Borderline Personality Disorder: A Lacanian Perspective

Borderline Personality Disorder: A Lacanian Perspective


To Elisa, my mother En ella y solo en ella estan ahora Los patios y jardines. El pasado Los guarda en ese circulo vedado Que a un tiempo abarca el vespero y la aurora. - Jorge Luis Borges ( El Hacedor, 1960)

Borderline Personality Disorder: A Lacanian Perspective

Borderline Personality Disorder: A Lacanian Perspective


Table of Contents
Preface xi

Acknowledgements The Borderline Concept in America Difficulties in the Definition and Study of the Borderline Patient Early Conceptions of Borderline Pathology Psychological Testing Models Borderline Pathology in Descriptive Psychiatry Post-traumatic and Dissociative Models Borderline Personality in the “DSM” Psychoanalytic Conceptions of the Borderline Early Psychoanalytic Contributions Frosch’s Psychotic Character Later Psychoanalytic Theorists II. Otto Kernberg and the “Borderline Conditions” Post-Freudian Developments In Psychoanalytic Theory “Object Relations” Kernberg’s Theory of the Borderline The Descriptive or “Presumptive” Diagnosis Kernberg’s Structural Analysis The Id in the Borderline Structure




2 6 8 8 11 12 13 13 15 17

21 21 22 25 27 29 35

Lacanian Psychoanalysis The History of Psychoanalysis in France Structuralism Linguistic Structures Lacan’s Novel Psychoanalytic Ideas The Mirror Stage: The Scenario of Ego formation Lacan’s Critique of Developmental Psychoanalysis The Symbolic Order Lacan’s Conception of the Oedipus Complex The Three Stages of the Oedipus Complex The Prohibition of Incest The Imaginary. the Symbolic and the Real The Unconscious Jouissance Need – Demand – Desire Diagnostic Considerations in Psychoanalysis Structure and Diagnosis Psychosis Neurosis The Hysterical Structure Hysteria in Men Obsessional Neurosis Phobia 35 36 38 40 41 41 43 45 49 50 54 55 59 63 65 66 70 72 74 75 76 80 81 84 91 93 97 98 102 .viii Borderline Personality Disorder: A Lacanian Perspective The Superego in the Borderline Structure The Genetic-Dynamic Analysis and Developmental Theory Kernberg’s Three Psychic Structures The Interview as a Diagnostic tool Empirical Assessment of Structural Diagnosis The Clinical Value of Structural Analysis III.

Borderline Personality Disorder: A Lacanian Perspective Perversion IV. Katherine as a Lacanian Patient The Demand for the Desire of the Other Identity or Desire? The Didactic Phase of Treatment From Interview to Treatment Lacanian Structural Diagnosis The Analysis of Two Dreams 127 131 131 134 135 136 136 103 ix 108 109 110 112 113 120 121 122 124 124 126 140 140 143 144 145 145 147 . Katherine as a Kernbergian Borderline Katherine as a DSM-IV Patient Kernberg’s Presumptive Criteria Kernberg’s Structural Diagnosis The Structural Interview Katherine: The Diagnostic Interview Identity Diffusion: Neurotic Integration vs. Borderline Fragmentation Use of Primitive Defense Mechanisms Projective Identification Assessment of Reality Testing Non-specific Ego Weaknesses Lack of superego Integration Excessive Pregenital Aggression VI. The Case of Katherine Katherine: The Presenting Problem Family Structure and Childhood History Work History Course of Treatment V.

Lacan and the Borderline Conditions Elements of a Lacanian Critique of the Borderline Concept The Merger of Psychiatry and Psychoanalysis The Critique of the Role of the Symptom The Treatment of Borderlines The Role of the Ego and the Ethics of Psychoanalysis Lacan and Family Therapy The Pre-Oedipal vs. Philosophical and Ethical Considerations The Borderline Diagnosis in Children and Adolescence Criticisms of the Borderline Conception in Children The Present Study and the Borderline Concept in Children and Adolescents Limitations of Interpretive Theory 184 184 187 199 173 175 179 181 151 152 153 155 157 162 164 164 165 166 167 169 169 170 171 172 Bibliography Index .x Borderline Personality Disorder: A Lacanian Perspective Oedipal Vicissitudes Katherine's Subjectivity Lacanian Inter-generational Analysis The “Name of the Father” Katherine as a Neurotic Individual VII. the Oedipal Controversy The Critique of Object Relations Theory Borderline Structure as Part of the Human Condition The Continuum of Diagnosis The Rise of the Borderline and the Decline of Hysteria and Perversion Empirical.

psychosis. When one surveys the literature readily available to American clinicians. rather than the patient. Nevertheless. One reason for this is that a major theoretical gulf exists between American and European/South American psychoanalysis. the borderline diagnosis has been largely ignored amongst psychoanalytically oriented clinicians in Europe and South America. T he diagnosis of borderline personality organization has taken its place in American psychoanalysis as a personality structure. in some quarters. 1956). and skepticism towards any approach that insists upon adding to this scheme. even eclipsed the traditionally recognized . but less than a handful of such comparative purpose. in spite of a recent surge in interest in Lacan in the United States (mostly outside departments of psychiatry and psychology) there has been very little dialog between American psychoanalysts and Lacanians on any issue of theoretical or clinical significance. psychosis and perversion. the significance of which has equaled and. Within Lacanian thought.Borderline Personality Disorder: A Lacanian Perspective xi Preface structures of neuroses. who is “undecided” and on the “border” between the traditional structures (Lacan. and perversion. there is a theoretical and clinical emphasis upon the three Freudian structures of neuroses. However. Lacan’s own reaction to the concept of the “borderline” seems to have been that it is the clinician him or herself. In fact. a gulf that can in part be attributed to the dominance of egopsychology and object-relations theory in the United States and an equal dominance of the theories of Jacques Lacan in such places as France and Argentina. there has yet to be a systematic dialog between American psychoanalysts and Lacanians on the question of the borderline diagnosis. one finds hundreds of books and articles pertaining to Lacan.

can profitably be understood and treated as a case of neurosis within Lacan's diagnostic scheme." a 25 year-old woman who the author saw for three years in psychoanalytically oriented therapy is presented and analyzed from both Kernbergian and Lacanian points of view. More specifically. I hope to demonstrate how Lacanian ideas can be of significant value in the diagnosis and treatment of individuals suffering from severe pathology. and that an alternative mode of treatment exists for these patient that is not dependent upon our accepting the borderline concept. by comparing the psychoanalytic theories of Otto Kernberg and Jacques Lacan in the context of the borderline diagnoses. I seek to initiate and contribute to a long overdue dialog between American and French psychoanalysis. It is shown that Katherine. borderline pathology is fundamentally a descriptive category that does not cohere from a theoretical. The case of "Katherine. By promoting such a dialog I hope to make a contribution that may help refine both theory and clinical work with the severely disturbed patients who have been designated “borderline” by Kernberg and others. Generally. The question of whether those patients described by Kernberg as structurally borderline. The reasons for this will become evident in this book. 2008 . do in fact constitute a homogenous group from the perspective of Lacanian theory is a critical one. and the conclusion that I drew is that from a Lacanian perspective. “structural” point of view.xii Borderline Personality Disorder: A Lacanian Perspective The present study seeks to make contributions of both a general and specific nature. June. psychotic or perverse structure. Liliana Rusansky Drob New York. who readily meets Kernberg's presumptive and structural criteria for Borderline Personality Disorder. As the main vehicles for this study I have chosen both a critical and comparative review of theories of Otto Kernberg and Jacques Lacan and an analysis of an illustrative case. and it will also become clear that from a Lacanian perspective a Kernbergian “borderline” may well have a neurotic.

my dissertation chairs at Pace University. Paola Mieli. Florence Denmark. I am especially grateful to my husband. my psychoanalytic supervisor who helped me clarify my own questions and who has worked with me throughout many years of clinical supervision and Lacanian readings. . Beth Hart and Dr. for their interest in my clinical work and their support of a psychoanalytically-based doctoral thesis. whose support and psychological knowledge has made possible for me to think aloud on the questions of diagnosis and who has become a role model to follow in his persistence in the completion of a written project. I would also like to thank Dr. Sanford Drob.Borderline Personality Disorder: A Lacanian Perspective xiii Acknowledgements I would like to express my gratitude to Beatriz Azevedo. I am greatly indebted my analyst. who has never given up on my path of articulating my desire.


leaving no room for this “fourth” pathology which plays such an important role in American diagnosis and treatment. no equivalent acceptance of the borderline concept is to be found amongst European analysts. While most American psychoanalysts regard borderline pathology as a distinct nosological entity requiring a specific dynamic formulation and therapeutic technique. object relations. Lacan. specifically rejected the borderline concept. much of Europe and South America. and his view that by virtue of language we are constantly “miscommunicating”. Single White Female. his notion that the ego is a center of misperception and untruth. whose “return to Freud” has dominated psychoanalysis in France. Lacan preferred to adhere to Freud’s basic nosological distinctions between neurosis. psychosis. tacitly denying that there are borderline patients. Films such as Fatal Attraction. Since the borderline conditions are conceptualized as a failure in the development or regulation of the ego or self. A number of factors have hitherto prevented a meaningful dialogue between American ego. In particular. and Girl Interrupted seem to have been written with this diagnosis in mind. who rejects .The Borderline Concept in America Chapter One The Borderline Concept in America I n recent years. and self psychologists and their counterparts in France. Jacques Lacan. Amongst these. and perversion. are Lacan’s radically different conceptualizations of the ego and his rejection of “a unified subject”. holding that it is the analyst who is on the “border” in his understanding of a difficult case. the topic of “borderline personality” has not only come to dominate discussions in clinical psychiatry and psychoanalysis but has filtered down into segments of American culture as well. and in some circles the term “borderline” is used indiscriminately in a derogatory manner to refer to any difficult personality. especially if young and female.

Nevertheless. Further. . How these patients are conceptualized and treated within a Lacanian framework will not only provides us with a great deal of insight into the distinction between Lacanian and American psychoanalysis. Difficulties in the Definition and Study of the Borderline Personality Clinicians have long described patients who either bordered on schizophrenia or appeared to have features of both neurosis and psychosis. In general. The first. appears to have little place for borderline pathology in his conceptual framework. A careful analysis of this issue will be helpful in discerning not only the points of contrast amongst the respective schools of thought but also points of (thus far) unrecognized convergence as well. Patients have been classified as “borderline” according to a variety of not always consistent criteria. 1985). the “psychoanalytic” or “structural” approach. there have been three main approaches to the classification of such patients. 1960). Dellis. a clarification of the reasons for this rejection and the alternative conceptualizations and techniques proposed by Lacan should be helpful in establishing a dialog between these two camps. and classifies such patients on the basis of their performance on psychological tests (Stone. groups patients not on the basis of symptoms but rather on the basis of a presumed underlying psychological dynamic or “structure” that individuals with varying symptoms and behaviors share in common. but should also provide us with a fresh perspective on the treatment of such patients. which has been termed the “descriptive” approach.2 Borderline Personality Disorder: A Lacanian Perspective the notion that there is an ego that must be regulated and developed. it is clear that Lacanians are indeed treating many patients who American clinicians would diagnose as borderlines. A third classificatory approach shares some features with each of the first two. since the rejection of the borderline concept is one factor preventing a meaningful dialogue between American and French psychoanalysts. The second. is based exclusively on symptomatic and behavioral observations. some of which emerged as a result of specific methodological tools that are utilized in the study of varying populations (Gunderson and Singer.

1970). although often working in the same or similar settings as descriptive psychiatrists. the communication of findings and theory is often limited to a select audience. Psychodynamic theorists argue that the specific features necessary for adequate dynamic/structural diagnosis only emerge in the context of the intensive interpersonal encounter of psychoanalytic treatment. outpatient clinical work. are found to exhibit specific patterns of transference. etc (Hoch. response to treatment. while another will be limited to .al. research studies on borderline subjects have set varying selection criteria for their samples. who have diagnosed the borderline syndrome thorough the administration of a battery of psychological tests. defense. for example. Singer. who in the course of psychotherapy. and are largely opaque to standardized empirical research. resistance. as a result of a variety of factors. Over the years. Finally. generally publish their findings in specialized journals with limited readership among other mental health disciplines (Gunderson. Frequently these classificatory methods also vary according to the setting in which they are employed. sources and personal biases. whereas psychoanalytic formulations have evolved mostly within the context of private. the dynamic/structural approach has traditionally been limited to intensive work with individual patients. or even similar.The Borderline Concept in America 3 These three classificatory methods are most often utilized in connection with widely varying sources of data and widely divergent ways of conceptualizing such data. it is frequently the case that behavioral and symptomatic observations are conducted by psychiatrists in hospital or other residential treatment settings. et. For example. 1968). those utilizing different classificatory approaches may not actually be referring to the same. Whereas the descriptive. patient populations. and to a certain extent. It may well be that the so-called inpatient borderline subjects will present symptoms and structures that are quite different from those of their outpatient counterparts and that those seen as borderline in public settings may be quite different from those who are so classified as borderline in private practice (Grinker. Adding to the confusion regarding the borderline diagnosis is the fact that. One study may include outpatients with or without overt psychotic symptoms such as delusions and hallucinations at the time of the study. are amenable to wideranging empirical studies that examine a large sample on the basis of standardized criteria. the various groups working with so-called borderline patients are often suspicious of each other’s methodology. 1959). psychological testing approaches. Psychologists. Further. Catell.

and socio-economic factors debated in the literature. (3) nature of the data base—empirical studies. a major controversy exists regarding the etiology of this condition. with the role of early childhood trauma (particularly sexual abuse). (Gunderson. and (4) selection criteria for the “borderline” classification. four major variables may be considered in any description of the so-called borderline patient: (1) Methods of classifying patients—descriptive. However. while psychoanalysts have taken a lead in examining this condition. structural. Empirical studies using the psychoanalytic model focused on the borderline personality disorder have been developed in the last twenty years (T. the borderline personality was by far the best researched of the personality disorders. in contrast. he posited that unless there was external validation of the criteria or some level of predictability based on family prevalence or course of illness. For example. While there is a relatively high degree of agreement on the phenomenology of the borderline disorder. public. Others. et. It is clear that patient selection has impacted upon the conclusions reached regarding the borderline diagnosis and its relationship to schizophrenia. al (1968) who conducted a widely recognized long-term study of borderline patients. such as Grinker. When Gunderson was approaching the issue of borderline diagnosis from an empirical point of view. (2) settings in which research is conducted—inpatient. other parenting factors. 1989). or intensive psychoanalytic psychotherapeutic investigation. the diagnosis would not sustain inclusion in the DSM-III.. In summary. feelings and physiological functioning. if not before. psychological testing. had an expected subgroup of schizophrenics amongst their patients. genetic predisposition. outpatient. Hoch and Catell. and there is even a . he insisted on including two criteria that were essentially psychoanalytic: vulnerability to regression and psychosis under transference-like conditions. private. Whereas Grinker found very few subjects with psychotic episodes at the end of the study. Hoch and Catell (1959) selected their patients on the basis of severe psychoneurotic symptoms but later found on closer evaluation during psychotherapy performed by psychoanalysts that these very patients exhibited signs of schizophrenia in their thinking. indeed accounting for the majority of scientific publications on this topic (Efrain Bleiberg. Further. selected subjects on the basis of good functioning in between hospitalizations and the presence of an ego alien quality to any psychotic symptoms. 1975) Certainly by 1990. 1995).4 Borderline Personality Disorder: A Lacanian Perspective inpatients who exhibited brief psychosis either on mental status or in their recent psychiatric history.

However. but rather to focus upon the meaning. is that during the years of the borderline concept’s initial formulation (roughly. the major drives and their vicissitudes. I do not intend in the course of this study to examine the diagnosis of Borderline Personality Disorder in every conceivable context. After doing so we will be in a position to explore some of the reasons why this diagnosis failed to emerge among psychoanalysts practicing outside of North America. This study focuses upon the borderline diagnosis within the context of psychoanalytic theory and treatment. the function of the ego. I will not elaborate in detail on the descriptive or psychological testing investigations of the borderline phenomena. . suggesting that psychoanalytic structural classification may not (in spite of Kernberg’s affirmations) correspond to the descriptive (DSM) Borderline Personality Disorder syndrome. As a result. In addition. and utility of this diagnosis within the context of psychodynamic theory and treatment. the emergence of the borderline concept in American psychoanalysis initially involved a confluence of both descriptive and psychoanalytic formulations. one might expect different formulations regarding so-called borderline patients among different psychoanalytic theoreticians and schools. American psychiatry was far more closely identified with psychoanalysis and developmental psychology than it is today. 1941-1975). Without discounting their significance. Part of the reason for this. relevance. only by tracing the roots of the borderline concept first within descriptive psychiatry/psychology and then within psychoanalytic and developmental theory can we come to understand its emergence as an important diagnosis amongst American psychoanalysts.The Borderline Concept in America 5 certain level of agreement regarding the psychostructural characteristics of these patients. many analysts who considered the borderline diagnosis (Kernberg among them) were profoundly influenced by developmental theorists who worked within academic psychology. Since the nature of the borderline disorder goes to the heart of psychoanalytic ideas regarding the nature of the human subject. except insofar as these methods impact upon psychoanalytic theory. etc. the psychoanalytic literature lacks nosological congruence with the general psychiatric descriptions.

(Prichard. schizophrenia simply represented a disorganization of psychic functions. Prichard’s initial patient was described as presenting with perverse feelings. However.C. the general trend for at least the next decade was to group all such “morbid personalities” under the diagnosis of “psychopathy” and again. Bleuler reopened the investigation of the field of severe non-psychotic disorders. the concept of “moral insanity” came to be restricted to antisocial individuals. Kraepelin described the first group as childish.” He viewed this condition as a “borderline state” between insanity and normalcy. 1835). the German psychiatrist who is often credited with being the founder of modern descriptive psychiatry. presumptuous. the “borderline” disorders fell into a state of neglect. A decade later. 1835). without a defect in his or her reasoning faculties and mainly without illusions or hallucinations. and temper. and the other types of dysfunction noted by Prichard were largely ignored. selfish. Although it appears that he was attempting to describe what might now be classified as personality disorders. took a keen interest in what had been referred to as “morbid personalities. Prichard (Treatise of Insanity. For Kraepelin. (2) liars and swindlers (who by today’s descriptive criteria would be classified as antisocial). First. and with no sympathy for others. Emil Kraepelin (1905). in spite of their eccentricities. Bleuler also described two forms of non-psychotic . irritable. For Bleuler. dementia praecox had represented the end-state of a chronic psychiatric deterioration. Bleuler questioned the term dementia praecox used by Kraepelin and replaced it with the term schizophrenia. unmanageable. Kraepelin even created a nosology of subtypes of the morbid personalities: (1) patients with instability of will (who probably come close to today’s borderlines). were not cognitively deficient and could even be gifted intellectually. habits. He referred to a syndrome of “moral insanity” which he characterized as “a form of mental derangement in which the intellectual faculties appear to have sustained little or no injury”. overbearing. and (3) “pseudoquerulous” individuals (who might be regarded as paranoid personalities). emphasizing that such individuals. He presented several different combinations of healthy and abnormal personalities.6 Borderline Personality Disorder: A Lacanian Perspective Early Conceptions of Borderline Pathology According to Salman Akhtar (1992) the earliest tentative description of a mental disorder that was not clearly viewed as insanity was made by J.

