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Vamik Volkan, a faculty member of the Washington Psychoanalytic Institute, has written a clinical study illustrating his treatment of patients who rely heavily on primitive splitting as a defensive function of the ego, rather than on repression. Most of the patients he describes are either psychotic, borderline, or narcissistic personalities. The book is one of the most recent contributions to,
and illustrations of, object-relations theory at work, which, according to Volkan is “of enormous help toward understanding these particular patients.”
In the forward, Otto Kernberg accepts Volkan's acknowledgment of his reliance on Kernberg's own theoretical concepts. He places this current work alongside those of psychoanalytic ego psychologists and object-relations theorists such as Erikson, Jacobson, Mahler, Fairbairn, Winnicott, Bowlby, Klein, Sullivan, and Parsons. In addition to demonstrating a flexible approach to treatment, Volkan makes original contributions to theory with his observations and discussions of emotional flooding, transitional object relations, and affect theory from a clinical viewpoint. Volkan's book is valuable reading since it raises important theoretical issues concerning the etiology of these illnesses and their treatment; it suggests a perspective about the theoretical developments within psychoanalysis; and it assists the modern psychoanalytic reader by further defining what modern psychoanalysis is.
Volkan confirms once again that these patients are treatable. However, whether the illnesses are the result of too little love or too much hate in their development (or some combination of entirely different causative factors) cannot be determined. Also, it seems confirmed that the relationship with the therapist is of importance in the treatment. By means of consistent interpretation of the defensive style of the patient's fragmented ego, the patient is taught gently and acceptingly that his perceptions, judgments, and approach to living are wrong