Philosophical view on Freud\'s case study of paranoia

Niederland, W. G. (1963). Further data and memorabilia pertaining to the Schreber case. International Journal of Psychoanalysis, 44, 201-207.
Ibid
Quinodoz, J.-M. (2005). Reading Freud: A chronological exploration of Freud's writings. Hove [England}: Routledge, 101-102.
Ibid,102.
Schreber, D. P. (1955). Memoirs of my nervous illness. (Trans. I. Macalpine & R. A. Hunter). New York, NY: New York Review of Books. 36
Ibid
Ibid 63.
Ibid 64.
Ibid 55.
Ibid 46.
Ibid 60.
ibid 99.
Ibid 99.
Ibid 184.
Ibid 180.
Ibid 5.
Chabot B, (1982), Freud On Schreber: Psychoanalytic Theory and the Critical Act, University of Massachusetts Press , Massachusetts, 35.
Ibid
Ibid 36.
Ibid 36.
Ibid 44.
Freud, S (1911), Psychoanalytic Notes on an Autobiographical Account of a Case of Paranoia, The Hogarth Press, London, 1958, 48.
Ibid 48.
Ibid 48.
Ibid 49.
Ibid 49.

Ibid 49
Ibid 50
Ibid 54
Ibid 57
Ibid 57
Freud, S. (1961-1963), Introductory lessons of psychoanalysis In J. Strachey (Ed.) , The standard edition of the complete psychological works of Sigmund Freud (Vol. 16-17) London, Hogarth Press, (Original work published in 1915-1917)
Popper, K. ( 1935) The logic of scientific discovery, Rutledge classics, New York
Ibid
2

Faculty of Arts
University of Maribor





Philosophy of psychoanalysis:
"Philosophical view on Freud's case study of paranoia"








Mentor: Student:
Prof. Dr. Boris Vežjak Andjela Bolta

Maribor, 2016.

Introduction


After concentrating on discovering the origin of the neuroses, and in particular of the hysterical and obsessional neuroses, Freud went on to look for a speci c mechanism that might lie at the root of nervous illness called paranoia. After Jung introduced him to autobiography of a judge Daniel Schreber called Memoires of my nervous illness, Freud thought that study of this case would be a great way for him to analyze and illustrate mechanisms through which paranoia as a nervous illness functions. One of the reasons also was that in this case he wouldn't have to falsify any case information in order to protect personal information about the patient and keep doctor-patient confidentiality, since Schreber's Memoires had already been public.
By introducing Freud's psychoanalysis of this, popularly called, "Schreber case" I will try to examine how psychoanalytical methods and interpretations are functioning and is psychoanalysis actually reliable enough to be called scientific psychological theory.


Daniel Schreber's biographical and historical background


Serving the purpose of better understanding of "Schreber case" and Feud's study of it, this chapter will provide some information about Schreber, his childhood, family, career and hospitalizations.


Childhood and family

Relatively little is known about his childhood, which is an interesting fact since childhoods of patients usually played very important role in Freud psychoanalytical case studies.
Daniel Paul Schreber was born in 1842 in Leipzig as one of five children of Pauline and Moritz Schreber. His father Moritz was a renowned physician. Moritz Schreber wrote over thirty books on child rearing, and founded an Orthopedic Institute. The aim of the elder Schreber's teaching seems to have been to instill a sense of discipline in children in the first few years of life. To that end, he prescribed elaborate methods by which children could be taught and disciplined, and illustrated his works with pictures of devices, to be used to keep a child in the correct posture during various activities. The sadistic nature of the pedagogical regime, with its grim fanaticism against children's 'crude nature', (and masturbation, in particular), has led a number of commenters to ask whether, and to what extent the father's ideology is implicated in the son's etiology. Some have taken it for granted that the elder Schreber's methods constituted a trauma, against which the 'delusional formation' is a kind of attempt at recovery. Indeed, some of the younger Schreber's hallucinations and delusions have clear correlates in the devices championed by his father. Nonetheless, much of this is mere speculation, as the facts of Schreber's early life are largely unknown. Some of the letters, written to Schreber by his sister Anna, which were found in the hospital where he was institutionalized are providing us with the information which describes Schreber household as 'oriented towards God', a god present at all times, not merely in their daily prayers, but in all of the family's activities. The eldest of the Schreber children, Daniel Gustav, became head of the family in 1861 after the father's sudden death. He himself was likely to have been psychotic, and died by his own hand at the age of 38, a few weeks after being promoted to a judge. He was unmarried, and died by a gunshot wound, with 'melancholia' ascribed as the cause of the event in obituaries.
Schreber was married, but he didn't mention his wife much in his memoires. We know only few information about his marriage mostly based on the letters exchanged between Schreber and his wife, but as far as we know his relationship with his wife didn't have much relevance in his case.

