The certainty of personal relationships and the uncertainty of science

Journal

of

PsychosomaticResearch,

1964.

Vol. 8, pp. 273 to 275.

Pergamon

Press Ltd.

Printed

in Northern

Ireland

THE CERTAINTY OF PERSONAL RELATIONSHIPS AND THE UNCERTAINTY OF SCIENCE G.

A. FOULDS

THE CLAIM

that the Science of Psychology can study the person as a whole is illusory. “I can know another person as a person only by entering into personal relation with him. Without this I can know him only by observation and inference; only ob.jectively. The knowledge which I can obtain in this way is valid knowledge; my conclusions from observations can be true or false, they can be verified or falsified by further But it is abstract knowledge, since it constructs its observations or by experiment. object by limitation of attention to what can be known about another person without entering into personal relations with them” (Macmurray, 1961). The social sciences suffer from the handicap that the object study, the organism, answers back. When the organism insists on becoming a person, we leave the realm of Science. Psychologists have long since recognized this; but, in so doing, they have often tended to believe that we also leave behind the possibility of valid knowledge. This is probably a more heinous error than would be the extreme opposite view, that we should only use Science when we cannot do any better. The Science of Psychology may provide us with objective knowledge in the sense of knowledge of the object or organism; but much of the scientific process is subjective. When I make a study of schizophrenic thought disorder, 1 have already made a subjective selection of the stimuli to which 1 will attend. 1 will make a subjective judgment about what individuals I will choose to call schizophrenic and about what I will choose to call thought disorder. I will then devise techniques which I believe will sample the behaviour which I have chosen to call thought disorder. A vast number of abstractions have occurred involving subjective judgment. The fact that my beliefs may be shared by the majority of my colleagues merely offers that much consensual validation at best, and at worst, folie tc n. Whenever we study groups of individuals or abstracted human processes, whenever we are being scientific, we are being in large measure subjective. We endeavour to make our subjectivity manifest, so that others may enter into it. When I was asked to take part in this discussion, 1 hazarded the guess that these might be some of the disquiets that led Dr. Shapiro to embark on the study of the individual patient. I felt that he was uneasy about too many abstractions that took us too far from our basic data and that he wanted to gain therapeutic control over certain phenomena. It should be noted that, even in treating the individual patient intensively, one has to treat him impersonally. One does not, to more than a very limited extent, enter into a personal relationship with him. There is little mutuality. Even the psycho-analyst does not normally reveal himself to the patient. When the patient’s behaviour is no longer predominantly determined by unconscious drives, when he is relatively able to intend his own conduct, when he is, therefore, capable of entering into mutual personal relationships, it is time to terminate treatment. 273

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G. A. FOULDS

With his Personal Questionnaire, Dr. Shapiro to some extent cuts down on the abstractions. This is largely a matter of the generality of the questions. By the conventional questionnaire techniques, one might learn that philosophers tended to be attracted by a particular type of woman (though one philosopher might prefer blondes and another brunettes); whereas physicists tended to have a freefloating sexuality and to be attracted by members of a variety of classes. By his technique, Dr. Shapiro might discover that Descartes preferred cross-eyed redheads (which was in fact the case). This is no doubt still a generalization from some unique cross-eyed redhead who perhaps tucked him up in bed at the age of three. If we suppose that this fancy distressed Descartes, and constituted a symptom, Dr. Shapiro might be able to show that, with treatment or the passage of time, Descartes’s relatively encapsulated sexuality became free-floating. He might further show the relationship between this and certain other symptoms. Some might change and some might not. This would be very interesting. What I am not clear about is whether, for Dr. Shapiro, understanding the relationship between Descartes and cross-eyed redheads is an end in itself; or whether this is a more than usually careful and detailed pilot study for understanding the psychological processes underlying the attraction of Women for Men. Shapiro, Marks and Fox (1963) showed how phobic and depressive symptoms varied somewhat independently and how Rational and Non-Directive treatments had different effects. This is admirable; but in what way was it essentially dependent upon the study being carried out on a single case ? Could the same experiment not have been carried out equally well on 30 cases of Anxiety Phobic States with secondary depressive features? What, within the framework of the individual case method, entitles us to call them phobic symptoms or depressive symptoms? IS it not that, when a large number of cases have been studied, certain symptoms have been found to be associated together ? Clearly, this will only have been possible when symptoms have been generalized, i.e. when similarities have been educed. If we operate at the idiosyncratic level, we may find that X complains of panic attacks in the Tube between Victoria and Sloane Square, Y between Sloane Square and South Kensington, and Z between South Kensington and Gloucester Road, and so on full Inner Circle. It seems that for Shapiro’s purposes claustrophobia would do quite well. For the alleviation of the condition the more specific information might be invaluable; but, as I understand it, Shapiro was concerned to measure changes in symptomatology, and to discover to what general procedures these changes might be attributable. He was not concerned with the individtial dynamics, with how to cure the patient. The therapist was presumably concerned with this; but the details of what went on within his sessions seems to be irrelevant to the research design and were not, indeed, reported. It is even possible that, at least in one respect, the Personal Questionnaire is less useful for assessing what comes out at the end of a session than is the conventional questionnaire. In spite of the findings of the Behaviour Therapists, symptom-substitution does sometimes take place. The Personal Questionnaire seems to be concerned with the assessment of changes in symptoms which were present initially, but does not allow for the emergence of new symptoms. The hysteric’s pain may be in his back at the first session and in his head at the fifth.

The certainty of personal relationships and the uncertainty of science

275

Some other points of comparison between the Personal and the Standard Questionnaire are :1. The Personal Questionnaire does give a weighting to symptoms; but this can equally well be done with a Standard Questionnaire. 2. Standard questions may be misunderstood. Oral administration helps to overcome this difficulty, though not completely. 3. With the Personal Questionnaire it is very difficult to decide where one symptom ends and another begins. 4. With the Personal Questionnaire there is no guarantee that the subject will be willing to discuss his most significant symptoms. He may be quite happy with his voices and not mention them spontaneously, but would do so if asked. 5. A Standard Questionnaire is unlikely to miss anything of significance if the questions be sufficiently generalized. When Shapiro’s four reported cases were scored up on the Runwell Symptom-Sign Inventory, the individual statement of symptoms The diagnoses could fairly easily be accommodated within the more general questions. came out the same, except that his Paranoid subject came out indeterminate on the RSSI as between Paranoia and Psychotic Depression-which, looking at the reported symptoms, does not surprise me at all. Changes with treatment could equally well be taken care of. Careful and detailed work on the individual case is an admirable way of eliciting really significant problems. I like to think that a good Clinical Psychologist is doing this, though possibly less systematically. I have always maintained that those wishing to do research on psychiatric material should learn something about Psychiatry. I have never regarded this view as preternaturally penetrating or daring; but ignorance of Psychiatry remains one of the main hall-marks of British Clinical Psychology. Shapiro’s way of working is to be welcomed, and is a highly desirable corrective to the large scale studies of rather carelessly assembled groups, designed, by investigators with no intimate knowledge of any members of such groups, for the purpose of providing statistically significant, but psychologically insignificant, differences between them on some pettifogging performance. To end on a concordant note, Shapiro and I are both naive enough to ask the patient what is bothering him. We do so rather differently and record the answers rather differently. At the present stage, this is perhaps just as well,

J. SHAPIRO M. B., MARKS Fox B. MACMURRAY

I. M.

and

REFERENCES 1961 Persons in Relation. Faber, London. 1963 Brit. J. Sot. and Clin. Psychol. 2, 8 l-93.