida ion (30) The wo cases cons i u e ol. 10 o he S anda d Edi ion. (3 1) The a he was Max G a , a music c i ic and membe o F eud's ea ly ci cle who a ended he ((Wednesday mee ings)). I is in e es ing ha his ela i ely simple case ha F eud published o didac ic eason done, and no because i illus a ed any new complexi ies o echnique o ma ked ou any new e i o y o diagnosis, has been e y li le he subjec o la e psychoanaiy ic in es iga ion o w i ing. This would seem o con i m F eud's s a emen s abou he g ea e alue o he cases on he on ie s o knowledge, e en i hey canno be comple ely esol ed, gi en in his accoun o he case o he Wol Man. See below, p. 290. (32) S anda d Edi ion, ol. 10, pp. 5-6. F eud's Case S udies and he Locus o Psychoanaly ic Knowledge 28 1 p ocess (33). I is also in e es ing o no e ha he seems no longe wo ied abou he ac lha his is only one case. Wo king now in he con ex o wha he was la e o cal1 a he psychoanaly ic mo emen )), F eud disco e ed ano he use o he case his o y - he pedagogical. In his conclusion o he Analysis o a Phobia in a R e-Yea Old Boy he w o e ha , S ic ly speaking, 1 lea n no hing new om his analysis, no hing ha 1 had no al eady been able o disco e ( hough o en less dis inc ly and mo e indi ec ly) om o he pa ien s analysed a a mo e ad anced age. Bu he neu oses o hese o he pa ien s could in e e y ins ance be aced back o he same in an ile complexes ha we e e ealed behind Hans's phobia. 1 a n he e o e emp ed o claim o his neu osis o childhood he signi icance o being a ype and a model, ... (34). This is a pa icula ly ini e es ing passage, in iew o he emendous i npo ance ha case s udies, and pa icula ly F eud's case s udies, ha e occupied in he cu iculum o he psychoanaly ic ins i u es. The accoun o Li le Hans's phobia and i s emo al cons i u es he i s psychoana- ly ic case s udy w i en la gely o didac ic easons (35). O cou se F eud had called his accoun o Do a's analysis ((sui able as a i s in oduc o y publica ion)), bu wi h he scien i ic eading public a la ge in mind. In he case o Do a F eud wan ed o demons a e his unde s anding o hys e ia; in ha o Li le Mans he wan ed o show psychoanalys s how psychoandysis p oceeds and ha he sexual ae iology o adul neu oses could be con i med in he analysis o a child. The di e en audience ha F eud en isioned is c ucial o he e olu ion o his hinking abou he alue o his case s udies. F eud's epo on his analysis o he Ra Man, No es upon a Case o Obsessional Neu osis, con i ms his imp ession abou he in ended ea- de ship o which F eud now di ec ed his case s udies (36). The case o (33) C JONES, E. (1955), The Li e and Wo k o Sigmund F eud, ol. 2, pp. 258-262. (34) S anda d Edi ion, ol. 10, p. 147. (35) I was also he i s child a ialysis, a p ac ice la e de eloped along sligh ly di e en lines by Melanie Klein. See he Psychoanalysis o Child a (London, Hoga h, 1932) and especidy he Na a i e o a Child Analys s (London, Hoga ). (36) The pos -F eudian psycheoanaly ic li e a u e on he case o he Ra Man is abundan . See KANZER, M. (1952), The T ans e ence Neu osis o he Ra Man, Psychoanaly ic Qua e ly, 21, 181-189; ZETZEL, E. 11. (1966), 1965: Addi ional No e upon a Case o obsessional Neu osis: F eud 1909, In e na ionalJou nal o Psycho-Analysis, 47, 123-129; MEYERSON, P. G. (1966), Commen s on D . Ze z~l's Pape , ibid., pp. 139-142; LIPTON, S. D. (1971), F eud's Analysis o he Ra Man conside ed as a echnical Pa adigm, abs ac ed in Buile in o he Philadeiphia Associa ion o Psychoanalysis, 21, 179- 183; CEDO, J. E.; GOLDBERG, A. (1973), Models o he Mind, pp. 11 1-1 14; and BEIGIER, J. S. (1975), A Commen a y on F eud's T ea men o he Ila Man, The Annual o Psychoanalysis, 3, 27 1-286. 