Carrier

Schreber graduated from law school and was a highly respected judge. In 1884, just prior to his first hospitalization, Schreber ran as a candidate for the Reichstag. Several commentators have noted that this was likely to have been a rebellious move against a kind of father-figure, namely, Bismarck, the 'Iron Chancellor' of Germany, who at the time was dissolving the Reichstag at will. In late 1893, after years of working as a judge at a relatively local level, Schreber was informed of his promotion to President of the Senate. This is the major event preceding his second and chronic breakdown. Whilst being amply qualified for the role, several commentators have noted that Schreber's new colleagues were men a generation older than him, and possible father figures.

First Hospitalization

Schreber's rst illness began in 1884 and took the form of depressive hypochondriasis, shortly after he had failed to win election to the Reichstag. He was at that time 42 years of age. He was treated in Professor Flechsig's clinic in Leipzig; Flechsig was a world-famous psychiatrist and neuro-anatomist who discovered the dorsal spine-cerebellar fasciculus (later named after him). After spending a few months in Flechsig's clinic, Schreber recovered completely.

Second Hospitalization

The second illness began some years later, in 1893, shortly after he was appointed to the important post of President of the Appeal Court in Saxony; he was then 53 years old. He su ered from an acute hallucinatory delusion, and was again admitted to Flechsig's clinic; six months later, he was transferred to another clinic in Dresden, the director of which was Dr Weber. He stayed there for all of eight years, securing his own discharge by applying to the court in Dresden. It was in the course of this procedure that Daniel Paul Schreber wrote his Memoirs of my Nervous Illness in which he described in detail the progress of his illness, his delusion and his hallucinations in order to support his application to the court for release: his intention was to demonstrate to the court that he had become socially well-adjusted and that his illness was no longer a su cient reason in law for continuing to keep him in a psychiatric institution. He was accordingly freed in 1902, the judge observing that, though he was still insane, Schreber was no longer a potential danger to himself or to other people. Daniel Paul Schreber retired to Dresden, where he lived with his wife and their adopted daughter. Five years later, he had a relapse of his depressive psychosis and had to be admitted to the psychiatric asylum in Leipzig, where he remained until his death on 14 November 1911 – the same year in which Freud's case study was published.


