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How is one to write about clinical work? This audacious book proposes a novel answer: make it up. Susie Orbach, a gifted writer on feminist, psychoanalytic and social topics, finds that conventional renderings fail to convey the living, emotional truth of the clinical setting. What we need, she thinks, is a new genre, which, according to the jacket copy, is what she offers here. Unlike
other popularisers, who either craft composites of actual patients or fictionalise autobiographical and biographical accounts of treatment, Orbach opts for fiction, pure and simple. Or perhaps not so pure and not so simple. The complications of psychoanalytic writing are stubborn.
Trust Orbach to go to the sore spot, the disciplinary frontier. Her literary strategy brings to the fore certain linked dilemmas of clinical writing that are not always acknowledged. Are clinical accounts fact, or are they fiction? Are they veridical? How does the reader know? Clinical psychoanalysis, in its particularity, unverifiability and uniqueness, can never meet the modern Western guarantor of truth: the scientific method. When one writes about a treatment, one's data are necessarily selective, as Orbach notes: one chooses a vignette, a few words, an action, a dream. Therefore, not only is it impossible to tell the whole story of a treatment; one tells the story as one sees it, and the way one sees it is influenced by one's point of view, which will inevitably comprise personal, theoretical and historical factors. There is always a bias.
To say that psychoanalytic writing is subjective is to understate the complexity of the problem. Clinical essays have always occupied something of a middle ground between science and literature or, if you would, reality and imagination. Praise for Freud's literary style—e.g. likening his cases to the detective story genre—is familiar and legion, even though Freud thought he was doing science. Demands that psychoanalysis assess itself by scientific standards persist (G