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Difference and Disavowal is an ambitious and provocative attempt to renew and revise psychoanalytic theory. This is a valuable contribution to the psychoanalytic treatment of individuals within the broad spectrum of patients who appear analyzable but who render traditional interpretation and the experience with the analyst (holding) ineffective. Bass does an excellent job of defining his field of investigation: the clinical dilemma faced by analysts confronted with global resistance to interpretation by patients with fetishistic difficulties. Using Freud's (1927) metapsychology of fetishism as a base, Bass shifts the conceptual and clinical focus from emphasis on psychoanalysis' central tenet of repression to the “fetishistic structures” that rely on disavowal. This shift occurs as a result of his change in understanding the development of reality and the roles of primary and secondary narcissism. Bass bases his inferences on a targeted but intensive literature review, as well as data collected from his clinical work. At the heart of the book, and repeatedly throughout each chapter, Bass promotes the formulation that patients exhibiting concrete mental processes defend against the potentiality of interpretation because of the anxiety elicited by its differentiating effect.
The first chapter, entitled “Concreteness and Fetishism,” is a new version of a previously published 1997 paper: “The Problem of Concreteness.” In this chapter, Bass introduces the group of patients who appear eligible for analysis but whose treatment does not progress with interpretation. Bass reviews evidence from the literature and finds that this dilemma occurs with analysts from all schools of thought who use standard technique. Early speculations about these patients conjectured that they concretized through blending fantasy and reality. The patient's active dismissal of the difference between internal and external objects allows him/her to live out his/her fantasy with little impact by reali