282 CARL. E. PLETSCH he Ra Man is less an illus a ion o a heo e ical hypo hesis han he case o Li le Hans, and mo e an a emp o explo e new g ound, bu i is he e o e e en mo e di ec ly o ien ed o he psychoanaly ic eade ship o he Jah buch. In no ing he incomple eness o his accoun o he case, F eud explained ha he had «no ye succeeeded in comple ely pene- a ing he complica ed ex u e o a se e e case o obsessional neu osis)). Fu he mo e, F eud no ed ha obsessional neu oses we e a less easy o unde s and han cases o hys e ia. This was pa adoxical, since obsessional neu oses cons i u e no only «a dialec o he language o hys e ia)), bu ((a dialec in which we ough o be able o ind ou way abou mo e easily, since i is mo e nea ly ela ed o he o ms o exp ession adop ed by ou conscious hough han is he language o hys e ia)). He sugges ed ha he di icul y was due o he ac ha ewe cases o obsessional neu osis had p esen ed hemsel es o analysis, such neu o ics inding i possible o ((dissimula e hei condi ion in daily li e)). In any case, obsessional neu oses cons i u ed a pa hology on he on ie o psychoanalysis, 'much like hys e ia had been an anomaly in neu opa hology when F eud began o s udy i . This is wha made F eud eel jus i ied in communica ing his insigh s o he psychoanaly ic communi y. In hese ci cums ances he e is no al e na i e bu o epo he ac s in he impe ec and incomple e ashion in which hey a e known and in which i is leei ima e o communica e hem. The c umbs o knowle~de o e ed " " in hese pages, hough hey ha e been labo iously enough collec ed, may no in hemsel es p o e e y sa is5ing; bu hey may se e as a s a ing- poin o he wo k o o he in es iga o s, and common endea ou may b ing he success which is pe haps beyond he each o indi idual e o (37). Wi h his 1 belie e we begin o see ano he pa e n in F eud's hinking abou his case s udies: hey a e exempla y in es iga ions, no necessa ily solu ions, o p oblems o psychopa hology. He now hough o his case s udies as pa s o a scien i ic esea ch li e a u e o which o he psychoa- nalys s would ob iously con ibu e. E en his impe ec and incomple e case s udies se ed o ma k ou he e i o y o u u e psychoanaly ic in es iga ions. In his conclusion o he sa ne case, he exp essed his wish ha (([all hough my communica ion is incomple e in e e y sense, i may a leas s imula e o he wo ke s o h ow mo e ligh upon he obsessional neu osis by a deepe in es iga ion o he subjec )). F eud may ha e been gi en o alse modes y on occasion, bu his is no one o hose (37) S anda d Edi ion, ol. 10, pp. 156-157. F eud's Case S udies and he Locus o Psychoanaly ic Knowledge 283 occasions. He was conce ned he e wi h he e y di icul p oblem o dema ca ing obsessional neu oses om cases o hys e ia, as we see om he same passage whe e he also s a es e y aguely ha «Wha is cha ac e is ic o his neu osis -wha di e en ia es i om hys e ia- is no , in my opinion, o be ound in ins inc ual li e bu in he psycholo- gical ield)) (38). This pos ula e emained o be u he speci ied by o he wo ke s who would analyze cases o obsessional neu osis. Thus we see ha F eud's diminished anxie y abou he incomple eness o his cases and his con idence in he coope a ion o his psychoanaly ic ollowe s go hand in hand. The case his o y had by his ime achie ed he s a us o a gen e peculia ly sui ed o communica ion among psychoanalys s. F eud clea ly saw bo h o his cases published in 1909 as a pa o a ongoing p ocess o psychoanaly ic esebch. They we e no me ely places whe e acqui ed insigh and knlowledge could be deposi ed ( o he bene i o he wo ld a la ge), buu a gen e which omen ed u he esea ch by in es iga o s who had al eady gained ..a con ic ion o he alue o psychoanalysis. F eud said li