Treatment of Primitive Mental States

By Peter L. Giovacchini, M.D. New York and London: Jason Aronson, 1979. Pp. 536.

'Originality does not consist in saying what no one has ever said before', wrote James Stephen 'but in saying exactly what you think yourself'. Which is exactly what Giovacchini does. This book could have easily, and more accurately perhaps, been titled My Thoughts, as it is less remarkable as a resource on primitive mental states than it is distinctive as an expression of one psychoanalyst's vigorous and candid effort to establish his way of perceiving and treating disturbed patients. More readers are likely to value the work as a source for debate than to use it as a definitive statement of the psychoanalytic way of treating disturbed people. It is a vast work and I cannot do it justice in a review; but, I shall indicate its range, point out some of the author's more controversial positions, and allow myself the occasional challenge, as the book's instinct is to call us to a place of debate.

Giovacchini begins his work with a lengthy mosaic of the theory of early mental life. He argues that the earliest stage of development is 'prementational'. In this 'preobject stage' the infant is unable to develop distinct perceptions of his external objects, or to objectify internal states of mind into mental representations, although the neonate has a form of homeostatic sensibility, a kind of physiological awareness of changes in his internal state or in the environment. As the infant differentiates the internal from the external there is a subsequent phase, that of 'a dawning awareness of a nurturing object', but the object is not understood to be separate from the self. Giovacchini believes that the transitional object is phasic, between the preobject stage and the era of object relating. The infant's incorporation of the mother's nurturing function—an aspect of the symbiotic fusion of mother and child—allows the infant existence in a state of being which to an observer might appear t