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Preliminary comments

This is a meta-clinical essay, inasmuch as its investigation
is directed to the boundary  between  conventional  clinical
practice,  and  those  other confused endeavors (philosophy,
religion) which purport to address the individual's "quality
of  life",  (read:  happiness,  blessedness,  kierkegaardian
ewige Seligkeit)

The meta-clinical nature of the essay is implicit in the in-
troductory  "case  presentation,"  which  is a parody of the
convention that presents a set of  "facts"  to  a  group  of
physicians  for  discussion,  to  train  the  students while
demonstrating the virtuosity of their teachers; oblivious to
the insight "dass alles Faktische schon Theorie ist."

Notably this case history has been stripped of all data that
would lend themselves to clinical instruction: what  remains
is the chronology of the patient's ordeal.  The implicit re-
interpretation of the "case history"  as  chronicle  of  the
fate  of a human being is the underlying achievement of this
essay. Such re-interpretation is unconventional,  unfamiliar
to  the  potential  readership of clinicians and potentially
objectionable to them.  Such re-interpretation is,  unfortu-
nately, also outside of the editors' intuitive capacities.

Obviously,  the editor missed the point, when he rewrote the
essay to suggest that the "case history", as if culled  from
the  medical  records  by some chief resident, had then been
presented to Dr. Meyer for his discussion, when in fact that
case history was a unique, quasi-artistic creation, present-
ed by Dr. Meyer to the audience and to the readership  in  a
(possibly  futile)  attempt to arouse them from their incul-
cated indifference to the patient's fate.  The "case presen-
tation"  is _not_ a product of the medical community, but in
in fact integral to Dr. Meyer's unique  description  of  the
physician's and the patient's dilemma.

As  you can surmise, I am just beginning to read your essay,
and will probably have more comments later. My intial  reac-
tion  is:  a)  that  I would try to get the essay published,
making whatever concessions are necessary, but  being  very,
very stingy and circumspect with additional effort and time.
b) I would try to identify the responsible editor, and  dis-
cuss  literary  issues,  such as the authorship of the "case
presentation" with the editor directly. Such a confrontation
would  surely  be  valuable  for you as pure experience, and
might be educational for the editor. Keep in mind that  this
is  a bargaining situation.  Not only you, but also the edi-
tor has something to gain if the  essay  is  published,  and
something  to loose, if it is not.  c) Satisfy your literary
affections by publishing the essay in its original form,  or
in the form _you_ consider optimal, on your own web page (or
mine).

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Copyright 2005, Ernst Jochen Meyer
