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This book covers a wide range of psychopathology which reviews current trends in narcissistic disorders with fuller reference to views of Kernberg and Kohut with which the author contrasts his own viewpoint.
Masterson's interest in narcissistic personality disorders stems from his work on borderline states which he considers outnumbers the cases called narcissistic personality disorders. Masterson defines the borderline as a personality having a deficient emotional investment in the 'self' with a corresponding lack of confidence. Whether one agrees with this definition or not, Masterson illustrates what he means. He defines the narcissistic personality disorder as grandiose, excessively self-involved, with a lack of interest or empathy with others. Underneath this 'façade' is an empty child full of rage and envy. In other words he sees the narcissistic character as a defence.
Masterson makes further differential diagnoses with psychotic and neurotic states which he considers important in assessment of cases for therapy.
The author claims that his theories are based on reconstructions in adult analysis, child analysis and child observation including knowledge of families so that a coherent understanding with historical links give fuller evidence to support his views. He criticizes analysts who interpret such cases exclusively at the oedipal level. He links nurture and nature derived from observations and analyses of mothers of borderline states, and delves into theories of early object relationships. Masterson cites mothers who are depressed, empty, ill or absent as contributing to the aetiology. He stresses as crucial the mother's libidinal availability to ensure successful separation-individuation needs: the child responds to unavailability by withdrawal and introjects 'a withdrawing maternal part object'. He refers to mothers who reward regressive behaviour because of their own problems or prematurely promote individuation because of the mothers' failure t