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On the Clinical Psychoanalytic Theory and Its Role in the Inference and Confirmation of Particular Clinical Hypotheses
Benjamin B. Rubinstein (1975)
Reprinted with Permission of International Universities Press
The General Clinical Hypotheses
[The section begins by noting that Freud accounted for] deviating behaviors of various kinds [by postulating] the principle of psychic determinism. …it is readily interpreted as a general guide for the formulation of particular clinical hypotheses which, as I have indicated, mostly concern persons. In whichever other way Freud may have understood it, he clearly understood the principle in this way also. Interpreted strictly clinically, it states in essence that (a) all activities in which person engages, whatever their specific nature, are motivated even on the face of it they may seem not to be; (b) within limits, people respond to external situations in more or less specific ways; and the presence in a person of certain motives and response dispositions may be explained, at least in part, by events early in that person's life.
I will refer to points a, b, and c as general clinical hypotheses, point a representing a general motivational hypothesis, point b a general situational hypothesis, and point c a general genetic hypothesis. The view I am proposing is that (1) the explanation of a puzzling logical event, as I have indicated, has the form of a particular clinical hypothesis connecting (usually by positing a cause-effect relationship) the event to be explained with other events, and (2) this hypothesis inferred in either of two ways, the more fundamental being inference in accordance with one or several general clinical hypotheses in junction with the original observation (i.e., the event to be explained) and whatever other relevant data we may have available.
I will consider the second way of inferring particular clinical hypotheses later on. Right now I want to mention that the general clinical hypotheses form an important part of the clinical psychoanalytic theory. As we will see, there are general clinical hypotheses of other types than those just enumerated.
The General Motivational Hypotheses
On several occasions, Freud expressed the hypothesis that, whether they seem to be or not, activities of all kinds (including actions, dreams, parapraxes, and neurotic symptoms) are motivated. I will refer to this hypothesis as the hypothesis of motivational determination. It clearly represents an extension of the commonsense view...that all action is motivated. … It is important… to note that I use the word "motive" as a generic term, referring not only to wishes and desires, but … also to such complex motivelike dispositions as fear, anger, love, hate, and curiosity.
Consideration, for example, of neurotic symptoms, such as a seemingly purposeless compulsive act, will convince us that the hypothesis of motivational determination can be accepted as generally valid only if we make a number of assumptions, namely, that (1) a person P's motives may be unconscious, (2) to be unconscious these motives must ordinarily be rendered unconscious, which is accomplished on the part of P by some unconscious activity such as repression, (3) motives may be rendered unconscious mainly if they are in some way unacceptable to P, and (4) notwithstanding repression and other similar activities engaged in by P, without his being aware of what is happening, his unconscious motives will tend to be expressed in a variety of indirect ways. These assumptions clearly function as ancillary hypotheses to the hypothesis of motivational determination. I will refer to assumption (1) as the hypothesis of unconscious motives, to assumptions (2) and (3), taken together, as the hypothesis of resolution of inner conflict, and to assumption (4) as the hypothesis of the persistent manifestation potential of unconscious motives.
The hypothesis of unconscious motives, as Freud himself has attested, is derived in part by analogy with the phenomena of posthypnotic suggestion, and the hypothesis of resolution of inner conflict, by analogy with the commonsense notion of unpleasure avoidance, unacceptability being regarded as a function of (unconscious) anticipation of unpleasure. The latter hypothesis is obviously related to the hypothesis that is formulated in terms of defense, in the traditional theory. But, whereas the hypothesis of resolution of inner conflict is strictly a clinical hypothesis, the hypothesis of defense, operating as it does with ego-id-superego relationships, is distinctly metapsychological. Finally, the hypothesis of the persistent manifestation potential of unconscious motives is important not only for the theory of the occurrence of unexpected, and in this sense puzzling, psychological events, but, as we will see later, also for the confirmation of motivational hypotheses. It obviously was adduced…for these very reasons. Rapaport referred to this hypothesis in terms of instinctual (or motive) pressure. Whereas Rapaport' s term clearly represents a transgression into metapsychology, the term I am using is more nearly merely descriptive and is metapsychologically neutral.
Let me briefly indicate how the hypothesis of motivational determination functions in clinical inference. Suppose we observe an activity qualifying as the means to attain the fulfillment of a motive-i.e., an activity the consciously intended or unintended effect of which is the attainment of this fulfillment. The hypothesis of motivational determination now allows us to infer that the person engaging in this activity may engage in it precisely to attain the fulfillment of the motive, regardless of whether or not his conscious intention is to attain this fulfillment. According to the hypothesis, in other words, an effect of any activity may be its consciously or unconsciously intended effect. In the same way, whether he is aware of it or not, if an activity a person engages in qualifies as the fulfillment of a motive, the person may indeed engage in this activity because it is the fulfillment of the motive in question. The fact that a hypothesis "allows" us to see things in a particular way makes it possible to regard the hypothesis as entailing certain rules of inference, in the case of the hypothesis of motivational determination what we may refer to as the means-end and the motive-fulfillment rules, respectively. It is clear that, although I have not specifically mentioned them, in the indicated inferences the hypotheses of unconscious motives and of the persistent manifestation potential of unconscious motives are also implicated.
The following example will help to clarify the points just made. Suppose that a female analytic patient acts very seductively toward her male analyst. By applying the means-end rule we can see this behavior as the expression of a resistance, i.e., as a means to avoid being analyzed. But the patient may also, by application of the same rule, be seen to be seductive as a means to test the analyst's sincerity, his determination to pursue their common analytic task. In both instances the patient's seductiveness fits as a means to an end, but to a different end in the two cases. On the other hand, however, application of the motive-fulfillment rule will make the seductiveness appear as what may be called a token fulfillment of an erotic motive, i.e., more specifically, as the fulfillment of a desire to flirt with the analyst merely for the sake of the (more or less mild) sexual titillation involved in flirtation.
I will cite another example of how an activity can be seen as a resistance by application of the means-end rule. Take the sometimes heard claim by a patient that the analyst does not understand him. If the patient indeed believes that the analyst does not understand him, then what the analyst has to say about him is bound to miss the point and is hence irrelevant. The patient's belief, in other words, is here explained as a means to the fulfillment of a (presumptive) wish not to take seriously the (perhaps anxiety- or guilt-provoking) things the analyst points out about him.
Analytic thinking depends heavily on application of the means-end rule. The various ways in which inner conflict may be resolved (i.e., the various "defense mechanisms") are clearly seen as the means to a specific end. We will come across other examples as we go along. In the present connection I will take as a last example the following statement: "The over-valuation of the object is a rather regular, though not omnipresent, feature of being in love.... Its function...is to counteract, or countercathect, the aggression" (Bak, 1973, p.3). I will not question the theoretical language the author uses. The significant point here is that the overvaluation of the object that is frequently part of being in love is explained as a means to counteract aggressive impulses toward the object.
