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An eminent and practiced psychoanalyst, when asked for his diagnostic appraisal of a patient's personality disorder, recently quipped that he operated with only three diagnoses, crazy, a little crazier and very crazy. Finer precision, he contended, was not psychoanalytically profitable. Historically, psychoanalysis has had a profound sway on the study and classification of personality disorders. But, as Marshall L. Silverstein observes, for the past 30 years psychoanalysis has made a dwindling contribution to the investigation of personality disorders. No doubt this waning influence has much to do with the nervous distance that psychoanalysis has kept from the advances in instrumentation, measurement, epidemiology and neuroscience that have increasingly shaped the study of personality disorders.
In Disorders of the Self: A Personality-Guided Approach, Silverstein, a professor of psychology at Long Island University, attempts to redress the rift between the study of personality and contemporary psychoanalytic thinking by exploring the contribution that self psychology can make to the field of personality disorders. The work itself, informative, clearly written and thoughtful, highlights the difficulties in finding traction in this endeavor. Silverstein is admirably modest in his claims for his study:
I do not suggest that by extending Kohut's (1971) self psychology to personality disorders I have stated a compelling case for its inclusion rather than exclusion as a valid area for further study … I have attempted only to demonstrate both theoretically and clinically how a viewpoint first articulated by Kohut — and developed further by his close colleagues and by subsequent advances in self psychology — might explain personality disorders as they are presently characterized.
Silverstein investigates the value of self psychological concepts for the understanding of personality disorders as they are currently conceived on Axis II of the Diagnostic and Statistical Ma