Consenting and Assenting to Psychoanalytic Work.

The moment is opportune for a renewed look at what we understand about patient consent to treatment. Until recently, little reference to informed consent could be found in the literature, as though it has never been a preoccupation for psychoanalytic practitioners. Yet several post-Freudian authors offer reasons to suppose the risk of misunderstandings about consent.

An example of dehumanization as a shield against our helpless openness to the other.

Cultural rituals requiring covering or otherwise distancing the dead may include as unconscious motivation the protection of the departed from dangerous impulses triggered in the living by their helpless forms. A parallel is drawn between the unconscious excitation associated with exposure to the prostrate human forms of a dead body and of an infant. Both send powerful, disquieting "enigmatic messages.

Meditation on lovesickness, loss, and temporality.

The film 2046 is used as a screen and a springboard from which to reflect on the compulsive plight of some lovesick individuals. A particular oedipal constellation that generates lovesickness is hypothesized, wherein an unmourned third object preoccupies yet frustrates the primary object. This thwarted longing for another on the part of the original parent figure inflicts a defect in the self-esteem of the subject, who is then compelled to seek out an object that will re-create, while promising to repair, the wound.

Further reflections on the impact of clinical writing on patients.

Though it is unlikely that instituting universal guidelines will ever be possible for patient approval of the analyst's use of clinical material outside of the treatment setting, the author offers some supplementary reflections to those already available in the literature. Broadly applied informed consent guidelines would increase the distortion that already exists in our clinical literature due to self-imposed restraints by writers. Moreover, the powerful irrational forces mobilized by consent in the dyad are not easily 'held' by traditional applicable legal categories.

Confidentiality with respect to third parties: a psychoanalytic view.

It is assumed that confidentiality is not one singular ethical entity but a conglomerate of quite different issues depending upon clinical context and the sector of information sharing at stake. The focus here is on how to think psychoanalytically about requests for information from third parties (payers, courts, public security). Defining confidentiality as a promise to 'never tell anything' outside of the relationship omits evaluation of the impact of the third's listening on the combined freedom of thought and freedom of speech in analyst and analysand.