Another point that this example brings out is that the author is trying to explain what he regards as group-typical behavior. As I indicated above, this is questioning of a different order than when we attempt to explain the group-atypical. Let me use this example to highlight the difference. Assume that we observe a person P who overvalues his love object. Since this is group-typical behavior we feel no inclination to ask, "Why does P overvalue his love object?" This fact, however, does not preclude the question, "Why do most people overvalue their love objects?" The question we are now asking is why a particular behavior is group-typical and, accordingly, is no longer of purely clinical interest. In fact, what it calls for is an answer in terms of biological and/or anthropological theory.
These examples give an indication of the versatility of the means-end rule. The motive-fulfillment rule, however, is also quite versatile. Let us for a moment return to the first example, the case of the seductive woman patient. Here the observed behavior may be related to more than one motive. Which of the inferred motives is actually present cannot be determined merely on the strength of its being deducible in accordance with our observation in conjunction with certain accepted rules of inference. One may be, or all, or none. This conclusion obviously applies also to the motives inferred in the other examples given. In part the indicated rules of clinical inference are purely logical. Accordingly, they primarily point up possible, not actual, relationships. That is why I have spoken about "rules" in the first place. Instead of referring to the means-end and the motive-fulfillment rules, however, we might also speak about seeing, or recognizing, that a means-end relationship may obtain between certain events, and about seeing, or recognizing, that a something may be a motive fulfillment. …
Although versatile, the means-end and the motive-fulfillment rules are not versatile enough. A number of activities cannot, by their application, be made to fit any motive. In such instances we may decide that we have reached the limit of application of the hypothesis of motivational determination. We can, however, also decide to extend the scope of the hypothesis by adducing appropriate ancillary hypotheses. Freud…chose the second of these alternatives. I will refer to the most commonly used additional ancillary hypothesis as the hypothesis of partial functional equivalence. It is derived in part by analogy with allegory, myth, and metaphor. But it also has features in common with the commonsense notion that if we cannot get what we want we may settle for something related to what we want. As we will see presently, the hypothesis belongs to the complex of partly clinical, partly extraclinical, hypotheses that in the traditional theory is referred to under the heading of the primary process.
At this point it becomes necessary to introduce a term that will refer not only to activities, but also to the products of certain activities. I will in this sense speak about psychological output events. A mental image, for example, is a psychological output event, and so is the activity of imaging.
Let us return to the hypothesis of partial functional equivalence. It is sufficient merely to indicate some of the rules of clinical inference entailed in this hypothesis. One rule allows us to regard certain output events as at least partial substitute fulfillments by virtue of being analogous with an actual fulfillment or with a fragment of such a fulfillment. I will refer to a substitute fulfillment as a partial functional equivalent of an actual fulfillment. Examples are dream symbols and certain neurotic symptoms. According to another rule, partial functional equivalence may also be established between events belonging to the same or to similar contexts. Displacements are examples. …
The hypothesis of partial functional equivalence does not limit us to seeing output events as the equivalents of fulfillments or of fragments of fulfillments. A complaint, for example, about something may be seen as the partial functional equivalent of a complaint about something else. The scope of the hypothesis may be even wider. …
If we consider the nature of the rules of clinical inference I have discussed so far, it becomes evident that the rules entailed in the hypothesis of partial functional equivalence can also be applied to output events to which the motive-fulfillment and the means-end rules have already been applied. A woman who is excessively aggressive toward her husband can be seen as wanting to dominate him, or as unconsciously using her aggressiveness as a means to provoke him to dominate her. But her aggressiveness can also be seen as in part the functionally equivalent fulfillment of an unconscious wish to castrate her husband.
As I indicated, the rules of clinical inference are in part purely logical rules. The inference proceeds in two steps. The first is a classification: this is the purely logical part of the inference. For example, we classify an event as fulfillmentlike on the strength of certain attributes it shares with the fulfillment of a motive. The next step, which is no longer purely logical, is the formulation of a hypothesis-in the case we are considering, the hypothesis that the fulfillmentlike event may indeed be the fulfillment it is like or the partial functional equivalent of this fulfillment. …
There are a number of other motivational hypotheses, either ancillary to the hypothesis of motivational determination or otherwise closely related to it. I will briefly consider two of the most important hypotheses of the latter type.
The first we may refer to as the hypothesis of convergent motives. It overlaps Freud's concept of overdetermination. In essence, it states that, if several motives can be inferred in accordance with a particular output event, then some or all of these motives may be simultaneously present and effective. Motives may converge in a number of ways. An output event, for example, may be seen simultaneously as the means to the fulfillment of one motive, as the fulfillment of another, and as the partially equivalent fulfillment of a third. The woman who tried to dominate her husband and the seductive woman patient provide examples of possible motive convergence.
The second hypothesis is linked to the commonsense notion of unpleasure avoidance. We may refer to motives that are compatible with this notion as probable motives. Generally, when we infer a motive by applying one or the other rule of clinical inference to an output event, we tend to infer a probable motive. We may speak about a hypothesis of probable motivation. The death instincts posited by Freud are, by this definition, improbable motives. When faced with a seemingly improbable motivation we usually try to make it appear at least somewhat more probable by applying either the means-end rule or a rule of partial functional equivalence. Suicide, for example, may be seen as a means to avoid unbearable pain or, in certain circumstances, as the partial functional equivalent of homicide, i.e., as the equivalent of killing a person with whom the person committing suicide has identified.
In some instances an improbable motive may seem difficult to explain away in one or the other of the ways just indicated. The woman mentioned earlier who did not learn from experience not to alienate her friends with her incessant complaints may indeed have been prompted to act the way she did by an improbable motive, i.e., more specifically, by an unconscious desire to defeat herself. In this case, however, it is possible to adduce guilt and thus to explain the woman's self-defeating behavior as an act of atonement, i.e., as the means resorted to unconsciously to allay the guilt.
Perhaps the strongest argument in favor of a hypothesis of improbable motivation is based on the consideration that in at least some cases of the types just cited less self-destructive means and equivalents may conceivably be chosen than those that are actually chosen. The hypothesis of improbable motivation now suggests, in accordance with the hypothesis of convergent motives, that these means and equivalents are chosen not only because they fit as means and equivalents, but also because they simultaneously fit as ends in themselves, as the fulfillments of a self-destructive motive. If such a motive is in fact present it obviously limits the scope of the notion of unpleasure avoidance, i.e., it goes, as Freud put it, "Beyond the Pleasure Principle."
In contemplating cases of self-destructive behavior one often gets a strong impression of compulsiveness and inevitability that seem to defy psychological explanation. If this impression is at all correct, then a concept like that of improbable motivation-at any rate for some of the cases considered-is a motivational concept in name only. Suicide to avoid unbearable pain, on the other hand, may be quite satisfactorily explained psychologically without recourse to the hypothetical operation of an improbable motive.