Bleuler’s contribution was to broaden the scope of severe non-psychotic psychopathology. a series of researchers were encouraged to embark on clinical and empirical studies of a group of unstable individuals who were thought to be neither neurotic nor frankly psychotic and who. From then on. He discarded the term “borderline” as he viewed these patients as a subtype of schizophrenia. They viewed these patients’ symptoms as pathognomonic of schizophrenia but noted that their schizophrenic signs were often evident in subtle rather than global ways. These he termed simple and latent schizophrenias. expanding the field of clinical psychiatry to the realm of the personality disorders. Although these patients appeared to be neurotic. Hoch and Polatin (1949) described a condition which they termed “pseudoneurotic schizophrenia”. Their sexual life was characterized by promiscuity and perversion.” These patients presented with a “normal” appearance. accompanied by shallow emotionality. murderers. which was. They displayed multiple severe neurotic symptoms. required not only a new diagnostic category but psychotherapeutic interventions tailored to their particular level of pathology. Hoch and Polatin again emphasized the fact that these patients were not “borderline” but a subtype of schizophrenia. in these researchers’ views. an incapacity to settle on one job or life pursuit. and sexual perverts. dereistic thinking. Although the psychiatric community did not accept their conceptualizations at the time. however. .The Borderline Concept in America 7 disorders characterized by the absence of hallucinations but with a tendency to turn to fantasy in place of reality. were extremely sensitive to criticism and often presented with expressions of extreme rage. He included among this group psychopathic personalities. Zilboorg noted that these patients were able to function without the need for hospitalization. Hoch and Polatin provided a convincing description of pathology in which neurotic and psychotic symptoms at least appeared to overlap. disorders which today would be descriptively classified under schizotypal personality disorder. No area of their functioning was free from conflict and tension. and an inability to sustain friendships. Zilboorg (1941) described a group of patients that he called “ambulatory schizophrenics. Hoch and Polatin held that behind this façade rested the core features of schizophrenia.

confabulatory and highly elaborate Rorschach responses. 1946). Gil and Schaeffer (1945-6) also provided evidence of preschizophrenic patients who on psychological testing showed weak ego structures and a prevalence of primary process thinking. . as early as 1921. Singer 1977). Herman Rorschach (1921) himself described a subgroup of patients whom he described as “latent schizophrenics” who presented with appropriate surface behavior but whose responses to the inkblots contained elements common to those provided by schizophrenics. provided further impetus to the study of a group of patients who. Grinker et al.” scattered attentional processes. conducted a study of 53 hospitalized patients in order to establish criteria for the diagnosis of borderline personality. He further suggested that borderlines give a higher percentage of emotionally charged responses in the context of simple percepts (Rapaport. Rorschach investigators have generally agreed that such patients do not exhibit similar ideational patterns on more structured cognitive and intellectual testing. However.1945. these patients typically provide fabulized. suffered from an underlying fragile. These authors described a group of such patients who showed a predominance of primary process thinking when presented with unstructured tests like the Rorschach. and a primitive quality of ideas and associations all suggest the presence of primary process thinking. Borderline Pathology in Descriptive Psychiatry In 1968. Indeed. “close to the surface” in such latent schizophrenic individuals. (2) defective interpersonal relationships. According to Rapaport (1946). the presence of self-referential answers. These investigators used 93 behavioral criteria and arrived at what they held to be four fundamental characteristics of the borderline syndrome: (1) chronic anger. the belief that the cards are “real. although functioning relatively well in social situations. (3) identity disturbance. For example. and potentially psychotic personality core.8 Borderline Personality Disorder: A Lacanian Perspective Psychological Testing Models The field of psychological testing (Rapaport et al.

especially those precipitated by drug use or in the context of intense intimate relationships. the borderline diagnosis continued to be criticized (Liebowitz. (2) The core borderline. However. it was criticized. In spite of Gunderson’s and Singer’s synthesis. . characterized by chronic rage and impulsive self-destructiveness. grossly inappropriate behavior. and (6) disturbed interpersonal relationships. lacking in authenticity. characterized by problems in reality testing.The Borderline Concept in America 9 and (4) depression rooted in feelings of loneliness. outbursts of rage. characterized by a rapid swing from dependency and passivity to manipulative and over-demanding behavior. (4) Individuals with chronic anxiety and anaclitic depression. as a group of affective disorders and finally as a psychostructural substrate underlying all severe pathology. (4) brief psychotic experiences. (2) lack of social adaptation. as a form of schizophrenia. A cluster analysis of their data yielded four subcategories of the borderline syndrome: (1) The psychotic borderline. as a result of identity confusion. identity disturbance. Through an analysis of the data of other investigators they arrived at specific criteria that they believed would establish the borderline disorder as a discrete diagnostic entity. (3) The as-if individuals. (5) bizarre and primitive responses on psychological tests. One reason for this was that the term “borderline” continued to be used in a variety of ways: either as a discrete diagnosis. and depression. The Grinker study was the first large-scale attempt to sort borderline patients via descriptive psychiatric criteria. (usually hostile and/or depressed). Gunderson and Singer’s six criteria were: (1) intense affect. Gunderson and Singer (1975) attempted to define the borderline conditions and clarify the confusion that at the time reigned with respect to this diagnosis. particularly for its poor inclusion and exclusion criteria and the lack of weighted criteria for the diagnosis of borderline personality. (3) impulsive behavior with self-destructive tendencies. As early as 1975. leading false lives with superficial relationships. characterized by a dependence on a pregenital love object such as the mother. negativism. 1992).

This represented an advance in the field. Sheehy reached conclusions similar to those of Spitzer but held that there are three core characteristics of borderlines: 1impulsivity. Gunderson and Kolb (1978). and there was an increasing .unstable affect. the diagnosis if borderline personality came to be generally accepted within clinical psychiatry and psychology. and 3. initiated a new comparative study among borderlines.interpersonal difficulties. Spitzer produced his own list of eight criteria: 1-anger. including low school and work achievement. (3) periods of social withdrawal and (4) chaotic sexual life with a tendency towards promiscuity. 2. (1) absence of hypochondriasis. 1980) compared a group of borderline patients with a matched control group of other personality disorders.10 Borderline Personality Disorder: A Lacanian Perspective Investigators continued the attempt to identify a series of symptoms that would define the borderline syndrome. was added that proved to be highly discriminatory for this group.000 members of the American Psychiatric Association. Spitzer (1979) and his colleagues created a list of criteria with 17 items based on Gunderson’s 1978 study and sent it to 4. working with the National Institutes of Mental Health.intense affect. 4-identity disturbance. In 1979. To Spitzer’s original eight criteria. 2.intolerance to aloneness.intense emotional relationships characterized by shifts between devaluation and idealization. 3-chronic feelings of emptiness and depression. and a singular motivation to avoid aloneness. 7-impulsivity. Eight hundred and eight participants responded that using these criteria they could discriminate a borderline from a nonborderline 88 % of the time. He asked the participants to judge the list’s discriminating ability. A second set of investigators (Sheehy. dissociative experiences. (2) absence of obsessive compulsive symptoms.physically self-damaging acts. as borderlines were here compared with other personality disorders instead of being compared to schizophrenics and those with affective disorders. depressed neurotics and schizophrenic patients. superficially high levels of socialization. 5. these investigators added four additional criteria. (related to substance use) and 8. From the 1970’s to the 1990’s. several psychosocial factors were included as additional criteria. sexual promiscuity. As a result of this study. 6. Although Spitzer called this hypothetically distinguishable condition “unstable character” rather than “borderline. Later a ninth criterion.” his study provided some evidence for the hypothesis that there was a descriptively identifiable borderline patient.

the “borderline” . 1990). during this period.” These patients. a style that is best accounted for in the context of a posttraumatic stress model. and even psychotic-like symptoms that had become the coping style for borderline patients. which in later life returns as an alien “voice. hyperarousal. As such. Such patients (who at one time might have been diagnosed as suffering from “hysterical psychosis”) are thought to have developed their pathology as a result of defenses they put in place in response to early childhood trauma. according to those who study the dissociative disorders. avoidance. 1975) and others that emphasize the connection between the borderline and affective disorders. are qualitatively distinct from schizophrenics.The Borderline Concept in America 11 interest in this topic amongst both researchers and clinicians. whereas the borderline/dissociative has the biological equipment to develop properly.g. Accordingly. dissociation. Post-traumatic and Dissociative Models More recently a number of clinicians have come to see borderline personality as a disorder of chronic post-traumatic stress (Bleiberg. auditory hallucinations) that is often observed in dissociative (and borderline) patients. though they are often mistakenly given the latter diagnosis because of their bizarre behavior and symptoms. in particular sexual abuse. Later in life any pattern of further re-traumatization produces the impulsive acting. These clinicians suggest that a history of trauma. (Klein 1975). who as a result of early childhood trauma have split off (dissociated) aspects of their identity. In general. we find studies and conceptualizations that link borderline conditions to the schizophrenic spectrum of disorders (Kety et al. Along these lines it might be argued that a qualitative distinction can and should be made between the true psychosis found in genuine schizophrenic spectrum disorders (which is believed to be biologically based) and the apparent psychosis (e. but doesn’t do so because of an abusive and unstable early environment. in addition to psychoanalytically based work. the borderline patient was exposed to a traumatic event that produced an overwhelming stress response. On this view the schizophrenic is unable to develop a stable ego and identity because of a biological failure. is present in the borderline patient.

6) Affective instability due to a marked reactivity of mood (intense episode lasting only a few hours). much of it related to the differential diagnosis between borderline personality and affective disorders. sex. 4) Impulsivity in at least two areas that are potentially self-damaging (e. 8) Inappropriate intense anger or difficulty controlling anger. self-image and affects. 7) Chronic feelings of emptiness. At the present time. gestures. or threats or self-mutilating behavior. 2) A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. published in 1980. 9) Transient. .g. and marked impulsivity beginning by early adulthood and present in a variety of contexts. spending. as indicated by five or more of the following criteria: 1) Frantic efforts to avoid real or imagined abandonment. binge eating). From that point on there was a veritable explosion of literature. 3) Identity disturbance: markedly and persistently unstable self-image or sense of self. stress-related paranoid ideation or severe dissociative symptoms. 5) Recurrent suicidal behavior. Borderline Personality in the “DSM” The American Psychiatric Association officially acknowledged the Borderline Personality Disorder for the first time in the version of their Diagnostic and Statistical Manual (DSM-III). substance abuse.12 Borderline Personality Disorder: A Lacanian Perspective psychoses are purely defensive/dynamic in nature and wax and wane in response to environmental demands. the DSM-IV describes the Borderline Personality Disorder as follows: …”a pervasive pattern of instability of interpersonal relationships. reckless driving.

In this section I will review the earlier psychoanalytic contributions to the borderline diagnosis and. can be markedly different. two patients diagnosed with the Borderline Personality Disorder. with the notable exception of Kernberg and his school (which will be reviewed later) some later psychoanalytic conceptions of the borderline personality. even from a descriptive point of view.The Borderline Concept in America 13 These criteria do not vary much from those proposed by Spitzer or Sheehy in the early 1980’s. with its emphasis on ego development and defenses provided fertile ground for developing an understanding of these patients’ intrapsychic structure and dynamics and provided a significant avenue for the investigation of this “new diagnostic entity” that had been suggested by more descriptive research. Stern (1938) was perhaps the first psychoanalyst to utilize the term borderline to refer to a distinct pathological entity in between neurosis and psychosis. Early Psychoanalytic Contributions A. as defined by DSM-IV’s descriptive criteria. He described borderline . It should be noted that since only five out of nine possible criteria must be met in order to reach the diagnosis. we must turn to a psychoanalytic understanding of the borderline concept. Psychoanalytic Conceptions of the Borderline Patient In an effort to clarify the underlying psychological characteristics that characterize borderline patients from a deeper (and not merely descriptive) point of view. While a psychoanalytic model is not the only possible means of conceptualizing the “deep structure” of psychopathology. in the case of borderline personality. The early psychoanalytic contributions to the borderline diagnosis helped set the stage for more systematic psychoanalytic investigations of severe (borderline) psychopathology in the 1970s and later. it has been the American psychoanalysts who have made the most persistent efforts in this direction. American psychoanalysis.

with the result that the child succeeds in placing the negative object outside. in the depressive position these emotions are redirected into feelings and expressions of gratitude. However. Each of these mechanisms took an important place in later psychoanalytic theories of the borderline structure. These individuals suffer from an inner feeling of emptiness. marked . the innate helplessness of the infant is an early expression of the death drive which floods the child with negative emotion. at the expense of experiencing “persecutory anxiety” from this object as a retaliatory response. including a history of cruel. destruction and greed. the infant later integrates these two parts in what Klein describes as the “depressive position. rejecting mothering. If this process of integration does not occur. Stern found his borderline patients to be poor candidates for psychoanalysis and characterized them as exhibiting ten basic features. the paranoid position governs the personality organization with splitting as the characteristic mode of defense. hypersensitivity to criticism and rejection. Melanie Klein’s contributions (1939) were particularly relevant to the borderline concept. a new defense mechanism arises that serves to protect the ego from aggression: a splitting of the object into good and bad aspects (This is what Klein terms “the paranoid position”). guilt. Whereas in the paranoid position the child is plagued by envy.” with a resultant change in the child’s affective organization. of specific importance were her descriptions of splitting of object representations and her illuminating discussion of the defense mechanism she termed projective identification. and in this sense prepared the ground for Kernberg’s later conceptualization of a stable structural organization of the borderline conditions. masochism and depression. This negative affect is projected onto the caretaker. defensive rigidity.14 Borderline Personality Disorder: A Lacanian Perspective pathology as a stable intrapsychic entity. pervasive inferiority and lack of self-assurance. sadness and reparation. According to Klein. We will see that such “splitting” provides an important organizing principle in Kernberg’s later conception of borderline pathology. the use of projection. The maintenance of this split brings about an idealization of the good part of the object and sadistic expressions towards the bad part of the object. In order to allay this anxiety. In 1942 the psychoanalyst Helen Deutsch used the term as-if personality to describe patients who appeared to be normal but whose personality is conditioned by pathological internalized objects. Stern also described these patients as frequently experiencing a negative therapeutic reaction to psychoanalytic interventions. and problems in reality testing.

Perceptual disturbances such as hallucinations and illusions are. which relate to the ability to experience one’s self and body. with the relative retention of the capacity to test reality. they demonstrated a number of weaknesses in such ego functions of concept formation. but were sufficiently realityoriented to know that their perceptions were indeed not real. Deutsch felt that these patients were somewhere on the continuum between neurosis and psychosis and that they had failed to integrate early identifications into a stable personal identity.The Borderline Concept in America 15 passivity. as real and familiar. Examples of . 2) The feeling of reality. is a measure of adaptation. While these patients were superficially adapted to the environment and were not obviously psychotic. planning. Frosch’s contributions centered on his conceptualization of “reality” in regard to which he described three distinct components: 1) The relationship with reality. judgment. and the capacity to defend themselves against primitive unconscious impulses. along with external events. (Frosch. In 1953. Knight used the term “borderline” to refer to individuals whose weakened ego structures placed them midway between neurosis and psychosis. However. distortions in the relationship with reality. for Frosch. suggestibility.g. or defects in the sense of reality. This. such disturbances are transient and reversible. 1969). the difference between psychosis and the psychotic character is that in the latter. in Frosch’s terms. Frosch held that these individuals might suffer certain illusions or perceptual distortions. a patient with reality testing problems can adapt reasonably well to reality by accommodating to his perceptual impairment). including sufficiently adequate reality testing to permit them to recover quickly from psychotic regressions. and symptoms of derealization and depersonalization. Frosch’s Psychotic Character Frosch (1964) coined the term psychotic character to describe individuals with psychotic personality features but who had certain ego strengths. which is to be distinguished from reality-testing per se (e. a measure of how the individual copes with and relates to the external world.

according to Frosch. where the patient suffers an ego regression resulting in a brief psychotic break that is completely reversible. For Frosch. as well as his conception of the psychotic character: A female patient suddenly felt the floor tremble while at a concert. According to Frosch all three aspects of “reality” are deficient in psychosis. The vulnerability to breaks in reality testing that Frosch occasionally observed in these patients are on his view attributable to extreme stress. When the answer was that they had not. The “trembling of the floor” represents a distortion of her relationship with reality. this concept implies the conventions of a culture and is dependent upon conformity to a socially agreed upon notion of reality. the patient took a few moments to think about this event and told Frosch that she was puzzled by her experience but concluded that the trembling must have been a projection of her own vaginal orgasm. She asked the people beside her if they felt the same. Nevertheless. and feelings of derealization. this person has retained his/her capacity to test reality. (Frosch. whereas the psychotic character shows impairments in the adaptation to and feeling of reality. a hallucination may be present as a distortion of a perception. but is able to maintain adequate reality testing. the bizarre nature of her explanation of her own distortions is.16 Borderline Personality Disorder: A Lacanian Perspective pathology in this area include the experience of a confused or grossly distorted body image. typical of the flood of sexualized content which overcomes the psychotic character’s ego defenses. which in Frosch’s view indicates that her reality testing remained intact. but if the individual is able to recognize the phenomenon as internally derived. Frosch provides an example that illustrates this point. . later the patient was able to recognize that these phenomena had been a personal experience. 3) The capacity to test reality refers to the ability of the individual to evaluate appropriately the phenomena in their world. Frosch reports that some of these patients experience constant cycles of regression and reversals according to the degree of their subjective vulnerability. For Frosch. depersonalization and estrangement that occur under stressful situations. 1970).

The schizoid continuum includes the schizoid and “as-if” personalities. the psychotic character. Beginning in1966 Kernberg commenced work on a synthetic and comprehensive model of the borderline personality that integrated both descriptive and psychoanalytic criteria. there are two broad groupings of borderline patients.The Borderline Concept in America Later Psychoanalytic Theorists 17 Kernberg. and (2) the schizoid continuums. While many clinicians and theoreticians have found Meissner’s sub-groupings useful. is the next major psychoanalytic thinker to make contributions to our understanding of the borderline. and which assisted the psychiatric community to reach something of a consensus regarding the nature of this disorder. and the psychoanalyst who has been most influential in contemporary discussions of borderline personality. The hysterical group is comprised (in descending order of pathological severity) pseudo-schizophrenia. However. 1982) concluded that those patients who have been classified as “borderline” cannot be properly brought together under a single structural diagnosis. we should here note that Meissner’s sub-classificatory scheme actually calls into question the possibility of defining the borderline personality in structural or dynamic terms. Each of these groups is in turn comprised of several sub-categories. Further. 1978). According to Meissner. those belonging to (1) the hysterical. but rather represent a spectrum or range of personality dysfunction. and the primitive hysteric. after the borderline concept is splintered into so many different pathological entities.” (Meissner. He concluded that the variety of psychopathological phenomena that have been subsumed under this disorder may account for the resistance to attempts to create an integral theoretical formulation (1978). We might ask what remains of the original borderline concept and the presumed “psychotic-neuroticborderline” diagnostic triad. the “false self” personality organization and patients who can be characterized as suffering from “identity diffusion. whose work will be discussed in detail in Chapter Two. Meissner proposed that we should think of borderline personality disorder in terms of a variety of subgroups in the same way we do with respect to schizophrenia. Meissner (1978. While the various subcategories of the hysterical subgroup can be classified according to a criteria that has traditionally been associated with the borderline concept . the dysphoric personality (borderline personality proper).

