Abstract
John Forrester died in November 2015, and was working on Thinking in Cases until near the end of his life. In her preface to the book, his widow, Lisa Appignanesi, mentions that she compiled the final chapter from a lecture and his notes. “The sources he brought to bear were always vast,” she writes. “Mimicking his agility in argument, let alone imagining a position he might arrive at, is a little like playing chess with a master when you barely know the rules of the game” (p. x). Adam Phillips comments in his introduction that Forrester “seemed to have read everything” (p. xiii). Forrester was indeed a polymath, and the scope of his erudition presented a challenge for me, as I imagine it will for many readers. This is a book that requires careful reading.
The initial challenge the reader faces is that, with the exception of Forrester’s opening chapter, each essay in the book deals with a particular “case,” with extensive reference to a background text. Some of these texts I had read, and some I had not. For example, The Structure of Scientific Revolutions is the central text cited in chapter 2, “On Kuhn’s Case: Psychoanalysis and the Paradigm.” My own reading of Kuhn’s classic work was too far in the past to fully inform a present reading of Forrester’s chapter. Should I then first read or re-read these background texts, or press on without doing so? Of necessity I pressed on. Although acquaintance with the texts Forrester discusses would certainly have enhanced the experience of reading this book, for the most part it did not prove essential.
Forrester’s intention is to make the case for “thinking in cases.” At the outset he informs the reader that as an historian and philosopher of science he has devoted the last twenty years to the history and philosophy of psychoanalysis—psychoanalysis, of course, being a discipline based on “thinking in cases.” Forrester poses, but does not attempt to answer, the question “Is psychoanalysis a science?” He does, however, refer to the six styles of reasoning that Ian Hacking has identified as characterizing different sciences and branches of knowledge (p. 2) and proposes adding “thinking in cases” to this list, as a seventh style of reasoning.
Chapter 1, “If p, Then What? Thinking in Cases,” is an introductory essay addressing the question of the case and its significance. It is wide-ranging and scholarly, but for me at least didn’t quite engage the imagination. If this is a fault, it is compensated for in his further five chapters, each one an essay on a particular “case” that stands alone, the only link between them being that they all, in one way or another, have something to do with psychoanalysis. Each of Forrester’s essays presents an exemplar of what “thinking in cases” might mean. Following the chapter on Kuhn, Forrester’s chapter 3, “The Psychoanalytic Case: Voyeurism, Ethics and Epistemology in Robert Stoller’s Sexual Excitement,” considers the case history of Stoller’s patient Belle in that text and the complexities of the relationship between Stoller and his patient. Chapter 4 considers a clinical paper and case history of D. W. Winnicott, with the theme of “holding as metaphor.” Chapter 5 is titled “The Case of Two Jewish Scientists: Freud and Einstein,” while chapter 6, “Inventing Gender Identity: The Case of Agnes,” concludes the book.
Each essay and its case is distinctive. I will try to give an idea of Forrester’s approach by considering two chapters. In chapter 2, the book’s longest, “On Kuhn’s Case: Psychoanalysis and the Paradigm,” Forrester begins by acknowledging that Kuhn’s influence upon him was direct, personal, and formative, as a consequence of reading The Structure of Scientific Revolutions and having taken courses with Kuhn at Princeton in the History and Philosophy of Science Program from 1970 to 1972: “So it was Structure that set me on course to become an historian and philosopher of science . . .” (p. 44). He goes on to reflect on where Kuhn located his identity, as historian of science or philosopher of science, and from the outset the reader is made aware of the links between Kuhn’s case and Forrester’s. In beginning the essay, Forrester states he “should at least declare some of the themes which will be its focus”; he then interpolates a surprising statement: “in exploring how Kuhn was and is linked to Freud and the case, I will be examining the function of Kuhn’s own psychoanalysis in his work . . .” (p. 26). The reader is offered the prospect that “Kuhn’s Case” is going to include some consideration of Kuhn himself as a “case” in psychoanalysis.
Forrester has, it seems, grounds for his essay into the connections between Kuhn’s psychoanalysis and the development of his thinking. Kuhn himself said in a published interview, quoted in the book, that his own capacity “to climb into other people’s heads,” which he considered essential in his work as an historian, “came out of my experience in psychoanalysis, so in that sense I think I owe it a tremendous debt” (p. 30). Kuhn also commented of psychoanalysis that “there is a craft, hands on aspect to it, that I know no other route to, and that is intellectually of vast interest” (p. 30). Forrester notes that the analysis in question lasted something like two years, and that Kuhn also commented that “in retrospect” he came to hate his analyst because he “behaved extremely irresponsibly,” in that he used to fall asleep in sessions “and then when I would catch him snoring he would act as though I had no business being at all angry or upset about it” (p. 29).
While recognizing that what transpires in an analysis is, we might say, hermetically sealed and inaccessible to the outsider, Forrester examines the circumstances of Kuhn’s life, before and after analysis, to make an indirect case that whatever did transpire there, it would seem to have been transformative. Forrester then puts his claim “at its crudest”: “Kuhn modelled his understanding of historical texts and figures on the experience of psychoanalysis. He learned how it is that one can climb into other people’s heads through psychoanalysis; and his vision of historical understanding remained that for the whole of his professional career as an historian” (p. 31).
