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USUALLY, knowing the ending of a book or a movie does nothing to diminish my enjoyment—I seem to keep that information in a different compartment as I immerse myself in the experience. But I had a very different experience with Susie Orbach's book. Knowing the punch line first—that all the patients, or should I say “characters,” are made up, and all the rich clinical detail and revealing exploration of her (no, not her) countertransference were fictitious—made this book almost impossible for me to read. I don't generally read fiction. I save it for last, preferring to dip in and out of nonfiction in different disciplines, or reading from the psychoanalytic oeuvre as a particular paper demands.
Toward the end of writing this review, I became acquainted with Diderot's (1784) amazing book, Jacques the Fatalist—a novel far ahead of its times, which questions the very narrative coherence of the novel. He challenges the comfort that narrative coherence and finality give people in the face of the messiness and uncertainty of real lives. I found myself having an “aha” experience as I understood that what continues to fascinate me in clinical work is the very uncertainty that is often omitted in the course of creating a “good case history” with a “successful” outcome. Don't get me wrong, I love neat stories, but I go to television for them. When I was less experienced, I felt awed by the neat case studies I read or heard, until the day I experienced the tidying up tendency first hand. I had done a resident a favor and conducted the intake interview in front of a team in exchange for her promise to write this interview up for our morning staff meeting. The intake interview was one of the more distressing—though not that uncommon—experiences of barely contained chaos, intense emotional tension, barely comprehensible psychotic