Picking up the Pieces: Two Accounts of a Psychoanalytic Journey by Fayek Nakhla and Grace Jackson. Published by  Yale University Press, 1993;  166 pages; £16.95 hardback.

This is a book about the analyst as deviant. Located at the outer limits of psychoanalysis, it is an account, by both patient and analyst, of a treatment in which a woman in a fragmented and violent delusional state tries to find her true self by cutting and bleeding using broken bottles and razors. Like a tale from the Twilight Zone the book is cloaked in the atmosphere of film noir: a clinical, impersonal office, a lonely analyst who is a stranger to New York, broken bottles in dark alleys, a woman who abandons the falseness of her perfect self in an addiction to cutting and blood. Written in a restrained tone Dr Nakhla's account comes to life only when he delineates the delicate issues of fear and hate in the countertransference. The parallel passages based on Grace Jackson's diary provide interesting echoes of her analyst's erstwhile countertransference hunches. She is ‘hacking away to find the self, talking is of no use and the analyst has to contain and restrain as she acts out her unintegrated state, often in his presence. The doctor is a cliff to which she clings, sometimes literally as he physically holds her, escorts her to the subway, takes her to a plastic surgeon and even visits her home to read her crucial diary. With the body as a transitional object for this self-mutilating patient, a sense of omnipotence emerges, incorporating the possibility of being rather than being done to. Through the separate/fused debris of regression she is able to move to a state of aliveness and the boundedness of a body self. This is the threshold of apperception, acknowledging the healthy private core of the self.