Reply to Commentaries

Embarras de richesses best describes my reaction to the commentaries. It is unusual to have one's work commented on in such depth and I am grateful to the contributors from whom I have learnt a great deal. I shall try to reply to each and create some links with my paper. Doing so will involve commenting briefly on my view of the psychodynamics and origins of psychotic thinking. There are, I think, differences in perspective (or psychoanalytic vertices, to borrow Bion's, 1967, term) that have emerged here and that it would be helpful to debate. I am grateful for the opportunity to do so as the more the problems of severe disturbance can be discussed, the better it is likely to be for psychoanalysts, who are increasingly viewed as being at risk of losing their role in the provision of effective treatment for severe and enduring mental illnesses.

Margaret Black's discussion is, as I see it, is most representative of the intersubjectivist tradition exemplified by Psychoanalytic Dialogues and offers the most significant differences in theoretical emphasis between us. There are, as Black points out, many areas of agreement, and I shall not dwell on these except to thank Black for her sensitive support for this kind of difficult work. The most important problem areas for me in her discussion concern (a) her emphasis on relation imagery in the organization of personality, (b) the primarily subjective reality constructs employed by the patient and the growth of dissociative structures, and (c) the need for a compliant but active environment to facilitate the redevelopment of self and ego. These are contrasted with my emphasis on unconscious ideation, “linear” mental development as Black sees it and my apparent need to “lock out” Miss A's disturbance by consigning it to the category of a psychotic self. Black believes that