The Damaged Core: Origins, Dynamics, Manifestations, and Treatment

This comprehensive and tightly argued book deals with the process through which a coherent self evolves, the various ways such development fails to occur, and the therapeutic measures to put things back together. Beginning with the child's early relationships and their internalization as the substrate of the self, the text moves on to psychodynamically sophisticated and developmentally anchored descriptions of certain psychopathological syndromes that are widespread and yet inoptimally discussed. Going from the most severe to the least severe conditions in this realm, the book deals with the psychotic core, the schizoid wish to die and be reborn, the fantasies related to unresolved separation-individuation, the sociopathic tendency to lie, and the impact of excessive narcissism on love relations. The book also provides a unique perspective on the treatment of these conditions in so far as it not only elucidates the ways that a therapist listens and talks to his patients but also the subtle but deep impact of his ongoing attitude toward psychotherapeutic work. Even the role the therapist's office silently plays in the conduct of his work is discussed in detail. The book is theoretically sound and contemporary. More importantly, it is clinically generous and provides a number of vignettes to illustrate the ideas proposed. The writing style is a refreshing admixture of scientific scrupulosity, literary elegance, and humane relatedness.

Table of Contents:
Chapter 1 Preface Part 2 Prologue Chapter 3 1. Early Relationships and Their Internalization Part 4 Structure and Dynamics Chapter 5 2. The Mad Core Chapter 6 3. The Schizoid Wish to Die and Be Reborn Chapter 7 4. Three Fantasies Related to Unresolved Separation-Individuation Chapter 8 5. Lies, Liars, and Lying Chapter 9 6. Narcissistic Love Relations Part 10 Holding and Healing Chapter 11 7. The Analyst's Office Chapter 12 8. Listening Chapter 13 9. Making Interventions Part 14 Epilogue Chapter 15 10. Survival, Vision, and Faith: Three Pillars of Therapeutic Attitude

About the Author :
Salman Akhtar is professor of psychiatry at Jefferson Medical College and Training and Supervising Analyst at the Psychoanalytic Center of Philadelphia.

Review :
Salman Akhtar uses his considerable skills as a psychoanalytic theoretician, clinician, and teacher to bring further clarity to the understanding and treatment of severe psychopathological conditions. His capacity to integrate a vast amount of information is impressive. He demonstrates the theoretical plurality that has marked psychoanalysis for the last two decades. He begins with the fundamental psychological issue for all severe psychopathological conditions, a damaged core, and follows it through development while addressing many theoretical and clinical issues. Most importantly, the reader is led to a greater appreciation of how patients are helped. This is a book of great value for anyone interested in severe psychopathology and its treatment. In this scholarly and comprehensive volume, Salman Akhtar writes beautifully about the most complex subject in psychoanalysis, which is at the heart of our desire to understand our patients; the formation of the self. Special attention is given to the processes of separation and individuation and Akhtar's careful examination of the environment created by the psychoanalyst adds a dimension that goes beyond words. The developmental process is explicated in clear language and illustrated with a series of clinical vignettes that capture the complexity of the human mind. Part of the appeal of Akhtar's work lies in the selection he makes from the universe of clinical concepts. Each of the segments fits into a coherent whole to be both gripping in the midst of the journey and deeply appreciated at the conclusion of the trip. The author provides fresh perspectives on classic Freudian concepts and presents more modern structures with a contemporary eye. The ultimate effect is of a satisfying tour…. When Akhtar's bibliography is encountered, there is surprise, even awe, at the range, scope, and sheer productivity of his original writings and edited works. Having sat with and steeped myself in… The Damaged Core for the last few months, I am hungry for more. More important, the students whom I have introduced his work are eagerly ready too. [Akhtar] structures with a contemporary eye….the author does a good job in covering topics of ground rules, the structure of the session, and logistics within it. Simultaneously, Akhtar sets an interpersonal tone in his writing that seems to be parallel to the kind of interpersonal feel one would expect in the room with him. It is clear, uncomplicated, tactful, and warm. Therapeutically, tone is as important as theory. We will all do well to learn from Akhtar's style of communication….I have not read a more clearly written guide to the experience-near navigation of the therapeutic process. SO many trainees in psychiatry and clinical psychology are desperate to know how to handle issues in therapy. Yes, they want to be guided by theory, but hey want to know what to say, as well. Akhtar provides both.