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Using the term borderline to refer to a symptomatically heterogeneous group of patients who nevertheless form a nosological entity because of their similar transference relationships. In older literature the term ‘schizoid personality’ was employed to designate a similar nosological group, placed somewhere between neurosis and psychosis. This character type was considered most predisposed to develop schizophrenia. The schizoid individual is one who is described as aloof, irritable, and unable to form close relationships. It was further believed that such an individual was unable to form the transference. However, we now know that this view is incorrect. The withdrawal, an aloof person is only one of the many personality types who may become borderline. These patients do form a transference relationship, which is frequently extremely intense, but differs significantly from that formed by neurotic patients. This transference has specific features recognized as a useful operational method of diagnosing the borderline patient.


The relationships established by these people are of a primitive order, like the relationship of a child to a blanket or teddy-gear, yet they owe their lives, so to speak, to processes arising within the individual. Their objects are not perceived according to the ‘true’ or ‘realistic’ qualities. (As borrowed from Winnicott’s concept of the transitional object, which he applied to the child’s relation to these inanimate objects (Winnicott, 1951), from which having applied this designation to the borderline patient’s relation to his human objects). The relationship is transitional in the sense that the therapist is perceived as an object outside the self, yet as someone who is not fully recognized as existing as a separate individual, but invested almost entirely with qualities emanating from the patient. Thus and so, that as placed of this object relationship midway between the transference of the neurotic (where the object is perceived as outside the self, whose qualities also disported by phantasies arising from the subject. However, the object exists as a separate individual). The experience of certain schizophrenics, who are unable to perceive that there is something outside the self. For these reason’s posit of the term transitional to be accurate, as it truly designates a transitional stage.

With that, a further description describing this state of affairs in the borderline patient will now be acknowledged. The relationship of the borderline patient to his physician is analogous to that of a child to a blanket or a teddy bear. We can observe that there is a uniform, almost monotonous, regularity to the transference phantasies, especially in the opening phases of treatment. The therapist is perceived invariably as one endorsed with magical, omnipotent qualities, who will, merely by his contact with the patient, affects a cure without the necessity for the patient himself to be active and responsible. We may question why this should be considered characteristic of the borderline patient, since most people attributes to their physicians certain omnipotent powers, especially if their need is great. The wish for an omnipotent protector may exist in everyone: The difference resides in the fact that the borderline patient really believes the wish can be gratified. Finding that the borderline patient’s belief in the physician’s omnipotence corresponds to a belief in his own omnipotent powers, for he thinks that he can transform the world by means of a wish or a thought without the necessity for taking action, that is, without the need for actual work. He said, in contrast to the neurotic patient, unable to perceive that after all the physicians are only a human being like himself: The idiosyncrasies of the physician’s personality, which make the physician a separate individual, do not seem to register. This intuitive awareness causing the certainty that many borderline patients share with some schizophrenics an uncanny ability to perceive accurately some aspects, mistakes the part for the whole, as these patients are not able to place what they note in its proper context. For example, Hendrick (1936) observed that the paranoid is correct in perceiving the hostility in others, but that is all he can perceive. It is striking that, no matter the many different personality types represented by a group of residents treading these patients, this phantasy of omnipotence uniform remains. It is soon found that the patient is unable to perceive the therapist as he is, for he is unable to perceive himself as he is. The omnipotent therapist corresponds to the omnipotence of his self-image, so that although the therapist is perceived as outside the self, he is endowed with qualities identical with those of the self, and the distinction between self and object is only partial.

The therapist is endorsed with qualities that are according to the patient’s own primitive and undifferentiated self-image composed in part of both omnipotently creative and omnipotently destructive portions. There is then constant danger that the omnipotently benevolent and protective physician may be transformed into his opposite. These people’s experience the harrowing dilemma of extreme dependence adjoined with an intense fearfulness of closeness. It is the familiar central conflict in both borderline and schizophrenic patients. The differences between these groups lie not so much in the content of the conflict as in the psychic structure available to mediate the conflict.

