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Clark's paper attempts to make some sense of patients who present as anti-life and are unwilling to envisage themselves as viable human beings with a capacity for living. The ‘dead’ centre created in them by a sense of being ‘an abortion, intrinsically unwantable’ produces a defensive structure against life, against both becoming and being.
Clark asks whether this fear of annihilation can be dealt with reductively within the transference (in terms of negative self objects) and to what extent a viable self can be therapeutically engaged. He distinguishes the ‘threatening nothingness that cannot be integrated’ from death anxiety or phobia: ‘a nothingness that vaporises the meaning of life’. He investigates carefully and with a sense of compassion, puzzlement and despair those patients whose defensiveness appeared more than as a flight from psychic reality or internal bad objects. He views the patients' manoeuvres as essential to their provisional survival because they bring a temporary evasion of the real feelings of pointlessness. Any mention of wholeness simply brings these patients closer to their inner emptiness.
He talks boldly of the impotence he feels as an analyst when the un-alive cannot receive the breath of life, when holding and not healing is all that can be attempted. The massive depressive anxiety against which the patients are defending themselves seems linked with narcissistic character disorders and connects with catastrophic damage to the self and its unity.