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Rosenfeld, S.K. Sprince, M.P. (1963). An Attempt to Formulate the Meaning of the Concept "Borderline". Psychoanal. St. Child, 18:603-635.

(1963). Psychoanalytic Study of the Child, 18:603-635

An Attempt to Formulate the Meaning of the Concept "Borderline"

Sara Kut Rosenfeld and Marjorie P. Sprince

SUMMARY

When we started to work as a group the term "borderline" was used roughly for those children who at the time of referral suffered from severe ego disturbances but whose behavior was not yet frankly psychotic—that is to say, they were not yet "over the border." We do not yet feel sure that successful treatment reversing the borderline process necessarily indicates that we may not have been handling a potentially psychotic person. It may well be that such a patient might without treatment have developed an overt psychosis, or he might have remained a borderline psychotic. Borderline psychotics

living in a benign environment may be spared a breakdown, while external stress usually exacerbates their condition.

Our observations in general confirm the findings of those authors who believe the fact of ego deviation to be of vital significance. We nevertheless do not feel sure that assessment of the degree and multiplicity of ego deviation alone will help us to distinguish between the borderline and the schizophrenic.

It seems to us that the crucial area for assessment and prediction would be the assessment of the capacity for internalization and inner representation based upon object cathexis. We believe that the stages of development in this area could be studied in minute detail and pin-pointed more accurately. It could be that this capacity for object relations and inner representation determines the outcome of the disturbance and indicates treatment possibilities. The type of treatment chosen would depend upon the capacity for maintaining object cathexis for any length of time.

No single disturbance in any one area would indicate a borderline disturbance. It is the multiplicity of deviations in all the areas we have discussed, together with this failure in maintaining object cathexis, which we think may be decisive. The degree of borderline disturbance varies from case to case, and there seems to be a sliding scale into which we would like to be able to fit our cases. This hierarchy would apply to every aspect of the personality that we have described. It is possible, however, that a child may be on a different level in each area. Hartmann (1952), discussing the reversibility of ego functions due to conflicts and regressive tendencies in different individuals, points to the variations in the degree to which ego functions maintain their stability even in what we call healthy adults. He suggests that this partial reversibility is, in the normal person, not incisive enough to create serious trouble. We have tried to emphasize that the reversibility of ego functions in our borderline children is particularly labile.

Broadly speaking, we are all fairly clear about the border between neurotic and psychotic. However, we do not seem to be as clear about the border between psychotic and borderline.

The children we have used for this study have been diagnosed as belonging to the borderline group. Examining their analytic material, we have found indications of specific characteristics:

1. Although the bisexual conflict is always present, it does not seem to be at the center of their disturbance as has been postulated by Katan and others. Rather, the majority of our cases has not attained a phase of phallic dominance, and their oedipal material appears to have an "as if" quality.

2. In all our cases the ego apparatus appears to be faulty, which may be due to inherent or traumatic factors. Although the origin of the fault cannot be precisely pin-pointed, there is evidence that it exists already very early. Moreover, there seems to be some connection between this fault and an early disturbance in the capacity to select and inhibit stimuli. In spite of this, considerably high-level ego functioning is observed in all our children, but with characteristic instability.

3. We have found in our cases that anxiety is characterized by primitive feelings of disintegration and annihilation and that signal anxiety is itself experienced as an overwhelming threat rather than as a warning to the ego of impending danger.

4. Finally, we have taken as our main point Anna Freud's remarks on the precarious maintenance of object cathexis and the ease with which it slides over into identification. It may well be that the weak object cathexis is linked with the instability of the object representation. Many difficulties seem to stem from this, and many of the symptoms seem to represent a defense against this process. This together with the other points mentioned above, and the relatively correct reality testing, may point to a borderline rather than a psychotic state. Freud (1924) said, "A loss of reality must be an inherent element in psychosis."

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