If one faces the belief that one’s safety in the world depends on another human being, and this is coupled with the conviction that closeness to this other person will be mutually destructive, the solution lies in maintaining the proper distance. This dilemma is beautifully illustrated by Schopenhauer’s famous simile of the freezing porcupines, quoted by Freud in his Group Psychology (1921?): ‘A company of porcupines crowded them very close together on a cold winter’s day to profit from one anther’s warmth and to save themselves from being frozen to death. Nevertheless, soon they felt one another’s quills, which induced them to separate again, and the second evil arose again. So that they were driven backwards and forwards from one trouble to the other, until they discovered a mean distance at which they could most tolerably exist.

The quills of the porcupine correspond to the anger of these patient, which is, like the quills most defensive. Although mutual destruction is feared, when we examine their anxiety closely we recognize that the true danger arises not so much from their aggression, as from the more tragic fact that they fear that their love is destructive (Fairbairn, 1940). Fairbairn observed that phantasy that can be easily confirmed: To give love is to impoverish ones' self - and to love the other person is to drain him. What is of not is that the hostility is expressed easily. It is only after a long and successful treatment that we can observe the genuine expression of positive or tender feedings.

It may be thought that to certain extent this is present in all of us, that a fear of closeness may be part of the human condition. This would appear to weaken the case that it is a specific characteristic of transitional relationships. If we grant that what has been described is part of the transitional object relation, and if what may have some

understanding agreement to have the quality of being a representative for the observation of all human beings, then how can it be maintained that transference based on a transitional object is diagnostic of the borderline group? So if that is, to resolve this question: The growth of object love is a development process co-determined by the development both of the instincts and of the ego (Anna Freud, 1952). There are three phases of object love that have been implicit in this discussion. We assume that the earliest phase exists in the young infant who responds to the mother but is yet unable to make any psychological distinction between the self and the object: The middle stage has been described as the stage of the transitional object relation: The more mature stage of object love is the stage where there is a distinct separation between self and object. This is, of course, a condensed and oversimplified view, but it should suffice to give a demonstration of a developmental sequence in the growth of object relations. This view is not merely implied from the observation of adults, but is also based on the direct observation of children. For example, Mahler (1955) has convincingly shown that in the developed of the normal child there is a continuing phase where self and object are imperfectly differentiated? The stage that she has described as symbiotic corresponds in a general way o what we have described as the transitional object. Further evidence that the stage of the transitional object is an advance beyond the earliest stage of object relations is presented by Provence and Ritvo (1961). They are able to confirm the observations of Piaget and others (Rochlin, 1953) that the child’s

interior of latitudinal liberation finds to his relation to the human object: Infants who were institutionalized and deprived of mothering did not develop transitional objects. Their observations suggest that some certain degrees of gratification from the material object have to be present for the child to reach the stage of the transitional object: The stage of the transitional object is not therefore the earliest stage of object relations. Freud wrote (1930) ": . . In mental; life, nothing that has once been formed can perish [that] everything is somehow preserved and [that] in suitable circumstances (when, for instance, regression continues back far enough) it can again be brought to light."

If applicable, we would then have in been as the remnants of earlier, more primitive stages of object relations are present in all of us to a greater or less degree. The difference between the borderline and the neurotic patient resides in the fact that for the most part the psychic development of the former became arrested at the stage of the transitional object, whereas the neurotic patient has passed through this stage, to develop love for objects who are perceived as separate from the self. It is true that, in the neurotic, remnants of these earlier stage may be found, and this is especially so when we look at certain creative processes where we can observer feelings of fusion and merging of the self with an object similar to those described in borderline patients. This is also  the true religious experience, as Freud noted (1930), the experience of religious ecstasy may be sensed as an appreciable fusion and may exist in otherwise normal persons. William James (1902) describes the conviction of the religious person as a belief that no harm can befall him if he maintains his relation to God. This relation is also experienced as a partial fusion and mingling of identities, which seems quite similar to our description of a transitional object reflation.

We cannot avoid using the concepts of fixation and regression. Freud’s analogy of the deployment of an advancing army, used to describe instinctual fixation and regression (Knight, 1953), is particularly apt for in describing the deployment of an army we introduce a quantitative factor, that is, where are most of the troops - are they in the forward, middle, or rear positions? In the borderline cases we would say that most of the troops are at the position of the transitional object, though a few may have achieved a more advanced position. In the neurotic individual, most of the troops have advanced beyond the position of the transitional object, though a few may be left behind.

