The Dread of Falling: Reflections on Primitive Mental States offers a comprehensive and original view of primitive mental states from a psychoanalytic perspective, allowing the reader to understand the nature of these states from developmental, theoretical and clinical vantage points.

The book begins with a review of early mental development and its relevance to the understanding of primitive mental states. Alina Schellekes explores major primary anxieties of being and considers object relations that characterize loose or shattered structures of the self. "The dread of falling" both describes a concrete anxiety prevalent in such states and serves as a metaphor and common thread through the book to portray the deep dread of losing base with one’s meaningful objects. Schellekes looks at how, in cases of severe developmental deprivation or late-onset trauma, mental void structures or states of emotional indigestible excess may evolve, creating complex challenges in the analytic process. Schellekes explores various mental survival tactics that are often developed and deployed by patients finding themselves in such extreme cases: omnipotent self-holding defences, autistic manoeuvers, rebirth fantasies and excessive daydreaming. She discusses the quality of analytic presence that is necessary when facing unrepresented mental layers and uncentered states of mind, so as to minimize the risk of toxic states in analysis and of premature terminations.

Including perceptive analyses of literary and fine art works, the book invites the reader on an intellectual and emotional journey through complex mental landscapes of patient and analyst, encompassing profound theoretical understandings and subtle clinical observations.