Nature will not decide for us: psychoanalysis without foundations

No, science is no illusion. But it would be an illusion to suppose that we could get anywhere else what it cannot give us. (Freud, 1927/1928, ch. 10)

The Foundations of Psychoanalysis: A Philosophical Critique (Grünbaum, 1984) is the foundational text of the sub-subfield we might call “psychoanalysis and science”. Beer’s (2018) review of the topic, for instance, focuses on the use of the concept of repression as something that can be empirically verified. This orientation is illustrated by the title of Part II of the book: “The Cornerstone of the Psychoanalytic Edifice: Is the Freudian Theory of Repression Well Founded?” In other words, the aim of the analysis is to submit psychoanalysis to some kind of scientific evaluation. In this case – a point Grünbaum stresses – an evaluation not only of its efficacy but of its foundations. At a time when the legitimacy of psychoanalysis has (once again) been put up for public debate (Costa, 2023), the subject has regained its importance.

I would like to focus on the book’s introduction (which is the part I read!). It is devoted to comparing Freud’s texts with those of philosophers who put forward epistemological proposals oriented by psychoanalysis (Habermas and Ricoeur). Although it looks like a “strictly philosophical” section, it has a lot to contribute to an understanding of contemporary psychoanalysis. In particular, it lines up with Eidelsztein’s (2017) project of a “critical study of the foundations of Lacanian psychoanalysis”.¹ In short, it seems to me that Grünbaum’s criticisms can be aimed at the practitioners of Millerian psychoanalysis (Forbes & Riolfi, 2014; Santos, Santiago & Martello, 2012). Four decades on, the problems Grünbaum pointed out remain – if they have not got worse.

The first three sections that follow (“Progress, perpetuation and diplomacy”, “Reality and rationality” and “Description and prescription”) situate the question, describing some aims and tools. The fourth, “Romanticism and Enlightenment”, follows the romantic strand in Millerian psychoanalysis, in agreement with Grünbaum. The fifth, “Foundation and closure”, in disagreement with him and inspired by Popperian anti-foundationalism, argues for setting the question of foundations aside. A fuller treatment of the bifurcation of nature, of a few other concepts (historicism, pseudoscience) and of the prevalence of anti-Popper sentiment in psychoanalysis is left for later texts.

1. Progress, perpetuation and diplomacy

[...] I have entrusted it to the term diplomacy. Values, if they are not to disappear, have to be diplomatically negotiated. A practical relationism that seeks, in a protocol of relationship-building and benchmarking, to avoid the ravages of relativism – that absolutism of a single point of view. (Latour, 2013, p. 481)

Part of the difficulty psychoanalysts have in responding to critiques like Pasternak and Orsi’s (2023) comes from an implicit agreement with their framing: that we must always start from Freud. This is also true of Grünbaum who, for all the excellence of his reading, accepts the premise that the way to talk about psychoanalysis (and especially about its foundations) is to talk about Freud’s work.

Given how nebulous psychoanalysis is as a discipline, it is understandable that he settles on this method. The psychoanalytic field is notoriously confusing: myriad approaches, interpretations, aims, metaphysics, organizations, and so on. Given this confusion, if someone wants to make a legitimate and relevant critique of psychoanalysis, it is natural to focus on the one point on which psychoanalysts actually converge: their reference to Freud. Put another way, the only point of commensurability across all the psychoanalytic matrices seems to be their deference to Freud. In science, this commensurability tends to come from some kind of evidence or criterion of objectivity. In psychoanalysis there is no such thing; what we have is Freud. But the need to count something as true or false remains.

The process resembles what we see in religious hermeneutics, in which ambiguous passages of foundational texts are reinterpreted to serve various ends. In this sense, this discursive mode does allow for some kind of progress, even if that progress is slowed down by the many procedural requirements it is subject to. That is: even if the aim is always to find again what Freud said, this “what Freud said” is always in dispute. But it is a slow dispute, because the system itself privileges perpetuation, not transformation. Which, let’s face it, is also a description very close to how science works (Kuhn, 1962).

Grünbaum has no interest in transforming the psychoanalytic mode of veridiction. His interest lies in building an interface with science that scientists can tolerate. Like Latour, who was doing an anthropology of the Moderns, he has no interest in transforming the mode of veridiction as such. The anthropologist is not there to criticize the people he is observing. If he does have a proposal to transform something (by including extraclinical evidence), it does not necessarily depend on transforming [PER]. Making psychoanalysis a science, in this sense, would not depend on psychoanalysts. The consideration of evidence can be included in psychoanalytic discourse, but that is not essential. What is essential is that this evidence be available so that scientific discourse can operate its own mode of veridiction, in which evidence plays a central role.⁶ The result is that [PER] becomes commensurable with [SCI].

