2. Paradigmatic Cases of "Meaning"-connections from Psychoanalysis

Let me now mention some paradigmatic cases of "meaning"-connections from psychoanalysis, which Freud himself linked to causal connections.

Case 1. In 1893, he wrote:

Breuer's patient [Anna O.], to whom I have so often referred, offered an example of a disturbance of speech. For a long period of her illness she spoke only English and could neither speak nor understand German. This symptom was traced back [etiologically] to an event which had happened before the outbreak of her illness. While she was in a state of great anxiety, she had attempted to pray but could find no words. At last a few words of a child's prayer in English occurred to her. When she fell ill later on, only the English language was at her command [footnote omitted].

The determination of the symptom by the psychical trauma is not so transparent in every instance. There is often only what may be described as a ‘symbolic' relation between the determining cause and the hysterical symptom. This is especially true of pains. Thus one patient [footnote omitted] suffered from piercing pains between her eyebrows. The reason [cause] was that once when she was a child her grandmother had given her an enquiring, ‘piercing' look. The same patient suffered for a time from violent pains in her right heel, for which there was no explanation. These pains, it turned out, were connected [etiologically] with an idea that occurred to the patient when she made her first appearance in society. She was overcome with fear that she might not ‘find herself on a right footing.' Symbolizations of this kind were employed by many patients for a whole number of so-called neuralgias and pains. It is as though there were an intention to express the mental state by means of a physical one; and linguistic usage affords a bridge by which this can be effected. In this case, however, of what are after all the typical symptoms of hysteria –such as hemi-anaesthesia, restriction of the visual field, epileptiform convulsions, etc.–a psychical mechanism of this sort cannot be demonstrated. On the other hand this can often be done in respect to the hysterogenic zones (S.E. 1893, 3:33-34; emphasis added).

It will be a corollary of my critical scrutiny below that the thematic affinities adduced here by Freud do not warrant at all the etiologic inferences he drew from them. The less so, since the "symbolic" affinities he marshals as support are grossly far-fetched and very tenuous.

Case 2. In 1896, Freud used the mere thematic kinship between a patient's experience of disgust and her symptoms of supposedly hysterical vomiting to claim the suitability of the given repressed experience as an explanatory causal determinant of the pertinent symptom (Grünbaum 1984, pp. 149-150). In particular, he gives the following example:

Let us suppose that the symptom under consideration is hysterical vomiting; in that case we shall feel that we have been able to understand its causation (except for a certain [hereditary] residue) if the analysis traces the symptom back [etiologically] to an experience which justifiably produced a high amount of disgust–for instance, the sight of a decomposing dead body [S.E. 1896, 3:193-194].

Thus, on the strength of mere thematic kinship, Freud infers that the repressed disgust was an essential cause of the hysterical vomiting in a person made vulnerable by heredity. And, in due course, our problem will be whether such an etiologic inference from a thematic ("meaning") kinship is sound.

The theme of aversion is likewise common to another traumatic experience and a subsequent hysterical symptom in the life of Josef Breuer's famous first patient Anna O. As reported in her case history, she had silently endured traumatic disgust on seeing a dog lapping water from a companion's glass (S.E. 1893, 2:6-7 and 3:29-30). And later, she almost died of thirst, because of her phobic aversion for drinking water. In Jaspers' parlance, we can say that the shared theme of aversion makes for a "meaning connection" between the original trauma and her later symptom. But I myself speak of such episodes instead as exhibiting "thematic kinship or affinity." And the main question will be what epistemological and ontological relevance, if any, these thematic kinships between mental events have to causal linkages between them. It will also be relevant that the thematic etiology on which Breuer based his hypnotic therapy of Anna O. was discredited by therapeutic failure.

Case 3. Freud's famous 1909 case history of the Rat Man Ernst Lanzer provides a cardinal exemplar of his inferential reliance on a thematic connection. And this reliance is not lessened, I emphasize, by the fact that Freud supplies other, temporally intermediate, events between the thematically cognate ones!

During the Rat Man's army service, he had become aware of an oriental punishment in which rats are allowed to bore their way into the criminal's anus (S.E. 1909, 10:166). And one of the dreadful thoughts with which he was obsessed was that just this rat punishment would victimize both the woman whom he eventually married, and his father, whom he loved and who had actually been dead for years by then.

