Writing about patients: what clinical and literary writers share.

Anyone who seeks publication wants readers, but self-expression, self-assertion, and self-promotion have consequences, especially for those who draw on clinical material and who must honor publication standards of integrity and reliability, as well as ethical codes governing confidentiality, consent, disguise, and collaboration. This paper employs tools of literary analysis, principles of moral philosophy, and psychoanalytic theories about writing to show that writers of fiction and autobiography also struggle with these dilemmas. They worry about their responsibilities to the sources of their stories, and wonder if changing names and dates will prevent friends and family, whose lives get used as material, from feeling embarrassed, betrayed, or exploited. Because they understand that the composing process blurs boundaries between fiction and nonfiction, fantasy and memory, self and other, they recognize that an author's relationship with his or her subject (matter) can disable the capacity to recognize when self-interest has taken over a concern for the welfare of others. More important, literary authors are free to write about writing, and what they render transparent about primitive, unconscious processes suggests that what clinical writing has in common with fiction and autobiography should be included in efforts to update ethical standards and procedures regarding psychoanalytic publication.