I should mention that Freud's concept of a "compulsion to repeat"… may be related to but is not identical with the compulsiveness of the frankly self-destructive behavior I am speaking about here. We may, however, with Freud tentatively adduce it in cases, such as that of the complaining woman, in which inability to learn from experience appears as the central problem. But we should note that, without the metaphysical trimmings with which Freud endowed it, the "compulsion to repeat" is a merely descriptive, not an explanatory, concept.
The General Situational Hypotheses
We can recognize three general situational hypotheses, the hypothesis of situation-specific responses, the hypothesis of in part functionally equivalent situations, and the hypothesis of merely subjective situations. In reference to the general situational hypotheses it is appropriate to speak about dispositions rather than about motives. The former is the wider concept. Motives may be regarded as dispositions of a particular kind.
We can divide the hypothesis of situation-specific responses into three subsidiary hypotheses, each with a different scope: I will speak about situational generalizations, situational quasi generalizations, and clinical situational correlation statements. Situational generalizations are believed to apply to all persons. An example is the hypothesis that if a person is insulted he will feel hurt (and often resentful). Situational quasi generalizations on the other hand, are believed to apply to most, and clinical situational correlation statements only to some persons. An example of a situational quasi generalization is the hypothesis that if a person comes up against an obstacle the chances are that he will try to overcome it. Other examples are the hypotheses that aggression is likely to provoke counteraggression and that infringements on one's freedom, unless seen as a means to an accepted end, are likely to be resisted. An example of a clinical situational correlation statement is the hypothesis that if a father has high ambitions for his son the latter is somewhat likely not to fulfill these ambitions. Whereas most situational generalizations and quasi generalizations are part of commonsense psychology, most clinical situational correlation statements are derived from psychoanalytic and related experience. Considering the above examples we can appreciate Rapaport's (1960, p. 184) characterization of situational factors generally as "causes of behavior."
It follows from the nature of the general situational hypothesis of situation-specific responses that, if we know of a situation, we can predict the response with a degree of probability corresponding to the degree of generality with which the relationship is believed to obtain and, conversely, if we know a response, we can postdict the situation in which this response occurred, the probability of the postdiction, however, being considerably smaller than the probability of the corresponding prediction. If A regularly leads to B, then, if A occurs, we can predict that B will also occur. But if B has occurred, we can only postdict that A may or may not have occurred before B. The probability of a postdiction, however, is likely to increase if we have at our disposal certain data, particularly information about the dispositions and life circumstances of persons whose involvement in the postdicted situation is part of the postdiction.
We may regard predictions and postdictions as being made in accordance with certain rules of inference entailed in the hypothesis of situation-specific responses. We may thus speak about a situation-disposition (or situation-response) and a disposition-situation (or response-situation) rule, the former generating predictions, the latter postdictions.
It is of interest to observe that decisions regarding the timing of interpretations in an analysis and what we call clinical tact are based on predictions of likely responses by patients. The "situation" in accordance with which we predict the effect of an interpretation includes everything we know about the patient and the stage of his analysis.
It is also important to note that, in regard to predictions in accordance with situational quasi generalizations, clinical situational correlation statements, and at least some situational generalizations, we must distinguish between what a person will do and what he will feel or feel like doing. If a situation is known we can often, by applying the appropriate situation-disposition rule, predict more accurately what a person will feel or feel like doing than what he will actually do.
A simple example will suffice to demonstrate the significance of the second general situational hypothesis, the hypothesis of in part functionally equivalent situations. A patient may react to an interpretation by the analyst in a way that resembles the response to an attack. By applying the hypothesis of in part functionally equivalent situations we can infer that the patient may indeed have experienced the interpretation in question as an attack. As is readily seen, the hypothesis of in part functionally equivalent situations represents the experiential counterpart of the motivational hypothesis of partial functional equivalence discussed above.
The third of the general situational hypotheses, the hypothesis of merely subjective situations, is based on a distinction between what we may refer to as merely subjective and subjective-intersubjective situations. Every situation is subjective in the sense that it is experienced by a person. A subjective-intersubjective situation is a situation that is experienced in more or less the same way by all (or most) persons present. A merely subjective situation, on the other hand, is a situation as it is experienced by one person only, this experience being distinctly at variance with the experience of the situation by others. The concept of psychic reality refers in part to merely subjective situations. If on the basis of some observed behavior we postdict a situation of a particular type, and if the available evidence does not support the postdiction, then we sometimes have reason to infer that the postdicted situation occurred anyway but as a merely subjective situation. A merely subjective situation may be based on misperception and/or misinterpretation. It seems that merely subjective situations often conform to a person's (conscious or unconscious) expectations. Thus one patient expressed the surmise that his constant expectation of being hurt by women may color his perception of them as treacherous and disdainful.
In the following case, a person P unwittingly contributes to the creation of a merely subjective situation: without being aware of it himself, P acts so as to provoke another person Q. When Q responds in kind, P sees Q's response as completely unprovoked and incomprehensible, an uncalled-for affront.
In the example given of the application of the hypothesis of in part functionally equivalent situations, the patient's experiencing an interpretation as an attack clearly represents a merely subjective situation.
The General Genetic Hypotheses
Under the heading of general genetic hypotheses I will consider hypotheses concerning the derivation of certain action and response dispositions. These hypotheses play a significant role in clinical inference. I can, however, mention only a few of the most important ones. Although theoretical notions concerning developmental and maturational sequences are regarded as clinically relevant, I will not consider them explicitly nor will I consider explicitly notions about interferences with the indicated sequences and related notions, such as those of regression and fixation. To the extent that any of these are relevant to the questions I am discussing they will simply be tacitly presupposed.
Freud recognized in the main two ways in which general action dispositions, such as certain character traits, may be derived. One isexpressed in a hypothesis we may refer to as the hypothesis of motive derivation. If we assume a set of basic motives, then at least a number of other motives can be seen as derived from these. In some instances the derivation is inferred in part by application of either the means-end rule or a rule of partial functional equivalence. For example, by applying the means-end rule we can derive a quest for money from a quest for power: here the fulfillment of the first motive, i.e., the acquisition of money, is clearly a means to the fulfillment of the second. On the other hand, by the application of an appropriate rule of partial functional equivalence, a quest for money can also be derived from a fascination with fecal matter. In both instances, as is readily seen, a motive is believed to evolve from another on the basis of its convergence (in the sense of "convergence" indicated above) with this other motive.
Of the "triad" of character traits, i.e., dispositions for specific ways of acting-orderliness, parsimony, and obstinacy-which Freud derived from early anal preoccupations, I have considered only one, parsimony, and this one by no means in all its aspects. Orderliness and obstinacy are derived in different ways. While orderliness, as Freud observed, qualifies as a reaction formation against a desire to mess around with feces (which is a way of resolving the inner conflict arising from this desire), obstinacy seems to be derived from a motive for fecal withholding, apparently by application of a rule of partial functional equivalence.
