This month's Scientific Meeting at the San Francisco Center for Psychoanalysis endeavored to tackle the thorny issue of how to reread Masud Khan in light of recent biographies that revealed a troubled man who committed several transgressions. The esteemed panel members attempted to decipher if Khan's clinical insights and theory building still hold value despite what we now know about Khan. Implicit in their analyses was the question of how truthful reported case material ought to be in order to ascribe clinical value to it. Can a fiction, whether it's an amalgamation of clinical data and analyst fantasy or a completely fabricated scenario, offer valuable insights into the human condition? What truth claims are necessary to determine its value? 

Amongst participants, there was general agreement that all reported clinical material reflects certain distortions associated with the subjectivity of the author, confidentiality commitments, or editorial constraints. Moreover, the rhetorical practice of using clinical material to substantiate a concept or theory pressures authors to report idealized aspects of the clinical encounter in order to provide a compelling example for their argument. Beyond acknowledging this common ground, two divergent lines of thought emerged from the process of evaluating the utility of clinical insights based on suspect clinical material. 

The first asserts that once distortions exceed a tipping point, the insights, value is diminished. From this perspective, gross fabrications in clinical material are deemed of little value since the insights gleaned do not accurately reflect what transpired within a therapeutic encounter. In other words, insights divorced from clinical reality are problematic as there is no basis to determine their validity. 

The second line of thought centers on a pragmatic approach to evaluate clinical insights based on their utility. In this view, the validity of insights rests on emotional resonance between the insight and one's clinical experience. Truth claims become less salient since the abstracted concept requires modification to be tailored to the specific therapeutic dyad. As such, clinical insights at best can only be used heuristically, which renders the need to determine the veracity of case material unnecessary. 

This rich discussion raised interesting questions about how we think about clinical insights, build theories, and communicate our ideas. Hopefully it inspires us to reflect upon how we, as individuals and as a field, evaluate the value of clinical material. 

Mark McKinley, M.A. 
IMPULSE Staff Writer