And the diagnostic criteria seem devoid of an inner logic. Patients drift from one personality disorder to another or qualify for 3 at a time. But everybody knows that Axis II doesn’t work as well. If these questions persist, at least the boundaries of the major DSM Axis I syndromes are clear. The results are familiar but also mysterious: Why do extremely sad people wake up too early? Why is unipolar depression common but unipolar mania rare? Why do the female relatives of sociopaths become somatizers? What’s the link between tics and obsessions? Diagnostic categories bubble up from observed clusterings of symptoms rather than being imposed by a preordained theory. The focus is on clear and reliable observation with a minimum of speculation. If you’re still with me, recall that our now ubiquitous DSM isn’t all of psychiatry but only the current incarnation of the “objective-descriptive” tradition, tracing back to Kraepelin. It’s page after page of “oral rage,” “pregenital strivings,” “structural derivatives of object relations,” “sadistic precursors of the superego,” and “pathological refusion of self and object images.” You don’t read Kernberg, you decipher him. He’s logical and well organized but offers no concessions to outsiders. Kernberg is an analyst speaking to other analysts. But I’m curious about what these extreme explorers bring back. And I wouldn’t trek to the South Pole or ride a diving bell to the floor of the Pacific either. And yet, I admire psychoanalysts’ willingness to immerse themselves in the lives of severely disordered patients. He prescribes intensive psychotherapy for almost everyone, and recommends a few months of hospitalization for regressed patients. He blithely lumps homosexuality among the personality disorders. He ignores biology hypomania, for him, is character pathology. Kernberg takes for granted the causal and explanatory power of infantile sexuality and unconscious mental processes. But reading Kernberg is a hellacious experience.įirst, he’s a true-believing psychoanalyst, so your reaction to him will follow your opinion of analysis if you’re allergic, stop reading now. It’s an acknowledged landmark the culminating and most characteristic expression of generations of psychodynamic observation and theorizing about severe personality disorders. He’s now been in the United States for 50 years, first at Menninger and now Cornell, devotedly leading meticulous, long-term studies of intensive psychotherapy for patients with personality disorders.īorderline Conditions and Pathological Narcissism (New York: Jason Aronson 1975) is the archetypal unread classic. Otto Kernberg was born, appropriately, in Vienna in 1928 and fled to Chile in 1939, one step ahead of the greatest pathological narcissist of them all. If not, at least you’ll have some clever opinions on the ready. Maybe it will inspire you to actually read a book. This new column aims to review important books you may have passed over. We’re all short of time and the required reading list gets longer every year. Psychiatrists, like everyone else, bear shameful educational omissions. Recently, litterateur and psychoanalyst Pierre Bayard anatomized this art of faked literary chat in his nearly serious study, How to Talk About a Book You Haven’t Read. Many people use the New York Times Book Review less to plot future reading than to pick up enough talking points about this week’s bestseller that they can skip it but still sound intelligent. Generations of high school students have bypassed Wuthering Heights and The Scarlet Letter in favor of CliffsNotes, and now Wikipedia. In our attentionally challenged era of blogs and twitters, sitting down to read such worthy tomes seems ever less feasible.īook reviews have long been a first defense against scholastic overload. Moreover, many of the best books are lengthy, densely argued, and studded with long Latinate words. Finally, one junior lecturer gets carried away, admits that he's never read Hamlet, and gets fired.Įveryone has these guilty secrets. In turn, each names a classic that all professors should have read but have not. In Changing Places, David Lodge's comedic novel of academic life, the junior faculty in literature at a provincial English university play a game called Humiliation.
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