The second way Freud derived general action dispositions (or dispositions for specific ways of acting) was by adducing the hypothesis that a child normally identifies with a parent (and later with others who for one reason or another are seen as models worth taking after). As the process of identification is defined, it involves the assumption by the child of at least some of the characteristic action dispositions-and occasionally of the neurotic symptoms-of the person with whom it identifies. Identification is supposed to precede the oedipal period and to continue beyond it. As Freud saw it, it may even be a means of overcoming the emotional oedipal involvements. At any rate, expressing himself in the language of metapsychology, he surmised that "It may be that... identification is the sole condition under which the id can give up its objects"
Apart from the two ways just considered, the development of action dispositions may also be derived by application of a hypothesis related reactions are recognized as such on the basis of the hypothesis of partial functional equivalence of past and present situations. I may mention in this connection that the seductive woman patient referred to above had learned as a little girl to get favors from her father by being "cute," i.e., seductive.
…Since transference reactions are typical for the group of psychoanalytic patients, we are not surprised if a patient in psychoanalysis develops a reaction of this sort. Accordingly, we feel no need for an explanation of why a particular psychoanalytic patient shows unmistakable signs of a transference reaction. What we are interested in is the kind of transference reaction he develops, and we certainly will be curious if he seems to develop none at all, since that is group-atypical. We may of course also ask why at least a majority of psychoanalytic patients do develop transference reactions. But, as in the case of the question why people generally tend to overvalue their love objects, this question goes beyond the confines of purely clinical inquiry.
Freud regarded transference reactions as expressions of a "compulsion to repeat" past events in action instead of remembering them. If we consider what I said above about the notion of a "compulsion to repeat," this formulation will seem compatible with the one I have just presented. We should note, however, that the repetition here is different from the repetition we sometimes think we can recognize in a hysterical or compulsive symptom. Breuer and Freud clearly had this second kind of repetition in mind when they wrote, "Hysterics suffer mainly from reminiscences." At least some cases of this type come under the heading of a general genetic hypothesis I will refer to as the hypothesis of revival in some form of responses to a past situation in a partly functionally equivalent present situation. …It differs from the hypothesis of partial functional equivalence of past and present situations in that the responses it refers to are more specific.
Among the general genetic hypotheses we must further recognize a hypothesis concerning the development of specific expectations as a consequence of certain experiences. It follows from what I said above about merely subjective situations that, if we have reason to suspect the presence of such a situation, we will usually have to direct our inquiry along the lines suggested by this hypothesis.
Other General Clinical Hypotheses
There are a number of general clinical hypotheses other than those considered above. I will briefly discuss five that seem particularly important.
The first of these hypotheses is an extension of the hypothesis of resolution of inner conflict to include not only inner conflicts caused by unacceptable motives, but also inner conflicts caused by unacceptable memories, as well as by unacceptable realizations about oneself and/or about significant sectors of one's world.
The second hypothesis involves the concept of unconscious fantasy. It is actually not a hypothesis but a set of hypotheses. Some of the hypothetical events referred to as unconscious fantasies correspond rather closely to what we think of when we speak about unconscious wishes, while others are better described as unconscious wishes coupled with dispositions of various sorts of which the persons in question are unaware. ….
The three remaining hypotheses are of a different character altogether. The first of these, i.e., the third of the hypotheses I am now considering, I will refer to as the hypothesis of context fragmentation; the fourth I will refer to as the hypothesis of integration of fragments from different contexts. Both play a crucial role in the process of dream interpretation. Dream symbols and displacements are usually inferred in accordance with the hypothesis of context fragmentation in conjunction with the hypothesis of partial functional equivalence, the equivalences, as I have indicated, being based on different relationships in the two cases. The hypothesis of integration of fragments from different contexts is applicable both to the dream as a whole and to the inference of dream condensation. When applied to the dream as a whole this hypothesis is essentially equivalent to Freud's hypothesis of secondary revision.
The fifth hypothesis is relevant specifically to patients' behavior in psychoanalytic sessions. It states that sequential items in a patient's verbal productions, even if seemingly unrelated, may nonetheless be intrinsically related to one another. I may mention that, apart from its relevance to dream interpretation, the hypothesis of context fragmentation is also often applicable to a patient's verbal productions during an analytic session.
The three hypotheses last considered seem to refer primarily to processes and thus would not meet [George] Klein's principal criterion for clinical statements, which is that, whatever else they are, they must be statements in some way involving the concept of meaning. Let us take dream symbolism as an example. In this case it might be possible to claim when we say that a particular dream element qualifies as a symbol we imply that to the dreamer it has a such and such unconscious meaning. If we have difficulty, as I do, with the concept of unconscious meaning, we might claim alternatively that when we say that a particular dream element qualifies as a symbol we imply that, unbeknownst to himself, the dreamer uses it to express whatever it is taken to be a symbol of. Although useful as vehicles for clinical interpretations, it seems to me that neither of these alternative statements can be taken very seriously unless we are able to back them up with a hypothesis, or a set of hypotheses, stating that (a) processes underlying dream symbol formation (i.e., specifically the processes implicitly posited by the general clinical hypotheses of context fragmentation and partial functional equivalence) do in fact occur, and (b) by virtue of its attributes, the dream element we are considering does in fact qualify as a symbol for such and such an unconscious "idea." These points are clearly related to the questions referred to earlier, namely, why dreams generally are the way they are and why a particular dream is the way it is.
I may mention that, without at least implicitly having posited the hypotheses I have referred to as the hypotheses of context fragmentation and of integration of fragments from different contexts, Freud could not have invented his method of examining dreams, which is to break away various elements from the context of the manifest dream and ask the dreamer to associate to each separately.
The Special Clinical Hypotheses
We have distinguished between particular and general clinical hypotheses. These hypotheses are statements about persons or can more or less readily be transformed into such statements. Strictly speaking, only the general clinical hypotheses, as I have indicated, form part of the clinical psychoanalytic theory, the particular hypotheses representing the application of this theory to actual cases. So far I have not mentioned a third group of clinical hypotheses, which I will refer to as special clinical hypotheses. Some of them represent more or less extensive generalizations of particular clinical hypotheses, the latter usually being derived in accordance with one or several general clinical hypotheses. Some have been taken over directly from commonsense psychology.
Among the special clinical hypotheses we can recognize motivational, situational, and genetic hypotheses. The strictly clinical aspect of the theory of basic motives (or drives) is a motivational hypothesis and so are the hypotheses concerning the various specific modes of resolution of inner conflict (i.e., the individual so-called defense mechanisms). Examples of special situational hypotheses are hypotheses of the type I used above to illustrate the general situational hypothesis of situation-specific responses, such as the hypothesis that when faced with an obstacle most people will try to overcome it. The theory of the Oedipus complex and of its dissolution or persistence in an unconscious state … represents a set of special clinical hypotheses, motivational, situational, and genetic. Other special clinical hypotheses concern the common meanings of particular dream symbols, the dynamics of, say, hysteria, and castration anxiety.