le enough abou he ans e ence in hese wo case s udies piiblished in 1909, bu ha may be p ecisely because hese a e cases w i en o psychoanalys s and psychoanalys s unde s ood his ma e by hen. The e is good e idence in ema ks he made o non- psychoanalys s on he subjec o ans e ence in he sa ne yea , ha he belie ed ha expe ience in analysis was a p e equisi e o he app e- cia ion o he alidi y o insigh s de i ed om psychoanalysis. In his Fi e Lec u es on Psychoanalysis gi en a Cla k Uni e si y in 1909, F eud s essed ha he expe ience o i-ans e ence plays a decisi e pa in b inging con ic ion no only o he pa ien bu also o he physician. 1 know i o be ue o al1 my ollowe s ha hey we e only con inced o he co ec ness o my asse ions on he pa hogenesis o he neu oses by hei expe iences wi h ans e ence; and 1 can e y well imde s and ha such ce ain y o judgemen canno be a ained be o e one has ca ied ou psycho-analyses and has onesel obse ed he wo kings o ans e ence (39). This con ic ion ha his ollowe s had e i ied he alue o his insigh s by hei own expe ience wi h he ans e ences o hei own pa ien s mus be seen as an impo an pa o he basis o his new a i ude abou case s udies. The expe ience o ans e ence ha F eud now began o p esuppose in he eade s o his case s udies can be iewed wi h ex eme skep icism (38) Zbid., ol. 10, p. 248. C : JQNES, E. (1955), The Li e and Wo k o Sigmund F eud, ol. 2, p. 264. (39) Zbid., ol. 11, pp. 51-52. 284 CARL. E. PLETSCH o i can be casually accep ed as specialized aining. I can be iewed as no mo e han he psychoanaly ic analogue o he p e equisi e aining p esupposed in he scien i ic epo s o e e y o he specialized disci- pline, om psychics o s a is ical demog aphy. O , expe ience wi h he ans e ence in he p ospec i e psychoanalys 's own analysis and in he supe ized analysis o his i s pa ien s can be aken as a i e o ini ia ion bound o p oduce belie e s and hus a highly unscien i ic communi y o in es iga o s. I seems o me ha he e is a leas a modicum o u h in bo h o hese posi ions, and u he mo e, ha he e is li le p ospec o esol ing he issue o he sa is ac ion o al1 hose who adop he opposed a i udes. This much mus be admi ed. In ac , he wo posi ions o m he pa ame e s ha gi e ise o he ques ion o psychoanaly ic know- ledge. Fo i psychoanaly ic aining, analysis, e c., is bo h scien i ic aining and eligious i e o ini ia ion, hen psychoanalysis is nei he simply science no eligious pseudo-science. Wha s ikes me as mo e in e es ing, howe e , is ha his expe ience wi h he ans e ence in he analy ic si ua ion ha F eud p esc ibed migh be he complemen o he case s udies in de ining he peculia na u e o psychoanaly ic knowledge. Fo 1 began by no ing ha psy- choanali ic knowlegde seemed anomalous in being loca ed in case s udies. Now in he p ocess o demons a ing he e olu ion o F eud's own hinking owa d his iew, we ha e disco e ed ha expe ience wi h he ans e ence is a p e equisi e o unde s anding he cases F eud epo ed. The ans e ence seems o be he pa icula kind o ((pe sonal knowledge)) equi ed o he psychoanalys . Bu unlike he many exam- ples o pe sonal knowledge gi en by Polanyi in his book by ha name, he ans e ence is only use ul when he psychoanalys is acu ely conscious o i . Unlike he many skills ha we lea n wi hou being able o desc ibe hem adequa ely o explain hem heo e ically, and by de ini ion unlike aci knowledge, ans e ence is a kind o knowledge ha depends upon he psychoanalys 's abili y o a icula e i . Thus i may be ha he ans e ence is mo e ho oughly ((pe sonal knowledge)) han he skills ha o he scien is s lea n by empa hy and imi a ion om hei eache s. I seems o cons i u e a o m o in e subjec i i y ha can only be de ined as a icula ed ((implici y)), o , in psychoanaly ic e ms, he unconscious made conscious. This would seem o be wha makes i bo h highly subjec i e and ye a sha ed medium o communica ion ha cons i u es he basis o he psychoanaly ic communi y o in es iga ion. IV. THE SCHREBER CASE F eud's analysis o Daniel Paul Sch ebe 's delusion was published in he Jah buch ü psychoanaly ische und psychopa hologische Fo schungen in 19 1 1. F eud's Case S udies and he Locus o Psychoanaly ic Knowledge 285 This essay, Psychoanaly ic No es on un Au obiog aphical Accoun o a Case o Pa anoia, is no a case s udy in he same sense as he o he s i am conside ing he e, inasmiich as F eud had no pe sonal con ac wi h Sch ebe , no did Sch ebe himsel ha e any expe ience wi h psychoa- naly ic he apy (as e en Li le Hans had). Sch ebe had, howe e , w i en an elabo a e accoun o his men al illness, and published i as his Memoi s o a Men al Pa ien (40). F eud used hese published memoi s as he basis o his analysis. None heless, he case is again p esen ed p ima ily o psychoanalys s a he han o he medical wo ld a la ge. Thus we may no e ha by his ime F eud's hinking on his case s udies had p og essed so a ha he made no he o ical use o he ac ha he pa ien 's au obiog aphicd accoun was in he public domain. He migh ha e a gued ha his would gi e his analysis an objec i i y ha his ea lie case s udies did no possess, opening i o he e iew o o he p o essionals in e es ed in pa anoia. Bu he was no longe conce ned in his case s udies wi h es ablishing his g ea e capaci y o deal he apeu- ically wi h a pa icula o m o men al illness. He was s ill e y much conce ned ha o he psychoanalys s should ead he case and assimila e his analysii; o i , howe e . In his espec , F eud's case his o y o Sch ebe bea s some simila i y o his ea men o Wilhelm Jensen's s o y ((G adi m, which also e ged upon becoming a case s udy o i s au ho (41). F eud's mos gene al aim in w i ing his acoun o Sch ebe 's illness was o es ablish he na u e o pa anoia and i s loca ion among o he psychoanaly ically unde s ood men al diso de s. As he had been a pains o dis inguish obsessional neu oses om hys e ia in his accoun o he analysis o he Ra Man, in his essay on Sch ebe F eud wan ed o es ablish pa anoia as a diagnos ic ca ego y by pene a ing o i s de ining ea u es oo (42). Al1 o his ough o emind us, 1 hink, o his o iginal an icipa ion in S udies on Hys e ia, o « he di ec ing hand which shall se up bounda y ma ks)) among he a ious men al diso de s. Bu he di icul ies in he a ea o pa anoia we e pa icula ly g ie ous and led o he ac ha F eud was compelled o base his discussion o his diso de upon a w i en accoun a he han an analysis. People su e ing om pa anoid delusions we e no ap o submi o psychoanalysis, a p ocess (40) Denkwu digkei en eines Nenienk anken (Leipzig, Mu ze, 1903), an English asla ion was made by Ida Macalpine and Richa d Hun e and published wi h an in oduc ion as Memoi s o my Nenious Zllness (London, Dawson, 1955). (41) ((Delusions and D eams in Jensen's G adi m (1907), S anda d Edi ion, ol. 9, pp. 7-95. (42) On which, see chap e h ee o he essay, «On he Mechanism o Pa anoia)), S anda d Edi ion, ol. 12, pp. 59-79. 