What is a Clinical Fact?

The author approaches the problem of defining what a clinical psychoanalytic fact is by proposing that there is such a thing as a 'psychoanalytic apparatus'—a working psychoanalysis—the proper functioning of which is revealed by the presence of certain emotional states. One of these is the presence of a sense of intimacy shared by patient and analyst within the analytic relationship, combined with a simultaneous sense of isolation of the participants. Another is a painful conflict engendered by the beauty of the analytic experience, similar, but not identical to a negative therapeutic reaction. He goes on to suggest that, when this apparatus is working properly (i.e. when psychoanalysis is occurring), both analyst and patient find that they gain a type of conviction about the patient's psychic reality or inner world that can only be obtained in analysis. The patient's psychic reality is therefore the domain of psychoanalytic clinical facts. The author concludes by proposing that, despite appearances to the contrary, this type of definition of a clinical fact can be used in a rigorous scientific manner, and he briefly discusses what is required to do so.