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A helpful way to think about Franco De Masi's latest book, for this reviewer at least, is as a culmination of many decades of thinking around the origins, meaning and expressive forms of psychosis. De Masi trained as a psychiatrist in Milan and then as a psychoanalyst. He has wide experience of working with hospital inpatients and outpatients and has spent the greater part of his career treating seriously disturbed individuals in a psychoanalytic setting. His abiding interest in the origins and course of psychotic illnesses led him to take an interest in the work of British psychoanalysts such as Segal, Bion, Rosenfeld, Joseph, Meltzer and Brenman. He has, as is widely known, published many papers on the subject of psychosis but he has also written significantly, and always with a characteristic clarity, on mortality, perverse thinking and behaviour, and the nature of the superego, among other subjects.
The conundrum of psychosis has always been his primary interest, and in this book he states succinctly his views on what psychosis is and is not. De Masi takes the reader on a conceptual and clinical journey that includes a fascinating summary of the history of psychoanalytic thinking on psychosis in order to set the stage for his own conclusions on the nature of the condition. As Howard Levine in his foreword to the book puts it:
There are two fundamentally different theoretical discourses in psychoanalysis regarding psychosis, each of which has its roots in the writings of Freud. In the one, psychosis is a malignant variation of early psychic development and the forces that produce neurosis, but its meta-psychological formulation remains continuous with neurosis and with early normative primitive mechanisms … believed to have failed to develop. In the second discourse, psychosis is of a different order than neurosis, structurally and meta-psychologically. (vii)
This latter point constitutes a major part of the value of this volume. De Masi provides a revised understa