It is clear that, like the general clinical hypotheses, the special clinical hypotheses may function as premises for the inference of particular clinical hypotheses. Those that are more or less extensive generalizations of hypotheses of the type last mentioned can, of course, readily be adduced to explain any particular case to which the generalization seems to apply. This is the second of the two ways referred to above in which particular clinical hypotheses may be inferred. The explanations it yields, obviously, are comparatively low-level.
Together, the general and special clinical hypotheses form the clinical psychoanalytic theory. In most traditional accounts, it is mainly the special clinical hypotheses that are included in this theory. I think I have shown clearly enough that to omit the general hypotheses is to miss part of the essence of the clinical theory, which is the role it plays in the fundamental forms of clinical inference.
Some Features of Clinical Inference in Accordance With General and Special Clinical Hypotheses
I have indicated that the general clinical hypotheses may be regarded as entailing certain rules of inference by the application of which particular clinical hypotheses are inferred. In this respect the special clinical hypotheses may be looked upon in the same way as the general. In a typical case we have two events and a relationship between them. This typical case, however, may be manifested in three different ways and thus give rise to as many variations of the inference pattern. First, both patient and analyst, although obviously not in the same manner, may be aware of one of the events, the second event and the relationship between them being inferred by the analyst. Second, the patient may be aware of both the events and the relationship between them, while the analyst is aware of only one of the events and has to infer the second as well as the relationship between the two events. Some events referred to by situational hypotheses belong to this group. If a patient reports "They curtailed my freedom," then he ordinarily knows whether or not he felt like resisting the curtailment of his freedom, whereas, unless the patient says so, the analyst has to infer in accordance with the appropriate special clinical hypothesis that he probably did. Third, both patient and analyst, although again not in the same manner, may be aware of both events, without, however, being aware of any connection between them, until the analyst has inferred it. Freud, by implication, called attention to inferences of this kind.
In the above discussion of the means-end and the motive-fulfillment rules, I mentioned that instead of speaking about rules and inference we may also speak about seeing, or recognizing, that a means-end relationship may obtain between certain events, and about seeing, or recognizing, that something may be a motive fulfillment. These two ways of accounting for their function apply to all general and special clinical hypotheses. Elsewhere (Rubinstein, 1997, chapter 7), I have elaborated on the second of the two ways just indicated. The view presented can be summarized in four points, namely, that (1) the relationship expressed in a particular clinical hypothesis defines the structure of that hypothesis; (2) we can speak about the structure of the events referred to by a hypothesis in the same way as we speak about the structure of the hypothesis itself; (3) when we formulate a particular clinical hypothesis we believe that the structure the hypothesis expresses reflects the structure of the posited concatenation of observed and (mostly) inferred events; (4) the general clinical hypothesis in accordance with which a group of particular clinical hypotheses is inferable may be regarded as expressing, so to speak, in a pure, rather abstract, and often general way, the structure of the hypotheses of this group. We can now add that with some modification the fourth point also applies to the special clinical hypotheses. In their case the structure is expressed, as a rule, not more abstractly, only more generally than in the corresponding particular clinical hypotheses.
Structure recognition most likely is learned in childhood. The ability to recognize complex structures may not, however, be acquired until later. The process of learning is presumably facilitated by the fact that the same structure is normally manifested in many different ways. Structure recognition can be described as at bottom a classificatory process.
It may well be that, although not necessarily consciously identified as such, the structure of a complex of observed and (mostly) posited events, because of previous learning, immediately catches our attention, and that this is the reason why several authors have felt justified in claiming that they "intuitively" grasp clinical connections and that this "intuitive" grasp is immediate and not further analyzable. From this point of view the various clinical hypotheses may be regarded as more or less specific classificatory schemata. This view, however, does not cancel out the view outlined above, according to which the general and special clinical hypotheses are among the premises in accordance with which particular clinical hypotheses are inferred. In the present connection I will not distinguish sharply between structure identification and formal inference, but will regard these expressions as referring to essentially the same process seen from different angles, the angles perhaps roughly corresponding, respectively, to the psychology and the logic of understanding. These in turn may correspond, at least in a general sort of way, to what Reichenbach referred to as the contexts of discovery and of justification. Accordingly, we may use the one expression or the other, depending on which seems to fit better into the context of what we are talking about at a given point. In the present paper description in terms of the logic of understanding will remain predominant.
In this connection a natural next step is to examine more closely the question of explanation. I have mentioned that the particular clinical hypotheses represent explanations of particular psychological phenomena. We have seen how these hypotheses are derived from the general and special clinical hypotheses. The hypotheses of the types last mentioned are of a higher order than the particular clinical hypotheses in the sense of being more abstract and/or more general. If we consider these relationships it appears that, from a logical point of view, explanation in psychoanalysis does not differ in principle from explanation in science generally, as expounded, for instance, by Hempel and Oppenheim (1948), Braithwaite (1955), Scheffler (1963), and Hanson (1971). According to Hempel (1965) and White (1965), explanation in history, although less complete, follows the same general pattern. This view is clearly at odds with a view, originally proposed around the turn of the century by Dilthey, that in history understanding is in terms of meaning and has nothing in common with the type of understanding that is involved in scientific explanation. In its application to psychoanalysis, this view currently enjoys a certain popularity among analysts. Freud's own writings are quite ambiguous in this respect, being formulated in a bewilderingly unsystematic way, now in terms of one, now of the other, of these contrary views. I have little doubt that the concept of meaning, as this concept is commonly used by analysts, is, at best, likely to blur the issues.
Practically as well as theoretically, it is important that, according to most modern philosophers of science, we can derive explanations from probabilistic statements, the explanations in these cases being themselves merely more or less probable. Freud, on the other hand, following views about natural science, and particularly about scientific laws, dominant in his time, without naming most of them, regarded a majority of the hypotheses I have referred to as general and special clinical hypotheses as universally valid. Examples are the hypotheses of motivational determination and of castration anxiety, and at least some of the hypotheses constituting the theory of the Oedipus complex. Thus he wrote, "What we call chance in the world outside can, as is well known, be resolved into laws. So, too, what we call arbitrariness in the mind rests upon laws, which we are only now beginning dimly to suspect." We note that, because of his unfamiliarity with probabilistic laws, to Freud the mere concept of a natural law implied universality. In discussing parapraxes, this view led him to maintain that "rudimentary cases," i.e., cases in which motivational determiners are not demonstrable, "should be judged on the basis of the more clearly marked cases, whose investigation yields such unambiguous conclusions as to the way in which parapraxes are caused." One can hardly imagine a clearer repudiation of even the possibility of a probabilistic law. Some of the points discussed above have already made it apparent that, although still favored by some analysts, this position is untenable. It seems to me that the more we subject them to scrutiny, the more evident it becomes that most psychoanalytic statements are probabilistic.