Schreber's Memoires

As mentioned in previous chapter, Schreber wrote his Memoires during his second hospitalization as an assessment to his application for releasement from asylum, but also for his family and acquaintances in order to help them understand his illness and the things he was struggling with.
His second illness started by him dreaming that his hypochondriasis came back. On one of these occasions, he was revolted by the thought which occurred to him, between a state of being awake and asleep, "that after all it really must be very nice to be a woman submitting to the act of copulation". He started suffering a severe onset of insomnia and voluntarily returned to Flechsig's asylum, where he subsequently developed a return of the "hypochondriasis" and displayed Žfirst signs of ideas of "persecution".
After hospitalization Schreber started to believe that there is a conspiracy to turn his body into a woman's through a process he called "unmanning." Even at this early stage, Schreber did not "exclude the possibility that some external influences were at work to implant" the idea in him. Schreber started suffering sleeplessness soon after starting his position as a Senatspräsident. Many of his colleagues were men older than him and he was feeling the pressure to impress them and that pressure was probably the main reason for insomnia. But at that time he already felt the suspicion that there are some "miracles" working on his suffering. Precisely who was behind these "miracles" became the subject of Schreber's laborious thought process throughout his second illness as he persisted in his effort to discover the responsible parties for his torments. As a result of this process, Schreber Ž finally developed an elaborately designed theological framework with which to justify his beliefs. Through his memoires Flechsig, his first doctor was marked as a responsible party in conspiracy against him. Schreber developed the idea that Flechsig is his persecutor, or, precisely his "soul-murder" He explains that his relationship to Flechsig must have begun with their ancestors dating back to the 18th century, at which time one of Flechsig's ancestors attempted "soul murder" against a distant relative of his. Schreber, therefore, feels that his relationship to Flechsig carries on a legacy which culminates in his persecution by Flechsig's soul. Throughout his memoirs, Schreber remains undecided as to whether the "actual" Flechsig is or was ever intentionally involved in his persecution. However, he conjectures that Flechsig may have lost a portion of his soul, which in turn haunts him and explained that portion of Flechsig's soul could torment Schreber's person without the "actual" Flechsig knowing. Schreber in his Memoires provided the complete theological explanation how this could be possible. Schreber concludes that an ancestor of Flechsig had, upon receiving such contact, abused his privilege, thereby placing the universe in jeopardy by offending the "Order of the World" (p. 56). For Schreber comes to believe that, upon God's withdrawal from the human state of affairs, there had developed, apart from God, the "Order of the World" with its own laws and systems of justice. Schreber reasons that there is "no clash of interests between God and human beings as long as" their relationship is in "accordance with the Order of the World". Since this relationship had been violated, "all creation" is at risk and he suspects from the start that God Himself was a co-conspirator, if not the instigator of the entire affair. Schreber thought that God has seen his "nervousness" illness as a threat and therefore created the conspiracy to "unman" him by transforming him into a woman. Unfortunately for God, the "unmanning" procedure had the opposite effect he intended. That is, God, through "divine rays," began "the gradual filling of [Schreber's] body with nerves of voluptuousness (female nerves)" which had the "reverse effect". Instead of Schreber being "abandoned" through this process, he actually developed an "increased power of attraction" for God. In turn, God was forced to develop other means to protect Himself, through either killing Schreber or destroying his reason, for example, causing him sleeplessness. Schreber thought that the world had come to an and that all the people he encounters are just "divine rays" as he called them, which are sent by go just as another way to torment him. In the third stage of his illness Schreber got to believe he can save the world by reconciling God and "Order of the World" through the process of "unmanning", by this he would procreate new race of man. Behind this, as behind every Schreber's belief there is actually fascinatingly coherent and detailed explanation written in his Memoires. After realizing that he could save the world by his "unmanning", he started to see it as a duty. He thought that his transformation into a woman is beyond his choice, since it would save the world. He found a meaning in his suffering: Nothing less than the salvation of the universe. In the meantime, he took to various devices in order to speed up the process of unmanning, such as "picturing" himself as a female in his "mind's eye" and wearing female adornments.
By 1899, Schreber's third doctor- dr. Weber reported that his condition had significantly improved. It was at this time, incidentally, that Schreber Žfirst learned he had been temporarily placed under tutelage as early as 1895, and so "approached the authorities demanding a decision as to whether the temporary tutelage was to be made permanent or whether it could be rescinded". In 1900, Schreber began to write his memoirs while beginning the process of achieving his legal independence. In 1902, Schreber succeeded in having his tutelage rescinded in the Court of Appeal, and, subsequently, in March of 1903, he left the asylum to be with his wife until her death. So, according to the memoirs, goes the story of one Daniel Paul Schreber's "nervous illness."