But how does Freud propose to explain those of the patient's obsessions that featured the awful rat theme? As we learn, at the age of three or four, the Rat Man had misbehaved like a rat by biting someone, presumably his nurse. Just as rats themselves are punished for such behavior, so also the naughty little boy Rat Man had thereupon been soundly beaten for it by his father, and had therefore borne him a permanent unconscious hatred ever since. Freud then explicitly infers the supposed cause of the rat obsession via the thematic kinship between the patient's own punishment for biting-like-a-rat, on the one hand, and the role of biting rats in the dreaded oriental anal punishment, which is supposedly going to afflict his father, on the other.

As Freud reasoned, the patient's latent memory of the cruel paternal punishment for biting had produced repressed hostility toward his father. This antagonism, in turn, had allegedly generated the unconscious wish–and, by the defense mechanism of "reaction-formation," the conscious fear–that the father would undergo the particular monstrous punishment of anal penetration by biting rats. The hypothesized hostile wish that the father would suffer this punishment had been morally unacceptable to the patient's consciousness. Therefore, he had repressed it, and had then supposedly turned it into a conscious obsessive fear of the father's punitive victimization by rats via "reaction-formation."

Clearly, without reliance on the thematic affinity between the patient's biting-like-a-rat and the rat-obsessions, the boy's unconscious hatred for the father could not give rise to Freud's etiologic scenario for the patient's obsessions. Thus, Freud interprets the rat obsessions etiologically as the patient's neurotic defense against his own unacceptable wish that his father would suffer the particular punishment of rat penetration.

Let us assume the actual occurrence of the punitive childhood scenario. Then the important issue of causation posed by Freud's etiologic inference is not whether the severe paternal punishment for biting produced hatred toward the father; instead, the etiologic issue is whether that particular presumed hatred then became the pathogen of the patient's obsessive fear of the father's victimization by the rat punishment.

Therefore, when I address that issue in due course, I shall have to ask the following question: Granting the existence of a causal link between the punitive childhood experience and hatred toward the father, does it at all support the further major etiologic hypothesis that this hatred, in turn, was the intermediate pathogen of the rat obsessions? My answer will be a clear "No"!

My last psychoanalytic example will now be drawn from etiologic inferences in the theory of transference.

Case 4. Inferences from thematic affinity also play a central, though logically somewhat different role in Freud's theory of the so-called "transference neurosis," a theory that is fundamental to the hypothesized dynamics of psychoanalytic therapy and to Freud's entire theory of psychopathology. These inferences, I claim, will likewise turn out to be fallacious (Grünbaum, 1993, pp. 152-158).

According to this part of psychoanalytic theory, the patient transfers onto his psychoanalyst feelings and thoughts that originally pertained to important figures in her or his earlier life. In this important sense, the phantasies woven around the psychoanalyst by the analysand, and quite generally the latter's conduct toward his doctor, are hypothesized to be thematically recapitulatory of childhood episodes. And by thus being recapitulatory, the patient's behavior during treatment can be said to exhibit a thematic kinship to such very early episodes. Therefore, when the analyst interprets these supposed reenactments as recapitulatory, the ensuing interpretations are called "transference interpretations." This much involves a retrodictive inference of thematic affinity.

But Freud and his followers have traditionally also drawn the following highly questionable causal inference: Precisely in virtue of being thematically recapitulated in the patient-doctor interaction, the hypothesized earlier scenario in the patient's life can cogently be held to have originally been a pathogenic factor in the patient's affliction.

In short, in the case of transference interpretations, the causal inference from thematic affinity takes a somewhat different logical form from the one we encountered in our previous examples. In the earlier examples, such as Anna O.'s hydrophobia, Freud had inferred the existence of a direct causal nexus between thematically similar mental events by relying crucially on their thematic similarity. But in the context of his transference interpretations, the thematic reenactment is held to show that the early scenario had originally been pathogenic. And once this etiologic conclusion has been drawn, the patient's thematic reenactment in the treatment-setting is also asserted to be pathogenically recapitulatory, rather than only thematically recapitulatory! Freud extols this dubious reasoning in his 1914 "History of the Psychoanalytic Movement" (S.E. 1914, 14:12), where he claims that it furnishes the most unshakable proof for his sexual etiology of the neuroses [den "unerschüttterlichsten Beweis" in his German original].

So far, I have outlined representative illustrations of psychoanalytic causal inferences based on thematic or "meaning" kinships.