Reply to Dr Schwaber

Editors' note

We chose to allow the anonymous author to speak for himself in his reply to Dr Schwaber's letter. The author's response also serves to summarize our reasons for allowing an option for anonymous submissions to the Analyst at work format.

Dear Sirs,

At the risk of compounding a felony, I would like to respond anonymously. The ‘accountability’ that for Dr Schwaber is part and parcel of ‘scientific merit’ would

be required only if the author was claiming to be proving something and, more technically, only if there was an implication that the reported findings might be replicable. These claims demand that the observer be available for interrogation by those interested in conducting similar experiments, but of course nothing of the sort is involved in the kind of clinical description invited by the Analyst at work series.

So the question is how we can best promote full, honest description. As Dr Schwaber notes, there are many opinions on both the narrative and the ethical dimensions of this issue, and any brief statement inevitably comes across as ex cathedra. I do not understand, however, why Dr Schwaber thinks that publishing the material anonymously would compromise an analyst's ability to acknowledge authorship to the patient ‘should it come to her or his attention’.

I must add that I cannot see at all how choosing the option to present anonymously limits the possibility for ‘candid’ exchange. Indeed, the challenging responses of the discussants to my case seem to refute that argument outright. In fact, I would suggest that presenting anonymously brings an intriguing side benefit: the case can be read and responded to without the prejudices, so common in our field, that are based upon personality, geography and theoretical loyalty.

Psychoanalysis will never resolve the tension between protecting our patients' confidentiality and sharing experience publicly; Freud noticed it from the very beginning and it continues to be a vexing problem today. Creative solu