It follows from everything I have said so far that, like scientific theories generally, clinical psychoanalytic theory functions as a tool enabling us to understand particular events. The general and special clinical hypotheses of which it consists may, however, also be regarded as guides for exploration in that they sensitize us to recognize events that may fit one or another of the structures expressed in them. In their capacity as guides for exploration, they may also, almost literally, be described as premises looking for an application. In some instances they may thus be applied not only to puzzling events requiring an explanation but to any event, however well understood otherwise, to which they seem to be applicable. … It …is impossible to compile a full list of the special clinical hypotheses.
A last point in this connection. In discussing the hypotheses involved in dream interpretation I observed that they presuppose the occurrence of certain other processes. I used Bak's speculation about why people generally overvalue their love objects to make a related observation. But we can hardly avoid noting that every case of clinical inference is based on a similar-mostly tacit-presupposition. If we did not (tacitly) presuppose processes of specific types we would be at a loss to explain, for example, the emergence of a partial functional equivalent of the fulfillment of an unacceptable motive or the emergence of the various forms of conflict resolution. In a sense, the general and special clinical hypotheses assert that such processes are in fact likely to occur. …
On the Clinical Confirmation of Particular Clinical Hypotheses
Particular clinical hypotheses present us in the main with two questions concerning, respectively, how they are inferred and how confirmed. It is obviously the task of any acceptable clinical theory to answer these questions. I have considered in sufficient detail the inference of these hypotheses. We have seen that in this process general and special clinical hypotheses play a decisive role-but only tacitly, as it were. It also became apparent, in my discussing what I have called the structure of the various types of hypothesis, that the logic according to which our inferences are reached is as little open to direct inspection as are the syntactic rules involved in our use of language.
As I just mentioned, the next question is how particular clinical hypotheses are confirmed. Sherwood has presented an excellent discussion of this question. I will take a somewhat different approach, consonant with what I said above about the probabilistic nature of (most) psychoanalytic statements. I will not ask which particular clinical hypotheses represent true statements, but to what extent any of them does and how that is demonstrated. A typical question is: "How probable is this particular clinical hypothesis?" And we may come up with the answer that it is somewhat probable, or highly probable, or that its probability is zero.
This view, clearly, does not preclude our considering the particular clinical hypotheses as a group. We may then direct our inquiry to what they all-or a significant number of them-have in common. The first thing to note is that many particular clinical hypotheses include theoretical terms, such as ''unconsciously,'' ''unconscious wish,'' and ''repression," and that those that do therefore are not directly testable. This is obvious if we consider that one property of theoretical terms is that they have no observable referents. A directly testable hypothesis must be expressed in an appropriate observation language; in the case we are concerned with, in what I have referred to as the psychological thing-event language (Rubinstein, 1997, chapter 2). The next point is crucial. It is part of the logic of scientific procedure that only a hypothesis that is directly testable, or in some way logically connected with directly testable hypotheses, can be confirmed or refuted, as the case may be.
To simplify matters I shall, somewhat arbitrarily, not regard as theoretical, terms referring to conscious events like conscious wishes, feelings, etc., which to an outside observer are not observable as such. Accordingly, I will regard particular clinical hypotheses that include such terms as directly testable if the conditions are such that simple avowal of the wishes, feelings, etc., whether spontaneously or in response to a question, suffices for the confirmation of these hypotheses.
Let us contrast two situations. Suppose we have no reason to believe that a person P is lying or that his memory is inaccurate. Suppose further that P tells us that at one time his freedom was drastically curtailed. In accordance with the situational quasi generalization that if a person is in some way constrained he most likely will want to free himself, we can formulate the particular clinical hypothesis that at the time P's freedom was drastically curtailed he wanted to be free. Since we have assumed that P is not lying and that his memory is accurate, this hypothesis can be tested simply by asking P whether or not at that time he did want to be free. Assume now that P acknowledges having wanted to be free at the indicated time. It would hardly occur to us to wonder whether P at the time he says he wanted to be free might have been mistaken about what he wanted or even about wanting anything at all. As Hampshire has observed, if a person claims he wants something, it would be senseless to ask how he knows that he wants it. P's acknowledgment, accordingly, fully confirms our hypothesis.
The situation obviously is entirely different when we formulate a hypothesis ascribing an unconscious wish to a person, e.g., a patient in psychoanalysis. We might do that if, in the example just cited, P is the patient and if he disavows having had a wish to be free in the indicated situation. The term "unconscious wish," as I have mentioned, is a theoretical term. The particular clinical hypothesis we are now considering, accordingly, is not directly testable. That, of course, does not mean it cannot be tested at all. But it can only be tested indirectly, i.e., by testing a directly testable hypothesis we have derived from it (alone or in conjunction with other hypotheses). According to the logic of scientific procedure I just referred to, if the directly testable hypothesis is confirmed, the not directly testable hypothesis in accordance with which it was derived is in some measure also confirmed.
The simplest directly testable hypothesis derived in accordance with our particular clinical hypothesis is that in the course of the analysis the originally unconscious wish will become conscious and be expressed by the patient. The difficulty with this hypothesis is that we cannot put much weight on the patient's avowal of such a wish, whether, as Freud noted, in response to a direct interpretation, or, as shown by Eagle, more or less spontaneously as a result of the analysis. In either case the patient may have inferred the wish in roughly the same way as the analyst (exhibiting intellectual understanding, as we are wont to say), or he may avow it for some extraneous reason-for example, because he wants to please the analyst. Besides, we cannot take it for granted that a wish actually expressed at time t is the same wish we (presumably for good reasons) assumed to be present in an unconscious state at time t - x. Accordingly, both Freud and Eagle, although in different ways, emphasize the importance of other types of indirect evidence than the evidence provided by the eventual direct expression of what we take to be the referents of theoretical terms included in the particular clinical hypotheses being tested. That does not mean, of course, that whatever the patient says, for instance, about those of his wishes that are presumed to have been unconscious at one time, is completely discounted. It means merely that only in the light of a certain (to be sure, not easily specifiable) amount of other types of indirect evidence can his avowal or disavowal be properly evaluated. The feelings associated with a patient's avowals and disavowals, as every clinician knows, are highly significant. I will touch on this question later.
In the following I will consider only particular clinical hypotheses including theoretical terms. I will also consider only indirect evidence other than the evidence provided by the eventual expression of what we take to be the referents of these theoretical terms. I will try to outline what in psychoanalysis is counted as such indirect evidence. Take a specific situation. We observe (or learn) that a person P has acted in a particular way, one effect of which is that he achieves A. Suppose P disclaims any desire on his part to achieve A. Suppose also that we have no reason to doubt P's veracity. We can now tentatively infer, in accordance with the hypotheses of motivational determination, of unconscious motives, and of the persistent manifestation potential of unconscious motives, that P acted in a way that led him to achieve A because he unconsciously wanted to achieve A.
