You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Dear Sir:
Steiner describes a modified, traditional psychoanalytic theory of the etiology of neurosis, but acknowledges ‘it is not much use to us when we are actually in a session trying to understand what is going on’ (1997, p. 1082). My thesis is that if traditional psychoanalytic theory of etiology is not clinically useful, and, further, if its validity is increasingly open to question, we need to consider whether to maintain and defend this theory, which subjects psychoanalysis to widespread, destructive criticism, such as Stone’s (1997) recent article.
Steiner’s version of traditional psychoanalytic theory, which seems to apply to males but is not extended to females, is that ‘the wound to self-esteem that arises in the Oedipus situation … the castration threat … from a malignant powerful father’ (p. 1078) gives rise to resentment and the desire for revenge. These feelings block reintegration of the splitting created by projective identification, resulting in a narcissistic personality organization. Although reintegration of projected parts of the self may well produce therapeutic benefit, it cannot be argued, as Arlow (1995) has, that whatever makes a patient well (reintegration of split-off parts) must have been what had made him ill (irreversibly split-off parts of the self). To test Steiner’s etiological theory that the most irreversibly bound projections in childhood lead to the greatest adult psychopathology probably requires something like a prospective longitudinal study from childhood to adulthood of twins, which is essentially impossible.
In relation to another disorder, hypertension, although some patients benefit therapeutically from a low salt diet, it cannot be argued from that fact that a high salt intake had caused the hypertension. Further, it is quite clear in medicine and surgery that many disorders are treated effectively even though the etiology of the disorder, as, e.g., with hypertension, is unknown. So, too, psychoanalytic treatment may be