Their diagnostic criteria derived from a review of the literature and included reversible defects in reality testing. the schizoid group is not readily classifiable in these terms. poor frustration tolerance. substantially disturbed affect. argues that in spite of the fact that Kernberg diagnosed two of Abend’s patients as borderline. 1976) emphasized the disturbed character of the borderline’s mother. these patients were healthier than the typical borderline treated by Kernberg and his associates. Rather these patients seem to be characterized by what has been called “the need-fear dilemma. etc. infantile interpersonal relationships. narcissistic personality features. Masterson and Rinsley (1972. lack of self-cohesion. the term “borderline” does not refer to a discrete diagnostic syndrome but to a rather loose “catch-all” classification for a large number of heterogeneous patients. characterized by an absent father. according to these authors. primary process thinking. The borderline’s early family experiences were.18 Borderline Personality Disorder: A Lacanian Perspective (affective lability. but who became unavailable if the child displayed any desire for independence. aggressive conflicts. the four patients studied did well in traditional psychoanalysis. In 1983. They described the mother of the borderline as a borderline herself who encouraged symbiotic clinging. In contrast to Kernberg. Goldstein (1985). and intense transference reactions in treatment. They presented their findings to the Kris Study Group at the New York Psychoanalytic Institute.). As the individual matures she/he is torn by a constant . ego-weaknesses. They based their work in part on the developmental theories of Bowlby and Mahler and agreed with Kernberg’s conception that impaired object relations play a significant role in borderline pathology. these authors suggested that such patients suffer from severe oedipal as opposed to pregenital or pre-oedipal difficulties. polysymptomatic neurosis. provided a critique of the borderline concept as it is understood by Kernberg and his followers. Abend. According to Abend and his colleagues. a psychiatrist who adopts Kernberg’s theoretical understanding of the borderline disorder. These researchers argued that their patients could not be distinguished on the basis of specific defenses (such as splitting and projective identification) or “level” of defense. They conducted an in-depth evaluation of four patients who met eleven descriptive “borderline” criteria and who had completed classical psychoanalysis.” an intense conflict between a need for others and a fear of being engulfed and destroyed by them. Porter and Willick. Further. impaired adjustment. primitive defenses.

and.The Borderline Concept in America 19 conflict between individuation and symbiosis. and he theorizes that borderlines externalize their split self and object representations only to re-internalize the resulting distorted object images. Volkan (1981) has presented a rather thorough psychoanalytic metapsychology of the borderline patient. According to Searles (1969). For Searles. Singer theorizes that the borderlines’ masochistic tendencies. Volkan’s work is based on object relations theory. these difficulties are subtle and are not easily recognizable unless the patient is in treatment for some time. in general. perhaps using only one or two words to describe their memories. between emotions and sensations. between symbolic and concrete realms. He describes the fear of the borderline as resulting not only from an intrusion by others but from a sense of being devoid of the self. and this seriously impacts upon his/her capacity to integrate the experiences of everyday life. As a result of this conflict. the borderline personality is destined to spend her life changing relationships.” or find that their patient fails to use the pronoun “I. This phenomenon of “multiplicity” is typical of a state of undifferentiation or depersonalization. they agree that a strange perceptual experience overtook them. between a thought and an action. Harold Searles. The failure to differentiate between reality and fantasy allows the borderline to believe his/her omnipotent thoughts. borderlines either feel that they can harm themselves or others or that they have become totally vulnerable and will be destroyed. along with an extreme anxiety and self-centeredness are the result of a need to a focus on the self as a means to ensure their continued existence. described how the borderline individual is unable to differentiate between reality and dreams or fantasy.” replacing it with “we”. swinging from extremes of idealization to betrayal and disappointment with their partners. Their speech is bizarre and they display intense motor activity. Finally. He describes this phenomenon in some of his patients who experience a flooding of ideas mixed with intense emotions. When such patients later recall their actions. who in the 1970’s and 80’s treated several outpatient and inpatient borderline and psychotic individuals with intensive psychodynamic therapy. Searles points out that the clinician treating a borderline will frequently hear references to the self as “a thing. Singer (1977) goes a step further in detailing the experience of depersonalization in the borderline patient. and experiences individuation as synonymous with abandonment (involving a loss or rejection by the mother). They talk unintelligibly. In an effort to explain the causes of the disorganization .

in which varied. including the singleparent relationship in which intense frustration builds up as a result of the parent’s unavailability resulting in a failure to integrate the negative and positive experience of others and self. often contradictory identifications of the mother function wreak havoc on the child’s intrapsychic stability. (Volkan. . in connection with a lack of environmental support. and a third scenario in which the child experiences himself as a depository of a representation of someone else who existed in the mind of the parents. 1980). multiple mothering. Volkan points to failures in the dyadic relationship with the mother. Volkan describes several parenting patterns that can result in borderline pathology.20 Borderline Personality Disorder: A Lacanian Perspective that occurs in the self and object representations.

In this chapter I will briefly place Kernberg’s work within the context of post-Freudian developments in psychoanalysis. Post-Freudian Developments in Psychoanalytic Theory The history of post-Freudian developments in psychoanalysis. (2) revisions in technique. and (4) the elaboration of the major neo-Freudian schools by Erich Fromm. particularly in the direction of briefer forms of treatment initiated by those such as Sandor Ferenczi and Otto Rank.. As is well known. Rudolph Lowenstein.Otto Kernberg and the “Borderline Conditions” 21 Chapter Two Otto Kernberg and the “Borderline Conditions” M ore than any other theorist. (1) the departures of Jung and Adler. the developments in “postFreudian” thought was well on the way to being established. These developments included. Otto Kernberg has brought the notion of the “borderline conditions” into the center stage in American psychoanalysis. J. Harry Stack Sullivan and Karen Horney during the 1930’s. particularly as they pertain to the development of psychoanalysis in America has been amply described in the literature (Greenberg. even before Freud’s death. and provide a more detailed description of Kernberg’s theory of the borderline personality. Heinz Hartmann. which will later be used as a springboard for dialog with Lacanian psychoanalysis. 1983). (3) the development of “ego psychology” and an emphasis upon the theory of defenses by such analysts as Anna Freud. and Ernst Kriss. After the 1930’s a schism occurred between Melanie Klein (and the so-called .

and which in other ways were radically different. Klein and her followers formed the British school of object relations (Gabbard. without either a consideration of. Heidegger. for example. Jacques Lacan. Amongst French psychoanalysts. Merleau-Ponty) had a major impact upon intellectual life in general. as a result of his direct challenges to ego psychology and his declaration that its basic tenets were opposed to the core of Freudian thinking. in spite of the various schisms in post-Freudian psychoanalysis. it is only in the last several years that Lacanian analysts have taken up the question of the “border” and the beginnings of a clinical and theoretical exchange between American and French psychoanalysts on the subject of the borderline conditions has appeared. and the virtual estrangement between French and English speaking psychoanalysts.g. and psychoanalysis in particular. that Kernberg could create. Levi Strauss) and linguistics (Saussure) rivaled existentialism for authority in intellectual circles. “Object” Relations Interestingly. or a response from those in France who had developed their thinking largely upon the work of Lacan. and eschewed such notions as “adaptive functioning” and the “conflict free sphere. psychoanalysis in France became increasingly separated from developments within England and the United States. was able to provide an integration of these currents within French thought with what he described as a “return to Freud.” which were the staples of ego psychology. As will be discussed in Chapter Three. Indeed. a single theme can . For this reason.g. his theory of borderline personality organization. with the result.22 Borderline Personality Disorder: A Lacanian Perspective British school) and those who embraced what came to be known as American ego psychology. Within France. Husserl.” and which involved a focus upon language and the unconscious. psychoanalysis in France developed along lines that in some ways paralleled the developments in England and the United States. in the decades after Freud’s death was a great center of philosophical activity. France. 1993). 1994). and where structural anthropology (e. where the study of phenomenological and existential philosophy (e. ( Roudinesco. and others develop. Sartre. a major schism occurred in the 1950’s with the expulsion of Jacques Lacan from the core of the International Psychoanalytic Association (IPA).

The three major theoretical positions in psychoanalytic thought in America today are the ego-psychological approach. and the role of the other in the construction of the individual’s psyche.” (Gabbard. object relations theory originated in England with the theories and clinical practice of Melanie Klein. a group of prominent psychoanalysts such as Donald Winnicott. The concept of the borderline conditions finds its place within each of these three psychoanalytic schools.Otto Kernberg and the “Borderline Conditions” 23 be said to dominate discussions in many if not all of the competing schools. As I have already indicated. leading to the concept of the “object” and object representation. Thus. and John Sutherland who were much enamored of Klein’s thinking. Ronald Fairbairn. but did not want to take sides in the debate between Klein and Anna Freud. and Kernberg’s theory has indeed been labeled “ego-psychological. 1997) According to Greenberg and Mitchell (1985). What appears to be common to all psychoanalysts today is an interest in people’s interactions with others. While there are elements within Kernberg’s theory that are best approached from an ego-psychological perspective. By the early 1980s. an “object” will be conceptualized as a derivative of a drive or drives. and did not focus upon the individual’s relations to others and the world until much later in his career. Freud initially developed his theory around the concept of drives. when a theorist considers the issue of object relations within the framework of drive theory. in the formation of the human psyche. after taking up the problem of the ego. “object relations theory” and the school of “self-psychology. developed what we now refer to as the object relations school (Gabbard. in particular early relationships. I will initially focus my discussion on object relations theory. 1997) All of these positions are currently characterized by their de-emphasis of the concepts of drive and defense and their theoretical prioritization of relationships. in order to provide background for my elaboration of its main representative regarding severe personality pathology. His early psychoanalytic formulations understood all facets of personality and psychopathology as a function or derivatives of drives and their transformations. Kernberg is largely in accord with this view of objects as a . Michael Balint. Greenberg and Mitchell (1983) declared that the problem of object (the other as internalized and represented in the individual psyche) had come to be the main focus within the various psychoanalytic schools. However.” I believe Kernberg’s greatest debt is to the (American) object-relations school. Otto Kernberg.

A second group of analysts. a view he shares with Edith Jacobson. (even a realistically necessary delay). The real mother may be internalized as a distorted image. including Fairbairn. amongst others. and the mother (object) as inattentive and unavailable.24 Borderline Personality Disorder: A Lacanian Perspective drive derivative. Object relations theory is therefore not an interpersonal model of psychoanalysis. substituting a model of object relations as the basic building blocks of mental life. Object relations analysts also provide for the possibility of partial internalizations which reflect different positive or negative aspects of the mother (the good and bad mother) as she is experienced in the fantasy life of the child. the infant attempts to gain control over the negative aspect of the mother by capturing it within himself. This fantasized mother will then be internalized as an introjected or identificatory object. tried to replace the drive theory altogether. in some cases attempting to transform the bad into the good object. the experience is colored by positive feelings towards himself and his mother. rejecting and abandoning. frustrated and angry. regardless of the cause of the delay. For example. When the food arrives. if the mother delays the feeding.. as evil and ungratifying. According to this position. but rather a theory of unconscious internal object relations that involves the transformation of relationships with external objects into internalized introjects and structures. the self-object (the mental representation of who we are) is not the result of an identification with either or both of our actual parents but instead results from powerful affective experiences and the experience of an “object” (usually the mother before the 16th month) that produces either satisfaction or frustration. according to the degree and quality of the demands of the infant and regardless of how competent the mother may be. When the infant cries desperately for his food he experiences the self as unpleasant. On the other hand. The infant will internalize the positive aspect of his mother as a soothing mechanism in order to deal with the possibility of losing his/her mother. The feeding experience provides a good example of this process. However. The development of the self-object unit involves two mechanisms: . the child’s object representation will be largely a function of his fantasized images and representations. the infant will experience the mother in a very negative way. and in other cases hanging onto the bad object because possessing a bad object is better than having no object at all.

as a specific structure of psychic organization that is to be distinguished qualitatively from the neuroses and psychosis. Kernberg has attempted to define it in both descriptive and dynamic terms.” in which undesirable parts of the individual are externalized (as in paranoia). borderline personality disorder and borderline personality organization. While the term borderline has been called “an idiosyncratic catchall term for difficult patients” (Gunderson. Kernberg’s Theory of the Borderline Kernberg belongs. 1987). The child’s self experiences are those parts of the parent that the child identified with (Laplanche-Pontalis.Otto Kernberg and the “Borderline Conditions” 25 (1) Introjection: This mechanism involves the taking in of an object (and its qualities) but in a manner that assures that it will be simultaneously experienced as “an other. Borderline personality disorder is a descriptive designation that refers to a more or less specific psychiatric . As we have seen in Chapter One. the object relations theorists perceive unconscious conflict as a struggle between different self-object units. (2) Identification: This mechanism explains how the self is modified as a result of an internalization of a significant external figure that is used as a model. As described by Kernberg and his followers. Each of these analysts tried to integrate aspects of an ego psychological point of view with the British school of object relations. the term “borderline” refers to a level of personality organization. Although an introject is experienced in the child as a soothing mechanism. there are two different though overlapping uses of this term. and superego). mainly the theory of Melanie Klein. 1987). along with Edith Jacobson to what has been spoken of as the “mixed model” of theoretical psychoanalysis in America. J. Whereas ego psychology views conflict as a struggle between different psychic agencies (id. ego.” Freud opposes “introjection” to “projection. it is still considered an object rather than a part of the self (Laplanche-Pontalis. Object relations theory views conflict and character formation as intensely influenced by the constellations of self and object representations derived from introjections and identifications. 1989).

but that not all cases of borderline personality organization will present with the descriptive features of a “descriptive borderline. While a peculiar combination of symptoms (some of which are clearly in the psychotic range) provide a “presumptive” diagnosis.26 Borderline Personality Disorder: A Lacanian Perspective syndrome characterized by a set of well known symptoms: impulsivity. only a . who regards the basic three structures proposed by Freud (neurotic. and perverse) to be without any need of augmentation or revision. and an arrested separation-individuation process resulting in an unintegrated ego marked by pre-oedipal aggression. 1985). By way of contrast. holds that borderline personality organization underlies all cases of borderline personality disorder. It is Kernberg’s view that the presenting symptoms of the (structural) borderline may be quite similar to the presenting symptoms in the neuroses and (non-borderline) character disorders and it is therefore only through a thorough structural diagnostic examination that the borderline organization will emerge. the borderline personality organization often initially presents as neurosis. from a descriptive point of view. all patients who present themselves for psychoanalytic treatment fall into one of three groups: neurotic. 1975). Kernberg is attempting to introduce a structural and (to a certain extent) etiological model of severe psychopathology that lies between neurosis and psychosis regardless of its phenomenological presentation (Akhtar. borderline personality organization is a broader concept with definite psychostructural implications. 1975). hypomanic. feelings of emptiness and boredom and the tendency to act out on self-destructive ways (Akhtar. While the contrasting perspectives can be synthesized one does not logically imply the other. borderline personality organization also underlies narcissistic. psychotic and borderline. In fact. In Kernberg’s scheme. paranoid. Kernberg. It refers to a character pathology in which there is evidence of identity diffusion. Kernberg understands borderline patients as suffering from a rather stable pathological personality organization. chronic anger. schizoid.” In effect. on Kernberg’s view. We will see that Kernberg’s tripartite structural classification of psychopathology stands in stark contrast to that of Lacan. and “as-if personalities. antisocial. characterized by a specific ego psychological structure that is highly resistant to change except through intensive psychotherapy (Goldstein. psychotic.” This is because. for example. identity disturbance. predominance of splitting over repression as the main ego defense mechanism. unstable relationships.

as these are not presumptive evidence of borderline pathology. fear of talking in public). usually bordering on bodily hallucinations.” can lead to a more definitive diagnosis. anxiety exceeds the binding capacity of the ego. from a descriptive point of view.Otto Kernberg and the “Borderline Conditions” 27 careful examination of the individual’s ego pathology. free-floating and accompanied by other symptoms or character traits. These fears need to be distinguished from phobias related to external objects such as animal phobias or fear of heights. especially. 1966). In the borderline personality. (b) Obsessive-compulsive symptoms. . According to Kernberg. anxiety appearing as a form of resistance. The Descriptive or “Presumptive” Diagnosis Kernberg’s “descriptive” model consists of a number of symptoms that he believes are “suggestive” of borderline personality organization (Goldstein. (c) Multiple and severe conversion symptoms of an elaborate kind. those patients whose symptoms are colored with paranoid or hypocondriacal themes. (2) Polysymptomatic Neurosis: This includes: (a) Multiple Phobias: Kernberg refers to phobias in which the patient is socially restricted and/or phobias related to the patient’s body or appearance (such as “fear of being looked at. 1985). (Kernberg. borderline patients typically present with the following characteristics: (1) Anxiety: The anxiety is typically diffuse. and is accompanied by other pathological signs. achieved through a “structural interview. The clinician must rule out chronic anxiety related to conversion symptoms or as in the case of patients in intensive psychotherapy.

are a sign of borderline pathology. However. the hypomanic and the cyclothymic personality disorders. Often these individuals also manifest sexual deviation with a compulsive quality and “acting out” personality types. (e) Hypochondriasis. Severe anxiety with mild hypocondriacal reactions is not indicative of borderline pathology. (4) The “Pre-psychotic Personality: This includes the paranoid. Perversions may not be clearly manifested until later in treatment when the patient’s fantasies are explored. the more unstable the object relations connected with these interactions (Kernberg. (3) Polymorphous Perverse Sexual Trends: According to Kernberg. usually involving several coexistent perversions as a basic condition for sexual satisfaction. the more chaotic and multiple the perverse fantasies. particularly if presenting with masochistic traits. and accompanied by health rituals. . complex fantasies. Patients whose sexual life is centered on a stable deviation with a constant object are not included in this category. associated with a withdrawal from social life. He holds that both symptoms should appear as strong trends and not secondary to other pathologies. According to Kernberg.28 Borderline Personality Disorder: A Lacanian Perspective (d) Dissociative reactions with a hysterical quality such as fugues and amnesia. 1977). (f) Paranoid trends associated with hypochondriasis: Kernberg believes this combination is typical of borderline personality disorder. psychogenic obesity. alcoholism. the depressive personality disorder is not included. the schizoid. patients who manifest sexual deviation with several perverse trends likely have a borderline personality organization. and kleptomania are also grouped under this category. (5) Impulse Neurosis and Addictions: Character pathology with repetitive impulsive behavior is presumptively “borderline” in Kernberg’s structural sense of the term. Drug addiction. especially if chronic. however.

