Commentary

Analysts asked to give a plenary presentation to the American Psychoanalytic Association usually try to pick a topic they consider important to the field. Robert Michels addresses the case report, and it is hard to imagine how anything could be more important. He focuses on the very essence of the way we try to communicate with one another and with the rest of the world about what we do.

Michels makes two main points. First he describes the many problems associated with the case report since Freud, somewhat uncomfortably, began using it. That there are problems is evidenced by the relative scarcity of comprehensive case reports in our literature. Their place is taken almost always by brief clinical vignettes. Constraints of time and space, of course, account for some of this, but Michels delineates several other factors that compound the difficulty of preparing case reports: (1) the question of what a good case report should contain; (2) the difference between oral and written reports; (3) the issue of objectivity versus subjectivity; (4) the question of how data should be obtained; (5) the question of at what point case reports should be written; and (6) issues of confidentiality and patient consent.

But Michels's main point is that case reports are always written for specific purposes. Some of these the author is aware of; some he is not. Willy-nilly, the author's intentions influence both the form and the content of the report, often in very revealing ways. Michels urges us, if we wish to derive the fullest understanding of each report we encounter, to pay attention to the author's aims, both conscious and unconscious.

Content factors. The issue of just what a good case report should contain seems to be fairly straightforward. “The case history,” says Michels, “is to be a narrative of what happened, illustrated with vignettes rather than verbatim paragraphs, that pays attention to minute details and includes verbatim dialogue. It must account for the patient's sympt