For me, on the other hand, as a practitioner of psychoanalysis, it seems important to consider transforming [PER]. As I have already pointed out, it strikes me as uncomfortably close to religious hermeneutics (which corresponds to the mode of existence [REL]). On the one hand, this means it is also close to science. But the central difference between [REL] and [SCI] is their relation to progress. Is the point to go forwards or backwards? To accelerate, intensify, scale – or to return? What is Good, change or stability?⁷

The Church [...] Here again we find a hiatus, an agonizing one during which a priest, a bishop, a reformer, a devout practitioner, a hermit, wonders whether the innovation he believes necessary is a faithful inspiration or an impious betrayal. No institution has invested more energy (through preaching, councils, tribunals, polemics, sainthood, even crimes) than in this obstinate effort to detect the difference (never easy to formulate) between fidelity to the past – how to preserve the “treasure of faith” – and the imperious necessity of constantly innovating in order to succeed, that is, to endure and spread throughout the world. (Latour, 2013, p. 43)

The paradigmatic example of progress in [PER] is Lacan. He had something new to say, but he knew that the right way to say it was to argue that he had nothing new to say, that he only rediscovering principles that were already there. On top of that, he intensifies the devotional discourse, so that his innovation can be absorbed without being noticed.

Naturally, today we have Lacanians (Eidelsztein, 2017) arguing for a similar return to Lacan. And so we go on returning.

I am glad to be able, in this way, to introduce you to the Lacanian movement, even though we do not believe that such a movement exists. We believe, rather, that there is a psychoanalytic movement which began to drift towards the cause of ego psychology, and which Lacan restored to its true practice and its true ends. (Miller, 2012, p. 15)

So I think it is important to call into question the very way this discursivity works – an utterly inconvenient task, since its explicit interest is in keeping things frozen. Which means we will have to be creative. One tool for this may be what Latour (2013) calls diplomacy.

In our specific case, it is important that this research be done with the practitioners, and not with their foundational texts. I am not an anthropologist, so what I can do to find out “what psychoanalysts really want” is documentary research. One interesting source of such data, it seems to me, is edited collections of texts by minor authors, associations and graduate programmes (such as Forbes and Riolfi, 2014, and Santos, Santiago and Martello, 2012). Another interesting source is non-academic documents – for example, an advertisement I received today:

Offering your “not-knowing” is synonymous with: LISTEN!!! Do not run the subject over with your knowledge and your many years of experience! The analytic experience will always be unique... Singular... That is one of the most beautiful things about human beings and about life! -- Source.

It seems to me that what matters is not the reality of the Freudian concepts but the rationality that organizes psychoanalysis in such a way that this mode of veridiction is taken as legitimate. The questionable behaviour of psychoanalysts does not originate in the falsity of the facts they believe in, but in the very workings of their institution – in the way that truth or falsity gets determined. So part of my methodological proposal is to avoid pages and pages of references to the Complete Works and the Seminars. We will see whether it is possible to do philosophy of psychoanalysis without hagiography or defamation.

Of course, you may already be reading this text as defamatory. On the one hand, we can simply write that off as an occupational hazard; after all, “the critique of the hagiographic mythology is perceived as defamation, and the critique of the defamatory mythology is perceived as hagiography” (Simanke & Caropreso, 2015, p. 12). But I think the point can be argued. Whether something counts as defamation depends on its aims: whether it is only interested in gratuitous denunciation (as Pasternak and Orsi, 2023, are) or whether there is some constructive intent.

The problem is that practitioners of psychoanalysis act as if they were at constant risk. If the aim is to return, every attempt to move forward is also, inevitably, a threat. Every change is a step away from the original authenticity of psychoanalysis. “Constructive intentions” are incommensurable, because the idea of constructing involves adding something, and the aim is precisely the removal of everything that is not the foundations. Extraterritorial, psychoanalysis is forever being persecuted: the plague always under threat of being sanitized by the System.¹¹ In this warlike context, you are either for or against. Every criticism of psychoanalysis is automatically classified as gratuitous, or ill-informed, or irrelevant.¹²

I am not here to destroy psychoanalysis, but I am not here to protect it either. I just want to see where we can go from here. My aim is the progress of the discipline. And that means it must run the risk of being transformed.