Forrester notes that Kuhn was skeptical about the value of psychoanalysis as therapy: “I’m not sure that it produces real therapy of any sort—but it sure as hell is interesting” (p. 30). We might wonder about Kuhn’s words. There is, of course, a huge body of evidence, based primarily on “thinking in cases,” to support the proposition that a well-conducted psychoanalysis facilitates therapeutic transformation and evolution within the personality. Kuhn seems to suggest that his own analytic experience did not provide much that he considered therapeutic. Perhaps it was not well conducted? Or, if we accept Forrester’s suggestion, that indeed there is evidence of a transformative effect on Kuhn’s life, did Kuhn simply not recognize the therapeutic impact of his analytic experience? Or was Kuhn able to make use of his analysis in a way he himself didn’t regard as therapeutic? Like Forrester I was struck by Kuhn’s comments that psychoanalysis is “intellectually of vast interest” and “sure as hell is interesting,” but for a different reason: Kuhn’s comments seem to suggest a restriction of the psychoanalytic experience, at the conscious level at least, to an intellectual sphere.
Forrester goes on to consider how Kuhn’s psychological orientation to the problem of scientific knowledge was central to his ideas: “I do want to emphasize one aspect of Kuhn’s work which may be regarded as part of the legacy of his overall interest in psychology, including psychoanalysis. Put baldly, Kuhn always approached the problem of scientific knowledge as governed by psychological dynamics” (p. 39). He comments: “The ‘psychological’ turn of Kuhn’s own mind is best known in his use of the gestalt switch to give content to the suddenness and lack of rationality underpinning a scientific revolution.” As Kuhn wrote, scientists “often speak of the ‘scales falling from the eyes’ or of the ‘lightning flash’ that ‘inundates’ a previously obscure puzzle, enabling its components to be seen in a new way that for the first time permits its solution” (p. 39). Although Forrester does not cite Wilfred Bion, the idea of the “gestalt switch” has obvious similarities to Bion’s formulation of the “selected fact” experience (1962), as an unpredictable experience of the apprehension of a new and previously unknown coherence.
This does not take us to the end of the essay on Kuhn, but it suggests some of the directions in which Forrester takes the reader, and the way cases proliferate in this book. There is the case of Kuhn as a thinker and of Kuhn as an analysand; the case of what constitutes scientific knowledge, and the case of the status of knowledge in disciplines that proceed by reasoning in cases, psychoanalysis in particular. There is the case of Forrester’s relationship with Kuhn, and Kuhn’s formative influence on him. Then, very present, but not addressed in detail, is the case of Forrester’s paradigm of psychoanalysis. And presumably there in the background, but not referred to directly by Forrester, is his experience of personal psychoanalysis. And what about the case of the reader and the reader’s “paradigm” of psychoanalysis? A lot can happen in two years, but in my psychoanalytic paradigm two years would be a very short analysis indeed—just time to get started, I might think. As psychoanalysts it would seem almost inevitable that we will do our own reading between the lines, framing other possible interpretations. Hopefully in this regard we can remain with uncertainty—uncertainty as to whether our “interpretations” are real insights or the imposition of our preconceptions and our own psychoanalytic paradigm.
The second case I will briefly consider is that of Robert Stoller’s somewhat infamous patient Agnes, discussed in Forrester’s relatively short final chapter. Stoller’s original paper was one of the background texts I had not read, but Forrester credits Stoller with being the first to coherently formulate the concept of “gender identity,” with Agnes one of the two principal clinical cases in that paper. Stoller argued for “the existence of a variable and indeterminate biological force of which ‘gender identity’ is the psychological expression” (p. 130). He was proposing that gender identity has, at least in part, biological determinants separate from biological sex.
“Agnes” was a boy whose conscious fantasy life as a child had consisted of playing at being a girl. Despite possessing normal male genitalia, he developed marked female secondary sexual characteristics during puberty. He became a patient of Stoller’s and eventually underwent gender reassignment surgery. However, some years after the reassignment, Agnes returned to consult Stoller, and “casually inform[ed] Stoller, with no hint that this is a new revelation, that at the age of twelve, she had started taking her mother’s stilboestrol, or DES, an oestrogen replacement.” “She” had counterfeited her mother’s medical prescriptions through to her late teens (p. 132). In the light of these revelations, and further background that emerged about Agnes’s experience growing up, Stoller apparently abandoned his hypothesis of the “indeterminate biological force of which ‘gender identity’ is the psychological expression.” Adopting a “psychoanalytic” vertex, he concluded that “the family preconditions for producing an effeminate boy . . . operated in the adult transsexual” (p. 132). It is an instructive case, illustrating that while evidence from a single case can never prove an hypothesis, it may go a great distance in falsifying one.
Forrester lucidly suggests that psychoanalytic writing “is not just writing about psychoanalysis; it is writing subject to the same laws and processes as the psychoanalytic situation itself.” Thus, he adds, “psychoanalysis can never free itself of the forces it attempts to describe.” He continues, somewhat enigmatically: “As a result, from one point of view, all psychoanalytic writing is exemplary of a failure. Psychoanalytic writing fails to transmit psychoanalytic knowledge because it is always simultaneously a symptom” (p. 66). Forrester’s book illustrates his first thesis, and is suggestive of his second, although as readers we are not privileged to know a symptom of what.
The psychoanalyst’s territory is “thinking in cases,” and this book offers both arguments for, and an experiential validation of, our privileging of the case as the source of knowledge. It should be of particular interest to psychoanalysts of a philosophical bent, though it might be of interest to a wider range of readers in that Forrester is able to illustrate, and bring to life, a “psychoanalytic” way of thinking about his cases. In the end what I found most absorbing were the anecdotes and stories about the “cases” themselves, and the many different directions in which they seemed to lead.