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The title of this book immediately raises some basic but complex conceptual questions in the mind of the reader. What is character? What do we mean by terms borderline, narcissistic, and manic depressive? While the title suggests a specific focus of how to understand and work with certain kinds of challenging patients in psychotherapy, it is impossible to consider that focus without contending with the conceptual questions lurking on the periphery. This is a brief book, and the author does not mean to take on such questions. He therefore assumes the reader has some familiarity with these terms and their referents. Thus, one will have to turn elsewhere (McWilliams, for example1) for a nuanced
(2011). Psychoanalytic Diagnosis. New York: Guilford Press.
discussion of the pros and cons of psychoanalytic nosology and of the notion that particular treatment strategies depend on such classification. Bollas is aware of the limitations and complexity of such categories, noting in his introduction that “no two borderlines, no two narcissists, and no two manic depressives are the same” (p. xii). There is always a necessary balance between the idiographic and nomothetic perspectives in understanding human beings.
Much academic psychological research supports the idea that nature is dimensional more than it is categorical and this includes the nature of personality disorders.2 A well-known quote of that incomparable empirical researcher, Leo Tolstoy, comes to mind:
One of the commonest and most generally accepted delusions is that every man can be qualified in some particular way—said to be kind, wicked, stupid, energetic, apathetic, and so on. People are not like that. We may say of a man that he is more often kind than cruel, more often wise than stupid, more often energetic than apathetic or vice versa; but it could never be true to say of one man that he is kind or wise, and of another that he is wicked or stupid. Yet we are always classifying mankind in this