My proposal that clinical material be submitted as read "as pertaining to" a
terminated case was intended to establish a useful frame, rather than be
taken literally. There is, after all, a long tradition of writing about one's
own inner explorations as if describing a patient.

Is it true that self-investigations presented under the guise of a patient is
now infrequent? I would imagine this is done less now not only because of the
maturation of the discipline (more patients, more cases, more available
literature), but also because of our increasing recognition of the pervasive
role that unconscious processes play in all aspects of mental life. It is a
wretched state of affairs to discover the ubiquity of our hidden psychic
world and to realize how easily others can read a text that for oneself
requires such effortful decoding (and is often impossible without help).

Others who have "access" to this text are invited: our analysts, supervisors,
colleagues. Others are incidental - readers, even patients who may, of
course, not be very care-ful and may jump to conclusions or themselves engage
in a defensive maneuver involving projection, rationalization, or whatever.
David Tuckett in a series devoted to the presentation of clinical data in the
J. of the International about two years ago suggested that one essential
component of a clinical dialog was the need for all to listen from within an
analytic frame that is thoughtful,  provisional, experimental and respectful.
This is harder to assure with an experience distant medium like print, but
might be an asset in this setting because of the ease and immediacy of
feedback. The risks are, however, still daunting.

The opportunity to read threads relating to clinical vignettes is quite
exciting. However, I do wonder what the purpose of such discussions might be
(as compared, e.g., with consultation, supervision, peer review, etc.). Those
"first line" resources should, I think, precede this one so that one can read
postings with the sense that a great deal of previous mulling and
reconsideration has taken place utilizing the clinical supports that are
time-honored for their effectiveness. That is where our reactions belong,
while print is more a venue for our subsequent thoughts.

I feel some loss about reaching this conclusion, and am certainly open to
discussion and rebuttal. I enjoy and value "freshness" in case presentations,
but now wonder if this may be too  voyeuristic a venue for material that is
"too" fresh. Of course, each of us has to make some determination as to
whether the material has "decomposed" enough to meet our own needs and
standards.


Bob Berley
Seattle