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.