” but rather refer to presumed underlying structural characteristics. which determine the channeling of mental processes that are “functions” in themselves. the object relations theorists further broadened the term “structural” to include the analysis of the derivatives of internalized object relationships (Fairbairn. Kernberg’s Structural Analysis From the psychoanalytic point of view. beginning with the analysis of the ego and its relationships to the other psychic agencies. are not “descriptive. This new concept of structure broadened the psychology of the ego and emphasized its cognitive and defensive aspects. However. Such formulations. 1951). to the “low level” types represented by chaotic and impulse-ridden individuals. a structural analysis originally involved the analysis of mental processes in terms of the three psychic structures id. the clinician must rely upon structural analysis. In his theory of the borderline Kernberg encompasses all of these meanings of structure. He holds that in order to arrive at a conclusive diagnosis regarding borderline personality organization. and represent “thresholds” in development. Hartmann (1946) and Rapaport and Gill (1959) broadened the term “structural” to refer to ego structures or configurations that have a slow rate of change. These distinctions are made on the basis of the degree to which repressive mechanisms (high level) or splitting mechanisms (low level) predominate. the Freudian. ego. Kernberg’s structural analysis of the borderline yields several basic criteria: . Kernberg regards borderlines as manifesting a low-level character disorder. such as the avoidant personality. and finishing with an analysis of internalized object relationships. Further. When Kernberg refers to low level character pathology as being presumptive evidence for borderline personality organization he has already begun to discard descriptive diagnosis in favor of a structural approach. and superego. of course. Such an analysis is done step by step.Otto Kernberg and the “Borderline Conditions” 29 Object relations theorists typically view character disorders on a continuum from “high level” types. ego-analytic and object-relational.

on unstructured psychological tests like the Rorschach (Kernberg. an absence of creative enjoyment or creative achievement. al. The most important of these defenses. erratic. Carr. but rather their brevity and reversibility. While the findings are not completely definitive. (3) Specific defensive operations: Kernberg elaborates six primitive defenses that he regards as pathognomonic for the borderline diagnosis. 1977). but show increased primary process thinking in comparison to neurotics. they are subject to increased primary process thinking in unstructured situations and in response to stress. What is noteworthy about the borderline’s psychotic episodes is not their particular form or content. et. 1981). c) a lack of developed sublimatory channels. for example. While not all borderlines have such transitory psychotic episodes (which can range from a few minutes to as long as perhaps two days) their presence in many borderlines illustrates the fragility of the ego-function of reality testing in these patients. These include (a) an inability to tolerate anxiety that does not result simply from the degree of anxiety but is rather a function of the individual’s failure to adequately cope with stress “overload.” (b) a lack of impulse control.30 Borderline Personality Disorder: A Lacanian Perspective (1) Nonspecific manifestations of ego weakness: Kernberg holds that several “non- specific” ego weaknesses are typical of the borderline patient. research has shown. . particularly in relation to the transference in intensive psychotherapy. (2) Shift toward primary process thinking: According to Kernberg. and (d) a blurring of ego boundaries as a result of the lack of differentiation of self and object images. while borderline patients are generally capable of engaging in secondary process thinking. involving the implementation of reason and judgment in their everyday lives. the reality testing of the borderline is essentially intact. for example. and/or with the use of alcohol and drugs. except for brief regressive psychotic episodes that can occur under stress. which involves unpredictable. behavior as a dispersion of intrapsychic tension rather than a specific enactment or an acting out in relationship to the transference. Primary process thinking appears in the form of primitive fantasies and the use of peculiar verbalizations and emotionally charged associations (Kernberg. According to Kernberg. that borderline patients engage in secondary process thinking on the structured cognitive tasks such as intelligence testing. Goldstein.

as we have seen in Chapter One. and it has a significant impact upon the child’s introjects and identifications. which is related to splitting. serves the borderline in much the same way that repression serves the neurotic. omnipotence and devaluation. Such idealization represents a protection against contamination. which is said to characterize a very early stage of psychological development. This developmental milestone is. never fully achieved in the borderline patient. However. he or she moves on to develop more mature psychological defenses centered on repression. While the borderline typically uses more mature defenses in his/her daily functioning. the use of splitting is typical of the borderline structure. Its most important role is in the defense against libidinal drives and their derivatives. or undoing. spoilage and . he or she has a tendency to fall back upon these six borderline defenses under stress. according to Kernberg.Otto Kernberg and the “Borderline Conditions” 31 splitting. refers to the tendency to see external objects as totally good in order to make sure that they are protected from the “all bad”. denial. According to Kernberg. involves the isolation of opposing affects and emotions and a failure to integrate negative and positive aspects of self and others. beginning with Melanie Klein (and later Fairbairn) further developed this concept in relation to the issue of ego integration. At this stage splitting serves to prevent contamination of good introjects by negative affective experience. whereas the neurotic employs such primitive defenses in childhood. According to Kernberg. the British school. where it is frequently combined with denial and a selective lack of impulse control.” as the child achieves libidinal object constancy. In severe pathology. isolation. (ii) Primitive Idealization: this defense. infantile projection and projective identification. Splitting. splitting persists to protect the ego by dissociating introjects and identifications of a conflictual nature (Kernberg 1977). At the infant stage of development the erotic and aggressive drives operate separately. “positive and negative”. In the process the ego evolves from the use of splitting to the use of higher. more mature defenses such as reaction formation. Amongst the other primitive psychological defenses employed by borderline patients are primitive idealization. (i) Splitting: The concept of splitting as a defense mechanism was first elaborated by Freud. “good and bad”. In normal development there is an integration of “good” and “bad. are aspects that are not integrated in experience.

primitive idealization manifests as identification with an omnipotent. the patient remembers a painful event or experience with no emotional connection or awareness of pain. When pressed. which the patient believes can be influenced or even destroyed through his or her own aggression. in an effort to reinforce the ego’s stand against a threatening aspect of selfexperience. 1966). to possess it and control it. in which the individual expresses feelings that are opposite those that are actually felt. designates a mechanism through which the individual introduces fantasies of his/her own projected aggression onto the object in order to hurt it. in the borderline this mechanism is diagnostic. (iii) Projective identification: This term. Sometimes. and is typically accompanied by splitting. (iv) Primitive denial: The denial Kernberg has in mind is blatant and global. Primitive idealization is not related to developmentally later forms of idealization that are present in depressive states. However. . the patient will intellectually acknowledge the presence of such negative affect but will not be able to integrate it with the rest of his or her emotional experience. This mechanism is different from neurotic denial in the sense that in primitive denial the material was never repressed and the patient was never at any time aware of the essential emotional connections. the higher level is represented by negation or isolation and the lower level by maniacal denial. The development of this pathological defense has an impact upon the development of the superego and the ego ideal. Kernberg views denial on a continuum of higher to lower levels.32 Borderline Personality Disorder: A Lacanian Perspective destruction of the good object. The individual experiences the aggressive impulse as well as the fear of the retaliatory response and therefore feels a need to control the external object in order to ensure that neither destruction of self nor object will occur (Kernberg. It is characterized by the lack of differentiation between self and object (in the particular area of projection of aggression). which was introduced by Melanie Klein. For example. idealized object that is viewed as incapable of being or engaging in anything negative. in which the patient idealizes someone out of guilt over their aggression for that object.

. Devaluation is the negative component of the split (bad object). Omnipotence is evident in the borderline’s expectation of gratification and the strong conviction that he or she must receive homage from others and be treated as “special. guilt and depression cannot be achieved if positive and negative introjections are not brought together (Kernberg. This produces a deficiency in ego development accompanied by an intolerable degree of anxiety in borderline patients. resulting in different degrees of differentiation characteristic of primitive personality organization in psychosis and borderline pathology. (4) Pathology of internalized objects: According to Kernberg. the building blocks of the psyche consist of internalized object relations that are formed by primitive self and object representations that are formed in accordance with a dominant affect or drive. leading to the borderline’s tendency to experience sudden eruptions of emotions and ideas. the affective states of concern. ego boundaries falter in those areas where projective identification and fusion with idealized objects take place. However. dismissed and devalued. whereas omnipotence is the positive component (good object).Otto Kernberg and the “Borderline Conditions” 33 (v) Omnipotence and (vi) devaluation: As is the case with primitive idealization. if an external object can no longer provide gratification. According to Kernberg. Later the failure of integration between libidinal and aggressive drives interferes with the ego’s capacity to modulate both thought and affect. . According to Kernberg it is for this reason that such patients develop a transference psychosis rather than a transference neurosis. There is never a real concern or love for the object. it is dropped. Further. these mechanisms also have an impact on the development of object relations and superego formation. the failure of the borderline to synthesize the good and the bad introjections and identifications is in large measure due to excessive primary (constitutional) aggression and/or aggression secondary to frustration. According to Kernberg. Kernberg holds that the mechanism of splitting interferes with the synthesizing functions of the ego. In the case of the borderline (and in contrast to the psychoses) differentiation of self and object images has occurred to a sufficient degree to achieve a certain integration of ego boundaries. This shift to devaluation is often accompanied by feelings of revenge and destructive fantasies in relation to the object that frustrated the patient’s (typically oral) needs.” Devaluation is the other side of omnipotence. and this is experienced especially in the transference with the analyst. omnipotence and devaluation are derivatives of splitting.

However. Kernberg gives as an illustrative example. Such dissociation also serves the defensive function of protecting good aspects of the self from contamination by hate and badness. she also mentions that she has worked as “a bunny” for Playboy magazine. Unlike the borderline. She further confides that she has become socially withdrawn in an effort to avoid sexual advances from men. and the interviewer experiences a great deal of difficulty seeing the person as a whole (Goldstein.34 Borderline Personality Disorder: A Lacanian Perspective 1966). 1985). These feelings are not present in the borderline. and is utterly surprised when confronted with this contradiction in her presentation. and who elaborates on men’s predatory attitudes with respect to sex. 1975). (Kernberg. a neurotic would be aware of the ambivalence within herself. . 1985). The subjective experience of identity diffusion is characterized by chronic emptiness. an infantile borderline patient who presents as her main complaint the feeling of disgust for being treated as a sexual object by men. A poor and partial view of self and others is also evident in the inability of borderline individuals to describe themselves in a meaningful and consistent way. Kernberg holds that a hysterical (neurotic) patient will be more prone to express her ambivalence and fear of arousing both herself and men. By way of contrast. the self. Only the conflict or tension between two contradictory affective states in the ego can produce a genuine depressive reaction. a shallow. especially. During the initial interviews in psychotherapy they provide confusing contradictory and descriptions of life events. (5) Identity Diffusion: Kernberg appeals to Erik Erikson’s notion of identity diffusion in describing the pathological internalized objects in borderline psychopathology (Goldstein. flat and contradictory perception of others and. their socalled depressive affects take the form of rage and defeat before external forces. The failure to integrate contradictory aspects of self and others is presumably due to the early aggression activated in these patients. The lack of temporal continuity regarding self and others explains the difficulty these patients have in locating actions and people when relating material in session.

in part from their failures to empathize with others. and even sadistic in nature. On the other hand. idealized objects full of power.Otto Kernberg and the “Borderline Conditions” The Id in the Borderline Structure 35 Kernberg emphasized an excessive amount of pre-genital aggression in the borderline patient as a causative factor in the genesis of the pathology. These structural failings are observed in certain characteristics of borderlines. The Superego in the Borderline Structure For Kernberg. there is also a fusion of ideal self and ideal object images. and manipulation of others without any consideration of their feelings are typical expressions of the borderline’s crude aggression. their experience of people as distant objects. which. these patients are constantly encountering sadistic or evil objects. such as their very limited capacity to make realistic evaluations of others. punitive. in general the borderline suffers from a primitive and unintegrated superego corresponding to her fragile ego and self. Direct exploitiveness. in particular. the aggressive drive and its vicissitudes. specific superego traits are not essential to the borderline diagnosis. The undifferentiated state of “all good” and “all bad” images impacts upon superego integration. the internalization of parental demands becomes extremely prohibitory. This aggression is generally expressed in an overt way. The emotional shallowness . or to feel either guilt or concern. borderlines are typically “always right” and feel fully justified. greatness and perfection. Thus. unreasonable demands. While superego characteristics differ greatly from one borderline individual to the next. in his discussion of the genesis and development of the borderline disorder. rather than producing a modulating ego ideal. As such. and their incapacity for intimate relationships. As we have seen. This superego state is so intolerable that it gets re-projected onto external objects. tends to reinforce a sense of personal omnipotence. As the borderline cannot adequately integrate good and bad aspects of the parental figures. and their opposites. which results. Kernberg thus focuses upon id organization. and it is common for these patients to present with a very sadistic superego related to internalized bad objects of the pregenital stage.

he or she has not achieved what Kernberg refers to as libidinal object constancy. This task. Kernberg’s theory here is related to and compatible with the developmental theory of Margaret Mahler. i. .e. enables the child to surrender “splitting” as its basic mode of relating and recognize that people and things in its environment are both bad and good. According to Kernberg. without losing her basic identity. A person in the borderline’s life is either all good or all bad. By the end of the first year. In this book. especially projective identification. can retain both good and bad qualities. the recognition that an object. Kernberg describes how before the end of the first year there is little or no differentiation between self and object. The Genetic-Dynamic Analysis and Developmental Theory Closely linked to Kernberg’s ego-psychological/structural model of the borderline personality is an object relations theory of borderline development that was first elaborated in Kernberg’s (1976a) second book. While the borderline has succeeded in this basic task. and all self-object representations are linked to either purely positive or purely negative affects. and thus the borderline remains continually prone to use idealization and devaluation as his/her basic mode of interpersonal defense. which is normally achieved at the age two or three.36 Borderline Personality Disorder: A Lacanian Perspective that we observe in our clinical work with these patients is related to their lack of integration of libidinal and aggressive drive derivatives and their unrealistic appraisal of others. self and object have become differentiated and are integrated when they are associated with positive and negative affect states. Object Relations Theory and Clinical Psychoanalysis. the mother. or can be associated with both positive and negative affect states. The borderline patient has not surmounted this developmental hurdle and continues to utilize “splitting” as a means of coping with the vicissitudes of his or her emotional life. the central developmental defect in psychosis is a complete failure to differentiate self from other and hence to establish the ego boundaries that would provide the basis for a view of a reality apart from the self. The borderline also maintains a distance from others in order to protect him/herself from an intimate encounter that might activate primitive defensive operations.

the boy. . The typical oedipal vicissitudes which. an excessive degree of aggressive drive during the first years of life. in the normal case. Thus. The ever-present oral aggression gets projected and causes a paranoid distortion of the early parental images. The issue of oral rage in the genital arena becomes a difficult issue for the borderline. 1985). i. genital strivings are permeated by pregenital oral rage with the result that the individual attempts to fulfill unmet oral-aggressive needs through genital activity. These solutions always represent unsuccessful attempts to deal with aggression and lead to several pathological formations. According to Kernberg. and these are translated into the typical self-defeating patterns in the borderlines’ later relationships. One pathological path for a boy is that of orally determined homosexuality. which is regarded by the borderline as an aggressive act. the mother is viewed as potentially dangerous. In this case. turns masochistically to the father in order to fulfill his oral needs. Therefore. their polymorphous perverse trends as pathological compromise solutions to their interpersonal anxieties. heterosexuality is viewed as threatening as the boy regards his mother as dangerous. Fears of a rageful father and of a dangerous castrating mother develop. In these cases. either as a result of congenital factors or early frustrations. afraid of his mother.e. These oral and anal sadistic impulses become contaminated in the father as well and later the family is viewed as a threatening “united group” (Kernberg. 1966). this process determines what we see in our clinical work with borderlines. the mother. as their constant involvement in homosexual acts and relationships involve an effort to fend off the reappearance of oral frustration and aggression. Usually such homosexuality is accompanied by aggression. the dyad “dangerous mother-father” gets translated into the realm of the sexual relationships.Otto Kernberg and the “Borderline Conditions” 37 As we have seen. Such borderline men can become very promiscuous. produce greater disorganization in the borderline. Moreover. increase castration anxiety and its derivatives. According to Kernberg. Kernberg provides a rather deterministic theory of the factors involved in the genesis of borderline personality organization. has the result of reinforcing splitting in the developing child or interferes with the attainment of libidinal object-constancy as Kernberg defines it (Goldstein. in particular.

. The main characteristics. Each individual’s psychic organization. As a result. mediating between the patient’s history. and (3) the individual’s capacity for reality testing. pregenital and genital aims are conflated under the influence of intense aggressive needs. regardless of which specific factors contributed to the etiology of the illness. both sexes appear lacking in sexual identity. These structures perform the function of stabilizing the mental apparatus. relate to: (1) the degree of identity integration (referring specifically to the integration of self and object representations. (2) types of defensive operations that the person employs. as Kernberg will emphasize. environment. borderline. However. As a consequence. On psychological testing. Kernberg’s Three Psychic Structures Kernberg holds that there are three broad ways in which the psyche can be structured: the neurotic. and psychotic levels of personality organization. 1984).38 Borderline Personality Disorder: A Lacanian Perspective Severe oral pathology in girls tends to produce premature genital striving for the father as a substitute for gratification of genuine dependency needs that have been frustrated by the girl’s mother. in both sexes excessive development of pregenital oral aggression tends to induce a premature development of the oedipal vicissitudes. becomes the underlying matrix from which behavioral symptoms develop. These patients’ lack of sexual identity is not a reflection of their confusion around sexual definition but more of a complex symptom involving strong fixations designed to cope with unmet oral needs. Table 1 summarizes Kernberg’s distinctions between neurotic. borderline and psychotic personality organizations. In sum. (Kernberg. the presence of polymorphous trends is the result of the combination of chaotic pregenital and genital tendencies. which define these three broad categories. such girls typically experience a reinforcement of masochistic needs and a flight into promiscuity in order to deny their dependence on men. and the direct behavioral manifestations of mental illness.

differentiation of self and others. Capacity to test reality is preserved.Otto Kernberg and the “Borderline Conditions” 39 Table 1: Kernberg’s Structural Criteria for Neurosis. Capacity to evaluate self and others realistically and in depth. Borderline Presence of identity diffusion: contradictory aspects of self and others are poorly integrated and kept apart. The use of splitting and low-level defenses such as primitive idealization. Defensive operations Defenses protect patient from disintegration and self/object merging. as well as intrapsychic from external origins of perceptions and stimuli is achieved. projective identification. isolation. denial and omnipotence. Reality testing Capacity to test reality is lost. Repression and highlevel defenses such as reaction formation. rationalization and intellectualization. . 1966) Structural Diagnosis Identity Integration Neurosis Self-representations and object representations are sharply delimited. Borderline and Psychosis (adapted from Kernberg. undoing. Interpretation leads to regression. Alterations occur in relationship with reality and in feelings of reality. The contradictions between self and others’ images are conceptually integrated Defenses protect individual from intrapsychic conflict. Psychosis Self-representations and object representations are poorly integrated with the presence of delusional identity.

