title: Kleinian guilt, determinism, and free will: implications for clinical theory and treatment.
abstract: The purpose of this discussion of teleological and deterministic concepts in clinical theory and treatment was not to offer definitive answers to a timeless philosophical problem. Indeed, a solution to the problem of free will in a deterministic science eludes even the greatest thinkers (cf. Howard and Conway, 1987). Following Feyerabend (1984), the purpose was instead to question one of the "general and lasting boundary conditions" (p.3)-causal explanations-introduced by Enlightenment-era philosophers of science to "protect" (p.3) science. I have attempted to demonstrate the logical inconsistencies of Klein's theory of etiology of infantile guild using both a teleological perspective that questions the assumption of causal explanations imposed on a scientific inquiry of human experience, and a deterministic perspective that affirms this assumption. When taken to their logical conclusions, both perspectives reduce to mutually irreconcilable theoretical and clinical absurdities. As as clinician I myself have chosen to work within a deterministic framework. I have found that perceiving the patient deterministically allows me to empathize with even the most unspeakable intrapsychic experiences. I share with my patient the antecedent conditions that efficiently cause our common experiences. It is this empathy for our share human condition-in al its transcendence, frailty, and profanity-communicated through interpretation that seems to give birth to the healing process (Goodman, 1991). This discussion doubtless also contains inconsistencies. Nevertheless, it contributes to the ongoing discourse of clinical theory and treatment because it draws attention to the enormous, yet still largely implicit, debt that clinical theory and treatment owe to philosophy. It is a great irony that the discipline that has historically put scientific inquiry in shackles also has the power to set it free. Whether teleology is the philosophical perspective to set clinical theory and treatment free, however, seems unlikely. In choosing to discuss Klein's theory of infantile guilt, I have taken seriously R.J. Rychlak and Rychlak's (1990) implicit support (cf. p.48) for a teleology that functions throughout the life span, et find it difficult to imagine both the unconscious and conscious minds with freely premising capacities-as if human being were actually two persons in one. One the other hand, reducing human beings to the status of Hobbesian machines-as the deterministic perspective seems to imply-presents a similarly unattractive alternative. To understand the nature of human suffering and the process of healing it, however, one thing is certain: A philosophical discourse of clinical theory and treatment must continue.
authors.affiliation: Department of Psychiatry, Cornell University Medical College, USA.
authors.forename: G
authors.initials: G
authors.lastname: Goodman
mesh_terms: D015984:Causality; D005610:Freedom; D006167:Guilt; D006801:Humans; D007223:Infant; D009769:Object Attachment; D011572:Psychoanalysis; D011574:Psychoanalytic Theory