Treatment of the Narcissistic Neuroses. Hyman Spotnitz and Phyllis W. Meadow. New York:  Manhattan Center for Advanced Psychoanalytic Studies, 1975.  vii + 254 pp.

This text is a definitive exposition of the group of innovations in psychoanalytic theory and technique that have become known collectively as “modern psychoanalysis.” In the authors' words, “Modern psychoanalysis was developed as a new approach to the study of narcissism.” The origins of this approach date back more than thirty years to the

efforts of the first author, Hyman Spotnitz, and others to extend the methods of psychoanalysis to the treatment of schizophrenia; his coauthor and colleague, Phyllis Meadow, is director of the Manhattan Center for Advanced Psychoanalytic Studies in New York, an institute which emphasizes the “modern psychoanalytic” approach to pre-Oedipal disorders in its training program.

The key postulate in the Spotnitz theory of narcissism is that the aggressive drive, not the libidinal drive, is the villain behind the myriad symptoms of the narcissistic disorders that increasingly occupy the attention of this generation of practicing analysts. In Part I of the book, devoted to theoretical considerations, the authors present a strong case for the view that disorders ranging from ego fragmentation in the schizophrenic to the psychosomatic complaints and insidious defenses of the character disorder can best be understood as resulting from inner-directed aggression. This view differs significantly from the traditional analytic position. Although writers such as Kernberg are becoming increasingly interested in the role of aggression, the representatives of the traditional school of thought (including Kernberg) still maintain that repression of the libidinal drive is at the root of all pre-Oedipal as well as Oedipal disorders. The “modern” school points out that both drives play a role in each of the various categories of emotional disorder, with the aggressive drive used as a defense against libido in some cases and libido as a defense against aggression in others. The authors have found that frequently in the narcissistic disorders the role o