In Kernberg’s research the interviews are typically tape recorded and later judged independently by qualified professionals. as is typically gleaned from a psychosocial inventory (Shapiro. 1977). confrontation and interpretation of identity conflicts. for example. those involving object representations and defenses. He will introduce certain inquiries or confrontations to assess the interaction with the therapist and the patient’s interpersonal functioning in general. defenses and reality distortion. He requires between five to six interviews to elicit the information necessary to assess a patient’s level and quality of psychopathology. Kernberg’s interview combines the traditional mental status examination with a psychoanalytically oriented inquiry that focuses on the patient-therapist interaction. cognitive means of exploring the limits of the patient’s awareness of certain material. particularly as these are expressed in the transference. Confrontation attempts to make the patient . Kernberg’s approach involves judgments derived from a series of interviews and interactions that are crucial for proper diagnosis. Whereas Deutsch (1942) advocated a psychoanalytic method of interviewing that would reveal the unconscious connections between current problems and the patient’s past. While Kernberg acknowledges that structural constructs. Kernberg uses clarification as a non-challenging. the structural diagnostic interview is the most effective tool for this purpose (Shapiro. who utilizes clarification. Kernberg considers that this type of interview has the disadvantage of minimizing objective data and does not explore the patient’s psychopathology and assets in a systematic fashion (Kernberg. He is not primarily interested in information regarding the patient’s personal history.40 Borderline Personality Disorder: A Lacanian Perspective The Interview as a Diagnostic tool From the practical point of view. 1984). Kernberg’s interview is essentially a provocative test designed to activate latent dynamisms and constellations. This interaction is characterized by an active participation on the part of the therapist. 1988). thereby permitting the interviewer to classify the patient according to the variables described above. are not easily inferred. 1988). It involves exploration of the patient’s awareness and mode of handling conflictual material. For Kernberg the diagnostic interview is the essential feature of a psychoanalytic assessment in accord with the principles of dynamic personality theory (Kernberg.

the concept of structure is “put to the test” using a psychoanalytic frame of reference. 1985). To the contrary.e.Otto Kernberg and the “Borderline Conditions” 41 aware of potentially conflictual and incongruous aspects of their presentation. The issue of empirical testing will be discussed in greater detail when we take up the dialog between Kernberg and Lacan. et. for example. Kernberg’s early focus on patient’s relationship with the interviewer is anxiety producing for the patient. 1981). in the DSM-IV. The Clinical Value of Structural Analysis Theoretically. Kernberg (1980) has taken such high . In such research.” which induces artificial conflicts to produce anxiety in the patient. Goldstein. Empirical Assessment of Structural Diagnosis Kernberg and other researchers have subjected their work on the borderline personality organization to empirical evaluation (Koenisberg et al.. Kernberg’s structural diagnostic approach is meant to contrast with the descriptive approach that is present. This work provides a paradigm for future approaches in the study of second-order inferences removed from the immediate observational field. those belonging to the realm of descriptive classification. i. as it tends to bring underlying psychic conflicts to the surface. al. the structural interview requires tact and empathy and should be carried out in an atmosphere of respect that does not highlight the interviewer’s superiority. this technique should not be confused with a traditional “stress interview. Carr. for example. as a high correlation has been demonstrated to exist. Indeed. between Kernberg’s “structural” and Gunderson’s “descriptive” methods of classifying borderline patients (Kernberg. However. Interpretation seeks to resolve the conflictual nature of the material by assuming underlying unconscious motives and defenses that make the previously contradictory material appear logical. Practically speaking there may be little difference. one of the advantages of Kernberg’s theory is that it has been subject to empirical testing.

1985).” albeit one that is couched in structural terminology. and genuine guilt.42 Borderline Personality Disorder: A Lacanian Perspective correlations to suggest that structural and descriptive classifications of the borderline are complementary approaches to the same diagnostic entity. however. Meanwhile. paranoid. Kernberg’s borderline classification is clearly broader than that what is described in the various editions of the DSM. signal the possibility that Kernberg’s object relations and ego-psychological approach to the borderline is another form of “description. Nevertheless. Typically. such individuals are lacking in such higher-level personality traits as empathy. not only for diagnosis. They may also. as Kernberg believes that nearly all anti-social personalities and many schizoid. Their inclusion in the borderline category would have major implications. In the meantime. . The question of whether Kernberg’s diagnostic scheme is truly “structural” in the psychoanalytic sense will be taken up in later chapters. depth. but for treatment as well. narcissistic and impulsive characters are best conceptualized as having a borderline level of personality organization (Goldstein. humor. cyclothymic. creativity. warmth. that of Jacques Lacan. the next chapter offers an alternative approach to structural diagnosis in psychoanalysis.

The majority of the cites to Lacan.Lacanian Psychoanalysis Chapter Three Lacanian Psychoanalysis W hile the past decade has seen an upsurge in interest in Lacan amongst American philosophers. object relations theory) and 6) Lacan’s staunch opposition to the emphasis upon “practical utility” in American clinical practice and his direct criticisms of American pragmatism. a psychoanalyst with whose theories most American psychologists are familiar. and ultimate expulsion from the International Psychoanalytic Association and his harsh criticisms of its members and dominant theories (ego psychology. literary and art critics. literary works. 1 . however. reflects Lacan’s views about the inherent ambiguity of all language. with whom American readers are relatively unfamiliar. Amongst these are 1) the fact that Lacan’s writings and seminars were originally published in French and until recently the majority have remained untranslated into English. 3) Lacan’s difficult tendency to develop and alter his views without clearly demarcating differences with his former approach. are in non-English language journals. in part.1 A number of factors can account for this situation. 2) the notorious difficulty and obscurity of Lacan’s writings—an obscurity that. 5) Lacan’s break with. 4) the numerous references in Lacan’s writings to philosophers. familiarity with Lacan’s ideas and approach to treatment remains quite limited amongst American psychologists and even most American psychoanalysts. This is in spite of the fact that a recent literature search (American Psychological Association: Psych Info) covering worldwide psychology journals over the past decade reveals 369 articles making explicit reference to Lacan whereas in comparison. only 160 make reference to Otto Kernberg. and linguistic theorists.

1984). An example of this is what Americans refer to as Freud’s structural theory” (Id. whereas American analysts generally hold that Freud’s second “structural” model superseded the first “topographical” one. While Americans have experience with such “French structuralism” in the fields of anthropology.44 Borderline Personality Disorder: A Lacanian Perspective Renee Major. 1984). place a far greater emphasis on the earlier point of view.” Whereas American psychoanalysts have tended to identify psychic structure with what they call Freud’s structural theory. i. these differences in style do not necessarily indicate that American psychoanalysis is more “scientific” and that French psychoanalysis is more “artistic. as Major indicates. As we will see. and links them to the traditional Freudian diagnostic distinctions between neurosis. and super-ego. literary criticism and philosophy. examined the cultural differences that have impacted upon the development of psychoanalysis in France and the United States. Another major area of difference between American and French psychoanalysis relates to their respective writing styles. As Major points out. Ego. however. ego. these ideas have not taken root in American psychology or psychoanalysis (Major. French readers tend to (critically) view American journal articles as having a medical narrative style. in a manner that differs radically from American ego-analytic and object-relations “structural” theories. or.e. indicate that psychoanalysis in each . the relations between the id. As we will also see. We will see that a key area of disagreement and potential miscommunication between American and Lacanian psychoanalysts centers upon their respective uses of terms relating to “psychic structures. in such a way that when one element changes. while Americans view French writing as (overly) philosophical and literary. More importantly. the French typically regard them on equal footing. any attempt to conceptualize “borderline” psychopathology within a Lacanian context must take these critical differences regarding the nature of psychic structure fully into account. and Superego) the French refer to as the “second topographical system” (Major. as in the case of Lacan. in his review of Elizabeth Roudinesco’s “The One Hundred Years Battle – The history of Psychoanalysis in France”. American and French psychoanalysts read Freudian theory in very distinct ways. Lacan develops such “structural” concepts in an original manner. the whole system of relationships changes as well. Lacanians utilize the term “structure” to refer to an anthropological and linguistic concept that refers to a particular organization of elements defined by their system of relationships. However. psychosis and perversion.” They do.

”. who took a liking to his then 30-year old German student. “Charcot. phenomenology and existentialism) that. political and historical context (Oliner.Lacanian Psychoanalysis 45 country has developed. he was. in accordance with each culture’s intellectual values. at least until recently. In the following section I will briefly examine the history of psychoanalysis in France and Lacan’s place within that history. 1988). we might add. can be traced back to the debate between the Cartesian rationalists and British empiricists. and with whom he shared ideas on the links between sexuality and neurosis. Further. Finally. Hegel. It wasn’t until 1914 that Freud’s original “Five Lectures on Psychoanalysis” . we need to evaluate the history of the psychoanalytic movement (as any other institution) within a social. Freud developed a close relationship with the leading figure at the Salpetriere. Whereas Lacan and other French psychoanalysts see themselves within the former tradition. and is expressed. the French had no representation in the group (most of whom were German speaking with Ernest Jones and Abraham Brill the two English-speaking exceptions). The History of Psychoanalysis in France As is well known. This distinction. Freud had an important first-hand experience of French psychiatry and neurology while studying at the Salpetriere Clinic from October 1885 to February 1886. presided by its then newly-elected president Carl Jung. several years prior to his initial psychoanalytic collaboration with Josef Breuer. French psychoanalysis has therefore taken seriously developments in rationalist and idealist philosophy (Kant. when after the publication of The Interpretation of Dreams and The Psychopathology of Everyday Life the first generation of analysts was firmly established as Freud’s circle. American ego psychologists are much more closely linked to the latter. a relatively unknown researcher who was not read by the French psychiatric community. whereas in France critical conceptual analysis occupies a similar position. There was also no trace of the French at the first International Congress of Psychoanalysis in 1908. Although Freud published three papers in France. In the United States. at the time. J. experimental science is generally regarded to be the paradigm of scientific truth and rigor. have been relatively ignored by American empiricist philosophers and psychologists.

was present at the meetings where these issues were heatedly debated. a young psychiatrist.46 Borderline Personality Disorder: A Lacanian Perspective were translated into French and became readily accessible to the French psychiatric community. the lay group. fully supported by Freud himself) to become a training analyst. He applied for admission at the SPP (at this point. Interestingly.” and the first French psychoanalytic journal appeared in 1925. A. While she had no personal clinical training and thus had no ability to publish her own cases (in spite of her wish to be an analyst). Bonaparte served as Freud’s personal French translator and became the most important propagator of Freud’s ideas in France. in which “The Evolution Psychiatrique” proclaimed that the field of psychoanalysis was directly related to general medicine. Allendy and Laforgue. It was Rene Laforgue (1925) who was the earliest promoter of psychoanalysis in France.” He was the first psychoanalytic theorist in France to take . “The Societe Psychoanalytique de Paris (SPP). this early French school distanced themselves from what they regarded to be “Freudian dogmatism”. “L’Evolution Psychiatrique. field. but not exclusively medical. held that psychoanalysis was the realm of the psychology of the unconscious. Bonaparte’s group. Bonaparte later acquired the letters that Freud wrote to Fliess and was instrumental (with the help of the United States ambassador) in securing Freud’s visa to exit Austria and obtain residence in England in 1938. she became extremely involved in the clinical training of psychoanalysts and.1982) In the meantime. neurology and psychiatry. the International Psychoanalytic Association obtained a foothold in France under the auspices of the Princess Marie de Bonaparte (a French woman. (De Mijolla. which belonged to the clinical. and by December 1938 he became a full member after starting a personal analysis with Rudolf Lowenstein. Jacques Lacan. A strong controversy ensued. she was very cautious regarding the French medical community. under the direction of Henry Ey. and they appeared more interested in facts that could be put to strict scientific test than in matters related to the unconscious or the vicissitudes of sexuality. Along with Rene Allendy. She founded. to transform itself into an organodynamic psychiatric entity that would limit membership to medical doctors. who had maintained a close relationship with Freud after having been an analysand of his). and the SPP opposed that view. as a non-physician. Laforgue organized the psychoanalytic group. with Lowenstein. At a certain point this group took steps. In 1936 Lacan presented a paper at the 14th International Congress of psychoanalysis in Marienbad entitled “The Mirror Stage. granddaughter of the Emperor.

who moved their investigations in the direction of forging a synthesis of linguistics (Ferdinand de Saussure). medicine.Lacanian Psychoanalysis 47 an innovative path with respect to the development of psychic formations. psycho-pedagogy. Lacan based his ideas about the nature of the ego on Wallon’s work with primates and their experience of confronting their image in a mirror. linguistics. On the one hand. who have pursued a rigorous academic program to achieve psychoanalytic qualifications and 3) Lacan and his followers. philosophy (e. Most of the members of the SPP were communists or were involved in what they called the humanism of the Resistance. and even religion. each of the heads of the above mentioned (medical. Lacan became a major figure in the 60’s and 70’s. but in other intellectual circles as well.g. However. psychoanalysis was viewed as “one more individualistic expression that amounts to a denial of any possibility of transforming the social order” (De Mijolla. and many intellectuals saw it as a new corrupting agent of imperialism. Jean Hyppolite and Hegel) and what Lacan called “the return to Freud” or the building of psychoanalysis based on Freud’s early writings and cases. After the war. Since the late 1960s psychoanalysis in France has extended in three directions: 1) the medical direction. 2) the psychological analysts. represented by the medically trained analysts who have focused mainly on psychoanalytic psychosomatic research. not only for psychoanalysts. (Wallon’s research suggested that whereas primates learn that the image is illusory and quickly lose interest in it. for many. Whereas in other countries divergent groups have made attempts to synthesize their theoretical tendencies. Due to his extraordinary capacity to articulate ideas and handle large crowds. 1982). Interestingly. . the French have tended towards a rather clear separation between their schools of thought. the human child becomes fascinated with his mirror image—see below). Others held the ideal of a large movement that would bring together members from different disciplines: philosophy. there was an atmosphere of mistrust towards psychoanalysis during the post-war years in France. a number of French psychoanalysts had a vision of a small society carefully filtering and controlling its membership. In part because of the polarizing political impact of World War II. rather different lines. psychoanalysis in France was re-organized along two. Merleau-Ponty.

Amongst the more controversial issues was the question of whether an analytical candidate was to obtain the consent of his analyst prior to establishing his or her own analytic practice. Later. Further. above all. The SFP proclaimed in its constitution that there were no theoretical differences with the former society but that the differences were in the “moral” order.48 Borderline Personality Disorder: A Lacanian Perspective psychological. Lacan’s practice of variable length sessions (the so-called “short sessions”) lacked psychoanalytic rigor. Jones. They aspired to have an institute with a more democratic climate and one that would be guided by mutual respect and freedom. Nacht and. he held that the analyst must be able to authorize him or herself—a notion that flew the face of psychoanalysis as an institution. Anna Freud. the members did not accept the clinical reasons that sustained the rationale for the short session. The new organization. As a member of the SPP. Bonaparte. In 1953 Lacan began his famous Wednesday evening “seminar” that for more than a quarter of a century exercised a profound influence on both psychoanalysis and intellectual life in France. Lacan had experienced problems in connection with what was termed his lack of orthodoxy in the practice of psychoanalysis. the SFP (Society Francaise de Psychanalyse) was founded in 1953. This split was significant. This seminar constituted the first regular psychoanalytic meetings that were not . At the time of his first arguments with the Society. Marie Bonaparte was his most radical opponent. and idea of a “Free Institute” was on Lacan’s mind. Even when Lowenstein tried to intervene in the SFP’s favor. including some of the analysts in the SPP and their trainees. and Lacanian) schools (Nash. Lacan held that psychoanalysis was ill-served by a rigorous prescription regarding the length and number of analytic sessions as well as the total duration of treatment. This new model was to oppose the medical model and was to be founded on a university model. Lagache and Lacan) had the same analyst: Lowenstein. The International Psychoanalytic Association (IPA) voted to exclude the new organization from their meetings and publishing resources. but Lacan was the most popular analyst among the trainees. as well as on the minds of many French. the controversy related to the standard practice of four to five sessions of 45 minutes each week and a minimum of a two-year training analysis. The heads of the Institute demanded a return to the rules. as up to 50% of the members of the SPP became members of the new SFP. According to the SPP. when Lacan came to establish his own school. the request was rejected by Hartmann.

the anthropologist. diagnosis. This school remained a training center for sixteen years and trained analysts who eventually established practices throughout the world. Claude Levi-Strauss and the linguist . the study group was informed that in order to continue with IPA sponsorship. one year before his death. in 1980. particularly. Structuralism Having provided a brief history of psychoanalysis in France. by way of introduction to Lacan’s theory.e. Included amongst those who have been influenced greatly by structuralist modes of thought are the cognitive psychologist Jean Piaget. Later.Lacanian Psychoanalysis 49 reserved only for analysts. (and much of his work can be regarded as both pre-structuralist—i. The structuralist movement has left its mark both in science and the humanities. In addition to the seminar. without at least a basic understanding of structuralist thought. However. As a result of this. Lacan also held a case presentation every Friday. to provide some background in the theory of French structuralism. a form of “psychoanalytic education” was available to all. Lacan dissolved his school as a result of the discord and infighting among its members. Lacan had to distance himself progressively from the training program. phenomenological. and it is impossible to understand his contributions to psychoanalytic theory and. that they decided to accept these analysts under the category of “Study Group Under the Sponsorship of the IPA. Although Lacan refused to accept ‘structuralism” as an epithet for his work. In 1964. “ This initially meant that there was an IPA committee that was to watch over training problems and make recommendations accordingly. as Lacan did not believe in the institutional transmission of psychoanalysis. and poststructuralist) the impact of structuralism upon him was undoubtedly great. The situation became so serious regarding the refusal of IPA to accept some of the most famous analysts of France. His way of working and transmitting psychoanalysis was felt to be peculiar by some and ambiguous by others.” He did this with a certain reticence. even those who were not themselves in analysis. it remains. Lacan founds his own school “The Freudian School of Paris.

Lacan ultimately applied the notion of structure to the formation of the unconscious. corporate or other institutional meeting.g. the change of one element in a phrase. and perversion in terms of the position that individuals take with respect to a generalized “Other.g. 1966). the symbolic order. sentences and phrases) on the basis of the relationships they have with one another at the same level (moneme with moneme) or at different levels (phoneme with moneme) (Benveniste. It is the system of such relationships that defines a “structure” as a matter to be studied. Lacan founded his views on structure upon the work of the structural linguists. words. psychosis.50 Borderline Personality Disorder: A Lacanian Perspective Roman Jakobson (Feher Gurevich. what Lacan refers to as. (e. that of Ferdinand de Saussure. structuralism situates them in the context of their relationships with other objects. in particular. phonemes. Linguistic Structures Lacan regards language to be the most basic and paradigmatic structure in human life and society.e. e. For example. Such structured relationships can be understood in terms of laws that are implicit in the structure and are initially difficult to grasp and articulate. law. 1999). most often going unnoticed by those individuals to whom the structure applies. and. Another common example might involve the hierarchical rules of verbal deference and exchange that are implicitly adhered to by participants at an academic. a . monemes. Examples of such structures include the rules of grammatical formation of sentences adhered to but not necessarily known to the speakers of natural languages. and the rules of marriage and kinship adhered to. that “the unconscious is structured like a language. Structuralism involves a novel manner of regarding objects and entities studied in the human sciences. and he proceeds to utilize linguistic structures as his preferred model both of the human psyche and for his work as a psychoanalyst. Lacan came to regard the basic diagnostic categories of neurosis. His famous dictum. but not always articulated. by both primitive and modern societies. Structural linguistics distinguishes units of language on different levels.” follows from this view.” one that is embodied in language. slips of the tongue. i. The grammatical or semantic significance of any one unit is a variable function of the relationship it has with all the others. Instead of defining such entities in terms of their inner or “essential” characteristics. and especially symptoms in structural terms. Most significantly for our purposes here. and he understood dreams.

a wider . The sign remains meaningless unless is interpreted in the context of its relationship with the totality of language.e. As such.e. The sign then becomes the relation of a signifier to a signified. Lacan appropriates this dual model of the sign and emphasizes that the signifier and signified are autonomous with respect to each other.Lacanian Psychoanalysis 51 word.g. Saussure describes a sign as a double-sided unit (Lemaire. and. we can never be absolutely certain of the meaning of any particular sign. and changes the significance of each of its component parts. Structural linguistics defines language as a global unit containing parts that are formally arranged in obedience to certain constant principles forming different hierarchical levels ranging from simple to higher and more complex elements. composed of a concept and its acoustic image. in which the elements that comprise it are summable and distinctive but still articulated in sub-sets according to specific laws. Lacan reconceptualizes a number of basic psychoanalytic ideas via the application of a structuralist model. as further words. 1984). a pause. the signifier and the concept. Saussure proposes to call the acoustic image. what Lacan describes as the “subject matter of psychoanalysis” is structured like a language. but we can only determine what the speaker means when we place these words in the context of the signs that follow (e. a comma. In the first place. as in the sentence “Two people are going to the store too). i. Furthermore. a question mark) can alter the entire meaning of the statement in question. we can say that structural linguists privilege the relationships between elements over the element themselves. such as the transition from the utterance of a sound to a complete narrative (Lemaire. as we will see. A structure is thus defined as an organization of the parts of a whole in accordance with certain definite rules of mutual and functional conditioning. these layers correspond to Freud’s first topographical model of conscious. Lacan understands the human subject as a schema composed of layers of structures. involve metaphor and metonymy. Lacan derives his distinctive understanding of these terms from Saussure. The unconscious. that there is no fixed relationship (of value or meaning) between them. In effect. i. The acoustic image is not a sound per se but is rather the psychical imprint of a sound. Two words when enunciated can sound the same. These laws are linguistic in nature. the signified. 1986). preconscious and unconscious.

