On Bearing Unbearable States of Mind: Ruth Riesenberg-Malcolm. Edited by Priscilla Roth. London: Routledge (New Library of Psychoanalysis). 1999. Pp. 208.

Dread of psychic pain and fragmentation drives certain patients to adopt extremely rigid and complex defensive strategies designed to help them maintain their precarious integrations. It is their hope that in this way they can forestall any personal change, change seeming to threaten only greater instability and pain. Consequently, the analysts of these patients find it especially difficult to develop and convey interpretations that are therapeutically useful and to manage the sometimes intense countertransferences that are evoked in the process.

In this collection of papers, published for the most part in professional journals during the past thirty years, Ruth Riesenberg-Malcolm manifests her dedication to understanding these patients theoretically and mastering the clinical problems they present. The author's orientation is that of other contemporary Kleinians in London. She steadily emphasises the unconscious fantasies that underlie the patient's experience of the total analytic situation in both its fixed and shifting aspects. The situation is understood to be centred on the patient's relationship to the analyst and the patient's experience of the analyst's relationship to him or her, the latter experience typically being strongly coloured by projective identifications into the analyst and by imagined or provoked enactments. Typically, these reenactments recreate formative or prototypical situations of pain, excitement, triumph, despair and other prominent constituents of the paranoid-schizoid position. In this context, the author makes use of John Steiner's explorations and integrative formulations concerning pathological organisations used as bulwarks against the extremely painful destabilising aspects of movement away from the primitive narcissistic modes of function to the concerned, guilt-stimulating, and reality-attuned object relations characteristic of the depressive position. In Riesenberg-Malcolm's clinical examples, the reader may note some degree of