Nevertheless, to what measure is played of the relation of these clinical observations to their problem of schizophrenia. Earlier reflections have stated that observations of the borderline patient may help to clarify certain nosological issues and may show where purely psychological or pure biological explanations fail. We have to consider the above material by this larger problem.

Clinical observations suggest that a nosological distinction be made between two groups of patients: One consists of those individuals whose defences are unstable, who display fluctuating ego-states, who appear to posses a capacity to suspend or abandon relations to external objects, as occurs normally in infantile fixational states of sleep. We would say that in these cases the illness appears to involve almost the total personality. In the contrasting group, of which the borderline patients form a portion, psychotic illness appears to occur only a part of the personality, and the defences of the ego are more stable: These patients might be unable to suspend or abandon their relations to external objects in a total sense. Their relation to external objects is impaired and distorted but somehow maintained.

The presence of psychosis is loss of ability to test reality. We know that the failure to deal; with reality is a consequence of an altered ego function (Hendrick, 1939), it is the consequence and not the cause of a psychotic deficiency (Federn, 1943), we know that the testing of reality depends upon the fact that the ego’s growth distinction, and has been made between self and object (Freud, 1925). It is only when this distinction has been made that there can be a differentiation of what arises from within from what arises from without. In an earlier paper (Modell, 1961) as it is presented of many clinical observations that suggest that there are degrees of alteration of this function of testing reality hat correlate with the degree to which self and object can be differentiated. Self-object discrimination is a dynamic process with no absolute fixed points. The borderline transference is based on a transitional object relation where there is some self-object discrimination, but where this discrimination is imperfect. That is, the therapist is perceived as something outside the self, but is invested with qualities that are identical with the patient’s own archaic self-image. Reality testing, then, is a process where degrees of alteration of functioning can be observed. If the definition of psychotics is based on the loss of the capacity to test reality, it would then follow that the points at which we designate a phenomenon as psychotic is not a fixed point but a broader area.

The dynamic that is the mobile nature, of this process needs to be emphasized. For example, borderline individuals may at certain times in their dealings with others can maintain a sense of reality. In the transference relationship this function may undergo a regression that may last only during the therapeutic hour. In these instances, the distinction between self and object that has ben maintained, although imperfectly, becomes obliterated. When this occurs the patient could be said to be technically psychotic in the transference situation. This dynamic regressions observed in the transferences is intermittently timed, in that they are unfortunately not limited to the treatment hour, and may extend into the patient’s life. When this occurs we should judge the patient to be not only technically but clinically psychotic. The step backward that some borderline patient needs to take to be judged clinically psychotic are a short one. This step may be adequately understood as for a dynamic and structural psychological regression involving a further loss of self-object differentiation. If the etiology of what we call psychosis results from a further loss of self-object differentiation, there is no need to introduce the hypothesis that the induction of psychosis in these patients is the result of a neurochemical process that operates at the point in time at which the psychosis becomes manifest. The crucial etiological issue is that there is no emergence of psychosis, but those factors that have interfered with the growth of the ego, which in turn have resulted in the imperfect self-object differentiation. For the etiology of psychosis in the borderline group would appear  to result from a developmental disorder of character that leads to an arrest of object relationships at the stage of the transitional object.

We know that the growth of object relations is the result of the interaction of two broad forces: The one relates to the quality of mothering: And the other to the child’s biological equipment. Now it is conceivable that inherited or prenatally acquired variations in the biological equipment may significantly interfere. For example, it has been observed that some infants may be born with an unusual sensitivity of their perceptual apparatus. It is conceivable that such an oversensitive child would find the stimulation of nursing less pleasurable than a normal child. If this were true, a biological factor in this instance could conceivably interfere with the child’s capacity to form his first object relationship. This is similar to Hartmann’s (1952) suggestion that neutralization of instinctual energy is a biologically determined process, and an inherited impairment of this process could also lead to an impaired capacity to form object relationships. Jones (Zetzel, 1949) proposed that some individuals have a relative incapacity to tolerate frustration and anxiety. He thought that this might be an inherited feature similar to intelligence. Others, such as Greenacre (1941), have suggested that the operation of biological processes may not be transmitted in the chromosomes but may be the result of specific prenatal or birth experiences. She suggested that a traumatic birth experience may lead to an excessive level of anxiety in the development of the child.

