It is a daunting task to be set to review a book that marks the culmination of over 50 years of study, research and writing in the field of personality development and psychopathology. Professor Blatt has written extensively in this field and has moved with the times, incorporating the latest thinking and research from across the globe into his work. Recently, this includes the increasingly large contribution of research studies exploring attachment theory and its implications for childhood and adult development.

For those wishing to keep up to date with research highly relevant to clinical practice, the book is a one-stop-shop that allows the reader to become conversant with attachment theory research, discussed in the initial chapters. For those who are willing and able to invest more time and thought into the implications of Professor Blatt's book, they are unlikely to be disappointed. Peter Fonagy asserts in his foreword that Blatt's work represents ‘the first comprehensive integrated model of personality development and could provide the foundation for the developmental psychopathology of the future’. No doubt some would contest this statement, but none the less this publication certainly represents a milestone in the integration of clinical experience, theorising and research from the psychodynamic school.

Blatt's thesis is essentially that although it has been recognised for decades that personality development appears to hold a tension between relatedness and self-definition (the desire/drive/need to be close to others physically, emotionally and cognitively and the desire/drive/need to be separate and ‘individuate’), what has not been fully recognised is the absolute interdependence of these processes.

Blatt takes as his springboard concepts such as the ‘dialectical spiral or helix’ to describe the way in which the infant's capacity to relate to itself and others gradually develops from its experiences of physical and psychological attunement and autonomy. From there he interweaves research on primates, which has similarly found their social organisation and behaviour to inhabit ‘agonic’ and ‘hedonic’ modes, narrative research identifying themes of ‘intimacy’ and ‘power’, and psychodynamic theory that has identified a tension between ‘competition and success’ and ‘brotherly love and humility’. On this basis, Blatt proposes a ‘dynamic structural developmental approach’ that views psychopathology as arising from an imbalance in these facets of development.

The book stands alongside such classics as Erich Fromm's The Fear of Freedom (1942) in its contemporary relevance and originality of thought. However, it is unique in its scholarliness and comprehensive integration of the research across psychology, psychiatry, psychodynamic theory, social anthropology and neuroscience, to name a few of the academic fields from which Blatt draws. One aspect of psychological thought notably absent from the book was any reference to systems theory or a nod in the direction of understanding how individuals in society seem to present in a ‘pathological’ way not simply due to their development in their proximal social systems (families) but also over time due to how, once pathologised, their behaviour is influenced by society's response to their new identity. The elusive concept of ‘power’ was conspicuous by its absence, yet we know the role that poverty and social disadvantage play in incidence of those identified with mental illness.

Of particular interest to me was the challenge Professor Blatt's work represents to current diagnostic systems. He sets out a convincing rejection of the current psychiatric nosology in favour of a classification system that can hold itself up to scientific scrutiny and is based on valid concepts. For a clinician who has spent many years attempting to help individuals diagnosed with ‘schizophrenia’ (which can sometimes mean ‘drug-induced psychosis’ or be an indicator of neurological damage as a result of a head injury, or refer to hearing voices following severe and ongoing trauma, or hide Asperger's syndrome and so on, but for which there is no evidence of a biological brain ‘disease’ as is so often misunderstood by those we work with) this is a breath of fresh, logical air. I can see Professor Blatt and the now retired Professor Mary Boyle (author of Schizophrenia: A Scientific Delusion? Routledge: 2002) exchanging thoughts on this topic. However, whether Professor Blatt's meisterwerk, despite its vast expertise, will be able to move the mountain of the DSM–IV–TR or the ICD–10, I have grave doubts given the market forces which pull in the other direction.