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Miller, J.P., Jr. Miller, A.H. (1990). Reflections on the Commentaries. Psychoanal. Inq., 10(4):585-591.

(1990). Psychoanalytic Inquiry, 10(4):585-591

Reflections on the Commentaries

Jule P. Miller, Jr., M.D. and Anne H. Miller, M.S.W.

Dr. Fosshage and his patient have a claim to our gratitude for their very valuable clinical material.

Our discussion will focus on two issues. The first is that of agency, of who is primarily responsible for the patient's difficulties; the second, subsidiary to this, concerns who is responsible for “damage” to the patient's objects. These issues were considered by most of our discussants.

The issue of agency was raised most sharply by Curtis as evidenced by the subtitle of his paper, “The Patient as Existential Victim.” Curtis is writing from the position of traditional psychoanalysis. A cornerstone of Freud's theory is the concept of psychic determinism. Addressing students, Freud wrote: “… you nourish a deeply rooted faith in undetermined psychical events and in free will, but … this is quite unscientific and must yield to the demand of a determinism whose rule extends over mental life” (1915-16p. 106) If one takes the concept of psychic determinism seriously, then all patients, insofar as they are troubled, are victims. Whether one assumes, for example, that the patient's pathology stems from excessive inborn aggressive drives, or from inadequate parental responsiveness, or from a mix of these and other factors, the doctrine of psychic determinism dictates that, in each instance, the patient's feelings and behavior are determined.

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