Absolute Truth and Unbearable Psychic Pain: Psychoanalytic Perspectives on Concrete Experience. Edited by Allan Frosch. London:  Karnac, 2012.  140 pp.

Patients who experience their emotional life concretely confront analysts with a profound and maddening paradox: the defining tool of the trade—language in the service of making meaning—can be woefully ineffective at reaching people whose pain is inextricably bound up with an impaired capacity for symbolization.

Compounding the problem, it can be difficult for clinicians to appreciate fully the depth of this divide, let alone find a way to bridge it. Fonagy puts it this way:

There is a genuine countertransference resistance against recognizing the barrenness of the internal world of a nonreflective patient. In some other patients reflective function may appear to exist, but it does so in a vacuum, in outer space, painfully and rigidly separated from actual psychic experience …. To overestimate the patient's mental capacity, to consider that his psychic reality is similar in quality to that of the analyst, can lead to a fruitless and repetitive search for the truth.1

Absolute Truth and Unbearable Psychic Pain: Psychoanalytic Perspectives on Concrete Experience, an excellent collection of essays, does not shy away from the emotional, technical and countertransference difficulties that Fonagy adumbrates, but it strikes an inclusionary and even hopeful chord that is unusual in discussions of the concrete patient. Inevitably, originality varies in a volume like this; concreteness is welltilled