In this article I endeavour to explore and clarify how the simple starting point of the biological given, the instinct for self-preservation, in part explains man's response to life, death and powerlessness, and how sensitization to primal psychic agony has shaped the development of man's psyche and civilization. General practice exposes the clinician to major events of life from birth to death. Training now addresses the social and psychological aspects of the patient's `management'. The broad mixture of disciplines and experiences struggled with in primary care has shaped and informed this article. In addition, the hypotheses and arguments are derived from my researches into Holocaust trauma in which annihilation threat, powerlessness, loss and the self-preservative instinct are central.
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