Book excerpt: Despite the burgeoning literature on the role of the father in child development and on fathering as a developmental stage, surprisingly little has been written about the psychiatrically impaired father. In Fathers Who Fail, Melvin Lansky remedies this glaring lacuna in the literature. Drawing on contemporary psychoanalysis, family systems theory, and the sociology of conflict, he delineates the spectrum of psychopathological predicaments that undermine the ability of the father to be a father. Out of his sensitive integration of the intrapsychic and intrafamilial contexts of paternal failure emerges a richly textured portrait of psychiatrically impaired fathers, of fathers who fail. Lansky's probing discussion of narcissistic equilibrium in the family system enables him to chart the natural history common to the symptomatic impulsive actions of impaired fathers. He then considers specific manifestations of paternal dysfunction within this shared framework of heightened familial conflict and the failure of intrafamilial defenses to common shame. Domestic violence, suicide, the intensification of trauma, posttraumatic nightmares, catastrophic reactions in organic brain syndrome, and the murder of a spouse are among the major "symptoms" that he explores. In each instance, Lansky carefully sketches the progression of vulnerability and turbulence from the father's personality, to the family system, and thence to the symptomatic eruption in question. In his concluding chapter, he comments tellingly on the unconscious obstacles - on the part of both patients and therapists - to treating impaired fathers. The obstacles cut across different clinical modalities, underscoring the need for multimodal responses to fathers who fail.