286 CARL. E. PLETSCH which would na u ally elici al1 hei ea s o pe secu ion and cause hem o asc ibe he pe secu ions o he psychoanalys . Ha ing i ually no pa anoid pa ien s, he e o e, and e aining hose ha he did encoun e o only he e y b ie es pe iods, F eud ound himsel o ced o ely upon he se endipi ously published accoun o Sch ebe . Thus his apologies o he ac ha unde hese ci cums ances he was no able o analyze he ans e ences .o he pa ien in he now well es ablished analy ic con ex (43). In iew o al1 o hese di icul ies, i is al1 he mo e in e es ing and e ealing ha F eud should ha e chosen o con ey his insigh s on pa anoia in he o m o a case his o y. The Sch ebe case seems o demons a e he signi icance o case s udies as he p i ileged gen e o psychoanaly ic knowledge in a nega i e way. F eud ound i na u al o make his a gumen s abou pa anoia in he con ex o his case s udy, e en wi hou ans e ence, ee associa ion o e en any pe sonal con ac wi h he subje c , because no o he mode o epo ing cons i u ed a plausible al e na i e. To be su e, he inclina- ion F eud ob iously el o ancho his hinking on pa anoia in Sch e- be 's memoi s may s em as much om he unusually lo id na u e o he pa hology o his pa icula case as om he impossibili y o gi ing a con incing accoun o pa anoia in a mo e abs ac mode. Bu wha e e he mix u e o mo i es, he incon es ible ac is ha F eud's epo on he Sh ebe case has emained he co ne s one o psychoanaly ic hinking on pa anoia o his day (44). In his ((A emp s a In e p e a ion)), he second chap e o he essay on Sch ebe , F eud no ed ha his eade s would ((only ollow him as a as hei own amilia i y wi h analy ic echnique will allow hem)) (45). Bu he case is a good illus a ion o how F eud's psychoanaly ic colleagues did in ac ollow him and by hei own a en ion o Sch ebe 's memoi s amplie he conclusions ha could be d awn om a single case s udy. A yea a e his publica ion o he essay on Sch ebe , F eud no ed ha , By a happy chance he same issue o his pe iodical [ he Jah buch] as ha in which my own pape appea ed showed ha he a en ion o some o he con ibu o s had been di ec ed o Sch ebe 's au obiogaphy, and made i (43) S anda d Edi ion, ol. 12, p. 9. (44) O he eno mous li e a u e on he Sch ebe case, see especially he book by NIEDER- LAND, W. G. (1974), The Sch ele Case psychoanaly ic P o ile o a Pa anoid Pe sonaliQ, New Yo k, Quad angle, which con ains good bibliog aphies o ea lie wo k on Sch ebe . The e was, o ins ance, a Symposium on he case, pape s om which we e published in he Zn e na ional Jou nal o Psycho-Analysis, 44 (1963), edi ed by Philip M. Ki ay. O he ecen wo k on Sch ebe is ep esen ed by CEDO. J. E.; GOLDBERG, A. (1973), Models o he Mind, pp. 125-134; and MEISSNER, W. W. (1979), Sch ebe and he Pa anoid P ocess, The Annual o Psychoanalysis, 7, 3-40. (45) S anda d Edi ion, ol. 12, pp. 36-37. F eud's Case S udies and he Locus o Psychoanaly ic Knowledge 287 easy o guess how much mo e ma e ial emains o be ga he ed om he symbolic con en o he phan asies and delusions o his gi ed pa a- noic (46). O cou se E nes Jones and o he w i e s since him ha e sugges ed ha F eud's ema ks abou pa anoia in his accoun o he Sch ebe case sowed he seeds o he soon o be accomplished disassocia ion o Ca l Jung and his ollowe s om F eud, and he e en ual disa ec ion o Sando Fe nczi (47). Bu so a om sugges ing ha F eud's essay ailed in i s ole o exempla o help main ain he cohe ence o he psychoa- naly ic communi y o in es iga ion, his demons a es he powe o he case s udy o de ine he bounda ies o he nascen discipline. Reading F eud's case s udies, i seems, no only guided and educa ed F eud's willing ollowe s, bu could also se e o sepa a e less o hodox analys s om he mo emen . In ac , F eud's nex case s udy would be e en mo e impo an in sepa a ing e an analys s. V. THE WOLF MAN F eud's analysis o he case o he Wol Man, his las leng hy case s udy, was w i en in he win e o 19 14- 15, en i led F om he His o y o an In an ile Neu osis (1 91 8), and published in his Kleine Sch i en, since he wa had in e i~p ed he publica ion o he Jah buch o which i was in en- ded. I qui e elabo a ely illus a es he ac ha F eud had come o use his case s udies o educa e and in luence he hinking o his