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This is an informative and thought-provoking book. Subtitled “A post-Kleinian approach to the treatment of primitive mental states,” it offers an integrated presentation of the key concepts and theoretical formulations of Wilfred Bion, Frances Tustin, Donald Winnicott, Esther Bick, Donald Meltzer, and other post-Kleinian British psychoanalysts of the Independent School. These formulations—“the container and the contained” (Bion), the formation of a “second skin” and “adhesive identification” (Bick), “autistic encapsulation” and “autistic shapes” (Tustin), “fear of breakdown” and “primitive agony” (Winnicott)—have to do with the earliest stages of mental development and the dynamics of the mother-infant dyad. Much of this work, particularly that of Frances Tustin, with whom Dr. Mitrani has had extensive communication, derives from the study and treatment of autistic and psychotic children. Dr. Mitrani contributes new conceptualizations of her own, e.g., “adhesive pseudo-object relations” and “unmentalized experience,” in the process of demonstrating the application and utility of these ideas to the treatment of “ordinary” adults who reveal a hidden, shut-away part of themselves stemming from some very early embryonic, fetal, or infantile experience of unbearable suffering or traumatic separation. In defense against such suffering they have evolved “extra-ordinary protections”—somatic, autistic, and psychotic—for purposes of psychic survival:
In the face of unbearable happenings occurring before birth and beyond, certain experiences are never had by the infant, and mental and emotional growth is subsequently truncated. However, such happenings do remain alive-if-encapsulated. Maintained in a kind of stasis, these are often reactivated by ordinary and extra-ordinary life events and, in the course of the psychoanalytic process, the opportunity arises for them to actually be experienced in the transference. Subsequently, development may once more be set in train. (p. 157)