Progress, in its classical sense, seeks the purity of the Enlightenment. Perpetuation, in its eternal return, has a similar goal: to conserve an original purity. To avoid transformation, to avoid contamination. Both therefore have Modern ambitions (Latour, 1993).

The kind of progress I am advocating here values precisely the categories that perpetuation neglects: hybridity, mutation, contamination, transformation and so on. The idea is to think a psychoanalysis that does not run on the mode of perpetuation and is open to the future. My hope is to manage some kind of diplomacy, by showing that these ideas are better aligned with the aims of psychotherapy (concerned, fundamentally, with what changes) than the values assumed by the mode of perpetuation (concerned, fundamentally, with the return to an original authenticity).

To encounter the Moderns in order to ask them: “But finally, what do you really care about?” – is it not to prepare ourselves better for the diplomacy to come? (Latour, 2013, p. 479)

2. Reality and rationality

Rationality requires no foundation, only critical dialogue: this spells the end of foundationalist philosophy. (Gattei, 2008, p. 3)

Hacking (1983) splits the philosophy of science into two parts: the question of reality and the question of rationality. The author of “entity realism” is, naturally, concerned with the question of reality.

Grünbaum is also interested in the question of reality – the existence of certain concepts. He does not, in fact, react well to Ricoeur’s idea of restricting his philosophy of psychoanalysis to the linguistic content that occurs in treatment. That would leave out both non-verbal content and extraclinical content. For Grünbaum (who does no more than take Freud seriously), it is not simply a matter of knowing whether the therapeutic practice of psychoanalysis is useful or effective. He wants to know whether psychoanalysis as a whole – including its social and political implications – is well founded.

He even denounces a special kind of hermeneutician who dismisses the need to consider the question of causality. To know whether an element of the theory really exists, we look at its role as the cause of another observable event. Without considering causes, the very notion of existence becomes superfluous.

Other hermeneuticians have sought to immunize their undertaking against the risks of causal imputations by reconceptualizing, more radically than Ricoeur or Gauld and Shotter, the very aims of the psychoanalytic elucidation of “meaning.” This stratagem has likewise had much appeal to a good many analysts. [...] Be of stout heart, they are told, and take the radical hermeneutic turn. Freud, they learn, brought the incubus of validation on himself by his scientistic pretensions. Abjure his program of causal explanation, the more drastic hermeneuticians beckon them, and you will no longer be saddled with the harassing demand to justify Freud’s causal hypotheses. One such hermeneutic advocate illustrated this repudiation of causation as follows: “the meaning of a dream does not reside in some prior latent dream [content, as Freud had claimed], but in the manifest dream and the analysand’s associations to it” (Steele 1979: 400). (Grünbaum, 1984, p. 57)

I am not a hermeneutician, but that is my case. It is in my interest to make the notion of existence superfluous. This trivializing solution, which Grünbaum scorns, seems to me the most adequate one. I do not find the discussion about the existence of things particularly relevant. I am more interested in the question of rationality – not the what, but the how.

We are off to a bad start if we ask what something is. (Pombo, 2021, p. 1)

When it is suggested that the “meaning of a dream” resides not in a psychic content but in the analysand’s present associations, the suggestion is to refuse the (Freudian) deciphering stance, whose aim would be to discover the place where that meaning resides. A similar example appears in Eidelsztein (2017), where he addresses the Freudian theory of the drives, which would be like little balls stored in a bag. For him, in Freud there really is an object kept inside the psychic apparatus; for Lacan, on the other hand, things are determined by their effects, their functions, their relations. This perspective, cybernetic in its leanings, is aligned with the pragmatism I am proposing here. It is precisely this passage from metapsychology to linguistics that allows the question of reality to be dropped. The Lacanian linguistic vocabulary lends itself to asking other questions.

The role of the dream in the clinic is to be useful. Whether or not that role results from a “causal relation between repressed contents and their manifestation in dreams under condensation and displacement” is, from a strictly practical perspective, simply of no concern. Which does not mean it will be a problem if someone finds that relation some day. But I allow myself the speculation that clinicians who care about dreams today will not change their behaviour, whatever the result of that investigation. Since there is no way for the clinician to manipulate this causality, worrying about it lies outside practitioners’ concerns.