The signifier can only be pinned to a given signified for a brief moment. i. we are constantly meaning much more and/or less than. According to Lacan. the value or meaning of a word is not intrinsic to it but is determined by the presence of other words in the system. Lacan. Such anchoring points involve a delimitation in the flow of the chain of signifiers with the flow of signifieds. the signifier is constantly “slipping out from under” its signified. can always prompt us to a new interpretation of what was said (For example. the value of which is not intrinsic to itself.e. The concept of value supersedes the concept of signification. the anchoring point is above all the operation by which the signifier stops the otherwise . through a thorough understanding of contexts and relationships amongst signs. held that even this relationship is completely mutable. in effect. anchoring or “quilting” points (punctuation. Structural linguists hold that the sign is arbitrary. we are able. via what Lacan refers to as points de capiton. A quarter. basic metaphors) that provide language with at least the illusion of stability. one of which is his insistence that one proper role of the analyst is to serve as a punctuation of the analysand’s speech in such a manner as to reveal his or her relation to the “Other” and the unconscious. Saussure held that once established there is an immutable bond between a signifier and the concept it signifies. It is only in relation to the entire community that a given sign is arbitrary. as no individual can change language at will.52 Borderline Personality Disorder: A Lacanian Perspective context. the “mutability of the sign” is a paradox. While there is no necessary relationship between signifier and signified. we seem to write or say. However. Two!”). however. with regard to the aforementioned sentence we may subsequently learn that the speaker was speaking emphatically “Two people are going to the store. as what matters are the system of relations between concepts rather than any absolute meaning determined by the relationship between a particular signifier and signified. for example is a coin made of metal. since signs in a given language are tied to the tradition of a linguistic community. Hence. for example. that “blue” in English. and “azul” in Spanish mean the same thing. to determine. what on first reflection. and that. but is rather a function of its position in relation to other coins within a monetary system. definitions. that is there is no natural relationship between the sound of a word and its signification. Nevertheless. This is evidenced in the idea that the enunciation of the word is different in different languages. According to Lacan. Lacan will apply these ideas in a number of theoretical and clinical contexts.

each term anticipating something of the meaning but not quite yielding it until the end when almost by a retroactive function. The change in the signified is a function of its relationship to later words and punctuation in the chain of signifiers.” where “City Hall” is used to mean “mayor. since identification always involves the substitution of oneself for the identified object (Lacan. The sentence completes its signification only with the last term. 1960). An example would be “City Hall denied all involvement. and from our point of view. seemingly arbitrary. and the psychotic slips into a use of language that is idiosyncratic. or après coup). refers to the fact that linguistic units can be selected and substituted for others on the basis of some similarity within a chain of signifiers. This retroactive dimension of meaning is represented by the anchoring point (it is “after the fact”. 1955 ). which he also uses broadly. This flux is a function of two linguistic axes. even in the absence of psychosis. on the other hand. meaning can be established. “identification” is also a metaphor. indeed. in contrast to neuroses. 1997). metaphors (Lacan. 1970). Interestingly. the In ordinary usage metonymy is a form of speech in which a term is used to denote an object that it does not specifically refer to but with which it is closely related (Evans. 2 . according to Lacan.” While he acknowledges that this is one form of metonomy (giving the example of “thirty sail” for “thirty ships”) Lacan uses metonymy in a much broader sense to refer to the entire chain of contiguous language. However. contrasting it with metaphor. Thus. dreams. According to Lacan. the notions of metaphor and metonymy are the basic concepts through which he understands the phenomena of the unconscious.” and he links the metonymic axis of language. Lacan goes on to hold that psychological symptoms are. what Lacan describes as the axes of “metonymy” and “metaphor. meaning is constantly deferred or “displaced. with Freud’s notion of “displacement” as a key element in the dreamwork and in the formation of psychological symptoms. as a result of such chaining. 1996). corresponds to the mechanism of “condensation” in the dreamwork and in symptom formation. Lacan holds that. Lacan holds that one of the defining features of psychosis is that.” In Lacan’s usage (and here he is indebted to the linguist Roman Jakobson) metonymy2 refers to the shift in the signified that results from the contiguous flow in language and to its links. even these anchoring points (points de capiton) are not present. Metaphor. signification is always in flux (see Dor. Metaphor. to denote the possibility of substituting elements in a chain of signification with other elements. For Lacan. a given signifier can represent more than one signified. and the signifier’s impact on former elements in the change. Topics such as the primary process.Lacanian Psychoanalysis 53 continuous sliding of signification (Lacan.


Borderline Personality Disorder: A Lacanian Perspective

formation of the symptom, jokes, and all other formations of the unconscious are understood by Lacan in terms of these two axes of language. According to Lacan, even such psychotic phenomena as neologisms, glossolalia, and delusional language are metaphoric and metonymic formations (Dor, 1997). Finally, and these are amongst Lacan’s major contributions to psychoanalytic theory, the process of desire is viewed as a metonymic development (as desire is continuously being displaced and deferred from object to object without ever reaching satisfaction) and castration is viewed in terms of a primal metaphor, i.e. The Name of the Father or paternal metaphor, which becomes the means through which the individual gains access to the symbolic order. Each of these themes will be made clear as we proceed. As will also become clear, Lacan links Freud’s ideas regarding the Oedipus Complex and structural diagnosis with his structural analysis of language. He holds that the individual’s capacity to utilize language in a “normal” manner is a function of his or her entry into the “symbolic order,” the rules of discourse and laws of the community that are fundamental to human society. Such entry is dependent upon the presence of a “primal signifier,” what Lacan calls “the Name of the Father,” which, on Lacan’s view, is instituted as a result of the restrictions (castration) imposed by the Oedipal triangle. Whereas the neurotic is said to repress castration and the paternal metaphor, and the individual with a perverse structure is said to disavow it, the psychotic is said to foreclose it, in such a manner that he or she is never fully implanted within the symbolic order. These ideas, which will be the subject of a more detailed discussion, both later in this and in subsequent chapters, are critical for any Lacanian understanding of the so called borderline personality.

Lacan’s Novel Psychoanalytic Ideas As I have indicated in the previous section, any understanding of Lacanian psychoanalysis is dependent upon an understanding of his use of structuralist linguistics. Lacan proposes, in effect, to read the human psyche like a text, and in order to grasp his reading we must come to terms with his basic theories regarding language. Lacan’s originality, however, is by no means limited to his reading of Freudian ideas through the lens of structural linguistics.

Lacanian Psychoanalysis


His corpus is filled with original and often controversial theoretical and clinical formulations, many of which are grounded in structuralism, but others of which are more closely linked to Hegelian philosophy, phenomenology and existentialism, intellectual movements that are generally thought to be opposed to the structuralist program. Lacan’s career as a psychiatrist and psychoanalyst spanned nearly fifty years, during which time his ideas were in constant development and flux. He spent 25 years of his professional life diagnosing and treating psychosis. However, Lacan’s death in 1980 has only increased the multiple interpretive possibilities that can and have been gleaned from his work. In the following sections, rather than attempt to provide even a cursory review of Lacan’s prolific theorizing, I will focus upon several of his key contributions, which (though they span different points in his career) promise to be most helpful in our efforts to grasp the borderline phenomena in Lacanian terms. While it may well be that Lacan would not have, at any given point in his career, maintained each of these positions, Lacanian analysts have not, in general, troubled themselves with maintaining a position that is consistent with a single period in Lacan’s thought, and have found it fruitful to incorporate into their own theorizing ideas from different phases of his long career.

The Mirror Stage: The Scenario of Ego formation Lacan wrote his paper on the mirror stage in the late 1930’s when he was still part of the International Psychoanalytic Association (Feher Gurevich, 1999). In this paper he elaborated the formation of the ego as the encounter of the subject with the other in what he terms the imaginary realm of existence. Lacan will later make a distinction, critical to an understanding of all his later thinking, between the “registers” of “the real,” “the imaginary,” and “the symbolic,” but at this stage of his thought his views on the imaginary were only beginning to take form. For Lacan the imaginary realm is characterized by conscious life; the way the subject is immersed in his reality and how he perceives it. The encounter with the imaginary realm is what Lacan calls the mirror stage. While Lacan seems to have initially regarded it as a developmental stage, he soon came to view the mirror stage as reflecting the very nature of human subjectivity.


Borderline Personality Disorder: A Lacanian Perspective

For Lacan, the “mirror stage” is a structural formation that accounts for the formation of the ego, and what is ultimately experienced in the transference between the patient and the analyst’s ego. The mirror stage is primordial not because of its developmental status, but rather because it prefigures the dialectic between alienation and subjectivity, what Lacan terms the “divided subject” (Lemaire, 1986). Lacan early on became fascinated by the discoveries of Wallon and later Baldwin (Evans, 1996) that the child obtains self-recognition in the mirror between the ages of six and nine months, during a period when the child gradually becomes conscious of his body and his image. These researchers noted that unlike a chimpanzee, who quickly realizes that his image in the mirror is illusory and thus loses interest in it, the human child becomes fascinated with his image in the mirror and seems to comprehend that it is an image of himself. This recognition becomes the foundation for the formation of an image of the self via identification with an “other,” who is outside. According to Lacan the entire process of identification is grounded in the imaginary dimension. Lacan elaborates on the concept of the imaginary by comparing animal instincts with the human drives. He describes how animals are naturally drawn to the satisfaction of their needs and can grow to function competently in a short period of time. On the other hand, a human baby is underdeveloped during the first six months of life, specifically in terms of motor coordination and motility. However, this immaturity is balanced by a strong sense of visual perception. The child can recognize a human face very early in life and respond to it. When the child recognizes himself in the mirror he feels joy, which is a sign of awareness, and the beginning of his fantasy life. According to Lacan, the mirror stage occurs in three successive phases. First, the child confuses reflection and reality by looking for himself behind the mirror. Second, the child understands that the image is a reflection, not the real being. Third, he understands that it is not only a reflection of himself but that it is different from the image of the other. Lacan holds that the mirror stage is the key to the formation of the ego. The child experiences his body as fragmented and uncoordinated, but because of the advanced development of his visual system, he is able to recognize himself in the mirror in spite of the fact that he lacks control of his own movement. The child sees his image as an integrated gestalt,

Lacanian Psychoanalysis


which contrasts markedly with the fragmentation of his own bodily experience. While initially there is an aggressive tension with this image, the child resolves this tension by identifying with it, leading to an imaginary sense of mastery and wholeness (Lacan, 1956). The identification with the image in the mirror extends as well to the identification with other children. When he is around other children his age, the child expresses his identification with the human form with the others in his games: “the child who strikes will say that he has been struck, the child who sees his fellow fall will cry” (Lacan, 1977). According to Lacan, the child now wishes to be recognized by others in his newfound sense of self, and even imposes himself on the other and dominates him. We see here the imaginary processes at work, a merging of self and other, and, according to Lacan, it is in the other that the child lives and registers himself (Lemaire, 1986). On Lacan’s view, the experience of the mirror is prior to the capacity for cognitive recognition and also to the advent of the body schema (Dor, 1997). The identification with the mirror image and the body is fragmented, but its function is to unify the self, to bring about a total representation of one’s own body. However, the child’s identification with an image outside of himself also carries a negative connotation, in that the ego becomes, in effect, a narcissistic image with an “inverted structure,” the very nature of which is external to the subject and objectified. Lacan follows a tradition in French philosophy that regards the ego as an objectified phenomenon that is outside of, and alienated from the human subject; the ego is above all a construct produced by “the gaze of the other”. For Lacan, the ego is hardly the seat of

subjectivity, judgment, reality testing, etc. that it is for the ego-psychologists, it is rather a narcissistic construction utilized by the subject to provide a false, and alienating, sense of coherence and value. This is a key concept in understanding Lacan’s critique of ego-psychology, and will be of significance to any Lacanian “deconstruction” of the borderline concept. According to Lacan, through the mirror stage the child acquires a sense of the totality of his own body but only does so by way of narcissistic identification with the others, and in the process establishes a fundamental alienation in an image that will produce a chronic misrecognition. In other words, the child identifies with an optical image of himself, rather than with his own subjectivity.

Out of the asymmetry of the mirror stage. not of the reality principle. but we speak about a self that is fundamentally alienated and displaced. this adaptive function is at the expense of the subject’s own truth. the unconscious. who is alienated and is unable to understand why reality constantly disappoints him. Lacan recognizes that misrecognition serves an adaptive function as the instinct of survival does for the animal. one being that since egopsychologists identify the subject with the conscious ego. Far from being the governing agency of the subject or self as it is in ego-psychology. ego-psychology. has identified with “the object in the mirror. While ego psychologists hold that by analyzing defenses they allow the ego to recover its discerning abilities and recognize external reality. The ego is trapped in the fundamental division of the subject. if the subject is able to misrecognize something.” which is at complete odds with the radical. However. it is because of this alienating identification with an image outside of itself that misrecognition becomes the fundamental characteristic of the ego. when we work exclusively with the patient’s ego.58 Borderline Personality Disorder: A Lacanian Perspective According to Lacan. For Lacan misrecognition is the content of consciousness.” the identification with the ego leads to an acceptance of the desires of the other. but of an “imaginary reality” (Lacan. the ego defenses arise. as such. namely that the ego is the psychic representative. ego-psychology furthers a program of identification with the analyst and “adaptation. since that object in the mirror is essentially the “other. our patients don’t progress. As we will see. This misrecognition also has profound implications in the realm of language and speech. at the expense of the true desire of the subject or self. We have a mistaken belief that we know what we are saying when we speak. the ego. sometimes to the point of deteriorating psychologically. a cover-up for the . for Lacan. 1966). However. According to Lacan.” to the neglect of his genuine subjectivity. like modern man in general. neglect the fundamental discovery of psychoanalysis itself. in fact they continue to suffer and wonder about their symptoms. since the ego itself is a defense. For Lacan. Lacan holds the opposite view. as Lacan states. liberating nature of psychoanalysis. is a snare and an illusion. he must know something that needs to be recognized. Misrecognition is not ignorance. they neglect Freud’s dictum that the “the ego is not the master in its own house” and. Lacan provides other far-ranging criticisms of ego-psychology. all is not lost. For Lacan. there is no point in differentiating ego from its defenses. In elevating this misrecognition.

This unavailability produces frustration and confusion. the child must come to terms with the fact that the mother is not always available. propose a developmental study of the child. it is always a construction made a posteriori . Lacan’s Critique of Developmental Psychoanalysis It is important to point out that while Lacan. However. Lacan has a number of other things to say about what American analysts speak of as preOedipal formations which presumably impact upon later adult structure. via the acquisition of language and along with it. in all his or her social relations. the birth of the unconscious . and. this is most obvious in subjects who feel insecure in their recognition by others or who fear being devoured by others. appears to be presenting a developmental theory of the ego. However. what is known psychoanalytically about the child’s psychological universe. and human motivation is always understood retroactively. psychic structure. or that at times she does not understand his needs and frustrates them. it is only with the advent of the symbolic order (or acquisition of language) that the child will bring his/her ego into the realm of the symbolic and the ego will appear more integrated. According to Lacan. he does not. Lacan goes so far as to state that it is not the place of psychoanalysis to conduct infant research. For Lacan. (Here Lacan is close to the object-relations theory of Melanie Klein.Lacanian Psychoanalysis 59 fragmentation and then for the split that constitutes us as subjects. in articulating his theory of the mirror stage (and other pre-Oedipal phases). the subject will be challenged again. Lacan views the preoedipal period as the time of total dependence on the mother. in the end. With the process of primal repression the subject’s original sense of helplessness retreats to the unconscious. However. each time the image of the other imposes itself on the ego. in effect. replace what is missing. as well as with respect the alienation incurred by the mirror stage. even rage. Infant research belongs to the field of developmental psychology or other pertinent disciplines.) The question that arises in the face of Lacan’s account of these pre-Oedipal events is how the human subject (child and later the adult) can organize itself with respect to this essential loss. This is the crisis that Lacan places at the entrance to the symbolic order. but it is present in all of us.

