Borderline Conditions

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BORDERLINE CONDITIONS

The nosological concept of borderline conditions (or states) arose from what was defined in the English-language literature as "borderline personality organization," a term used to refer to a wide range of patients whose symptoms could not be explained in terms of either neurosis or psychosis.

There are three common misconceptions concerning borderline conditions to be avoided if their dynamics are to be understood, the first two of which arise from the term itself:

that they exist at the "borderline" of neurosis or psychosis or constitute a transition between the two, when in fact they are neither pre-psychoses nor severe neuroses;
that they are transitory "states" because of the various forms in which they can manifest within one individual. Otto Kernberg (1975) prefers to use the term "borderline organization" because, as Daniel Widlöcher (1979) emphasizes, this is an unstable condition existing within a stable structure;
finally, that the wide variety of clinical manifestations eliminates any need to define the fundamental psychodynamics that these conditions have in common.

The borderline condition is more than a pathology that consists more often in manifest behavior than internal suffering and in an attitude of object-dependency that, depending on the level of mentalization, can range from drug addiction to violent passages to the act in the "psychopathic" subject. This disorder can produce a wide range of visible manifestations, including extraordinary lapses of consciousness, an "as-if" mode of existence with loss of feeling, and an indefinable state of inefficacy. This range nevertheless stems from the same narcissistic rationale, the same archaic reaction, and a similar way of establishing the required defenses in the outside world.

The narcissistic component of the borderline condition restricts the experience of conflict to its traumatic impact. The Oedipus complex is overcome without having been resolved (Bergeret); however, the narcissistic disorder is neither a depression nor a form of neurotic or psychotic decompensation experienced as an object loss. This in no way detracts from the archaic nature of the need, the intolerance of frustration, the intensity of the rage, or the violence of the reaction. Accordingly, the pregenital quality of the need becomes a threat to an object that is absolutely necessary but has become frightening through projection—an object both that needs protection and from which protection has to be sought.

In the context of such a risk and this overwhelming atmosphere, the borderline patient actively strives to deal with reality rather than to negotiate the drive. Given the impossibility of dissociating the affect from the representation in a way that would enable repression and displacement to occur, and in the absence of an internal object that would be the guarantor of subtle difference, everything is organized in the external world so as to secure the object. Accordingly, this demonstrates the radical choice that the subject has to make in using the denial of the reality that he is able to perceive but not cathect to avoid any conflict. This subject also deploys splitting and—to avoid any internal conflict between love and aggression—completely separates good from bad in the external world or intensely idealizes the object on which he cannot rely.

The concept of omnipotence provides the key to a better understanding of a wider range of manifestations in borderline conditions, including that which characterizes the deeper disorder beneath the neurotic exterior, which ranges from unstable behavior to antisocial reactions and also extends from childish personalities and depressive tendencies to what is described as narcissistic perversion. Heinz Kohut (1971) classified the megalomania in borderline conditions as one of the "archaic narcissistic configurations" that exist in the Self, which is considered not as an agency of the psychic apparatus but at the very least as a structure in which the representations retain a degree of autonomy in relation to the rest of the life of the drives.

In sum, the borderline condition remains an entirely external striving that results from an incapacity to tolerate internal ambivalence, which produces both the economy of depression at the internal level and the economy of delusion at the external level.

Augustin Jeanneau

See also: Abandonment; Act, passage to the; As if personality, the; Character neurosis; Dependence; Developmental disorders; Narcissistic injury; Narcissistic neurosis; Negative therapeutic reaction; Prepsychosis; Psychoanalytical nosography; Psychotic/neurotic; Transference hatred.