The value of the dream, like the value of any signifier, is that of prompting associations in a way that makes changes in life possible – for that is the aim of the clinic. The metaphysical question of whether the dream “really has” a content or “merely represents” one, like the question of whether we have access to the dream or only to a report of it, seems to me irrelevant.

As a clinician, I am simply not interested in the justification of Freud’s causal hypotheses. But then, obviously, I do not see myself as a Freudian. And certainly not in the way someone like Miller (2012) does: he founds a Freudian school (which is Lacanian), calls the ultimate Truth the Freudian truth, advocates the return to the Freudian cause, and so on. To repeat the quotation:

I am glad to be able, in this way, to introduce you to the Lacanian movement, even though we do not believe that such a movement exists. We believe, rather, that there is a psychoanalytic movement which began to drift towards the cause of ego psychology, and which Lacan restored to its true practice and its true ends. (Miller, 2012, p. 15)

When I spoke of devotional discourse, this is what I meant. It is for this kind of person that the confirmation or disconfirmation of Freud’s causal hypotheses ought to pose an existential risk. Talk to psychoanalysts and you will notice that no such risk arises. The risk psychoanalysis runs is constant, but it is abstract. The truth of the Freudian certainties is not in question. They are not what is at risk – the risk is that these truths will be suppressed, not that they will be refuted. That, precisely, is the problem.

The Brazilian School of Psychoanalysis – School of the Freudian Field (EBP – ECF), founded on 30 April 1995 by the World Association of Psychoanalysis (WAP), in Rio de Janeiro, is part of the movement to reconquer the Freudian Field launched by Jacques Lacan on 21 June 1964, when he founded his School. The EBP takes psychoanalysis as its objective and, as its aim, the restoration of its truth and the transmission of its knowledge, offering it up to scientific scrutiny and debate. It provides training and guarantees the relation of the psychoanalysts who are its members to that training, opening it to debate. (from the EBP website, emphasis mine)

3. Description and prescription

knowledge has no final legitimacy outside of serving the goals envisioned by the practical subject (Lyotard, 1984, p. 36)

My suggestion that we set aside the questions of foundation and reality may sound like the everyday line: “of course there is evidence, I see it work in my practice every day”. But, unlike the proposals of Habermas, Ricoeur, Miller and others, I do not take psychoanalysis to be a new method for reaching a new truth. “Truth”, in this context, just means “it serves my purposes”. The interesting discussion is about what those purposes are.¹³

The question of rationality is usually understood as the discovery or creation of a “scientific method” or a “scientific logic”. That strikes me as an outdated framing. (The search for a logic proper to science is one of the few contexts in which it seems legitimate to me to say that Popper was a positivist.) Even so, through his anti-foundationalism, he helps us think about rationality in a more interesting way.

The concern with existence can be described as: “if it works, it must work because something caused that effect”, which invites us to find out what that object is. Discovering causes is what makes a science well founded. Since psychoanalysis deals with the objects Freud invented to serve as causes for the phenomena he observed, psychoanalysis will be well founded when it manages to prove the existence of those objects. It would then be what Habermas and Ricoeur want it to be: the innovative discovery of an object and a method – much like the invention of the microscope or the telescope, as suggested by Strachey and Eissler (Grünbaum, 1984, p. 34).

In this sense, psychoanalysis would be not just a new dialect for talking about old things but genuinely a new science: a new method, a new object, a new logic. First we had logic, then dialectics, and now the laws of the unconscious. First we had Reason, then Spirit, and now the Real. Habermas goes so far as to claim that, more than just a new tradition, it would be the prototype of the human sciences.

Grünbaum sets out to refute this hypothesis that psychoanalysis offers anything more than a conceptual novelty. He holds (along with Freud, and Popper, and Pasternak) that there is only one science. He does so by claiming that all of Habermas’s suggestions on the matter run against what Freud said. So it is not by external criteria that Habermas fails, but only because he does not correspond to reality as psychoanalytic discursivity determines it.

I agree with all these “positivists” who feel no need to discover the newest, truest scientific method.¹⁴ But I disagree with them insofar as they think that Science has such a method. I take a Rortyan position here, one that is content to understand different practices (the sciences, art and so on) as different vocabularies for coping with the world. Of particular interest here, this perspective dispenses with the need to establish the reality of things, given that reality is the result of the process of inquiry (Latour & Woolgar, 1986), and not an inert matter that inquiry tries to represent.

