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Psychoanalysts working with patients who fall within the “widening scope” of psychoanalysis can find themselves in a conflicted relation with the theoretical models on which they base their work. On the one hand, they rely on such models to bring a sense of order and clarity to clinical material that can be a chaotic mix of verbal association, shifting emotional tones, distorted thinking processes, affect storms, action, and evoked countertransferences. On the other hand, overreliance on theories of development and pathogenesis (particularly insofar as they stray from description of closely observed clinical phenomena) can serve to draw the analyst away from the chaos and irrationality that are part of the texture of that clinical material, reducing his or her appreciation of the uniqueness of the individual whose inner life the clinical material represents.
This book by Léon Wurmser falls on a point along the continuum defined by this dialectic closer to clinical observation than to abstract theory, and his observations and descriptions are focused, richly evocative, and of great clinical usefulness to the reader. Even so, Wurmser has an elaborated theory of psychic development and pathogenesis, and this theory challenges in fundamental ways the Kernbergian theory, which for many analysts of this reviewer's generation is central to the understanding of severe psychopathology.
Wurmser, instead of placing a theory of pathogenesis and psychic structure at the center of his thinking and then using clinical observation to exemplify the theory, places clinical observation at the center,