Key Papers on Borderline Disorders: With IJP Internet Discussion Reviews

Views: 659
Ratings: (0)

The International Journal of Psychoanalysis Key Papers Series brings together the most important psychoanalytic papers in the journal's eighty-year history in a series of accessible monographs. Approaching the IJP's intellectual resources from a variety of perspectives, the monographs highlight important domains of psychoanalytic enquiry. Key Papers on Borderline Disorders, the third volume in the series, grew out of technical innovation. Psychoanalytic papers to appear in the journal were posted on the IJP website and the psychoanalytic community responded on emerging psychoanalytic ideas almost before they have been fully formulated. They were discussed by an international audience of remarkable intellectual force and insight, and this book is based on the responses.

List price: $31.99

Your Price: $25.59

You Save: 20%

 

10 Slices

Format Buy Remix

1: Thick- and thin-skinned organisations and enactment in borderline and narcissistic disorders

ePub

ANTHONY W. BATEMAN, London

In this paper the author argues that enactment is any mutual action within the patient/analyst relationship that arises in the context of difficulties in countertransference work. Such enactment is common during the treatment of borderline and narcissistic disorders. In order to delineate different forms of enactment, which in his view may be either to the detriment or to the benefit of the analytic process, the author describes a patient who was identified primarily with a sadistic mother and who threatened the analyst with a knife during treatment. Three levels of enactment involving countertransference responses are described of which two, namely a collusive countertransference and a defensive countertransference, were detrimental to the analytic process. The third level of enactment was beneficial but only because the intervention by the analyst was independent of the analytic process and yet in response to it. The author uses Rosenfeld’s distinction between thin-skinned and thick-skinned narcissists to illustrate how enactment is most likely when a patient moves between thick-skinned and thin-skinned narcissistic positions. Nevertheless, the move between thin and thick-skinned positions presents an opportunity for effective interpretation, allowing progress in treatment

 

la: Internet discussion review

ePub

PAUL WILLIAMS, London

Bateman’s paper appeared in Part 1, Volume 79, and was placed on the website some weeks in advance of publication. It was the ninth paper selected for discussion by the Discussion Group (see the IJP Home Page for details) and achieved great interest and praise, particularly for its frankness and clarity. In the paper Bateman argued that enactment is ‘any mutual action within the patient/ analyst relationship that arises in the context of difficulties in countertransference work’ (1998, p. 13). Such enactment is common during the treatment of borderline and narcissistic disorders. In order to delineate different forms of enactment the author described the analysis of a patient identified with a sadistic mother and who threatened the analyst with a knife during treatment. Three levels of enactment were delineated of which two (a collusive counter-transference and a defensive countertransference) were detrimental to analytic work whilst the third was beneficial but only because the intervention made by the analyst was independent of the analytic process, and yet occurred in response to it.

 

2: The central phobic position: a new formulation of the free association method

ePub

ANDRE GREEN, Paris

The author discusses a particular quality of associative behaviour observed in some borderline patients, and its role in maintaining a central defensive position, clearly discernible in a complex use of the analyst, and a particular functioning of the mind that the author terms phobic. Illustrating his argument with a detailed clinical account of the gradual joining of associative themes in one particular patient, the author both demonstrates the theory underlying his practice and exemplifies the deeper theoretical underpinning of his approach to psychoanalysis. This implies a new formulation of the free association method. By constructing an analytic space in which free association and psychoanalytic listening are possible, the analyst can voice and link previously catastrophic ideas, quite unknown to the patient’s consciousness, to help the patient to create meaning and obtain relief from previously dominant but unknown terrors. Concluding his paper, the author links his clinical account both to his ideas on temporality and negativity and to the relationship between oedipal and pre-oedipal elements.

 

2a: Internet discussion review

ePub

PAUL WILLIAMS, London

Introduction

Andre” Green’s paper was published in Part 3 (IJP, 81: 429-51), and made available some weeks earlier at no charge for internet discussants and web visitors (www.ijpa.org). This extended, densely argued and detailed clinical and theoretical paper must be read in full if Green’s argument (and the paper’s multiple internal linkages) are to be grasped, and if the ensuing, sometimes conflicted discussion is to make proper sense. This review touches upon some of the principal themes addressed by Green, but not all of them, and then only briefly. Similarly, the internet discussion is summarised. Those interested in reading the paper and discussion can also download both from the IJP website.

