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In this monograph, Dr Dorpat presents a shift in focus for 'denial'. Ordinarily seen to be related only to severely pathological or traumatic conditions, denial, rather than repression, is presented as the basic building block of mental defence.
Dorpat bases his conceptions on a synthesis of theoretical assumptions derived from diverse sources, including ego psychology, Bion's formulations about early ego development, studies in cognition, and ideas from the study of brain physiology and pathology. But his failure adequately to acknowledge the speculative nature of the formulations, instead stating his hypotheses with certainty, creates major problems for the psychoanalytic reader. Dorpat sets a tone that is accompanied by a pre-emptive style of presentation of the evidence, and it does not allow for the reflective and critical mode such speculative work demands.
Another major difficulty in assessing the book relates to the quality and use of illustrative clinical material. The section utilizing extended material from an analysis comes from the published report by another analyst. It is used in part to set up the technique of 'classical analysis' as a 'straw man'. To demonstrate his own technical approach, which derives in part from his approach to denial, he relies on once weekly psychotherapy with a patient seen serially over thirteen years. The other clinical material consists of very brief vignettes to highlight the object-relations pathology and early traumata sustained by the patients. But they do not give enough information to allow the role of other conflicts in their pathology to be assessed. In their discussion, there is a tendency to leap to formulations that seem more theoretically than clinically derived. Although this is a theoretical, rather than a clinical work, the questions posed by the clinical evidence are important. Methodological issues involved in the derivation of theoretical formulations need to be spelled out by the author. As pre