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Atkin, S. (1974). A Borderline Case: Ego Synthesis and Cognition. Int. J. Psycho-Anal., 55:13-19.

(1974). International Journal of Psycho-Analysis, 55:13-19

A Borderline Case: Ego Synthesis and Cognition

Samuel Atkin

SUMMARY

I have attempted to present an impressionistic portrait of a borderline patient. Regretfully omitting a thoroughgoing dynamic formulation and report of the treatment, my recapitulation will bear largely on the defective integrative or synthetic process in the aetiology of the borderline.

This patient lived in a fragmented world, the result in large part of inconsistencies in her thinking which affected her language, her time function, her judgement and her reality-testing. These defects seemed to have their genesis in some arrest or early disturbance in the ego's integrative capacity. I believe this defect also affects her psychosexual development, which stopped short of genital primacy, requiring as it does both the subordination and integration of the component instincts to the primacy of the genital zone and the formation of an object of constancy toward whom the sexual aim is directed.

We noted the immature state of patient's ego in the area of object relations. Her pregenital libidinal aims were directed toward part objects or primitive, global, all-need satisfying objects. We observed how readily she destroyed objects that frustrated her; how limited was her capacity to mourn; and how she moved from object to object, remarkable in their sameness, on whom she displaced massively her needs and drives. At the same time there was pseudo-object constancy, timeless involvement with objects who disappeared and reappeared through the years.

The analysis unfolded in two distinct stages, a narcissistic phase and a transference neurosis. True, the transference neurosis was qualified by the ready interchangeability of the pregenital and genital components and the ready shifts between the anaclitic and the neurotic transference. (She is still a borderline.) But the advance from the anaclitic to the transference neurotic phase was apparent in many functional areas. Her bland, non-conflictual acceptance of her polymorphous sexual activities was replaced with neurotic confiict and guilt, with manifestations of resistance, anxiety, symptoms and other defensive manoeuvres. The appearance of anxiety with the analysis of the disjunction in thought and action was also a proof of her ego maturation.

In summary, I have demonstrated an integrative defect that retarded the patient's development at a level that resulted in an immature personality organization. I believe that where the integrative defect as manifested in the functional cleavage appears to be the underlying aetiological factor in a result which is a juxtaposition of a narcissistic neurosis and a transference neurosis, we have a borderline patient.

The borderline has no typological or nosological specificity. Borderlines manifest a variety of syndromes and may be quite unlike each other in endowment, life history and predisposition to the kind and severity of psychopathology. What they have in common is a crucial defect in synthetic function. These considerations have an important

bearing both on the prognosis and analysability of each borderline patient.

POSTSCRIPT

Having been alerted to the 'split' by my borderline patient, I have found it, with clinical significance, a not uncommon occurrence. We are all acquainted with people in whose lives contradictory themes in their world of feeling, social reality, politics, ethics, exist side by side without any clash. Perhaps the concept of the 'split' in personality development may explain this phenomenon. On second thoughts I believe that some disjointedness in personality organization is universal. And a fully integrated internalized world may be only an ideal.

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