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Drs. frank and suchet articulate effectively many of the quandaries inherent in a constitutional perspective on psychic functioning. They are constructive in pointing out aspects to which I may not have given satisfying-enough attention. The issues they raise certainly enriched my understanding, and I found myself in agreement with a number of their criticisms and caveats. (For instance, I may indeed at times—for rhetorical purposes—have inadvertently expressed myself too strongly.) That said, my reply will concentrate on areas where I felt I was misinterpreted or where I simply disagree.
Dr. Frank helpfully offers “biopsychosocial” as an overarching term for my attempt to encompass constitutional (anatomical, neurophysiological, or biophysiological), psychological, and social factors. I can see why he prefers this term, and objects to my usage of the term “organismic” to refer to constitutional as opposed to the full range of factors. Now that Frank calls attention to it, I recognize that organismic does have echoes of Kurt Goldstein's (1990) thinking about the integrated, holistic system whose parts are dissected and isolated only at our peril. For me, the term had stronger connotations of the somatic/constitutional aspects of one's selfhood, those that link us to other “organisms” in nature. But it is important to factor in others' associations with our own in selecting terminology.
Frank is certainly on target when he says that “… for the most part, individual biology contributes crucially to our experience of dynamic selfhood rather than to otherness.” This is true simply by definition, as