This is our particular clinical hypothesis. Because of its tentative nature it obviously needs to be confirmed. The first step in confirmation is to predict, in accordance with the hypothesis of the persistent manifestation potential of unconscious motives, that if P indeed harbors an unconscious wish for A, this wish will be manifested in other ways also, for example, by events qualifying as substitute fulfillments and/or by events qualifying as fragments (e.g., in dreams) of such substitute fulfillments. In addition to the hypothesis of the persistent manifestation potential of unconscious motives, the prediction that events of the first type will occur is derived in accordance with the hypothesis of partial functional equivalence, and the prediction that events of the second type will occur is derived in accordance with the hypothesis of partial functional equivalence in conjunction with the hypothesis of context fragmentation. Other "allusions" to the presence of a wish for A might also be predicted in accordance with one or another general or special clinical motivational (or related) hypothesis, separately or in some combination with other such hypotheses. These various predictions clearly represent directly testable hypotheses and, if confirmed, provide indirect evidence of the type indicated above for our particular clinical hypothesis.
Evidence of a different type for the presence of a wish for A may be derived by postdicting, in accordance with appropriate genetic hypotheses, that P in his early years actually was subjected to experiences that were likely to lead to the establishment of a wish for A as a permanent disposition and that this wish was of such a nature that it was likely to be repressed. This last point obviously requires us to adduce special motivational hypotheses regarding the nature of motives that are likely to be repressed and, besides, hypotheses concerning the conditions under which the repression is most likely to happen. It is further at least a theoretical possibility that the occurrence at a particular time in the past of some indirect manifestation of the unconscious wish for A, in accordance with an appropriate situational hypothesis, may be postdicted on the basis of our knowledge of (or surmise about) the prevailing situation at that time. We may here speak about postdictive prediction. Similar manifestations-again as a theoretical possibility-may also, in accordance with the same hypothesis, be predicted to occur in future situations of the type referred to in the hypothesis.
The following three formulae summarize in simplified form the predictions and postdictions involved in the confirmation, as just described, of a particular clinical hypothesis:
1. If h1 & (M1 & M2), then eMa &/or eMb, etc.
2. If h1 & (G1 & G2), then eG1 & eG2.
3. If h1 & (S1) & s1, then eS1.
In these formulae h1 is the particular clinical hypothesis stating in part that a wish for A is present in an unconscious form. M1 and M2 are general (or special) motivational hypotheses, G1 and G2 general (or special) genetic hypotheses, and S1 a general (or special) situational hypothesis. eMa and eMb are motivational evidence items. eG1 stands for evidence in favor of the occurrence of past situations leading to the establishment of a wish for A, and eG2 for evidence in favor of the occurrence of past situations leading to the repression, if established, of the wish for A. A situation of the type referred to in S1 is s1 and eS1 indicates a response of the type predicted by S1. I have tried to indicate the special standing of the general and special clinical hypotheses by placing the signs for them inside parentheses.
The three formulae indicate that a particular clinical hypothesis (in the case we are considering, hypothesis h1) is usually confirmed in more than one way. The posited presence of an unconscious motive, for example, is thus confirmed by the identification both of items qualifying as its antecedents and of items qualifying as its consequences, the former having been postdicted, the latter predicted. In part the formulae illustrate Waelder's "pentathlon theory" of clinical confirmation.
It seems fairly clear that, up to a point, the greater the number of predicted and/or postdicted evidence items that have been unequivocally identified, the greater the degree of confirmation we shall feel inclined to regard the particular clinical hypothesis we are considering as having achieved. One or two unequivocally identified predicted and/or postdicted items may conceivably have occurred by chance, but hardly several of them. Partly because it can only be tested indirectly, our particular clinical hypothesis can be shown to be at most quite probable. …
The identification of a postdicted item usually involves the retrieval of old memories, but may also come about in the form of information from outside sources. As in the case of avowals and disavowals, the extent to which the process of memory retrieval is fraught with feelings is highly significant. The expressions of feelings are of course generally relevant to the problem of clinical confirmation of particular clinical hypotheses. To give even a vague idea of what is presumably involved I must for a moment transgress into extraclinical theory. I will regard feelings, such as love, anger, fear, etc., as part of the experiential correlate of specific action and related dispositions. It then follows that the expression of a particular feeling is recognized as such mainly by (1) characteristic so-called expressive movements as exhibited in facial expressions, gestures, tone of voice, etc., and (2) direct or indirect expression, in words or deed, of the correlated specific action and related dispositions.
Let me take a schematic example. Suppose we have formulated the particular clinical hypothesis that a person P hates another person Q. If P now at some point in his analysis claims that he indeed hates Q, we will, generally speaking, take his claim the more seriously the more he exhibits expressive movements characteristic of hating. Since, however, expressive movements can, to a large degree, be suppressed on the one hand and faked on the other, we will primarily take P's claim seriously if he shows some evidence of the presence of the specific action and related dispositions that are correlated with feelings of hate. For example, while we may have some doubt that P is using the word "hate" in its ordinary sense if he merely says "I hate Q," we will feel inclined to believe that he does indeed use the word in this sense if he says, for example, "I hate Q; I could kill him," or "I wouldn't care if I never saw him again," or "I think it would serve him right if he lost everything he has." It is further highly significant if we can demonstrate the existence in the past of a situation (or set of situations) that, according to a relevant special situational hypothesis, is at least somewhat likely to have given rise to responses and dispositions normally correlated with the feelings a person expresses—in the case we have been considering, hate. There is of course much more to be said about this topic, among other things about the dispensability of the concept of empathy and about the experiences on the part of an observer that have led to the theory of the role of identification in the recognition of feelings in other people. …
…It has never been sufficiently clear what the theory is capable of predicting … and misunderstandings on this point therefore arise easily. We must take note of five points concerning predictions and postdictions in psychoanalysis. One is that, as I have indicated, every prediction and every postdiction represent a directly testable hypothesis. The second is that in clinical practice the predictions, particularly those based on motivational hypotheses, are for the most part merely implicit. The third is that we do not predict the occurrence of specific events but only of any event or group of events of a certain class of events, namely, in the dummy case I considered above, events that in accordance with the listed general motivational hypotheses qualify unequivocally as manifestations of a wish for A. Appropriately modified, this point also applies to postdictions in accordance with situational and genetic hypotheses. The fourth point is that, whereas in other scientific disciplines the conditions for the occurrence of a predicted event are clearly specifiable, in psychoanalysis-with the exception of predictions based on situational generalizations or quasi generalizations-they are not. Certain general conditions, however, are specified, namely, conditions believed to provide opportunities for the expression of unconscious events, i.e., as it were, to give freer play than they ordinarily have to the processes posited by the hypothesis of the persistent manifestation potential for unconscious motives. These conditions include so-called free association, by which some of the restraints determining habitual conversational patterns are eliminated, and the general setup of the psychoanalytic situation.
