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This is the second of two works dealing with contemporary ego psychology and its relation to the technique of psychoanalysis and psycho-analytically-oriented psychotherapy. The first (Ego Psychology: Theory and Practice, published in 1974 and reviewed in this Journal, 57, 1976, 362–3) was rightly well received, for it traced clearly the development of classical ego psychology, and usefully summarized the major contributions of Heinz Hartmann (and his colleagues), René Spitz, Margaret Mahler and Edith Jacobson, as well as the relevant ideas of Phyllis Greenacre, Heinz Kohut and Otto Kernberg. In addition it presented an ego psychological approach to the treatment of neurotic and 'borderline' (including narcissistic) conditions.
With the earlier volume as background, the authors now extend ego psychology into a developmental theory, leaning heavily on the ideas of Margaret Mahler. They propose that the concept of ego should be thought of as synonymous with organizing process, and that pathology be seen as the outcome of malformation in the developing ego organization taken as a whole. They point to defects in classical drive theory and are aware of the importance of object relationships in ego development. They go on to suggest that affects must be distinguished conceptually from the drives, leading inter alia to a clearer understanding of narcissism as a normal line of development.
Obviously strongly influenced by Anna Freud's concept of developmental lines, the Blancks understand illness as occurring 'wherever the organizing process has begun to veer in a deviant direction' and propose a diagnostic schema based upon deviance in one or other of a large number of dimensions of ego development, aspects of the total broad developmental movement of the child from autism to separation-individuation. The developmental facets described include the pathways from living in the body to living in the mind, from undifferentiated self-object to differentiated self with gende