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Willick, M.S. (1987). Borderline Psychopathology and its Treatment: By Gerald Adler, M.D. New York/London: Jason Aronson, Inc., 1985. 255 pp.. Psychoanal Q., 56:553-558.
(1987). Psychoanalytic Quarterly, 56:553-558
Borderline Psychopathology and its Treatment: By Gerald Adler, M.D. New York/London: Jason Aronson, Inc., 1985. 255 pp.
Review by: Martin S. Willick
This is a welcome addition to the literature on borderline disorders. It clearly and concisely formulates the author's understanding of the way in which failures in development contribute to the borderline syndrome, and there are many clinical illustrations of the way he uses his understanding in treatment.
Although many psychoanalysts feel, as I do, that the term borderline refers to a broad, heterogeneous group of disorders, Adler restricts the term to patients with certain cardinal symptoms of terror of an utter aloneness that feels like annihilation, feelings of inner emptiness, panic, and intense separation anxiety. He stresses that these patients lose the capacity to hold on to the memory of important objects when separated from them.
Adler concurs with Otto Kernberg's formulation that traces the disorder to the very young infant's inability to integrate self- and object representations, which are established under the influence of libidinal drive derivatives, with those associated with aggressive drive derivatives. Nevertheless, he feels that this "ambivalence theory" does not satisfactorily explain the feelings of utter aloneness, emptiness, and annihilation panic. He writes:
I believe that the quality and organization of introjects is important in the development and treatment of the borderline disorder, but at a later point in development and at a later time in treatment than is generally supposed. Even more crucial to borderline psychopathology, in my view, and even more significant for treatment, is a functional insufficiency and correlative instability of certain kinds of introjects and identifications that are needed to sustain the psychological self.
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