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Book Review: Handbook of Behaviour Modification with the Mentally Retarded.

groups, the first dealing with theory and the second with the psychoanalytic process. The reader who plows straight through the book will find, not surprisingly, a certain amount of repetition as Loewald returns to his favourite themes. It would take a very lengthy review to abstract and discuss each of the papers in depth, while a more superficial treatment would be unfair to both author and reader. For this reason I will draw on Loewald's writings about internalization for purposes of illustration. (I have selected this as a focus both because of its importance in psychoanalytic theory and because of my interest in it but I could just as easily have chosen memory, time, separation, the instinct, psychic organization or the analytic process.) While I have telescoped and condensed statements made over a period of years, the consistency of Loewald's views makes this possible, I believe, without serious distortion. Loewald believes, as do most analysts, that distinctions between subject and object are present only fleetingly (if at all) in the very young child and, for this reason, "Speaking of internalization on such early levels of development means speaking of processes by which inner and outer are being differentiated by recurrent sortings and resortings" (p.81)that is differentiation of self and object is taking place. Elsewhere (p.265-6) he refers to primary internalization and primary externalization as boundary-creating processes establishing internality and externality, while later internalizations, dating from the Oedipal period, serve to enrich the inner world thus created. In a characteristically pithy clarification of a common formulation regarding "object loss" in regression, he states, "What we observe in clinical or experimental states of regression is not that objects get lost, but that they become less objective, as it were" (p.17). For Loewald, "Internalization is structure building" (p.265), referring here to the ego and superego in particular. Structures consist of progressively higher levels of organization of the personality. It is not objects as such that are internalized but interactions and relationships (p.29l). In the process they undergo a change towards abstraction from their original interpersonal context. Loewald states, "In repression the oedipal object cathexes, while detached from the parental persons, persist in unconscious fantasies of such object relations, whereas in genuine superego formation we are confronted not with unconscious fantasies portrayals, as it were, of object relations but with intrapsychic reconstructions, non-objective, if I may use this term here in a sense similar to what we mean when speaking of nonobjective art" (p.77). Internalization is a process that is rarely complete and which can be reversed through secondary externalization to a variable degree, for instance in the course of psychoanalytic treatment. On the other hand, in progressive internalization, an internalized interaction may gradually come closer to the "ego core." Loewald cites the example of sphincter morality: first a parental expectation, then an expectation partly internalized in the precursory stages of superego formation, finally an automatic control, a primitive ego function (p. 271). With respect to the drives, the relationship being internalized becomes progressively desexualized and deaggressivized (p.51). Loewald expressly disavows Hartmann's concept of "ego apparatuses of primary autonomy" that is, functions "that do not have their origin and equivalents in instinctual life" (p. 209). Many of these points are further illustrated in his papers dealing with the resolution of the Oedipus complex ("The Waning of the Oedipus Complex") and the termination of analysis ("Comments on Some Instinctual Manifestations of Superego Formation"). The reader should gather from this synopsis that one of Loewald's significant attributes as a theoretician is his capacity to encompass and synthesize important aspects of the "classical" psychoanalytic and contemporary object relations theories in a way that illuminates the meaning of both. His influence has therefore been in the direction of expanding rather than fragmenting psychoanalytic theory. This is further illustrated by his favourable review of Kohut's The Analysis of the Self and by his critique of Kohut's postulation of object love and narcissism as separate lines of development, a dichotomy Kohut subsequently dropped. It is unfortunate that Loewald felt Kohut's selfobject concept referred to an undifferentiated precursor of the object (p.213, p.350), an interpretation with which many students of Kohut's writings might disagree and which, it is possible, Dr. Loewald himself may have subsequently modified. Reading and reviewing these papers has been both pleasurable and enlightening. It is to be hoped that Dr. Loewald will continue to teach us through his writings for many years to come.