The fifth point is of a somewhat different nature. The reader can hardly have avoided noticing that the same general clinical hypotheses from which particular clinical hypotheses have been derived have also yielded the relevant predictions. This is an instance of the intimate relationship between explanation and prediction that Hempel and Oppenheim were the first to point out for science generally. …
Two Clinical Cases Illustrating Some of the Points Made Above
…After a few months in analysis a patient in his early thirties began to speak less and less. Periods of silence up to 20 minutes became frequent. On occasion the patient fell silent in the middle of a sentence. He stated that he simply could not bring himself to speak. The patient's behavior during the silences suggested that he was holding something back, not just information, however, and not just the expression of feelings, but also speech as such. For example, on several occasions he was obviously trying to say something but could not get a word out. Organic pathology was excluded. Accordingly, the analyst, on the basis of what seemed like analogous activities, very tentatively formulated the particular clinical hypothesis that the patient's silences represented the in part functionally equivalent fulfillments of a repressed motive to withhold feces.
After some time the patient began to come late to his sessions. Occasionally he appeared only a few minutes before he was scheduled to leave. Although he had no financial problems he also began to pay his bills up to two months late. It turned out, further, that the patient was almost incapable of making any decisions, even important ones, until the very last minute.
Like the silences, coming late, paying late, and postponing decisions can be classified as activities by which something is held back. Accordingly, these additional symptoms are readily seen as in part functionally equivalent fulfillments of a fecal-withholding motive. Implicitly activities of this general type-although not the actual activities that were observed-were predicted in accordance with the tentative particular clinical hypothesis in conjunction with the general clinical hypotheses of unconscious motives, the persistent manifestation potential of unconscious motives, and partial functional equivalence. Interpretations presented to the patient in accordance with both this and a number of alternative views had at best a temporary effect.
Additional items of evidence were gradually elicited. The analyst postdicted that perhaps something happened during the patient's toilet training that might explain the establishment and persistence of an abnormally insistent fecal-withholding motive. Indeed, one day the patient reported that, according to his mother, he had been fully toilet-trained before he was one year old. Although this story may well have been exaggerated, it is nevertheless possible that the patient's toilet training started before he was ready for it. The surmise was rendered plausible by the fact that in the patient's accounts the mother emerged as an extremely meticulous, quite temperamental person who was also very unhappy in her marriage. These traits of the mother, taken together with the known circumstances of her life, are compatible with the hypothesis that she was impatient to get the patient, who was the younger of two sons, toilet-trained as soon as possible and that she went about it in a no-nonsense way. If so, and if indeed, because of his age, he was not ready for it, the patient's toilet training may have been at least somewhat traumatic to him, thus contributing to the abnormal development of the fecal-withholding motive.
Except as noted, this construction-which, because of the (presumed) analogy between the patient's behavior toward the analyst and toward his mother during toilet training, was suggested by the general genetic hypothesis of partial functional equivalence of past and present situations-was not confirmed, nor did interpretations derived from it have much effect. That a fecal-withholding motive had been established and rendered highly arousable was, on the other hand, evident. As far as the patient could remember, between approximately the ages of seven and 10 he developed a habit of postponing going to the toilet for as long as he possibly could. It became quite a game he was playing with himself to see just how long he could resist the urge to defecate. Usually he managed to reach the toilet at the very last moment, but on two or three occasions he was too late and soiled his pants. He felt very humiliated when this happened and eventually stopped the game. The motive for fecal withholding thus became unacceptable and may indeed have been repressed. The patient began to talk about this "game" only toward the end of the third year of his analysis. Whether it had been "forgotten" till then could not be ascertained. It is tempting to speculate that the "game" represented the reawakening of the primary conflict by processes posited by the general genetic hypothesis of revival of responses to a past situation in an in part functionally equivalent present situation, the latter situation being in a very specific sense merely subjective.
We may note that the data, although they seem to render the original particular clinical hypothesis quite probable, do not exclude alternative hypotheses. For example, the patient's fecal withholding could conceivably have been an early expression of a primary general disposition to withhold, of which the symptoms observed in the analysis would then be later expressions. Offhand this may not seem like a particularly credible hypothesis. The point is, however, that, as I just indicated, it is confirmed by exactly the same clinical data as the original hypothesis. The choice between the two hypotheses will be determined primarily by the nature of the general genetic, specifically developmental, hypotheses we decide to adopt
The following case illustrates (a) how the identification of a postdicted item is made possible through information from an outside source; (b) that postdiction in accordance with a genetic hypothesis is not of a particular event but of any one of a class of in some way similar events; and (c) how the general genetic hypothesis of revival in some form of responses to a past situation in a partly functionally equivalent present situation may be applied more easily than in the preceding case.
After having been drafted into the army during wartime, a highly intelligent young man developed a dread of being sent overseas and subsequently a series of compulsions, the most persistent of which was a compulsion to take a series of deep breaths whenever he was in a stressful situation and, likewise, whenever he passed a funeral home. On these occasions the patient, who was not religious, often had to say a brief prayer asking God to protect his mother. The symptoms continued for quite some time after he had been discharged from the service.
We note that being drafted into the army during the war represents at least a potential threat to life. The patient was fully aware of this fact and reacted to it with intense fear, most closely describable as fear of death. It seems plausible to assume that this fear was in some way causally related to the breathing compulsion and the associated ritual involving the mother. Adducing the hypothesis of revival in some form of responses to a past situation in an in part functionally equivalent present situation, the analyst hypothesized that the ritual represented a reaction formation against an old, fear-derived rage directed against the mother that had been revived by the present fear of death, and the breathing compulsion the revival of a perhaps aborted response to a breathing difficulty that had been somehow linked with the rage against the mother. Accordingly, the analyst postdicted that the patient, while at his mother's breast, may have had breathing difficulties associated with what-in adult language-might be described as a fear of suffocation and, hence, death. This turned out not to have been the case. One day the patient came in with the following story, which his mother had just told him. when he was around two or three years old he often refused to eat his soup. On these occasions the mother used to press his nostrils firmly together, thus forcing him to open his mouth. Then, while he was apparently gasping for breath, she quickly poured a spoonful or two of the soup into his wide-open mouth.
This information clearly confirmed the essential part of the postdiction. It is of interest to observe that, in accordance with the hypothesis of partial functional equivalence of past and present situations, the patient would have been expected merely to react with rage against the war, or the enemy, or his commanding officer, etc. We do not know why he reacted instead (or perhaps in addition) as indicated in the hypothesis of revival in some form of responses to a past situation in an in part functionally equivalent present situation, nor can we form a clear idea about the processes this hypothesis presupposes. The intensity of the early trauma may offer a clue to the first of these questions. In the present connection, however, I cannot speculate further on this matter.
[Next comes a rather technical section concerning Popper's falsifiability criterion. Rubinstein then summarized the content of the final section as his defense of] the thesis that the general clinical hypotheses must ultimately be substantiated neurophysiologically. This is an ideal, of course. It can be approximated only gradually, through the construction of theoretical models that at any given time are compatible with our neurophysiological knowledge at that time.
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