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This is an important, profound and challenging book with which every practising analyst needs to come to terms. Deeply considered, the book is about our daily clinical work. The starting point is the authors' view that disorders of narcissism are not in fact self-contained structures but disorders between self and other—whether one is considering internal representations or external object-relationships. The nature of a narcissistic disorder is that it involves the patient in controlling or controlled behaviour. Logically a particular representation of 'self' implies a representation of 'other' and a particular form of object-relating for the subject implies, if there is to be any stability in relationships at all, a form of object-relating for the object. (The case where there is no stability in either external or internal relationships is treated as psychosis.) Ultimately narcissistic relationships are either sadistic or masochistic because whether we are talking about internal or external relationships, what narcissism implies is that the subject will either control the other (sadism) or be controlled (masochism). A further study of narcissism becomes, therefore, the study of sado-masochistic relationships—the authors making the point that different descriptions and disagreements about borderline and narcissistic patients in the literature are often the result of one author considering the sadistic type and another the masochistic, types that pose different technical problems.
The next step the authors take is to distinguish not two but four classes of narcissistic disorder, this further distinction being made on the basis of the way sadistic or masochistic individuals relate to power. 'Agents' are the dominant partners provoking a sado-masochistic relationship, 'patients' are the passive ones. There is thus the potential for narcissistic agents and patients and sadistic agents and patients. External and internal relationships are formed between agents a