A note on confidentiality
As noted in this text, the identity of some of Freud’s patients and those of other early pioneers was later unmasked. The importance of confidentiality in clinical discussions and publications grew to become an ever more pressing ethical concern. Yet the communication of analytic knowledge requires detailed illustration to come alive.
Since no two cases are ever identical, it would be a gross impoverishment only to speak in generalities. Some clinicians opt routinely to ask patients’ permission before drawing on any of their material; others criticize this tendency, pointing to how it interferes with analysis, and note how even a request after a treatment might be an unwarranted intrusion.
If one option would be to eschew publication, another is to combine features of several patients and use other forms of camouflage sufficient to protect identities. The point usually, in clinical writing, is to focus the reader’s attention on a particular aspect of a case, without pretending to offer an elaborate portrait, in the manner, say, of Freud’s own book-length studies of patients.
We may need to rely more in future upon the writings of ex-patients themselves, such as those eloquent autobiographical reflections described in Chapter 1. As is commonplace nowadays, clinical vignettes used in the present text, drawn from my own or colleagues’ experiences, are heavily disguised.