“No Mortal Can Keep a Secret”: Reading Freud’s Cases as Preparation for Candidates’ First Efforts to Write About Their Patients

Clinical writing is sometimes viewed cynically, as a way to ensure progression – through training and beyond – by demonstrating one’s allegiance to received views. For candidates and faculty alike, this belief may defend against awareness of an even more troubling truth: that in writing about one’s patients, one inevitably reveals a great deal about oneself. As Freud’s remark on Dora’s chattering fingertips implies, even writers who aspire to stay within the bounds of received wisdom may betray themselves. In this paper, I present a way of teaching Freud’s first two major cases (“Dora” and “Hans”) as prelude to a clinical case writing sequence at my institute. When teaching Freud, I encourage candidates to read his writing as we might hope for others to read ours: both critically and sympathetically. With perspective provided by knowledge of Freud’s personal history and era, we discuss the implicit personal and political motivations that are now possible to discern between the lines of his texts. When teaching clinical writing courses, I remind candidates of our earlier, shared encounter with Freud; in writing about their patients, they too will reveal more than they can know in advance. I encourage candidates to embrace this feature of case writing, and to regard their peers and instructors as companions in a quest to understand their patients and themselves. Though I recommend including some study of Freud’s cases in candidates’ writing instruction, I also argue the importance of finding one’s own, unique approach to teaching the practice of clinical writing, which is – for every clinician – deeply personal.