Fantasy or Structural Defect? The Borderline Dilemma as Viewed From Analysis of an Experience of Nonhumanness

Abstract

The experience of nonhumanness, a crucial aspect of the phenomenal self of borderline states, is studied in two cases to test assumptions concerning the application of the classic ego-psychological or object-relations and self-psychological models. Are these experiences to be seen as fantasy and treated as manifest content, with dynamically active unconscious conflict and meaning, requiring interpretation, or as a developmental arrest in which structural disturbances are ameliorated through clarifying and empathic interventions?

The first case is of a patient with a neurotic depression and hysterical and obsessional character traits, treated in a classic psychoanalysis. Even though dyadic oral and anal fantasies were strongly in evidence, the ego was well integrated.

The second case is of a severe borderline patient who showed. depressive panic and agoraphobia. Her major ego disturbances, poorly integrated and differentiated self- and object representations, and primitive defenses prevented effective psychoanalytically oriented treatment. Interventions were used to consolidate self-representations, internalize tension-regulating structures, promote adaptive ego functions and reality testing. These clarifications were necessary to move the patient to where she could tolerate facing unconscious dynamic conflicts. Only at that point could repression be lifted, memory emerge, and interpretation be utilized.

Get full access to this article

View all access options for this article.

References

Abend, S. , Porder, M. & Willick, M. (1984). Borderline Patients: Psychoanalytic Perspectives New York: Int. Univ. Press.

Adler, G. & Buie, D. H. , (1979). Aloneness and borderline psychopathology: the possible relevance of childhood issues. Int. J. Psychoanal., 60:83–96.

Arlow, J. A. (1963). Conflict, regression and symptom formation. Int. J. Psychoanal., 44:12–22.

Bak, R. , (1954). The schizophrenic defense against aggression. Int. J. Psychoanal., 35:129–133.

Brenner, C. (1979). Depressive affect, anxiety, and psychic conflict in the phallic-oedipal phase. Psychoanal. Q., 48:177–197.

Bowlby. J. (1958). The nature of the child's tie to his mother. Int. J. Psychoanal., 39:350–373.

Calef, V. & Weinshel, E. (1979). The new psychoanalysis and psychoanalytic revisionism. Psychoanal. Q., 48:470–491.

Fairbairn, W. R. D. (1954). An Object Relations Theory of the Personality New York: Basic Books.

Fenichel, O. (1945). Psychoanalytic Theory of Neuroses New York: Norton.

10.

Freud, A. (1936). The Ego and the Mechanisms of Defense. Writings, 2. New York: Int. Univ. Press, 1966.

11.

Freud, S. (1911). Psychoanalytic notes on an autobiographical account of a case of paranoia. S. E., 12.

12.

Freud, S. (1914). On narcissism: an introduction. S. E., 14.

13.

Freud, S. (1915). Instincts and their vicissitudes. S. E., 14.

14.

Freud, S. (1926). Inhibitions, symptoms and anxiety. S. E., 20.

15.

Frosch, J. (1983). The Psychotic Process New York: Int. Univ. Press.

16.

Greenacre, P. (1941). The predisposition to anxiety. Psychoanal. Q., 10:66–94.

17.

Hartmann, H. (1939). Ego Psychology and the Problems of Adaptation. New York: Int. Univ. Press, 1958, pp. 362–396.

18.

Hartmann, H. (1953). Contribution to a metapsychology of schizophrenia. In Essays on Ego Psychology. New York: Int. Univ. Press. 1964, pp. 182–206.

19.

Heimann, P. (1966). Comment on Dr. Kernberg's Paper. Int. J. Psychoanal., 47:254–260.

20.

Jacobson, E. (1964). The Self and the Object World New York: Int. Univ. Press.

21.

Kernberg, O. F. (1967). Borderline personality organization. J. Amer. Psychoanal. Assn., 5:64–685.

22.

Kernberg, O. F. (1970). A psychoanalytic classification of character pathology. J. Amer. Psychoanal. Assn., 18:800–822.

23.

Kernberg, O. F. (1975). Borderline Conditions and Pathological Narcissism New York: Aronson.

24.

Kernberg, O. F. (1976). Object Relations Theory and Clinical Psychoanalysis New York: Aronson.

25.

Kohut, H. (1971). The Analysis of the Self New York: Int. Univ. Press.

26.

Mahler, M. S. , Pine, F. & Bergman, A. (1975). The Psychological Birth of the Human Infant: Symbiosis and Individuation New York: Basic Books.

27.

Masterson, J. F. & Rinsley, D. B. (1980). The borderline syndrome: the role of the mother in the genesis and psychic structure of the borderline personality. In Rapprochement: The Critical Subphase of Separation-Individuation, ed. R. F. Lax , S. Bach & J. A. Binland . New York: Aronson, pp. 299–329.

28.

Modell, A. (1976). The holding environment and the therapeutic action of psychoanalysis. J. Amer. Psychoanal. Assn., 24:285–307.

29.

Rangell., L. (1959). The nature of conversion. J. Amer. Psychoanal. Assn., 7:632–062.

30.

Rappaport, D. (1957). A theoretical analysis of the superego concept. In The Collected Papers of David Rappaport, ed. M. M. Gill . New York: Basic Books, 1967, pp. 685–709.

31.

Strachey, J. (1934). The nature of the therapeutic action of psychoanalysis. Int. J. Psychoanal, 15:127–159.

32.

Singer, M. (1977). The experience of emptiness in borderline and narcissistic disorders. Int. Rev. Psychoanal., 4:459–479.

33.

Singer, M. (1979). Some metapsychological and clinical distinctions between borderline and neurotic conditions with special reference to the self experience. Int. J. Psychoanal., 60:489–499.

34.

Singer, M. (1981). Anal sadism, rapprochement and self-representation: analysis of a preverbal complaint of emptiness. J. Phila. Assn. Psychoanal., 8:173–192.

35.

Singer, M. (1985). Borderline Patients: A Psychoanalytic Perspective, by S. Abend, M. Porder and M. Willick. Psychoanal. Q., 54:270–278.

36.

Singer, M. (1987). A phenomenology of the self: apersonalization, a subcategory of borderline pathology. Psychoanal. Inquiry, 7:121–137.

37.

Stone, M. (1984). Borderline disorders: diagnosis, genetics, and personality factors. Hillside J. Clin. Psychiat., 6:3–22.

38.

Waelder, R. (1939). The Criteria of Interpretation. In Psychoanalysis: Observation, Theory, Application, ed. S. A. Guttman . New York: Int. Univ. Press, 1976, pp. 189–199.

39.

Winnicott, D. W. (1945). Primitive emotional development. In Collected Papers: Through Pediatrics to Psychoanalysis. New York: Basic Books, 1958, pp. 145–156.

40.

Winnicott, D. W. (1960). The theory of the parent-infant relationship. In The Maturational Processes and the Facilitating Environment. New York: Int. Univ. Press, 1965, pp. 37–55.

41.

Winnicott, D. W. (1960). Ego distortions in terms of true and false self. In The Maturational Processes and the Facilitating Environment. New York: Int. Univ. Press, 1965, pp. 140–152.