Overview

The clinical phenomena of masochism, narcissism, and compulsive drug use persist with such compelling force against conscious will power that the patient's every interest and happiness is poisoned, each success destroyed. Fuelled by chronic traumatization and the superego conflicts that derive from it, these severe neuroses have components of resentment and denial, leading to double identity (multiple personality and dissociation), rooted in double conscience. This work argues that the particularly intensive conflicts and anxieties characteristic of the severe neuroses can be approached analytically: the paradigm can be tailored to allow for such modifications as medication, behaviour therapy, and family interventions, without compromising the analytic situation. This is an account of an analyst's successes and failures, especially of those interventions experienced as decisive in given treatments with traditionally unanalyzable patients.

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9780765701770

Table of Contents

Reviews

Wurmser's erudition, theoretical knowledge, and clinical wisdom flow in his writing like an untappable Niagara. His resolve to conceptualize gives his latest book a new and welcome balance between conflict, trauma, and affect, productively borrowed from infant studies. The author is a humanist who brings fully to life the frequent inhumanity of the inner judge. Best of all, he has a unique way of conveying the chaos characteristic of the severe neuroses while making the dynamics understandable to the reader. -- Joseph Lichtenberg, M.D., editor-in-chief, Pyschoanalytic Inquiry; presdent, International Council of Psychoanalytic Self Psychology In this important new book, Wurmser's brilliant discussion of the severe neuroses--too often glibly branded as borderline disorders--takes into account new appreciation of severe childhood trauma and its effects, while preserving a nuanced understanding of conflict and of the flexibly applied but disciplined analytic method for the treatment of severe neurotic suffering. His comprehension of the centrality of conflict analysis and of superego conflicts in particular combines with his insights into the intricate interrelationship of shame, guilt, anxiety, masochism, and aggression to make this work a tour de force. -- Melvin R. Lansky, M.D., UCLA Medical School; director of education, Los Angeles Psychoanalytic Institute In this book, Leon Wurmser shares with us his profound capacity to work with the severe neuroses, resisting the ambiguities of the diagnostic label borderline. He demonstrates his respect for and recognition of the ego's versatile uses of pathology in the service of defense against early trauma. He sensitively and with consummate skill demonstrates being 'with' the patient, while avoiding the degree of interpersonal, therapeutically dependent atmosphere that in wide-scope treatments often undermines much of the potential for structural growth. His profound knowledge of the ways in which a patient's superego takes up arms against the process of growth brings about therapeutic changes that often have been neglected in work with the severe neuroses. We can be grateful that Dr. Wurmser has made his work available in such generous theoretical and clinical detail. -- Paul Gray, M.D., training and supervising analyst emeritus, Baltimore/Washington Institute for Psychoanalysis

Wurmser's erudition, theoretical knowledge, and clinical wisdom flow in his writing like an untappable Niagara. His resolve to conceptualize gives his latest book a new and welcome balance between conflict, trauma, and affect, productively borrowed from infant studies. The author is a humanist who brings fully to life the frequent inhumanity of the inner judge. Best of all, he has a unique way of conveying the chaos characteristic of the severe neuroses while making the dynamics understandable to the reader.--Joseph Lichtenberg, M.D.

Author Information

Léon Wurmser, M.D., is clinical professor of psychiatry at the University of West Virginia and training and supervising analyst at the New York Freudian Society. Former professor of psychiatry and director of the Alcohol and Drug Abuse Program at the University of Maryland, he has also taught extensively throughout Europe. Dr. Wurmser trained as a psychiatrist in his native Switzerland and received his psychoanalytic training in this country. Author of 300 articles and coeditor of the six-volume textbook Psychiatric Foundations in Medicine, he has written several books such as The Hidden Dimension and The Mask of Shame. Dr. Wurmser is a recipient of the 1997 Margrit Egner Foundation Award in recognition of outstanding work in anthropologic psychology and philosophy. He maintains a private practice in psychotherapy in Towson, Maryland.

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