Freud's interpretation of Schreber's Memoires as a case study of paranoia


Before being introduced to Schreber's Memoires, Freud had already been familiar with cases of paranoia. He decided to use Schreber's autobiography as a case to be analyzed in order to explain mechanisms of paranoia to the psychiatric community.
Before introducing Freud's study of Schreber's case, it would be good to point out his views on paranoia before being introduced to Schreber's Memoires. In his correspondence with Flies in 1895, eight years before publication of memoires, he defined paranoia as pathological mode of defense. When patients have some physical disposition which they cannot accept or tolerate, one of the ways they defend themselves is by becoming paranoic. Also, in some writing we can find that not long before reading Schreber's autobiography, Freud had come to a conclusion that paranoia and revulsion against homosexuality as personal disposition are linked. Main mechanism through which paranoia functions is projection.
Schreber's Memoires served Freud to develop a thorough theory of mechanisms of paranoia. He believed that Schreber had latent homosexual desires which through the mechanism of projection led him to paranoia. In essay about Schreber's case Freud explains this mechanism as a process through which "an internal perception is suppressed, and, instead, its content, after undergoing a certain kind of distortion, enters consciousness in the form of an external perception". Freud argues that in Schreber's case (as in every other case of paranoia linked to homosexuality) there are some homosexual desires which Schreber himself feels revulsion against. Projection process in which suppressing of internal perception distorts into an external perception is illustrated like this:
"I (a man), love him (a man)."
"I do not love him, I hate him. "
" He hates me"
"I do not love him, I hate him, because he persecutes me."
First statement represents the feeling, or psychical disposition which subject cannot accept and feels the need to suppress it. He suppresses it by reversing the verb "to love" into the verb "to hate". After that, subject reverses subject and object and in that way we get the statement "He hates me." Next, he projects this proposition into external world, or, better said – into consciousness, since, as Freud explains, this process is subconscious. The entire process transforms subject's unacceptable internal desires into their opposite and locates them outside of the subject. In that way we get the statement " I do not love him, I hate him, because he persecutes me (hates me) ."
In Schreber's example, Freud believes that he transformed his latent homosexual desires towards Fleshing into believe that Fleshing is persecuting him. It is important to say, that Schreber's process of paranoia and his homosexuality didn't become with him having feelings to Fleshing. As mentioned before, Schreber had thought about "how it must be nice to be women submitting to the act of copulation". Schreber had homosexual dispositions before, but Fleshing was maybe first man that evokes some subconscious homosexual feelings in him.
Freud finds Schreber's latent homosexuality as the root of his illness and he goes on to provide further evidence in favor of his argument. For example, he notices that Schreber's illness at Flechsig's asylum took a turn for the worse when his wife went on vacation, thereby leaving him unprotected "against the attractive power of the men about him" Why then does Schreber go on to create an elaborate theological explanation for his suffering in which God becomes the primary persecutor, as well as his salvation? Freud argues that "it was impossible for Schreber to become reconciled to playing the part of a female wanton towards his physician," and thus the role of Fleshing became replaced by God, who "called up no such resistance on the part of his ego" Through his idea of God as the recipient of his soul-voluptuousness, Schreber is able to turn what might otherwise be viewed as a disgrace into a "great cosmic chain of events . . . instrumental in the re-creation of humanity after its extinction" Further, by his idea of creating a "new race of men," Schreber was also able to live out his fantasy of bearing children, which he was incapable of doing with his wife. Therefore, says Freud, Schreber's "ego found compensation in his megalomania, while his feminine wish-fantasy gained its ascendancy and became acceptable". Finally, "the struggle and the illness could cease".
Freud also took this interpretation a step further by suggesting that, behind the Žfigures of God and Fleshing, Schreber held repressed homosexual feelings toward other persons whom he had loved; namely, his father and brother, respectively. Freud supports this contention in various ways. For example, he argues that Schreber's vision of the sun, which he identifies with God, is a symbol for the father, and so reveals a "father complex." That is, "his father's most dreaded threat, castration, actually provided material for his wish-fantasy (at Žfirst resisted but later accepted) of being transformed into a woman". In his theory of paranoia, Freud portrays the paranoid schizophrenic as "Žfixated" at the stage of narcissism, between the stages of auto-eroticism and object-love, in the development of the libido. The paranoid schizophrenic, according to Freud, experiences a regression to this stage of narcissism wherein the person withdraws his or her "libidinal cathexis" from the world. In fact, Freud argues that the formation of delusions, the symptom of paranoid schizophrenia by which we recognize its pathology, is "in reality an attempt at recovery, a process of reconstruction". In the case of Schreber, Freud recognizes the withdrawal of "libidinal cathexis" in Schreber's experience of the end of the world, which he interprets as "the projection of his inner catastrophe; for his subjective world has come to an end since he had withdrawn his love from it". It follows that Schreber's attempt to save the world is truly an attempt to return his love to the world.