ellow psychoanlys s a he han he medical wo ld a la ge. In ac , F eud used he case o he Wol Man o a bi a e his di e ences wi h Adle and especially wi h Jung. As he no ed in ega d o he con ex o his w i ing he case, A ha ime 1 was s ill eshly unde he imp ession o he wis ed e- in e p e a ions which C. G. Jung and Al ed Adle we e endea o ing o gi e o he indings o psychoanlysis. This pape is he e o e connec ed wi h my essay "On he His o y o he Psycho-Analy ic Mo emen " which was published in he Jah buch de Psychoanalyse in 1914. I supplemen s he polemic con ained in ha essay, which is in i s essence o a pe sonal cha ac e , by an objec i e es ima ion o he analy ic ma e ial (48). I should no escape ou no ice ha in linking his essay «On he His o y o he Psychoanaly ic Mo emen )) o he case o he Wol Man he e, F eud calls he la e ((objec i e)) and implies ha he o me is mo e (46) Ibid., ol. 12, p. 80. (47) JONES, E. (1955), Tke Li e and Wo k o Sigmund F eud, ol. 2, pp. 268-269. (48) S anda d Edi ion, ol. 17, p. 7. 294 CARL. E. PLETSCH knowledge pa excellence. No ha hey cons i u ed he only kind o psychoanaly ic knowledge. As a i s dis inc ion, one migh con as his knowledge o psychoanalys s deposi ed in he case s udies wi h he knowledge o psychoanalysis ha F eud pu eyed in his mo e exposi o y and heo e- ical wo ks (62). A de ailed in es iga ion would undoub edly yield many u he dis inc ions based upon di e ences in he ways in which psy- choanaly ic knowledge is ansmi ed and he uses o which i is pu (63). The e a e, in o he wo ds, many discou ses o psychoanalysis. Bu we do no need o begin by knowing e e y hing; i.e., we do no need o make an exhaus i e s udy o al1 he di e ing discou ses o psychoanalysis be o e we can begin o dis inguish psychoanaly ic knowledge om o he o ms o knowledge. i case s udies a e indeed he gen e o peculia ly psychoanaly ic knowledge - he ke nel o Knowledge o psychoanalys s- we should begin ou desc ip ion o psychoanalysis and psychoanaly ic knowledge he e. F eud's oeu e opened he discou se o psychoanalysis, bu i seems ha all he issu es ha ha e de eloped in psychoanaly ic discou se since F eud a e p e igu ed in he issu es o F eud's w i ing. 1 ha e aced only one o hese issu es, showing ha behind he explici di e ence be ween he gen es o F eud's w i ing in ended o di e en audiences he e lay a ension be ween he posi i is ic no ions o science ha F eud had imbibed wi h his medical educa ion, in which heo y p edomina ed, and ano he no ion o knowledge ha a ose ou o o was p oduced by he psychoanaly ic mode o knowing i sel . The iew o knowledge implied in F eud's inc easing eliance upon case s udies, he iew ha can be compa ed o a combina ion o Kuhn's exempla s and ; Polanyi's pe sonal knowledge, ne e ully iumphed o e F eud's ; commi men o heo y and i s e aci y. Bu e en hough his iew ne e came o p edomina e in F eud's mind, we a e jus i ied in acco ding i he s a us o a dis inguishing ea u e o psychoanaly ic knowledge. Fo i ep esen s he mos adical depa u e om he adi ion o posi i is ic scien i ic discou se in F eud's oeu e, and we may assume ha F eud (62) 1 do no allude o Cli o d Gee z's dis inc ion be ween ((model o ~ and ((model o » he e. Tha is qui e di e en . (63) As a as he knowledge o psychoanalysis ha is had among non-psychoanalys s is conce ned, psychoanalysis is ob iously one hing o he psychoanaly ic pa ien who has come o know psychoanalysis h ough his o he own expe ience in analysis and ano he o he academic s uden o psychoanalysis who has ead F eud's ea ises by no expe ienced analysis. And simila ly, he psychoanaly ic knowledge acqui ed by psy- choanalis s has many o he componen s han me e ly he case s udies, e.g., wha hey