‘Disguise or Consent: Problems and Recommendations Concerning the Publication and Presentation of Clinical Material’: Glen O. Gabbard and the Editorial by David Tuckett

In his Editorial Tuckett expresses the view that the requirements set out in the statement issued by the International Committee of Medical Journal Editors (ICMJE, 1995) for all disclosed clinical records that are published not to be disguised and for the informed consent of the patient to be obtained prior to inclusion in any study are in conflict with the very nature of psychoanalytic work. He points out that within the Journal there is a request that confidentiality should not be breached, but that rules of how not to do it are not defined. Within psychoanalytic organisations the adoption of transparent ethical codes has been slow and there is no consensus. The IPA has deleted from the ethical section of its procedural code that relates to confidentiality the phrase ‘within the contours of applicable legal and professional standards’ (International Psychoanalytical Association, 2000).

In his quest to create a framework for ‘transparently accountable discipline taking account of patients' rights and seeking to encourage peer review publication and establishment of best practice’ (2000a, p. 1066), Tuckett raises a number of highly relevant questions. The ICMJE statement deals with medical accountability and with the public's concerns not to abuse the patient's rights. The issue is how ‘the ethics of informed consent, the ethics of practice, the integrity of the psychoanalytic setting and the “fact” of our need to communicate with each other can be reconciled’ (p. 1065). Tuckett deals with the issues of safeguarding against sub-standard practice and of developing a policy that will take into account social and legal pressures and human rights legislation. The psychoanalytic encounter is based on necessary trust, which depends not only on what the individual professional conveys to his patient but also on the status that the profession has in the local culture. If confidentiality is extended to the belief in secrecy and if psychoanalysis becomes a secret soci