It is not that these questions of existence should not be investigated. Part of the failure of prescriptive approaches in the philosophy of science (that is, Popper) is their inability to control what people investigate; people study what they want. Personally, I do not find it interesting to ask questions about “what things really are”. But, beyond this matter of preference, I think this kind of question leads us to go looking for the secret essences of objects¹⁵ – a risk all the more present in the Millerian atmosphere of romanticism.¹⁶

This is what Pasternak and Orsi (2023), for example, want: for science to ask nature what to do, and for nature to answer. In other words, for nature to decide for us (Popper, 1945). For it to decide not only what things are, but what to do with them. It is, fundamentally, a confusion between descriptive and prescriptive modes of language:

Clearly, this mode of legitimation through the autonomy of the will gives priority to a totally different language game, which Kant called imperative and is known today as prescriptive. The important thing is not, or not only, to legitimate denotative utterances pertaining to the truth, such as “The earth revolves around the sun,” but rather to legitimate prescriptive utterances pertaining to justice, such as “Carthage must be destroyed” or “The minimum wage must be set at x dollars.” In this context, the only role positive knowledge can play is to inform the practical subject about the reality within which the execution of the prescription is to be inscribed. It allows the subject to circumscribe the executable, or what is possible to do. But the executory, what should be done, is not within the purview of positive knowledge. It is one thing for an undertaking to be possible and another for it to be just. Knowledge is no longer the subject, but in the service of the subject: its only legitimacy (though it is formidable) is the fact that it allows morality to become reality. (Lyotard, 1984, p. 36)

Between rationality and reality, the assessment of therapeutic efficacy falls more on the side of rationality. Efficacy is decoupled¹⁷ from its reality: for patient and therapist alike, it does not matter which causal mechanism is in operation. All that matters is that the treatment works.

But what is “working”? What is an “effective” treatment? Despite the essentialist formulation (“what is X?”), this is a problem of rationality. It is not a matter of discovering or representing entities, but of deciding what we consider rational, useful, interesting, effective, successful and so on.

Part of the critique of this idea that the Fact determines what we ought to do was made by Popper (1974) in his critique of logical positivism.¹⁸ Popper insists on it fairly often: we are the ones who decide. This is not only because he was an neoliberal individualist. His aim was to stress that we are not swept along by the universal laws of history or by self-evident truths. In the end, the task of deciding is different from the task of describing.

4. Romanticism and Enlightenment

“All observation is theory-laden” can be considered the cornerstone of Eidelsztein’s (2017) work. But if the point is so trivial, why would it be the foundation of that work? Because, even though Freud argued along these lines, his heirs seem to have gone in another direction. That is: by the very rules of psychoanalytic discourse, something seems to be wrong here.

As guidance on technique, it is a good theory. “The analyst makes room for the analysand to discover which theories they already hold”, or something of the sort. “One must not understand”, in the sense of not imposing a signification of one’s own on what the patient says, and thereby making room for their fantasies. Providing a space for listening, without the patient having to worry about what the analyst wants from them.

The risk is always this epistemological leap: it is not just an opportunity to discover the patient’s idiosyncrasies. Those idiosyncrasies are the Truth. And the true truth (as opposed to the secondary knowledges of science) is obtained by way of not-knowing.

It is only a rhetorical game, but one with large consequences. In these few steps we have already laid the groundwork for a romantic theory of knowledge.²⁰ A theory which, even as it stresses the Power of the Human Being, also ends up making nature decide for us. We are swept along by the revelation of the singular truth. Romanticism is a response to scientism, but it remains Modern.

Shot through with romantic and phenomenological influence, this is no longer just a way of discovering certain ideas you already believe or preferences you have. It is a way of discovering the undomesticable truth, the untameable force of human nature that grants us our dignity. “One must not understand” – letting the thing-in-itself emerge in its spontaneity.²¹

This is the exact opposite of “all observation is theory-laden”. Ironic, considering that, with one small modification, it would be exactly the same thing. All it would take is for the content discovered at the end of it all to be one more theory, one more vocabulary: someone’s final vocabulary (Rorty, 1989).

But that would be a generic theory of psychotherapy – and we know, as a matter of principle, that psychoanalysis is special. It deals with what is deepest. So this must mean that we have finally found the true way – the Freudian method – of reaching nature as it really is. We have discovered the language in which the book of nature was written: silence.²² The method for finding it again will therefore also be silence (not-knowing, not-understanding, nonsense), so as not to deform the authenticity of being with the presence of outside vocabularies. The Freudo-Millerian truth – which is nothing more than the authenticity of common sense – arises in the silence of the clearing of Being.