The abstract to Green’s paper refers to a quality of associative behaviour observed in some borderline patients, and its role in maintaining a central defensive position, discernible in the use of the analyst, and a particular functioning of the mind that the author terms phobic. Through a detailed clinical account of associative themes in a particular patient, Green delineates his concept of the ‘central phobic position’, and, in so doing, the theoretical underpinning of his approach to psychoanalysis. His conceptualisation implies a new formulation of the free association method. By constructing an analytic space in which free association and psychoanalytic listening are possible, the analyst can voice and link previously catastrophic ideas, quite unknown to the patient’s consciousness, to help the patient to create meaning and obtain relief from previously dominant but unknown terrors. The author concludes the paper by linking his clinical account to his ideas on temporality and negativity and to the relationship between oedipal and pre-oedipal elements.

 

3: The unconscious and psychosis: some considerations on the psychoanalytic theory of psychosis

ePub

FRANCO DE MASI, Milan

The author contends that the various psychoanalytic theories and techniques employ different models of the unconscious, each relating to a different unconscious reality describable in terms of specific mental functions. He reviews in particular the Freudian dynamic unconscious, based on repression; the Kleinian unconscious, which adds the notions of unconscious fantasy and splitting of the object; Bion’s conception of the unconscious as a mental function of which the subject is unaware but which can formulate thoughts and metabolise emotions; and the neuroscientific view of the unconscious as coinciding with that of which one is unaware and not with the Freudian repressed. The author thus distinguishes between the dynamic and the emotional unconscious and between ‘unconscious’ and ‘unaware’, and notes the role of distortion of the ‘unaware’ perceptions involved in the analytic relationship in the impasse situation. He is particularly concerned to show that, whereas neurosis involves the dynamic unconscious, psychosis alters the emotional unconscious, the entity underlying the sense of identity and the ‘unaware’ consciousness of existence. In psychosis the emotional unconscious is blinded, so that the patient is conscious but lacks awareness. The dynamic unconscious is also affected. After presenting two case histories, the author draws attention to the need for further clinical and theoretical research in this field.

 

3a: Internet discussion review

ePub

DENISE CULLINGTON ROBERTS, London

This is a densely argued paper. De Masi’s subject is the unconscious and his argument is that although it is treated as if it were a unitary, unambiguous concept, this is not the case. He argues that there are different definitions of the unconscious in various psychoanalytic theories; that they are separate and reflect different clinical situations, describe different functions of the mind and determine different clinical techniques. He is particularly concerned to look at the specific question of the unconscious as it applies in psychosis. De Masi looks at the developments in Freud’s understanding of the unconscious as a system of the psychic apparatus made up of contents that are barred from access to the preconscious-conscious system by repression: ‘The characteristics of the unconscious system are those of the primary system, involving the absence of negation and doubt, indifference to reality and regulation by the pleasure-unpleasure principle’ (p. 114).

 

4: Psychopathology and primitive mental states

ePub

ROBERT CAPER, Beverly Hills

The author discusses the psychoanalytic concept of primitive mental states, arguing that normal primitive mental states contain omnipotent fantasies that in an adult would be classified as delusions and hallucinations, but also contain sufficient reality sense to allow the infant to learn through experience that its omnipotent unconscious fantasies are not real, but only ordinary unconscious fantasies. Psychopathology of the type requiring psychoanalytic treatment is connected to persistent unconscious omnipotent fantasies (delusions). It is not the result of a regression to a normal primitive mental state, since in a normal primitive mental state, such delusions and their resultant inhibitions, symptoms and anxieties are graduaUy and spontaneously overcome through learning from experience. The unconscious delusions related to psychopathology persist because they are insulated from the effects of the learning from experience that would ordinarily convert them into unconscious fantasies by the use of transformations in hallucinosis, reversal of perspective and realistic projective identification by the psychotic part of the personality. Together, these mechanisms distort experience in such a way that reality appears to confirm, not challenge, the delusions, making learning impossible. The theory that psychopathology is due to a regression or fixation to a normal primitive mental state acts as a defence against the awareness that the mental states associated with current psychopathology are not like normal primitive ones, and that they differ from normal primitive mental states by containing forces that are sufficiently destructive of learning from experience to have prevented the patient’s mental state from evolving in a normal fashion.