lea n om hei own aining analyses, wha hey app ecia e abou he conce ns o hei ellow analys s, wha hey ead abou analysis, e c. F aud's Case S udies and he Locus o Psychoanaly ic Knowledge 295 would no ha e pe mi ed himsel o be d awn in o such a depa u e i his ne hod and he exigency o communica ing wi h his ollowe s had no pulled him in ha di ec ion. I onically, his s o y o how F eud came o iew his case s udies as he locus o peculia ly psychoanaly ic knowledge -in spi e o himsel and his posi i is ic aining- is a s o y ha could appea in an un econs uc ed his o y o science. Wi hou much exagge a ion, we can say ha he da a o ced F eud o his iew. Bu F eud's da a we e no he ine da a. o he nine een h cen u y physical science. His da a we e pa ien s, hei d eams, hei slips o he ongue, and ul ima ely hei ans e ences and F eud's coun e ans e ences. F eud's ambi ion o sol e he p oblem o hys e ia g adually led him o ans o m he ins usi e hypno ic he apy he lea ned om he F ench in o a me hod o in e subjec i i y. In his he allowed himsel o be ins uc ed by he pa ien s, s a ing wi h Anna O. Bu his me hod o in e subjec i i y -analyzing ans e ences- yielded knowledge ha F eud ound i di icul i no impossible o con ey o eade s in he usual gen es o scien i ic communica ion. He ound himsel o ganizing a communi y o in es iga o s who expe ienced ans e ence in hei own analyses (o en wi h F eud) and in hei analyses o pa ien s. Fo his communi y, he case s udy p o ed he ideal gen e o communica ion. Thus F eud was o ced o his no el iew o knowledge by wo s ic ly social con igu a- ions: his ela ionships wi h his pa ien s and wi h he scien i ic commu- ni ies, i s o medicine and physiology and la e o psychoanalysis. This b ings us squa ely back o he ase ion ha he ques ion o psychoanaly ic knowledge is a ques ion o discou se. Fo he wo ela ionships ha pulled F eud owa d his iew o psychoanalysis as pe sonal, exempla y knowledge in he case s udies u n ou o be he i educible axes o psychoanaly ic discou se. The discou se o analys and pa. ien is psychoanalysis in he sense o a p ac ice, and he discou se o analys and ellow analys s is psychoanalysis in he sense o a discipline. Wi hou hese wo le els o discou se any o he is un hinka- ble. E e y o he discou se o psychoanalysis de i es ul ima ely om one o bo h o hese. F eud's case s udies (and he case s udies published since) a e o cou se no iden ical wi h hese wo le els o discou se. Bu o al1 he w i ings o F eud and his ollowe s, i is in he case s udies ha he discou ses o analys lanalysand and analys l ellow analys a e mos ully p ecipi a ed. The discou se o analys lanalysand canno by i s e y na u e be eplica ed o a eade . As F eud no ed in his epo on he case o he Wol Man, a e ba im ansc ip o he wo ds exchanged in a 296 CARL. E. PLETSCH whole analysis would be comple ely inadequa e o ep esen ing ha analysis o a hi d pa y (64). Bu a he han ansc ibe analyses, F eud g adually de ised he case s udy as he ehicle and nea es app oxima- ion o he in e subjec i i y ha ob ains in an analysis. This app oxima- ion can be deciphe ed by o he analys s who ha e expe ienced ahs- e ence in he analy ic si ua ion. Thus he discou se o analys l ellow analys is much mo e clea ly e lec ed in he case s udies, bu again, he ela ionship is no one o equi alence. The case s udies a e a sedimen o his discou se, whe eas hey a e ansla ions o he discou se ana- lys lanalysand. Bu in he case s udies we hea only one oice in he discou se be ween analys s, he oice o F eud. And we can only a emp o in e and ex apola e om ha oice he na u e o he discou se a nong psychoanalys s. Wi h hese ese a ions we can s ill conclude ha he case s udies cons i u e he mos cha ac e is ic