Lacan conceives his mirror stage (and other concepts. I believe that. including the Oedipus Complex). Lacan’s distrust of developmental approaches to psychic structure follows in a rather straightforward manner from his view of language. the significance and structure of the subject’s psyche is only reinterpreted and resignified as an adult. While Lacan may be criticized on the grounds that he utilizes developmental concepts and then denies that they are developmental. Although in other contexts Lacan’s theories might be conceptualized in quasi-developmental terms and even be put to empirical test. at least in his more mature formulations. It will be worthwhile to reflect in some more depth on Lacan’s position in this regard. For Lacan. This is why language and its rules are crucial to the understanding of these structures as they are produced in the analytic exchange between analyst and patient. Further. but the unconscious as it is studied in the context of the psychoanalytic situation. frustration (when the child does not receive what he needs). and it is clear that at least in the case of the mirror stage he was stimulated in his thinking by developmental events. For Lacanian psychoanalysts it is more appropriate to discuss structural moments of psychic development rather than developmental phases or stages. makes no sense to try to understand adult psychological functioning through an analysis of meanings that were present for the child. etc. Just as the significance of a chain of signifiers and each of its elements along the way is not revealed until the end. particularly in the psychoanalytic situation.60 Borderline Personality Disorder: A Lacanian Perspective (Feher Gurevich. as it constitutes a major difference between Lacanian psychoanalysts and their American counterparts. is based upon reconstructions from working with adult patients. and castration (the . He certainly does not hold that human psychopathology emerges according to a set sequence. the subject matter of psychoanalysis is neither child development nor personal history per se. as these meanings have been altered and resignified in the adult psyche. Lacan articulates certain moments in the constitution of human sexuality via the Oedipal complex. including his thinking regarding the mirror stage. at critical periods. according to Lacan. in his own work. in logical/structural as opposed to developmental terms. 1999). by re-working the topics of privation (the mother gives or deprives according to her wishes). during prescribed libidinal or developmental stages. and hence his view of narration and history. and could prove a major stumbling block in their potential communication.

and most importantly. the patient may have done his “working through” outside of the session (This is. At a certain moment in the session. Regardless of what occurred “objectively” (if such a concept even makes sense) what matters is the analysand’s psychic experience. However. these events do not have the same meaning at the time of their occurrence as they do in the psychoanalytic situation. but not temporal sequence. The patient listens and processes the new data. he may have come back to the words he spoke and the exchange with the analyst in a different way. and has nothing to do with objective time. the analyst decides to interrupt the session and suspend the analytic process. symptoms) follows a logical. Lacan argues. accentuating or underlining what he or she believes is important (usually the suffering related to the symptom). to “see.Lacanian Psychoanalysis 61 understanding of the child that the mother is lacking something and that he is not the one who can satisfy her). they are in fact atemporal. When a patient relates his or her history in treatment. In Ecrits (1945) he concludes that the modus operandi of the unconscious. repeating or questioning what the patient has said. These moments. as he puts it. (This cut of the session indicates the moment of conclusion). As a result of analysis the patient has constructed a new logical discourse regarding something that at one point had a . They can occur at one age for one child and another age for another. The patient may elaborate further.” a time to “comprehend” and a time to “conclude. Lacan explains that the “timing” of human development is not evolutive but logical. for example. This narrative constitutes the patient’s psychic reality. This logic implies that for an individual to arrive at his or her “truth” each significant psychic event implies a time. This is the logic followed by the unconscious processes. he/she makes a historical presentation of the facts and events that occurred during his/her life. parapraxis.” (Lacan. Further. according to Lacan. the moment of understanding). 1945). When the patient comes in the next session. they occur at some point when the child is dealing with the contingencies of his environment. are necessary but are not developmental phases that follow a prescribed temporal sequence. The following general account of the way Lacanian analysts work using the so-called “short” (but really “atemporal”) session should help clarify the atemporality of the analytic process.” by. what he calls the “formations” of the unconscious (dreams. (This is the moment of seeing). Although these moments are described as a temporally ordered sequence. the patients says something that the analyst is puzzled about and the analyst makes a “punctuation.

and a challenge to live and achieve meaning for another (Frankl. but rather because. as a result of primary repression. Lacan’s problem with a developmental psychoanalytic approach to the structure of the human psyche is analogous to a historian’s objection to our trying. according to Lacan. Lacan does not deny the role of time in child development. whether an event has a traumatic effect is not the result of the intrinsic nature of the trauma but rather because such trauma represents a resignification of that which was structurally traumatic on an earlier occasion. and. For example. According to Lacan. most significantly the position the patient occupies in his discourse with the other. Thus. However. whereas a hundred sessions may prove ineffective for this purpose. Although the mechanisms of trauma and resignification may be universal. however. the singularity of each subject renders different meanings for presumably similar or even identical life events. We want to hear the history of the patient. Lacan does not deny the existence of growth and development. The actual events in objective time are not analytically meaningful until they are signified. 1959). The words exchanged in five minutes may be enough for a patient to open a new chain of signifiers. if the analyst would have extended the session to forty-five minutes. we must attend to the particular linguistic structures the patient chooses. everything could well have been lost in a torrent of words that confuse things to the point where neither analyst nor patient knows what they are working on. Another example can be useful in explaining Lacan’s position: the significance of a “traumatic” situation. chronological time has no meaning in analytic work.62 Borderline Personality Disorder: A Lacanian Perspective different meaning. In terms of infant development. he holds that in focusing on such development the analyst will inevitably fail to understand the structure of the human subject. whose work is directed to the issues of discourse and unconscious processes. In effect. not because we want to find evidence for possible causes of the patient’s suffering. understood and re-signified by the patient. the actual length of the analytic session is also unimportant. Further. one for which. the subject has no recollection. as analysts. such development is not explicitly relevant to the psychoanalyst. without reference to Hitler and World War II. Indeed. . say. life in a concentration camp (which all would regard as “objectively” traumatic) may be overwhelmingly traumatic for one individual. to understand the significance of events in Germany in the 1920s. who commits suicide or allows himself die.

slips of the tongue. However. As we will see. however. Lacan takes the example of Freud’s observations of his 18-month-old grandson who would throw and retrieve a spool as he uttered the words: “fort”. All understanding for Lacan is apres coup (after the fact). To elaborate upon this aspect of the symbolic order. etc. but (in the logical sense) it is at first alienating. will also hold that language has a liberating function. the symbolic order. and at the very origin of the unconscious. the point of differentiation between neurosis. psychosis and perversion. the unconscious will be the repository of all phonemic traces.” and his subjectivity possessed by something that is outside himself. is one more vehicle through which the individual is trapped by the “other. Freud understood this event as the way the child could master the situation of the loss of his mother by taking symbolic control through words indirectly referring to his mother’s presence and absence. they are presented in the form of symptoms. for Lacan. the phases and events in childhood are only explanatory of adulthood to the extent that. for Lacan. is how the unconscious comes into being. This moment inaugurates the child’s subjective experience in the world of language and as he increases his vocabulary. However. the child’s inscription in the symbolic order marks. he grows to . one that is characterized by the loss of his world vis-à-vis his mother in order to become his own being. like the imaginary order. the acquisition of language marks a new structure in the mind of a child. a structure into which the child is unknowingly inscribed even before he was conceived. as the child is expressing a certain mastery through his words. Lacan interprets the “fort/da” as an indication of primary repression. The Symbolic Order For Lacan. Lacan. From then on. Having said this. his feelings of loss are being repressed. While we may be able to learn much about the child by observing him/her in his development. and this. words and subsequent representations of lack or loss. according to Lacan. “da” (“gone”. Lacan found it impossible not to speak in terms of historical development—albeit a development that is understood in terms of its re-signification in adult life.Lacanian Psychoanalysis 63 No amount of contemporary narrative from the 1920s will substitute for our re-comprehension of those same events after the war. “there”). The symbolic order is the order of language and culture.

The acquisition of language is a paradoxical process. . As Lacan states it in his Ecrits (1977): ”We can say that it is in the chain of the signifier that the meaning insists but none of the elements consists at any given moment. However. it is deceptive in so far as the subject’s unconscious remains bound up with the signifiers of the “other’s” desire. (1977. unlike the imaginary. not something that simply resides within our own intrapsychic depths. they are composed of a signifier and a signified (which Lacan symbolically divides with a bar) and thus express and embody the division between what the subject says consciously and what is barred from the conscious discourse. like the imaginary constructions provided by the mirror stage and the ego. the language within which he “resides. However. This is why Lacan believes that language is such a powerful tool. We are forced. language both saves and deceives. to accept the notion of an incessant sliding of the signified under the signifier”. it provides the child with a certain autonomy.64 Borderline Personality Disorder: A Lacanian Perspective encompass many possible experiences and facts of reality. that our “unconscious” is. be brought to a halt. but is rather. and the subject can learn to differentiate his subjectivity and desire from the demand of the other (see below). in psychoanalysis. at least temporarily. and general society/culture). On the one hand words alienate. it is only in the register of language that this “sliding” can. p. on the other hand. What Lacan means to say by this is that since the child is born into a language he/she inherits from others (his parents. more properly.” It is because the language we speak is imbued with others’ meanings and intentions. something that resides out in the world. grandparents. the language through which he expresses himself. For Lacan. according to Lacan. then. 153). it fosters the subject’s splitting and alienation. the register of the symbolic offers an opportunity for the subject to transcend his alienation and partake of a new subjectivity that is only possible through the act of speaking.” and the language he represses insures that his subjectivity is not his own but is rather completely inundated with the purposes and desire of an “other. and in fact the only proper tool. it causes both the formation of the subject and. on the one hand.

whether the subject is male or female. 1908). the subject desires the parent of the opposite sex and develops a rivalry with the parent of the same sex. and other meaningful actors in the life of a child even before his arrival to the world). These multiple identifications provide a script in which the subject is led to play out the drama of conflicts among the members of the family (Lacan. via the introduction of a third term between the mother and the child. Lacan defined a complex as a whole constellation of interacting imagos or the earliest internalization of the subject’s social structures (parents. By 1910. and the resultant insertion of the paternal metaphor into the unconscious psychic structure. it became the motor of psychoanalytic theory.Lacanian Psychoanalysis Lacan’s Conception of the Oedipus complex 65 For Lacan. the symbolic order is instituted as a result of the Oedipus complex. In his view. In the positive form of the complex. The child enters the complex around the age of three and leaves it by the age of five or six when several important factors emerge: the child identifies with the rival and as a consequence resolves gender identity. the superego develops as an internalization of the parental prohibitions as a self-censoring agency. the Oedipus complex is. the subject always desires the mother. of greatest significance in the present context. In the 1950’s. for Lacan. However. Lacan initially addressed the issue of Oedipus in 1938 in an article called “The Family”. latency. Freud had made the Oedipus complex the central focus of psychoanalytic investigations into the neurosis and after that time. a paradigmatic triangular structure opposed to all dual structures. Lacan’s thinking here produces a radically asymmetrical way of understanding the Oedipus Complex and has enormous consequences for the issues of sexual difference and gender identity. . The Oedipus complex as we know it from Freud is an unconscious set of relationships that occur in a triangular form and is characterized by specific affects related to the parents (Freud. and the father is always the rival. in which sexual desires are displaced by other more intellectual interests prior to adolescence. and the child enters a new phase. grandparents. Lacan began to produce a distinctive re-conceptualization of the Oedipus Complex. 1957). Freud argued that all psychopathological structures could be traced to a problem in the resolution of the Oedipus complex (Freud. 1910).

the father (inserted through language). they mate always for reproductive purposes and they don’t have conditions in their choice of mates. and we have specific conditions for choosing one mate over another or for selecting an object to fulfill our sexuality. he elaborates this complex as a structural moment that occurs at the level of discourse. Lacan holds that the first phase or “time” of the Oedipus Complex occurs in the context of the imaginary level of existence. Human sexuality is completely different. Lacan believes that without the Oedipus Complex. with the frequency and intensity we wish. (English: drive) a word that has a very different meaning than its usual English translation as an “instinct. If the child is someone. the Oedipus complex has important consequences for the formation of the symptom and for the psychic organization of the adult. The Formations of the Unconscious (1958) Lacan identifies three stages that are necessary in order to achieve the passage to the symbolic order. i. However. the “other” is the mother. he disassociates the complex from the primal scene and all the specificities of the familial relationships.66 Borderline Personality Disorder: A Lacanian Perspective namely.e. in the mirror or in the mother’s gaze. psychoanalysis cannot be sustained. Further. they have a copulating season. In addition. He asks the question: How is sexuality established in human beings? The answer is related to the German word Trieb.” Animals have sexual instincts. and in the process the subject is confronted with the problem of sexual difference. These stages follow a logical as opposed to chronological order. we can have sexual relationships only for pleasure. that is. he makes several changes from the original version of the myth as it was interpreted by Freud. this complex represents the passage from the imaginary phase to the symbolic phase. it is only . The Three Stages of the Oedipus Complex In Seminar V. All of these issues are determined as a result of the oedipal vicissitudes. According to Lacan. We can ask ourselves if the oedipal tragedy can actually represent the human condition and the vicissitudes of human sexuality. and the child is initially involved in a dual relationship with her in which the child comes to recognize himself somewhere else beyond himself. First. Our anatomy does not absolutely determine our sexual identity.

there is never a dual relationship per se. the imaginary phallus. In Lacan’s writings. Lacan uses the term phallus to indicate that what concerns psychoanalysis is not the biological presence of a penis but the “signifier of desire” (that which we lack). However. but is rather simply a representation of what the mother lacks or desires. This position of total dependence leads the child to believe that his satisfaction is tied to the place he occupies for his mother. we have the prohibition of the father already operating over both mother and son/daughter. having no symbolic substitution for himself.Lacanian Psychoanalysis 67 because he is someone for his mother. and for the child. the child is filled with . is not to be confused with the biological organ. but it is clear that he referred to the “fantasy” and not to the real thing in most of his discussions on sexual difference. namely. It is this lack which Lacan terms “the phallus”. Lacan regards the presence of the imaginary phallus as the third term in this early stage of the Oedipus Complex. Lacan’s introduction of the concept of the phallus is a potential source of controversy and confusion. differs from Freud’s conceptualization. there is already a triangle between the mother.” and the compliment of her fulfillment. and. For the mother. according to Lacan. according to Lacan. In identifying himself with the phallus. the concept of the imaginary phallus in the first stage of Oedipus. anxiety in the child increases. In this stage. to be “that which she desires. We are here in the realm of primary narcissism. both the mother and the child are marked by a lack. occupy. representing that object which the mother desires beyond the child (unless the mother is implying that the child is occupying that place which means she does not “lack anything”). As a result. The child wants to be everything for her. With the strong emergence of sexual impulses in the child (infantile masturbation). in which the child. and that which the mother lacks. become the phallus for her.” It is unclear if he made a clear distinction between phallus and penis. the child is simply trying to satisfy the mother’s desire. Therefore. in effect. the lack is that which she desires beyond the child. inasmuch as. Although it appears that there is a dyad functioning between mother and child. the child. but cannot. the lack is the place in filling the mother’s desire that he wants to. Freud referred to the concept of phallus as the fantasy of “having or not having. For Lacan. the phallus. indicating that even here the imaginary father is already functioning. any attitude of the mother that will favor her possession of the child will alienate the child from subjectivity and a place in society. is a blank surface for the mother to write upon.

in the child’s mind. must first recognize his speech. According to Lacan. and not the recognition of his role in procreation.68 Borderline Personality Disorder: A Lacanian Perspective feelings of impotence and confusion. 1977). this process. In Freudian terms.” or if the mother does not recognize the position and speech of the father. the child does accept this law. (Lacan. This is what Lacan calls the “normative function of the Oedipus complex. It is speech alone that gives a privileged function to the father. If on the other hand. In the second phase of Oedipus. who acts as a sort of gatekeeper to the child. this stage is what is denominated “primary repression” and is constituted essentially by alienation. This intervention. The mother’s acknowledgment of the father’s presence enables the father to occupy the third position in the Oedipal triangle in which the child sees the father as a rival for the mother’s desire. which is the basis of the symbolic order as opposed to the power of homogeneity. the father reinstates the phallus as the object of the mother’s desire but the child is no longer identified with it. the subject will remain identified with the phallus and continue to be subjected to his mother’s desire. who. relieves the child of the anxiety associated with occupying the place of the phallus for the mother. in the imaginary order).” According to Lacan. He can thus. has an implication of privation. In this way. The third “time” of Oedipus is marked by the real intervention of the father who signals to the child what he can and cannot have. This is called the Name-of-the-Father. Lacan discusses that the father. this second stage of the Oedipal phase is called “secondary repression” and essentially corresponds to a phase of separation. If the child does not accept the “Law. if the father is to be recognized by the child. identify with the father and transcend the aggressivity inherent in his imaginary identifications. while the father initiates this privation. (Lacan refers to this as the power of heterogeneity. which is called “castration” in psychoanalytic theory. possesses the phallus. allows the child to give and receive in a full sexual relationship and to also have a . the fusion with the mother. there is an intervention by what Lacan refers to as the “symbolic father. in introducing to the child the law of the symbolic order. The father’s speech denies the mother access to the child as phallic object and forbids the child complete access to the mother. which occurs. the mother. he identifies with the father. However. In Freudian terms.” as it introduces a law establishing difference between the child and his parents as well as the norms of generational and sexual difference. it can only operate via the mediation of the mother.

What is it that Hans is anxious about? He is anxious about his sexual pleasure. and the consequent development of a phobia incident to these vicissitudes. For example. As long as the horse is feared. Freud’s case of “Little Hans” (Freud. (and here we see the birth of sibling rivalry). Thus. the presence of the baby represents the evidence that he is not everything for his mother. in fact. In this case. around the age of five. or even an institution. but rather to the one who implements the paternal function. a friend or another female. 1999). Like other phobics he has demarcated a specific . the phobia of being bitten by a horse becomes his protection against castration anxiety. she is busy with the baby and can no longer devote the same time and attention to him that she had previously. Thus for Lacan castration is understood in both a negative (limiting) and positive sense. At the same time. We must emphasize the obvious fact that for Lacan. is unable to separate Hans from his mother’s excessive loving demands. 1909) provides an important illustration of the oedipal vicissitudes as they are interpreted by Lacan. Subsequently Hans develops a phobia to horses. a function that could be carried out by an uncle. which is linked to his mother coupled by the abrupt appearance of his sister as a threat to the loss of love that he represents for his mother. When Lacan discusses the “father. he does not experience anxiety. and his mother would at times take him to her bed. to experience sexual feelings accompanied by masturbatory activity. Hans would bathe with his mother. When Hans starts. it is actually inscribed in a language that was already present before any of the participants in the oedipal triangle were born. which for Lacan constitutes a place in a family constellation that promotes the realization of the self through participation in the world of culture. castration is the symbolic operation that cuts the imaginary bond between mother and child.Lacanian Psychoanalysis 69 Name. The father who wanted to be a “friend to his child” placed no restrictions on him. This Law is not proper to the father. we have a very permissive mother who is very attached to her son and a father who. he becomes very anxious.” he does not generally refer to the real father. the negative aspect enforces the prohibition of incest and the positive aspect assures the child’s inscription in the generational order of a family and society. On a Lacanian view. in spite of being quite sympathetic. his sister Hanna is born and his mother becomes less available to him. the child’s parents also had to experience the situation of loss with their own mothers. (see Ferrari. language and society. Castration is not the fear of losing the penis. and grants the child (boy or girl) the ability to symbolize this loss in words.

primarily those concerning the exchange of women. avoid the phobic object. Through his analysis of the changes allowed or prohibited in a social system. He defined a structure of kinship as a system in which all the members who are related in a family fall into two categories: the possible marriages and the forbidden ones. that is. without the need to project his anxiety regarding sexuality and loss onto a phobic object. This necessary separation would have enabled Hans to identify with his own father. The Prohibition of Incest Lacan studied carefully the myths described by Freud in Totem and Taboo and took a great interest in the regulation of culture and the transformation of the law of nature to the law of culture. A man or a woman is separated from his/her biological family in order to be united with a member of another clan assures the perpetuation of the species (Feher Gurevich. who pursued this theme in field studies that he carried out in Australia and South America on the rules governing various social practices. these individuals know the rules of marriage without being conscious of the principle of prohibition imposed on the blood marriages. We can infer that Hans’ father. . i. He only has to avoid that territory. did not intervene in separating Hans from his mother. which is clear from his own decision to consult with Freud about his son’s symptoms. and marks the division between nature and culture. but the fact that the individuals who operate within it are unaware of the conditions for mating. What is so original about Levi-Strauss’ work is not the discovery of the law. In his book The Elementary Structures of Kinship Levi-Strauss described how in society there are laws that govern these relationships. the institution of marriage and the establishment of familial relationships.e. 1999). in order to avoid experiencing anxiety. words and goods.70 Borderline Personality Disorder: A Lacanian Perspective (presumably manageable) territory for his anxiety. Levi-Strauss believed that he was able to establish that the prohibition of incest constitutes the foundation of the symbolic system. although with the best intentions. which operate at the an unconscious level. and that these laws are organized in ways that are analogous to the structure of language. Lacan took note of the structural anthropologist Levi-Strauss (1949). separates animals from humans.