It must be to admit that all these proposals, while plausible, remain unproved. However, they suggest that if we do establish a biological etiology in the borderline psychotic group, it will refer to those factors that interfere with the establishment of object relations in infancy and therefore lead to an arrest of ego development. Although those biological factors that interfere with the growth of object relations remain unproven - though probable - there is considerable clinical observation tending to support the view that some failure in maternal care is present in all those casers where there has been an arrest of the growth of the ego. This failure may take many forms. It may be actual loss of the mother or separation from the mother, as Bowlby (1961) has emphasized. However, from clinical experiences it does not seem to have been actual physical loss of the mother that took more subtle forms. Occasionally the mothers were unable to contact their children, as they themselves were severely depressed or even psychotic. In others reconstructing the fact that there had been significant absence of the usual amount of holding and cuddling was possible. In still other patients the physical care appeared to have been adequate, but there was a profound distortion in the mother’s attitude toward the child. For example, mothers' incapacity to perceive the child as a separate person may induce a relative incapacity on the child’s part to differentiate a self form object. We are not, however, able to state that these deficiencies of mothering will in themselves, without the contribution of other biological factors form within the child, lead to an arrest of the ego’s growth at the stage of the transitional object.

It may prove important to emphasize that the crucial issue in the borderline patient and the related group of circumscribed psychoses is not the onset of the psychosis or psychotic-like condition, but is the developmental arrest that results in the impaired differentiation of self form objects. A loss of reality testing that defines the onset of psychosis is but a slight further accentuation, or regression, of an already impaired characterological formation.

The difference between the group that we have in describing and to those ‘other schizophrenias’ appears in a certain instability of defences that followed a fluctuating ego state, and the culmination in the ability to suspend relations with objects in a manner analogous to dreaming while in the waking state. It's evolving impression that these two groups are separate nosological entities, and that a member of one does not become a member of the other. It's interpretation that this observation is to suggest the fact that something must be added to permit an individual to sever his relations to the external world by means of a dream-like withdrawal. As Campbell (1935) stated it,

- "I prefer to think of the schizophrenic as belonging to a Greek letter society for which the conditions for admission remain obscure." In that the capacity to suspend relations to external objects, which the borderline group does not posses, is determined by the presence of something that is unknown, and something that may be of biological and not of psychological origin. Some can gain admission to this fraternity, and others simply cannot, no matter how hard they try.

A biological hypothesis seems as to be  unnecessary to explain the onset of psychosis in the group whose defences are stable, that is, in the borderline group, however, something must be added to develop a ‘major schizophrenia’, and, yet, that the differences between the borderline and schizophrenic groups have been explained about the strength of the defence structure operating in the former group. For example, Federn (1947) has suggested that the schizoid personality protect the person from becoming a schizophrenic? Glover (1932) believed that a perversion that may frequently be observed in the borderline group also acts as a prophylaxis against psychosis and is, in his words, ‘the negative of certain psychotic formation’. If we could assume that the strength of defences was entirely psychologically determined, we would have no need to introduce a biological hypothesis. The argument that certain defensive structures protect against a greater calamity seems reasonable, but to believe that such an assertion begs the issue. For the remaining is the question to why these defences are effective: What is it that permits such defences to be maintained? If we wished to maintain the argument for a purely psychological determination, we might say that the strength of the defences is simply the consequence of the degree to which the ego has matured. The gist of this argument would be that the difference between the schizophrenic and the borderline is the result of the fact that the arrest in ego development is more extensive in the schizophrenic patient, perhaps because of an even greater disturbance in the early mother-child relationship. This may be a plausible argument: But the fact that many schizophrenics do not develop until mature adult life negates this hypothesis. For observation does not show that ego development in the schizophrenic is necessarily more primitive or more severely arrested than that of the borderline patient. We know that individuals who develop schizophrenia can come to the conclusion in adjoined agreement: often they have distinguished careers before the onset of their illness. It is inconceivable that such accomplishments could be possible in an individual whose growth had been arrested at the earliest levels. Schreber (Freud, 1911) was a distinguished jurist and was thirty-seven years old at the time of his first illness. There is, in that way, no evidence that the ego-arrest of schizophrenic patients is in all instances greater than in borderline actions. So, the possibility is not to assume of any difficulty of explaining the differences between the borderline and the schizophrenic group on purely psychological grounds.