THE CASE HISTORY

REFERENCES

BERNSTEIN, R. (1992). The resurgence of pragmatism. Social Research

59:813–840.
BROMLEY, D. (1986). The Case-Study Method in Psychology and Related
Disciplines. New York: Wiley.
EDELSON, M. (1988). Psychoanalysis: A Theory in Crisis. Chicago: University
of Chicago Press.
FISHMAN, D. (1999). The Case for a Pragmatic Psychology. New York: New
York University Press.
FRIEDMAN, L. (1997). Ferrum, ignis, and medicina: Return to the crucible.
Journal of the American Psychoanalytic Association 45:21–35.
PUTNAM, H. (1998). Pragmatism and realism. In The Revival of Pragmatism,
ed. M. Dickstein. Durham: Duke University Press, pp. 37–53.
REICHENBACH, H. (1938). Experience and Prediction. Chicago: University
of Chicago Press.
RORTY, R. (1998).Truth and Progress. Cambridge: Cambridge University Press.
SPENCE, D. (1982). Narrative Truth and Historical Truth. New York: Norton.
WEST, C. (1989). The American Evasion of Philosophy: A Genealogy of
Pragmatism. Madison: University of Wisconsin Press.
417
300 Mercer Street, #20C
New York, NY 10003
Fax: 973–746–7986
E-mail: Drarnoldwilson@cs.com

Response by Robert Michels

It is a double privilege to be invited f irst to present a plenary
address and then to respond to f ive distinguished and thoughtful dis-
cussants. They each agree that the topic is important, and in general
they agree with my thoughts about it, though with several important
elaborations, explanations, and amendments. My response will be
highly selective and will focus on their additions and some possible
points of difference among us.
Imre Szecsödy and David Tuckett write from the greatest geo-
graphic distance and emphasize the broadest context of my remarks.
Szecsödy speaks of the purpose of case reports as “opening windows
on the analytic process” and quotes with approval the IPA committee
that warned that “unless we make some wise decisions, psycho-
analysis will be dead—at least as a therapeutic approach.” He shares
 Robert Michels

my criticism of colleagues who do not contribute to the opening of

those windows by sharing their clinical experience with the profession.
Such sharing is essential for research, for interdisciplinary dialogue,
and for our relationship with the community.
Tuckett too focuses on the signif icance of the case history for the
essential functions of the psychoanalytic profession. The case history
provides the basic data for our science. Though biased like all scien-
tif ic data, this material offers the only route to new psychoanalytic
knowledge. I fully agree with Tuckett that the essential clinical data
must include not only what was said in the session, but also what the
analyst thought but chose not to say and, to the extent the analyst is
aware of it, why that decision was made. Tuckett adds that “we must
rely on the author’s integrity to give us the facts as he or she experi-
enced them.” Doubtless that is true, but I don’t think integrity is our
biggest problem. We need, I think, to develop a tradition of present-
ing the analyst’s thoughts—not only thoughts directly linked to the
ongoing clinical transaction, but also those relating to the meaning of
the case (and of the case history) to the author. Tuckett feels that I am
418
too worried about the possible “obtrusive effects” of the “analyst’s
reporting intentions.” I am very interested in the effects, but not espe-
cially the “obtrusive” effects. Without some reporting intention, there
would be no report at all. What I am arguing is that the report cannot
fully be understood without placing it in its intentional context. Analysts
should recognize that motivation and intentionality affect all human
behavior, and that we lose valuable data when we ignore them. I am not
arguing that analyses, or case reports, are diminished in value by the
extraanalytic motives of the analyst-reporter. I am arguing rather that
an analysis can be understood more deeply and in richer detail when
we include those extraanalytic motives in our consideration.
The only real difference I have with Tuckett is with his views on
conf identiality and the ethics of reporting cases. I agree with his con-
clusion that there may be irresolvable conf licts between the interests of
a specif ic patient, on the one hand, and those of the profession and the
community on the other, and that as a profession we must constantly
press, in general, for what is best for the profession and the community.
However, it is a powerful tradition in medical ethics that when it comes
to specif ics the balance of these competing interests, and the ultimate
decision, is to be determined by the patient and no one else—not the
doctor and not even a negotiation between patient and doctor. Freud
 THE CASE HISTORY

