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This is the fifth book in a series called “The Boundaries of Psychoanalysis,” published by the Confederation of Independent Psychoanalytic Societies (CIPS). The book consists of eight chapters, each written by a different author(s), with the common goal of better understanding the phenomenon of “concreteness” and presenting different approaches to treating concrete patients. The chapters may be read separately and in any order. Each chapter contains at least one clinical vignette—which is a strength of the book because the theoretical material is often quite dense and difficult to grasp. “Concreteness” in this context has a very specific meaning, as described by the Series Editor, Fredric T. Perlman:
The essays comprising this volume address a… phenomenon… that appears across a spectrum of diagnostic and clinical contexts and often underlies diverse clinical manifestations such as impulsivity, enactments, intractable transferences, bodily preoccupations, and the general fixity of the patient's representational world … . The patient unconsciously assigns a fixed meaning to persons and events, including the analyst and the analytic relationship, which is, for the patient, obvious and self-evident … . The patient's ideas and feelings are thus experienced… as facts of life: inescapable, fundamental, and absolutely true. (Perlman in Frosch, 2012, pp. xv–xvi)
In other words, such patients are not amenable to interpretation in any form. They feel and believe that the way they see the world is the way the world is. Not so long ago, these patients would be seen as untreatable, let alone analyzable. They are trapped and can't reach out; their therapists, on the other hand, are equally trapped because they can't reach in.
If I may make a slight detour here, there is a parallel problem in philosophy, which was tackled by Ludwig Wittgenstein, perhaps the greatest philosopher of the twentieth century, in his 1921 work, Tractatus Logico-Philosophicus. I do this for two reasons. Firs