Writing and Intimate Privacy

Writing has never felt like a choice. More of a necessity, like breathing. I published my first paper when I was twenty-five. I have continued to write ever since. Writing and publishing often go hand in hand but not necessarily—at least not for me. First and foremost, I write to discover what I think. I have seldom managed to clarify what I really think about all manner of topics without a pen, paper, and an imagined interlocutor. There is always someone in my mind to whom or for whom I am writing, even if I will never publish it. It is a comforting form of being alone in the presence of a listening internal other. As I write the words, I imagine the agreement as well as disagreement with what I am articulating, and this provides the impetus I need to sharpen my thoughts.

I emphasize the distinction between “writing to discover what I think” and “writing to publish” because I experience them as distinct activities, propelled by different states of mind in relation to both internal and external objects. Writing with the intention of being published requires me to own the narcissistic currents that drive the wish to be published. The desire to share our ideas, to further our field, and to be recognized for our efforts are ambitions, in part at least, that reflect self-interest. Even so, they are legitimate ambitions and, I would add, essential to advancing our development as analysts through exposing ourselves to criticism and challenge.

Writing for publication is an intervention. As a writer I hope to impact my reader. In my experience, the decision to publish inevitably also impacts my relationship with the individual patient whose material my writing may be based on. I have found this to be a very thorny, taxing question that requires me to grapple with the ethics of publication. Until a few years ago, I subscribed to the dominant view that very careful anonymization of clinical material sufficed and that seeking consent was not an ethical requirement. My views on t