This book aims to show how complex, clinical phenomena can be understood in terms of a few simple mechanisms. It offers a model that is drawn out of, articulates with, and underpins, the main analytic models. The book weaves together three main threads. The first concerns identity and the significance of variations in the individual's sense of self. The second is an account of the nature and functioning of the non-verbal self, rooted in the nature of affect and the functioning of an 'affective appraisal mechanism', located in the brainstem and the right hemisphere of the brain. The third is a theory of narcissism, which is understood to underlie all other psychopathologies, and to follow from the functioning of the affective appraisal mechanism. While the book's origins and premises are simple, its implications and applications are far-reaching.
The simple origins concern observations of certain phenomena, observable primarily in borderline, hysteric, and narcissistic states, although also very much a feature of everyday life: that the more deeply an individual feels something, the more certain, real, and true it feels to him or her, but that, paradoxically, the less of a sense of 'I' he or she has. The clinical implications of this are enormous, and tell us a great deal about identity and the range of psychic experience and forms of relating.