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Freud's description of the 'exceptions' is reviewed in the light of accumulated clinical experience with 'narcissistic' patients and from the perspective of the distinction between active and passive libidinal aims. Analysis of narcissistic patients often reaches a point at which they conclude that they 'want too much'. This insatiability is attributed in the discussion to a block to satisfaction of passive libidinal wishes and a consequent overemphasis upon active libidinal wishes. An analogy is drawn to the metabolic block of diabetes mellitus, which produces starvation. This formulation is applied to the 'exceptions' to account for a number of clinical observations. The main anxieties and guilt that lead to the block to satisfaction of passive wishes are considered. The central role of unconscious guilt is emphasized, and some of the problems encountered in the attempt to make the patient aware of it are elaborated. The mechanism by which unconscious guilt over active libidinal and aggressive wishes leads to defences against passive libidinal wishes, owing to failure of signal guilt and inadequacy of ego ideal functioning, is described. Implications for treatment are outlined, and one aspect of the psychoanalytic process is related to the block to passive wishes: the gratifying experience of being understood.