Dear Eric,

In a message dated 97-05-31 12:44:45 EDT, you write:

<< David--I think you emphasize what is shared by most psychoanalytic
schools. In
my view, all schools including Freudian emphasize environmental factors in
pathogenesis but differ on postulated mechanisms by which such factors cause
pathology.  Although Freud acknowledged the importance of genetic factors,
Freudians rarely refer to these in clinical discussion.>>

If one maintains the view that most psychological suffering and conflict is
"caused" primarily by the environment, then I'm afraid that we have little to
offer our patients, since there's little we can do to change what "happened."
 And to add that a part of the matter must be "genetic" (which I cannot
dispute) is not satisfying to me, since it undermines the idiosyncratic
meanings of people "choosing" their modes of dealing with their conflicts and
experiences (i.e. their "pathology").  I realize I may be in the minority
here, but I view people as "choosing" their pathology (consciously and
unconsciously--at least on the subjective level of psychological reality),
since this maximizes my ability, and that of my patients, to understand and
grasp what is going on inside of them.  In brief, this is my vision of what
constitutes the psychoanalytic approach.

<<You raise an important point when you say that the environment does not
account for differences in unconscious phantasies between people living in
the same environment.  First, it is important to note that no 2 people can
possibly live in the same environment. Identical twins raised together elicit
different responses from their parents. >>

Yes, you add an important point here.  But again, what we are left with in
the consulting room is not the capacity to find out "what really happened,"
but rather to work with the patient to understand what meaning the "events"
had for them, and perhaps also to come to an approximation of what the
patient felt had transpired.

<< However, the main point I tried to make is that whatever differences
between
individuals there are in unconscious phantasies must be explained ultimately
in
terms of genetic and environmental factors.  Each individual experiences a
common environment differently, and the way a person experiences his or her
environment is called "psychic reality." But psychic reality must itself be
explained in terms of earlier environmental factors interacting with genetic
endowment.>>

Again, on theoretical grounds, it is difficult to dispute your points here,
and I do not disagree.  But do reduce human choice and the phenomenology of
experience to "an interaction between the environmental and genetic poles" is
to talk like we know more about human suffering and survival than is actually
the case.  I guess I'm speaking right now from that part of my mind that is
often skeptical about abstract theory and metapsychology as capable of
helping us understand why people suffer and why they make the choices that
they do.  For example, why did the Holocaust occur?  Because of an
interaction between the environmental and genetic poles of the people
involved?  This hardly does justice to the human dilemma...and is a part of
the reason why I'm personally more comfortable discussing things in the
"clinical" versus "theoretical" sphere.

Thanks for your comments.

David Mittelman
(Michigan)