apparently agreed, as he sought his patients’ consent for case presenta-

tions. In fact, as I mentioned in my address, most patients agree to
be presented, but it is up to them, not us. This is what is meant by
informed consent.
Tuckett closes his discussion echoing my view, and Szecsödy’s,
that we must “move the practice of psychoanalysis out of an individual
organizational context into a collective [I would say professional] one.”
To do so requires communicating with one another about our work,
and that requires case histories.
Arnold Wilson tells me that I am a closet (or, more likely, naive)
pragmatist. He is concerned not by what I say but—appropriately,
I believe—by my failure to ground it on a consistent philosophical foun-
dation. He agrees with me that the question is what helps us solve our
problems, not what is true. Science is not a goal in itself; it is but a means
for solving problems, and not all problems are best solved by science.
(I am reminded here of the misguided attempt of late to use science to
solve the political and public relations problems of our profession, a
tactic leading usually to bad science and little problem solving.)
419
Wilson points out that a pragmatic attitude toward the case history
has another benef it—the histories will be more interesting! Originality
and imagination will be valued over abstract theoretical concerns or
rehashes of someone else’s imagination. Pragmatism also counsels eti-
quette—if we want to have more case histories, we have to reward
rather than humiliate those who present them.
Philip Rubovits-Seitz’s discussion focuses on the case history itself.
He sees value in reporting the whole analysis, primarily because
it provides crucial clinical evidence for the justif ication of analytic
interpretations, a central problem in the scientif ic advance of psycho-
analysis. He is skeptical about using coherence, external conf irmation,
patients’ responses, and prediction or postdiction as tools for justif i-
cation. He believes that if you want to understand an event in an analysis
most fully, you must do it in the context of the entire analysis. He argues
for better records in order to have better case reports, and agrees with
Tuckett that these records must include the analyst’s thoughts, as well as
the patient’s and the analyst’s words.
Stephen Bernstein also focuses on the case history itself. He wants
to use it to “reveal” work to colleagues and to “show others” what
psychoanalysis is. In other words, his purposes are evaluative, rhetori-
cal, and political rather than scientif ic. He agrees with me in wanting
 Robert Michels

to f ind the “hidden analyst” and “hidden process” that may be diff icult
to f ind in existing case histories. He believes that the problem is the
lack of a structured format for presenting the material: “without such
help, writers often inadvertently hide the analysis and the analyst.”
Much of his discussion is devoted to illustrating such a structured
format.
I f ind myself in clearest disagreement with Bernstein when he says
he does not believe “that the act of writing must necessarily hide or
falsify the experience.” For me, this would mean that writing is not
behavior that can be understood by our usual psychoanalytic
approach—that it does not involve conf lict, defense, compromise, and
(among other intentions) hiding and falsifying aspects of the experi-
ence. I do not think it possible to avoid these intentions; I simply want
to take them into account. Standardized formats can be valuable if data
from many analyses are to be pooled for systematic research, but rules
and structures can limit data as well as facilitate it. I f ind myself more
sympathetic both with Wilson’s pragmatism and with the clinical
psychoanalytic approach of trying to understand the traditions and
420
structures that encourage analysts to limit what they tell us, and the
motives that have generated those traditions and structures, while at the
same time encouraging them to tell their stories in their own ways.
Bernstein is concerned that I will evaluate analytic work by evalu-
ating the “writer’s intention,” and that this is “perilous.” He is right
on both accounts. The writer’s intention is a very weak tool, but we
only have weak tools, as Bernstein knows better than most. I would
consider all of the data that are available, and yet still view the whole
process as “perilous.”
I am gratif ied that my colleagues share my interest in the case
history, and my view that it is central to psychoanalytic dialogue.
Psychoanalysis has changed greatly from its beginnings, but it enters
its second century even more f irmly grounded than at its birth in the
shared clinical experience of the psychoanalytic process as reported
in case histories.