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Green once observed that the clinical realities that led Freud to recognize the existence of the areas of the mind that lay beyond the pleasure principle1—i.e., unconscious guilt, pathological narcissism, masochism, and various forms of negative therapeutic reaction—and that necessitated introduction of the structural theory2 brought about a
… dispersion, or even fragmentation of psychoanalytic thought into many opposing theories (ego psychology, Kleinism, Lacanism, Bionian, Winnicottian and Kohutian, etc.) … all [of which could] be interpreted as attempts to propose a solution to the limitations of the results of classical treatment.3
Contemporary analysts continue to be confronted by these limitations as the expanding frontiers of our field have brought us into contact with increasing numbers of “widening-scope” patients, whose pathologies lie at or even beyond the borders of our theoretical formulations and therapeutic reach. The challenges they present are so fundamental and critical that the current crisis of psychoanalysis,4 and perhaps even the ultimate survival of our field, may well turn upon the extent to which our clinical understanding can be extended to encompass a treatment of these patients that is both truly effective and consistently psychoanalytic.
With so much at stake, it is gratifying to be able to report that, in Primitive Agony and Symbolization, René Roussillon addresses these problems in a way that is lucid, persuasively argued, and grounded in solid