Editorial

Once upon a time, analysts simply wrote about their patients. Freud did. Analysts were writing to analysts. In that era, learned journals in many different fields were read by learned specialists, who subscribed to the journal. Numbers were small. It was not expected that the unlearned would read the journals, and it seems they usually didn’t.

In more recent years, this situation has changed in two fundamental ways. Firstly, journals (and other specialist writings) have become wholly accessible to readers who are not specialists. In our field, analysts may write for analysts, but their publications have become completely available to patients and to other interested parties. Secondly, the top-down model between analyst and patient has changed in our field, as it has in all others, so that patients feel entitled to be respected as equal partners in the enterprise of psychoanalysis – and analysts agree that that is ethically correct.

A third development is that in the medical world, the consent of patients to the details of the treatment is now recognised as ethically essential. Psychiatric treatment therefore follows this model. There has always been a relationship between psychiatry and psychoanalysis, sometimes closer, sometimes more distant, often confused and confusing. Freud famously advised against analysts necessarily being medically qualified, and the two most influential analysts of the next generation – Anna Freud and Melanie Klein – were not. Yet the American Psychoanalytic Association continued to insist that candidates must be medically qualified for decades to come. More specifically, the medical model focuses on “informed consent” and is designed to manage issues from participation in trials to agreement to surgical procedures or medication regimens to the use of body parts, etc. “Informed consent” here means being provided with details of possible outcomes for patients (quantified benefits, side effects, complications, likelihood of failure, etc.) in an