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This book brings new life to a topic seemingly put to death by “the decade of the brain.” It focuses on primitively fixated and regressed patients who are mad, but not crazy, not schizophrenic, due to failure of development of early structure. This refers to the psychotic core that lies at the dawn of the psyche when the continuity of raw, primordial experience is fractured by overwhelming and uncontainable tension states of displeasure.
Volkan's introductory chapter sets the stage by positing the book's thesis: that the basis of madness is a disturbance in the undifferentiated mother-infant matrix. He describes five fates of this infantile psychotic self. An interesting midrange category is described as a healthier self encapsulating the infantile psychotic one just enough to allow its voice to be heard in cracks experienced as focalized bizarre traits.
Kehtonen's remarkable chapter deals with the primordial psyche, Freud's body ego, “the psychic projection of the body surface.” It is represented by simultaneous fusion of self with object and the affect of pleasure, and with sense impressions of the body surface and of internal somatic processes. This is the coenesthetic psyche-and-soma experience of oral instinctual gratification.
The dream screen and the Isakower phenomenon in adults infer these noncognitive, perceptual-affective experiences of pure feeling awareness. The boundaries of the body ego, argues Kehtonen, are based more on this psychic satisfaction than on actual physical boundaries. With traumatic overstimulation from hunger, etc., the continuity of the body ego is disrupted. This results in a loss of libidinal dominance, and a defensive union of pleasure with death, in a wish for sleep, rather than with drive objects. Sleep (death) is now the only release from tension.
An important distinction is made between vital and categorical affects (following Stern), in which the former relates to the solidification of the body ego and the complex experience of al