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The author discusses Rothman's work with patients on the primitive edge in the context of the modern psychoanalytic approach to the treatment of severe narcissistic disorders. The writer also touches on the work of the Paris School of Psychosomatics and of modern analysts who have treated somatic cases. Salient features of the modern psychoanalytic philosophy and theory of treatment for preoedipal conditions as developed by Hyman Spotnitz are presented in some detail.