 

4a: Internet discussion review

ePub

PAUL WILLIAMS, London

Caper’s paper is a discussion of ‘primitive’ mental states and focuses on the question of whether or not psychological illness in an adult can be thought of as a regression or fixation to a ‘primitive’ mental state (representing an early stage of normal development). An intensive discussion of fundamental issues raised by this question followed, although it took place between a small number of discussants. The paper begins by reviewing observations by Freud and others on the subject. Freud described an early egg-like state of hallucinatory gratification based on the pleasure principle (Freud, 1911). This state of unreality is usually only partially successful, as physical needs supervene (e.g. hunger), which indicates that the lack of contact with reality is not total. Klein, Bick, Bower, Stern and Emde, amongst others, have confirmed the validity of Freud’s view— Caper feels that Emde’s work on the mutuality of attunement between mother and infant is particularly relevant (Emde, 1988a, b).

 

5: Problems of female sexuality: the defensive function of certain phantasies about the body

ePub

LOREDANA MICATI SQUITIERI, Rome

The author discusses certain modalities employed by the female mind when entering into a relationship with the representations of the self and with those of her own anatomy, i.e. with representations of internal and external reality. The hypothesis is that for women in whom representations of a fragile self predominate, the body is not only felt as a mysterious, receptive cavity, but also as an unreliable organism. Here an equation between the precariousness of the self and that of the body seems to be established and the female body is felt as a wounded body, which, through an opening over which there is no control, may lose its inner contents and let in dangerous aggressors. The absence of a penis, which is discovered later, may become the symbolic representation of this precariousness. The vaginal opening may also be seen in a way that triggers persecutory anxieties. The phantasy that defends against these painful perceptions may be that of secretly and guiltily having some qualities of a male body, which are represented by reassuring male sexual attributes. In borderline and psychotic syndromes, the phantasy of having a male body appears to become concrete and almost delusional. In one case of female homosexuality, the unconsciously active phantasy is that of having the attributes of both sexes. These phantasies are defensive manoeuvres connected with early self-loss and non-integration anxieties. They are far removed from the maternal and paternal identifications that should pave the way to mature, psychic bisexuality; that is, to the presence of male and female psychic attributes and to the availability of the cathected object of both sexes.

 

5a: Internet discussion review

ePub

PAUL WILLIAMS, London

Micati Squitieri’s paper appeared in Part 4, Volume 80, and was placed on the website (http://www.ijpa.org) several weeks earlier for discussion. In brief, the author discusses early mental representations of the body that may be chosen by a female child as a defence against developmental difficulties, particularly ‘primitive agonies’. In cases of women in whom representations of a fragile self predominate, the body is felt not only as being a mysterious, receptive cavity, but also as an unreliable organism. Where the self is perceived as fragile, the body also tends to be thought of as being so fragile as to increase the self’s fragility. Following this hypothesis, the inner representation of the precariousness of the self tends to take the form of an unreliable anatomy and, in turn, the perception of a delicate, mysterious anatomy sharpens the feeling of the fragility of the self. The female body may be experienced as a wounded body (Argentieri, 1982, 1985), which, through an opening over which there is no control (Bernstein, 1990), may lose its inner contents and let in dangerous aggressors. The vaginal opening may also be seen in a way that triggers persecutory anxieties. A defensive phantasy (Micati, 1992) created as protection against these painful perceptions may be that of, secretly and guiltily, having some qualities of the male body (robustness, strength, solidity), represented by reassuring male sexual organs.

 

Details

Print Book
E-Books
Slices

Format name
ePub (DRM)
Encrypted
true
Sku
9781780497204
Isbn
9781780497204
File size
0 Bytes
Printing
Disabled
Copying
Disabled
Read aloud
No
Format name
ePub
Encrypted
No
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Sku
In metadata
Isbn
In metadata
File size
In metadata