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Toward the end of his life, after more than fifty years of psychoanalytic practice, André Green turned his attention to what he termed his “least fortunate experiences” (p. xxvii): that is, patients he had attempted to treat or whose treatments he had consulted on and who did not fare well. Like Freud (1937) in “Analysis Terminable and Interminable,” Green was looking back across a lifetime of clinical experience, and while he was mindful of the many patients he had helped and had come to understand, he asked himself what if anything he could in retrospect learn from considering his least successful cases.
But where Freud proposed that innate, constitutional factors—“resistances from the Id”—determined the limits of what was therapeutically possible, Green hypothesized that what might look like constitutional factors because they develop so early, and are so long-lasting and resistant to change, are more probably a set of disturbances resulting from very early, preverbal traumata.1 For Green, this last term included not only the initial event—e.g., a needed object who is hurtful or seriously neglectful, or who fails to soothe or relieve the infant's distress; the sudden loss of emotional availability of a once loving mother as in the Dead Mother Syndrome (Green 1980)—but also the unfortunate ways in which that trauma and its consequences were reacted to by the external environment, especially the ongoing failures of the external world to mitigate and relieve those consequences. In Green's view, this combination of factors produces ego deformations that disrupt the creation of a psychic framing structure, an internal space in which emerging experience can be psychically represented. In the absence of that structure, the trajectory of subsequent psychic