Even if Miller is suggesting an interesting practice, we can see from his disciples that the romantic language, and its epistemological pretension to surpass science, play a non-trivial part in it:

So is psychoanalysis romantic, then, or is it of the Enlightenment? Is it scientistic or is it magical? No wonder Grünbaum restricts his scope to Freud!

There is a fundamental tension in psychoanalysis between romanticism and Enlightenment (as suggested by Eidelsztein²⁵). But, contrary to what he suggests, Freud was not just a romantic. Nor was he entirely a positivist (Figueiredo & Loureiro, 2018). It is therefore in our interest to study the bifurcation between nature and culture, between the natural and the human sciences, and so on, which shows up under the name of Modernity.

Notice, too, how I have ended up doing exactly what I wanted to avoid – arguing about what Freud really believed. We can see the same thing in the quotations above: how the mode of veridiction in psychoanalysis runs through talking about what other people believe. If Pasternak wants nature to decide for her, Miller wants Freud to have already decided, leaving us only the opportunity to “get used to the real” (Lacan, 1974/2013, p. 77). Nothing is his responsibility: biology is Lacanian (Miller, 2001), truth is Freudian, and so on. To tell the truth, Lacanian psychoanalysis doesn’t even exist!

It is because of all these workings that I put forward the peculiar hypothesis that, in psychoanalytic discourse, the Freudian text is a strict equivalent of reality. And the way to make a well-founded statement, therefore, is to reference Freud properly (in a situation of normal science) or to show that he in fact already believed something (in a situation of extraordinary science). Thus Freud’s discovery perpetuates itself eternally. Indeed, the newest thing in psychoanalysis is Freud.

5. Foundation and closure

“The Moderns are those who have kidnapped Science to solve a problem of closure in public debates.” One doesn’t have to be a genius to imagine situations in which the adventures of knowledge can be put on the wrong track in this way. We discover such situations as soon as we turn back to the agora where, as we have seen, the fate of categories is decided – amid the tumult, the controversies, the endless quibbles, the polemics always at risk of slipping into violence and rampage. Let’s suppose that there arises, here, a way of “saying something to someone,” a life form, a literary genre, that procures the unexpected advantage of giving the impression to anyone who uses these tropes that they put an end to debate, bring closure to controversies, by mobilizing, through various conduits, various ploys (which will never appear as ploys), these transfers of necessities, transfers that have now become indisputable. What appeared so improbable, in the previous chapter, in the amalgam between ways of knowing and the peregrinations of existents now takes on a formidable efficacity: through a subtle bypass operation, a seemingly metaphysical question (of what is the world made?) is linked to a question of argumentation (how can we put an end to the endless squabbling?). (Latour, 2013, p. 129)

The theme also turns up in Beer (2020), on the normative function of truth, as well as in Christian Dunker’s various replies (Costa, 2023) to Pasternak and Orsi (2023). These “positivist” attempts to determine the truth usually aim at avoiding the complexities of politics.²⁷ As if an especially precise, true and well-founded description could, at last, serve as a prescription.

While Pasternak busies herself adjudicating whether the placebo effect “really exists” (which will only be true once it is found in the brain), more serious scientists seem to be heading the other way – perhaps all antidepressants are no more than placebo (Kirsch, 2019). Another example is the controversy documented here, in which we learn that even if psychoanalysis does have evidence of efficacy, that evidence is of terrible quality (Ferreira et al., 2022). What actually happens is that this (terrible) level of evidence quality is shared with other psychotherapies and with medicine alike (Matthias et al., 2020). But nobody is going around saying that medicine has no foundations.²⁸ It seems, then, that the problem is not about discovering the reality of things but, for a change, an aesthetic, political, moral problem – filtered through the way we know how to argue about things, that is, through the mirror of nature (Rorty, 1979).

So the question of how to measure efficacy is not something to be answered by a universal logic of science or by some specific method that would be the scientific one; it is, in the end, a question of what we want from a treatment. Hence the first difficulty in measuring the efficacy of a psychotherapy: psychologists from different approaches do not agree among themselves on what counts as a successful treatment.²⁹ And there is no immediate datum of reality that will settle that controversy for us.

This is a translation of A natureza não decidirá por nós: psicanálise sem fundamentos, first published in Portuguese on Fora Freud on 9 February 2025. Where no English edition is cited, translations of quotations are mine.

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