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The authors are psychoanalysts. Drs Gear and Liendo, Associate Professors in the Department of Psychiatry of the University of Toronto, while Dr Hill, who practises in New York, has academic posts both in Toronto and New York, lecturing on psychoanalysis and social and political theory. They feel that difficulties have arisen in the analysis of narcissistic disorders because of the failure to recognise the extent and importance of the issues of power and authority, both in the transference and countertransference, and also in the narcissistic structure in society and their effect on family and social life:
In our view, narcissism is a structural condition and is neither a defence nor a fixation but a bi-polar organisation of the psychic apparatus that always alternates between a sadistic and a masochistic position, each being the necessary complement and mirror of the other. Our theory explains narcissism as a bi-popular structure, with sadism and masochism as the two poles and provides a detailed method of analysing the narcissistic analysand, whether he presents himself as a sadist or a masochist (p. 3).
Kohut's description of the narcissistic personality disorder coincides with what they recognise as the masochistic patient—‘the victim of mental illness’—and that of Kernberg as that of the sadist who is for them an agent, ‘a transmitter of mental illness’:
We realised that we frequently used a theory and technology of victims of mental illness to understand and modify the transmitter of mental illness. When this mismanagement occurred we had the potential to become iatrogenic agents of
Page 206mental illness, including our own, instead of agents of mental health. If we treated patients as if they were agents, we became reinforcing agents. Conversely, if we treated agents as if they were patients, we were assuming the position of the patients (p. 18).
The book seeks to integrate Freud, the structural psychoanalysis of Jacques Lacan, the structural linguistics of Ferdinand d