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The appearance now of the fourth in the sequence of Otto Kernberg's closely argued and incrementally reasoned books on the phenomena of the borderline personality organization and of pathological narcissism—their diagnosis, their prognosis, and their effective therapeutic management—warrants an appraisal of Kernberg's overall impact on the psychoanalytic world as theoretician and clinician in addition to the specific opportunity it provides to assess the place of this newest volume in the intellectual unfolding of his conceptions of the nature of our psychoanalytic understanding of these sicker patients. This is so because it seems quite clear by now that there is probably no psychoanalytic author more widely read or quoted in the world today both within specifically psychoanalytic circles and in the far wider arena of the psychoanalytically influenced world of mental health professionals;1 nor is any psychoanalytic author more squarely placed in relation to our ubiquitous clinical concerns with these new paradigmatic patients of our time—the borderline and the narcissistic—who so crowd our consulting rooms while simultaneously so bedeviling our therapeutic efforts.
Yet despite Kernberg's secure eminence in these regards, such an appraisal is neither simple nor uncontroversial. To set its overall