Problems with Freud's interpretation

After reading the richly complex and textured memoir of Schreber, one is likely to feel somewhat disappointed by Freud's treatment of the case. In reading Freud's essay, one does not get the feel of a continuous, cohesive whole, such as with his case study of "Rat Man" or "Wolf Man," for example. Freud leaves many loose ends untied, although he admits his treatment of Schreber's memoirs is indeed limited in scope. Freud scratches the surface of the memoirs just enough to provide support for his theory of paranoia and leaves it behind. It seems like Freud didn't take in considerations Schreber's memoires as a whole, but he abstracted certain parts of it which he found adequate for confirming his, already made, theory of paranoia.
Freud presented his psychoanalysis as, with no doubt, scientific theory. He even regarded himself as the last in the line of heroic scientific figures who changed our very concept of human nature. As he wrote in his Introductory lessons to psychoanalysis:
"Of course, the progress of science will by its very nature correct popular misunderstandings of how the world works, and occasionally reveal surprising, even unpleasant, truths about ourselves. Sigmund Freud famously situated himself in line with Copernicus, who taught us that Earth is not at the center of the universe, and Darwin, who taught us that humans are creatures of nature just like any other. For Freud, the third blow against 'human megalomania' was his discovery (as he claimed it was) that conscious experience, thought, and action was determined by unconscious, primitive drives:
Human megalomania will have suffered its third and most wounding blow from the psychological research of the present time which seeks to prove to the ego that it is not even master in its own house, but must content itself with scanty information of what is going on unconsciously in the mind..."
In other words, Freud didn't just believe that psychoanalysis is a scientific theory, but he also lined himself with Copernicus and Darwin and considered psychoanalysis to be one of three most important steps in history of science and ways how we perceive human nature.
If we want to examine should psychoanalyses really be considered as a scientific theory in ways which, for example, psychics and mathematic are, we should start by examining its methods. If we look at Freud's analyses of Schreber's Memoires, we can see how Freud took one example of mental illness and scratched only its surface on order to derive arguments in favor of his theory. We cannot deny that at first reading, and maybe even second, Freud's explanation of Schreber's state seems very coherent and logical, and I will dare to say intuitive, too. One of the problems that we can find here is that there could be at least a dozen interpretations of Schreber's case made and all of them could be equally coheren, intuitive and logical. Also, Freud's interpretation of Schreber's case could be applied to many different cases, in other words, by using psychoanalytical methods we could easily interpret some behavior as paranoia. From what we can see in Freud's analysis of Schreber's Memoires, Freud derived from it only what he found useful for supporting his theory, but is this the way how one scientific theory should be confirmed and verified?
Scientific theories should not be supported and approved by finding many examples which support them, but completely opposite. History of science has proven that there can be thousands of examples that are confirming one theory, but a single counterexample would be enough to disclaim the whole theory. What Freud did with Schreber case was using it as an example that works in favor of his theory of paranoia and this is the usual method of psychoanalysis. Not only that there could be many psychological interpretations of Schreber's case that would lead us to completely different conclusions and by criteria of coherence and ituitivity be as relevant as Freud's interpretation, but also Freud's interpretation doesn't provide any scientific evidence. It is just an interpretation.
What psychoanalytical theory lacks in order to be rational and scientific is falsifiability. As famous philosopher of science, Karl Popper argued, one scientific theory is good if it is falsifiable. What does that mean? If a theory is falsifiable it means that there are many different ways to (empirically) test it. By these criteria, psychoanalysis is completely non-falsifiable. Freud used Schreber's case to prove and confirm his theory of paranoia, and by Poppers criteria it would be waste of time, because no matter how many examples Freud would collect in favor of his theory only one counterexample would disclaim his theory. The way in which Freud should have present and construct his theory in order to be scientific would be to make it falsifiable, which he didn't do. There are no ways to put his theory of paranoia on a test in order to verify it. Popper also claimed that each scientific theory is consisted of many hypotheses and that if only one hypothesis is wrong the whole theory could be proven wrong, and the way to test scientific theory is to test its hypothesis. We can agree that Freud's theory consists of hypothesis, but, again, all hypotheses that are constructing Freud's theory of paranoia are not falsifiable, therefore the entire theory is not falsifiable. Freud uses the same psychoanalytic method not only in Schreber's case, but also in most of his case studies. The entire theory of psychoanalysis is based on similar methods - particular cases which are analyzed and presented as examples of some kind of nervous illness or psychological mechanism. Everything that constructs psychoanalytical theory is based on thousands of examples which are proving the theory, but not having any examples of putting theory on any kind of falsification tests. This is the reason why Popper would call psychoanalysis pseudo-science.
Even if Freud's study of Schreber's Memoires really seem coherent, logical and intuitive, by scientific criteria it is only on the level of interpretation and as non-falsifiable, doesn't have any scientific value. Therefore, we can say that, by the same criteria that ontological topics are sorted into the field of metaphysics, psychoanalysis could be sorted into the field of metapsychology.



REFERENCES

Chabot B, (1982), Freud On Schreber: Psychoanalytic Theory and the Critical Act, University of Massachusetts Press , Massachusetts, 35.
Freud, S. (1961-1963), Introductory lessons of psychoanalysis In J. Strachey (Ed.) , The standard edition of the complete psychological works of Sigmund Freud (Vol. 16-17) London, Hogarth Press, (Original work published in 1915-1917)

Freud, S. (1909b, 1911, 1918/1963). Three case histories. New York: Collier.

Freud, S (1958), Psychoanalytic Notes on an Autobiographical Account of a Case of Paranoia, The Hogarth Press, London, (Original work published in 1911)
Niederland, W. G. (1963). Further data and memorabilia pertaining to the Schreber case. International Journal of Psychoanalysis

Popper, K. ( 1935) The logic of scientific discovery, Rutledge classics, New York
Schreber, D. P. (1955). Memoirs of my nervous illness. (Trans. I. Macalpine & R. A. Hunter). New York, NY: New York Review of Books
Quinodoz, J.-M. (2005). Reading Freud: A chronological exploration of Freud's writings. Hove [England}: Routledge