and speci ically psychoanaly ic knowledge in he F eudian oeu e (65). Looking back hen, wha does he e olu ion o F eud's a i ude as he w o e he case s udies e eal? F eud's awa eness o he signi icance o he case s udy eme ged hand in hand wi h his ealiza ion ha psychoa- nalysis cg>ns i u ed a new kind o knowledge. Ea ly in his ca ee as a psychoanalys , when F eud hough his insigh s and disco e ies o be aluable me ely as inc emen s o amilia scien i ic knowledge, he was s ill obli ious o he impo ance o his epo s on pa icula cases, e en emba assed by hem. Only when he began o ealize ha his new insigh s migh cons i u e a new kind o knowledge did he begin o ealize ha hey equi ed a no el so o epo age. Thus he case s udies lead ' us no only o an app ecia ion o an impo an issu e in psychoanalysis - he dis inc ion be ween knowledge o psychoanalys s and he know- ledge o psychoanalysis- hey lead us o an awa eness o he issu es in knowledge in gene al. In i s mos cha ac e is ic o m, psychoanaly ic knowledge canno be adequa ely desc ibed as science o pseudoscience. As a discou se, one discou se o se o discou ses among many o he s, i mus be desc ibed as one o many kinds o knowledge. To con on he ques ion o psychoanaly ic knowledge, we mus b acke he ques ion o science. (64) S anda d Edi ion, ol. 17, p. 13. (65) The ensions be ween he discou se o he anaiys wi h himsel , he anaiys wi h he pauen and anaiys wi h ellow analys consu u e issu es wi hin he discou se o he case s udies i sel . To examine hese a speci ically li e a y me hod would be necessq. The place o s a would be wi h Ge a d Gene e, (# on ie es du eci , Figu es 11 (Pa is, Seuil, 1969), pp. 49-69, and ((Discou s du ecio, Figu es 111 (Pa is, Seuil, 1972), pp. 67-282. F eud's Case S udies and he Locus o Psychoanaly ic Knowledge 297 Ea ly in his ca ee F eud was posi i ely in oxica ed by he au a o na u al science and his highes ambi ion was o make his ma k as a scien is . As he no ed in his Au obiog aphzcal S udy, and o he places, F eud had ne e been mo i a ed by inclina ion o be a hede o he apis . Cu iosi y and ambi ion led him o science (66). The ole o scien i ic ambi ion is especially clea in The In eq e a ion o D eams whe e he pu o wa d such pseudo- heo ies as ha e e y d eam mus be he ul illmen . o a wish. Fo mulae o his so ha e enabled philosophe s o science like he neo-posi i is Ka l Poppe o ca ego ize psychoanalysis as a ((pseudo-science)). Poppe claims ha ((no desc ip ion wha soe e o any logically possible human beha io can be gi en which would u n ou o be incompa ible wi h he psychoanaly ic heo ies o F eud)) (67). Thus many o F eud's heo ies appea o be un es able and unscien i ic. This is a c i icism ha psychoanalys s ind di icul i no impossible o answe . Bu 1 ha e ied o show ha i is an inapp op ia e c i icism. Ce ainly i is an unin e es ing one (68). I 1 ha e been igh in showing ha he case s udy g adually eme ged in F eud's wo k as he locus o he mos speci ically psychoanaly ic knowledge, hen c i icism ha suppo- ses psychoanaly-sis o-be loca ed in heo ies is su ely misplaced. Tha is no o sugges ha psychoanalysis is immune o c i icism, o cou se. A knowledge loca ed in exempla y case s udies and communica ed as pe sonal knowledge may ha e g a e p oblems o i s own, bu hey a e di e en p oblems han hose o heo e ical sciences. -- (66) See ((Au obiog aphical S udy)), S anda d Edi ion, ol. 20, pp. 8 and 71-72, and «Th Ques ion o Lay Analysis)), S anda d Edi ion, ol. 20, pp. 253-254. (67) POPPER, K. R. (1972), Objec i e Knowledge: an e olu iona~y App oach, Ox o d, Cla en- don, p. 8. '68) Tha may be why Poppe has no pu sued he ma e u he han in a ew snide ema ks abou psychoanalysis in passing.