Response to Plaut: ‘The writing of clinical papers: the analyst as illusionist’

I am delighted that Dr Plaut has joined the discussion on clinical papers with his contribution ‘The writing of clinical papers: the analyst as illusionist’. The issues seem to fall even more clearly into two categories, ethics and technique - the ethics of whether or when, and under what conditions, it is acceptable to write or speak about patients, and, if it is, how to do it most effectively.

Prompted by his first statement, I looked up the word ‘clinic’ in the dictionary and found to my great interest that the definition given there was ‘teaching of medicine or surgery at the hospital bedside’. So Dr Plaut's linking of the word with ‘suffering humanity’ can be put into a more specific context: the dimensions of teaching in and through the patient's presence and present suffering can be seen as highly significant.

Of course, as Dr Plaut noted, the reasons I gave for writing clinical papers omitted the personal ones. At the time I deliberately focused on the ‘official’ reasons as I felt that the activity required justification. But the personal motivations are important. I particularly liked Dr Plaut's idea of a paper arising out of ‘surprise and discovery’, and can certainly recognize that in my own experience. The excitement and emotional energy thus engendered are important elements in fuelling the thinking and writing process through to a conclusion. For myself however I would say that curiosity is the strongest motivating factor. Like Dr Plaut I start with an observation - perhaps I am surprised by a response, or by something falling into place, or not falling into place, or what he calls a ‘turning-point’ - and I want to know how and why: what is it that works in analysis, or not, or, more modestly, what works with a particular patient? I am interested in reading other people's clinical papers for the same reason.

Dr Plaut is right that the ‘sharing and hammering out’ of ideas can take place very profitably in intimate discussion groups with colleagues. But the