Learning Disabilities and Psychic Conflict A Psychoanalytic Casebook.: Arden Abel Rothstein, PhD and Jules Glenn, MD. Madison, CT:  International Universities Press. 1999. Pp.  504.

Rothstein and Glenn have set about the formidable task of considering how specific neurophysiological deficits disable a patient's capacities to comprehend, learn and communicate, and may contribute to disruptions of affect, impulse life, fantasy, moral development and conflict formation. Utilising case material, they encourage the enrichment of the analytic process by detailed exploration of the interrelationships between such dys-functioning, and defence organisation, character structure, and conflict. This volume could easily comprise the basis for a course in a psychoanalytic curriculum. It begins with a general discussion of clinical, theoretical and technical issues in patients with learning disabilities, followed by an extensive review of the literature over the past eighty years. Six child and three adult psychoanalytic case studies each have an appended commentary by the authors.

Although 5 to 10 per cent of the population may suffer from learning disabilities, the authors point out that the analytic literature contains little clinical material which explores their meanings in the context of conflict, compromise formation and personality development. Analysts are alerted (p. 3) ‘to prevent these kinds of oversights in the future’, and to consider their patients' learning disabilities as they emerge in analysis and in writing about their work. The body of the text is organised around appended discussions of the nine psychoanalyses reported, with the intent that a methodology be developed (p. 7) ‘for verifying psychoanalytic