The Therapeutic Action of Writing About Patients: Commentary on Papers by Lewis Aron and by Stuart A. Pizer

Going public with information developed in privacy is always an act brimming with complexity. The therapeutic and legal communities have both embraced the belief that individuals will be most forthright in disclosing information about themselves, and thereby enhancing their opportunity for benefit, if there is a guarantee that the information will not be used to harm the one who divulges it. This has been codified into laws protecting confidentiality and granting the help seeker the privilege of determining whether to permit a wider audience access to what is recognized as his or her own private property. Our ethical standards not only embody the legal but also implicitly elaborate the rationale that the act of going public with any information is so fraught with danger of harm that a provider who wishes to do so should first treat that wish with great suspicion. It is this assumption that I wish to highlight and question, as it is laced throughout the papers by Dr. Aron and Dr. Pizer. I wish to ask, in the simplest way, is the act of writing about a patient better thought of as helpful rather than harmful? Further, how might a psychoanalytic perspective illuminate this issue?

Aron's reminder that we as analysts must take into account unconscious motivations and meanings is an essential starting point. In a scholarly overview of the literature about the ethics of writing, Aron provides us with a clear summary of our concerns with this issue dating from our origins as a discipline. He highlights the fact that, from Freud's time onward, the rationale for publication has been that