At this holiday season, I found extremely stimulating to read Dr. Luepnitz's sharp and challenging remarks

Controversies are difficult especially because the complex nature of psychoanalysis makes that the focus we are discussing continously moves from natural sciences at one end of the pendulum to hermeneutic and humanities, at the other.

According to where the focus of the problem is, the shared criteria of evidence which should guide de debate will also vary.

I agree that "rats and stats" is not a recommendable neighbourhood but, on the other side, I am not at all comfortable near Nietzsche's words. Could we say that Auschwitz is a theory and not a fact? Could we say that our psychic reality is constructed by our words?

Some militars involved in my country's dictatorship (decades ago) still say that to claim the truth about missing people during dictatorship is part of a conspiracy against them and not a fact. However, a new and more truthful view of this period slowly found its way. Words and discourses were helpful but also the appearance of bonds in military camps and kidnapped children adopted by other families also were irrefutable facts. Facts command words but words are also facts, and sometimes the impossibility of words, the unthinkable of e.g. genocides, are also a fact. Then the question is how to discuss about this kind of questions which involve, at the same time, facts which cannot be denied as involved meanings (or lack of meanings) which are also real.

The question of the kind of evidence which we rely on becomes, from my perspective, the crucial problem.

I confess that Freud's, Winnicott's, and many other psychoanalysts' narratives have a profound influence on me. But, at the same time, I feel very comfortable with Leichsenring's data. Also when Shedler (2009) tells me that the 0.7 effect size of psychotherapy is greater than benzodiazepines or antidepressants and other drugs. However, do we have any of such kind of evidence confirming that differences in our theoretical approaches make any difference regarding patient outcomes? Should we claim for this kind of study? My guess is that we do not operate with Freud, Klein, Lacan, etc. but with our implicit relational theories that are constructed from those authors' work but developed in our own experience as professionals and human beings. 

For a real intellectual intercourse we need to agree on the kind of evidence that addresses the nature of the problem we are discussing. We need to describe which problems we are addressing with clinical evidence and which problems could be enlightened by the addition of extraclinical evidence.

Best regards and an excellent 2013 for all,

Ricardo Bernardi

Add comment


Security code
Refresh