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I was recently given the opportunity to review Symbiosis and Ambiguity: A Psychoanalytic Study, the first English edition of Simbiosis y ambigüedad: estudio psicoanalítico, published in 1967. Although its author, José Bleger, has been widely read,1 his central work on early object relations has not been. This book is an attempt to rectify that omission.
The preface of the book is by Bleger's fellow Argentinian, R. Horacio Etchegoyen, a noted Kleinian. Like Etchegoyen, Bleger is firmly grounded in a theoretical perspective beginning with Fairbairn and leading to Klein and Bion. Whereas it is not clear how Bleger's lucid contributions, which date from the mid-1960s, have remained relatively unknown to North American and European analysts, after reading Symbiosis and Ambiguity, I would agree with the editors, who point out that “although written almost a lifetime ago, its combination of theoretical innovation [and] detailed clinical illustration … [make] this book as relevant today as when it was first published” (p. xviii).
The editors have provided a detailed and very valuable minisynopsis of the book's chapters in their introduction, which can help orient the reader and which I will not reiterate here. One important historical note bearing on the development of Bleger's ideas is that he and his wife started their medical careers by treating patients in a family clinic setting. As a psychiatrist, prior to beginning psychoanalytic studies, Bleger was sensitive to the way in which individuals participate in a shared (frequently familial) drama.
This understanding likely attuned Bleger early in his career to the links between autism (as a dynamic/psychological presentation) and symbiosis. Whereas an autistic patient is typically experienced by the analyst as keeping him or her from penetrating the patient's inner world, in Bleger's view, the patient is equal