We will later explore how this theme is of significance in understanding differential diagnosis and in particular the inability of the so-called borderline patient to withstand intimate relationships without losing his/her sense of personal integrity. According to Lacan. It provides the child with an explanation of his or her origins and pre-history.” and how is it that we can apply this metaphor in our daily clinical work? The most important function of the paternal metaphor is a symbolic one. Finally. Further. the child is empowered to speak about his own lack. and he is therefore not fully inscribed in the symbolic order. In our culture. but the very fact of a prohibition that is universal. but in other cultures such prohibitions might differ. Lacan implies that prohibition is a necessary condition for the existence of desire. While it can be debated whether the objects of incest prohibition are completely trans-cultural. in the child’s life. the imposition of some sexual prohibition is is universal. his language does not reflect the inscription of the Name of the Father. If the name of the father operates. aunts and uncles. a psychotic individual may be able to speak. As a result. This is not a natural event. and is thereby further empowered to enter into the world of interpersonal relationships. rather it is a cultural/symbolic one that raises the child out of the realm of biology into the matrix of language. and situates other family members such as grandparents. intimates how his parents’ desires were played out. Why is it that Lacan insists on the significance of the metaphor of “The-Name-of-thefather. Contrary to Freud’s statements that this prohibition is transmitted phylogenetically. the psychotic is not able to express his loss and lack as a full desiring subject. An imposition of our occidental culture. . according to Lacan. the paternal metaphor represents a boundary or limit that permits the child entry into the laws and traditions of his culture. culture and law. according to both Freud and Lacan. and makes human sexuality unique. is that the symbolic father is the representative to cut the bond with the mother. the child’s fantasies actually defy the law of the prohibition of incest (if not literally then imaginatively) that is imposed on the subject by the culture. Lacan re-formulated the theory of the prohibition of incest within a psychoanalytic framework. While. we have certain sexual prohibitions. Lacan states that this prohibition is cultural. a condition of our language.Lacanian Psychoanalysis 71 On the basis of Levi Strauss’ findings. It is not the specific prohibition. and enables him/her to achieve an adult identity that will permit him/her to establish his/her own family.

However.” For Lacan “reality. Lacan says “the real is whatever exists outside of symbolization and language” (Lacan. and we have discussed the symbolic register (or “order’) in the context of Lacan's understanding of the Oedipus complex and the role of language in the structuring of the unconscious. the Symbolic and the Real One of Lacan’s most innovative contributions is his distinction between the three registers of the “symbolic”.” Although Lacan's use of the term “real” shares something with both common sense and its application in the history of philosophy.” distinction.” as we normally use the term." that is. and it is only language that permits the real's differentiation into a world of things. a pre-linguistic being that exists prior to the subject’s constructions of or about it. However. it remains for us to describe what is Lacan’s very difficult conception of the third register." The reason for this is that the real can neither be imagined nor symbolized. but simply appears in experience as that which is intrusive and traumatic. psychoses. 1953) In Ecrits. refers to the real as "the impossible. We have already discussed the register of the imaginary in the context of the mirror stage and Lacan’s critique of the ego. the “imaginary” and the “real. According to Lacan. In the first place for Lacan "reality" is often used in a sense that is completely opposite to that which he refers to by the “real. We will have more to say about these two registers in the context of Lacanian diagnostics. and his conception of the essence of neuroses. the real as trauma cannot be permanently identified with any specific objects or things. It is because the real is not assimilable by the subject that it takes on a traumatic character. The real. the “real. is simply that "which resists symbolization absolutely" (Lacan. the real is completely undifferentiated in itself and is “absolutely without fissure” (Lacan. 1954). is completely enclosed and determined by symbolism and language.72 Borderline Personality Disorder: A Lacanian Perspective The Imaginary. In Seminar 11. It is only the symbolic that introduces a "cut” into the real. and as such it is “impossible " to attain it in any way. the "real” is closer to what to philosophers have referred to as “being in itself. the real should not be confused with "reality " as it is commonly understood. Lacan. and perversion. as it was formulated by Lacan in the early 1950's. and beyond the power . whereas the "real" is used to indicate a register that is completely opposed to and unassimilated by language. For Lacan. 1953). which plays an important role in his structural diagnoses.

Lacanian Psychoanalysis 73 of the subject to conceptualize and symbolize. and unexpected natural disaster.” For Lacan. In fact. Lacan holds that whereas psychology focuses upon (symbolized) reality. Since it is completely unmediated and cannot be "understood” by the subject. at the moment of their initial entry into consciousness they represent a traumatic intrusion of the real. the “real” may return in the form of a hallucination. For Lacan. Because the real is connected with the limits of human experience it becomes a major concern for psychoanalysis. initially. While at times Lacan seems to suggest that the real can be assimilated to reason. Lacan also links the “real” to the concept of “matter” and especially to the realm of biology. Muller) have held that a failure to bind the real effectively is characteristic of so-called Borderline psychotic states (Muller.” The real represents a limit to both imaginary construction and symbolic knowledge. 1959)." . its intrusion into experience is traumatic and anxiety producing. the job of the psychoanalyst is to approach the “real. Further. For Lacan. elements that enter the psyche but which at least. until such point that the individual is able to symbolize and thereby assimilate their experience. This might occur. as the result of a trauma that returns to consciousness as flashbacks and intrusive dreams. “The real” need not necessarily intrude upon the subject from the outside. However. however. It can be either material or psychical. 1982). certain Lacanian theorists (e. He will go on to describe neuroses. the real is both outside and inside the subject (Lacan. or a sudden. Common examples of the real might be a car that seems to come out of nowhere to cause an accident. it most often serves in his psychology as a radical unknown. For Lacan. and the birth of Little Hans’ sister. It is by no means an equivalent of “external reality. for example. Lacan points out that when an experience cannot be assimilated into the symbolic order. Such elements will later take on imaginary and symbolic significance. both the imaginary and symbolic orders are superstructures that are built upon a foundation of the real. In Seminar Four Lacan describes the real elements that intrude upon Freud’s "Little Hans": the real penis as it is experienced in masturbation. psychoses and perversion in terms of the various linkages between these three registers. psychoanalysis is committed to "treating the real by means of the symbolic. escape a linguistic narrative. particularly the human body in its pure physicality (as opposed to its imaginary and symbolic functions). the “real” is the primal object of anxiety.g.

give him/her a name. carrying him in her body. the parents symbolize the child in their minds. The role of the analyst is to listen for these key signifiers and to be in tune with the patient’s discourse. as for Freud. free association is the main tool for accessing the unconscious. the signifier moves constantly as free association proceeds. The complaint that a patient shares regarding her husband’s aloofness may in fact reflect her current marital situation. the arena of spoken language. 1998). Its elements are organized according to particular laws which Freud denominated condensation and displacement and which Lacan refers to as metaphor and metonymy. the parents’ signifiers are projected onto the child at the time of his birth. This speech is what Lacan calls the chain of signifiers. This is because even before the child is born he is assigned a place in the world of language. . the child comes to carry the burden of the parent’s expectations regarding their own desires and even those of their own parents’. aspects of the unconscious are formed even prior to the child’s birth. rather the unconscious is always something that is actualized in speech. It is not a reflection of the language in which the child lives and also the tongue spoken to the child by its mother (Nasio. and ultimately. however. This is what Lacan refers to when he says “the unconscious is the discourse of the Other”. While his mother is expecting him. the unconscious has the structure of a language. The language of the unconscious is always revealed in speech. Lacan names this particular language. As such. As we have seen. In Lacanian analysis the affects or emotions of the patient are also treated as signifiers. It is important to point out here that the signifiers in the unconscious are not an already formed chain of words with a given meaning.74 Borderline Personality Disorder: A Lacanian Perspective The Unconscious According to Lacan. the subject’s unconscious is fully constituted by his/her insertion in the symbolic order. according to Lacan. or in a dream according to metonymic and metaphoric processes one signifier taking the place of another (metonymy/condensation) or one signifier being replaced by an adjacent one in the associative chain (metaphor/displacement). the analyst may be listening to the marriage of the patient’s parents. By the time the child learns how to speak these signifiers have had their impact upon the child’s unconscious.” As we have seen. “la langue. For Lacan.

. Again. as the child grows. according to which the psychic apparatus tends to reduce the tension to a minimum or to keep it as constant as possible. the symptom represents that portion of primal pleasure or enjoyment that has refused to be articulated and returns.” and a portion of it comes to constitute “the symptom. a portion of the energy corresponding to this pleasure is “trapped” in what we call “erogenous zones. For Lacan.” At the same time. and the norms of social life. continue to engage in self-defeating behaviors. This environment or as Lacan calls it (“the other”) insists upon the systematic inhibition and.” Lacan too.Lacanian Psychoanalysis Jouissance 75 Lacan elaborates upon the concept of the function of the pleasure principle that Freud had discussed in 1920 (Freud. he is obliged to limit or drain that energy from his body in order to conform to the demands of its social environment. to make the subject suffer. recognized that interpreting the meaning of a symptom to a patient does not end his or her suffering. but pain. According to Lacan. it is a law that commands the subject to “enjoy as little as possible. takes up this theme by arguing that if people do not learn from their painful past experiences. 1920). Lacan uses developmental metaphors to describe his understanding of what he refers to as jouissance. According to Lacan. There appears to be an investment that many patients have in maintaining their neurosis. rules. the subject constantly attempts to transgress the prohibitions imposed on his enjoyment. in Beyond the Pleasure Principle. in effect. since there is only a certain amount of pleasure that the subject . to go “beyond the pleasure principle”. there is a paradox inherent in the pleasure principle as the principle actually comes to function as a limit to enjoyment. However. Freud.” which can be expressed as bodily or psychological suffering. and repeat negative relationship it is because they have a great investment in their suffering. Freud believed that in order to explain such therapeutic failure he needed to “go beyond the pleasure principle. According to Freud. The result of this transgression is not more pleasure. such as weaning. “emptying out” of the pleasure that the child takes in its body. According to Lacan. ultimately. education. an infant has an enormous amount of energy that is completely focused upon its own organism. it appears that most of our symptoms tend to repeat in a constant search for pain that contradicts the principle of constancy.

the drive is to a certain extent. it becomes a discourse. but just goes through it. For Lacan "need" is the biological instinct that drives hunger and other requirements of the organism. we must review the idea of Trieb or the drive. Lacan holds. This excess of satisfaction is the subject of Freud’s essay. Lacan underlines the fact that the drive never appropriates the object. The amount of pleasure produced represents a surplus that the subject cannot tolerate. need is something that human beings share with animals. Lacan situates his discussion of desire in the context of two other concepts. that the power of the motherer actually fosters an experience of helplessness in the child that goes beyond the one that he/she is born into. however it continues its path to return to the source of pleasure and to re-start the process all over again. This is not only because the caretaker can appease the baby’s sensations by producing pleasure. which is the complaint we hear from the patient. Beyond the pleasure principle (1920). his painful enjoyment. enjoyment is actually experienced most of the time as intolerable suffering. and this painful pleasure is what Lacan calls “Jouissance. How does this process occur? In order to answer this. . need and demand. Need is the basic stance of a human infant at the time of birth. is. pleasure becomes pain. Need – Demand – Desire Lacan’s theory of “desire” is central to his conception of psychoanalysis. however. According to Lacan. The position of the subject in relation to his jouissance. is not hedonistic pleasure. as we will see shortly. circumventing the object and returning to its source. which is almost a pure expression of unconscious drives. he or she is completely at the mercy of a caretaker who is generally the mother but who may be any person or institution responsible for the infant’s care.e. but on the contrary it is an energy that keeps returning to provoke suffering. Beyond this limit. appeased. While manifested in discourse. Lacan describes the circuit of the drive starting at the erogenous zone. The energy and feeling that represents a transgression of the symbolic structure of language. i. It is. When the drive is trapped in the linguistic expression. to re-start the circuit over and over again.76 Borderline Personality Disorder: A Lacanian Perspective can endure. the avenue Lacan takes to confirm diagnosis.” According to Lacan. moreover.

In this way the child proves to himself that his motherer cannot provide everything. According to Lacan. is a demand for love. that whatever she hears or senses from the child is mediated through her own interpretation.Lacanian Psychoanalysis 77 because the motherer is a speaking being. the child's demands become for the mother per se. begin to identify his own desire. which appears to be a request to satisfy a need. and with this his demand becomes a demand for the mother's love. As such. the child is actually demanding his own separation. However this demand for love cannot be completely satisfied. he learns how to manage his suffering while she is absent. because the "other. and in order to accomplish this. immersed in the world of language. This is because. and it is in this way that he will. Children demand continuously. the child pushes its demands to the point where the mother cannot meet them. he/she places impossible demands on the mother. but because they are demanding love. a demand is always a demand for an object that cannot be supplied. not because they need something." (generally the mother) becomes associated with the fulfillment of the child's demands. Thus "demand" is initially the child's articulation of its needs vocally and eventually in speech. she attains an importance that goes beyond the mere satisfaction of the child's needs. and in this way learns what the mother cannot give. on Lacan’s view. the mother appears and disappears from the child’s immediate experience. . However. According to Lacan. the specifics of the request are not as important as the nature of the mother’s response. However. The child’s basic needs are soon transformed within a relational context via the register of language. but in actuality. Further. Soon the growing infant learns that he must understand what the mother wants in order to keep receiving pleasure and avoid pain. while at the same time speaking to the child and immersing the infant in language. At this point demand becomes the opposite of need. When the child asks his mother for something. the child’s need-driven requests are transformed into a demand for the mother herself. according to Lacan. while a need can be completely satisfied. according to Lacan. Even if the mother fulfills all of the child's needs. The child will continuously demand something. As the infant becomes attuned to the mother’s communications and desires. there is still an excess of demand for the mother's love.

an anorexic young woman who has decided not to eat satisfies a desire that goes beyond the demand of her mother. which for him is the “mark of the subject” and the arena in which analysis does its fundamental work. One does not desire the other as an object to be possessed. for the mother. Desire changes objects that are also revealed in dreams and slips of the tongue. It is the nature of desire that it can never be satisfied. A . desire can never be fulfilled and. is another word for “lack. for Lacan.” According to Lacan. which is something that we want consciously. with a symptom that represents a refusal to eat is the expression of her desire. where the child desires to be the phallus that is the allfulfilling object. Desire. This position of the daughter. desire takes form when demand becomes separated from need." The reason why children are so demanding is that it is only through demanding the impossible that they can begin to understand what it is that they themselves desire. For example. which according to Lacanians are complementary. according to Lacan.78 Borderline Personality Disorder: A Lacanian Perspective That which constitutes the child’s excess demand and that which can never be completely satisfied is what Lacan calls “desire. Another meaning connected to “the desire of the other” is that our desire is always for that which is desired by others. Desire is equivalent to the process of distortion that converts a wish into a particular image. Thus from the concepts of need and demand Lacan derives the concept of desire. it is the other’s desire that makes what we desire desirable. Lacan holds that man's desire is "always the desire of the other. Thus. desire is always unconscious. and is to be contrasted with a “wish”.” that which is the missing object of desire. she wants to eat “nothing. Lacan illustrates this view that desire is for the desire of the other in his description of the first time of the Oedipus complex. desire seeks to perpetuate and reproduce itself in a nearly infinite "chain of signifiers. Desire dominates our lives and sets us apart from the animals. with the result that it ceases to motivate the subject. Whereas need can be satisfied. that is why in psychoanalysis it is less important to listen to the content of a phrase than to the particular words chosen by the patient. according to Lacan. The difference between demand and desire is important in clarifying certain issues of diagnosis." This famous phrase has a number of meanings." as the subject continuously displaces his desire onto new objects that he mistakenly believes will fulfill him/her. but rather as a subject who reciprocates one's own desire in love.

from one signifier to another. While the objects of desire constantly escape the subject. The subject is continuously attempting to articulate his or her desire. According to Lacan. however. Human life becomes a chain of demands as the subject moves from signifier to signifier in a vain effort to “fulfill “himself. In fact. of the futility of one’s succession of demands. we want to own our dream home and surmount many difficulties to obtain it. Learning to recognize and to speak of the essential gap in one’s being. we even forget how important the house was for us. demand is always for an object that cannot be given (this is what neurotics do all the time. to sensations of the body and refers to something that can be given (like food. and for Lacan the purpose of analytic treatment is this very articulation. once we have it. something else becomes our desired object. and each of which he futility believes will be the answer to his own desire. it is not only the illusions of the mirror stage that alienate the individual from his own desire (by making him believe that he is something that he is not). each of which is meant to fulfill the lack or want-of-being at his core. The symbolic order is therefore another source of the subject’s alienation. but the entire symbolic order that envelops the subject in its network of language. In addition to seeking a material fulfillment for its demands. the ego seeks fulfillment in the other. Lacan tells us. they demand from the other endlessly). According to Lacan. as the individual's identity is continuously linked to each of the demands she makes in an effort to fulfill herself. To take a mundane example. desire can be articulated in speech. once achieved. is a condition for psychoanalytic cure. one cannot desire what one already has. However in doing so he moves from one demand to another. the ego is intrinsically related to this metonymy of desire. which on the one side is a source of alienation. rules and communal structures. Lacan holds that desire is continuously being displaced into a symbolic demand. Desire is for an object that sometimes can be reached but because of its metonymic essence. also provides the avenue for a partial escape from the network of symbolism that threatens to dominate and obliterate the individual subject. it is no longer desired and another object takes its place. However language. warmth). For Lacan the subject is always alienated from his desire. .Lacanian Psychoanalysis 79 third meaning is that desire is always for something other than what we have. To summarize: a need belongs to the biological realm.


Borderline Personality Disorder: A Lacanian Perspective Diagnostic Considerations in Psychoanalysis – Lacanian Views Lacan takes seriously the question of what makes for a psychoanalytic diagnosis in

contrast to a medical or even psychological diagnosis. The question was posed by Freud himself, as he realized the contradictions inherent in the problem. We use a diagnostic framework to make decisions regarding treatment; however, diagnosis evolves during the course of treatment and in the process, a very different picture may emerge. In order to make a medical diagnosis, the examiner has at his disposal technical and biological instruments that allow for the collection of objective data (MRI, blood samples, XRays, etc). This type of assessment leads to a classification of diseases that includes a wide range of pathologies. A medical doctor can then, establish with a reasonable degree of certainty the presence of a particular illness. The psychoanalyst, according to Lacan, has only one instrument: his/her listening skills. Although the patient can relate a history of suffering in a convincing manner, his speech is saturated with the fantasies and deceits that underlie all human communication. Even when the subject wants to be honest, Lacan asserts that he “is always blind to his suffering”. What he or she says cannot be taken at face value for diagnostic purposes. The direct observation of a patient’s symptoms is unavailable as well. Lacan agrees that diagnosis and treatment are interconnected. Thus, in order to be consistent with a psychoanalytic approach Lacan suggests that diagnostic inferences and treatment interventions are to be suspended for a period of time during the initial interviews with a potential patient, and no contract between patient and therapist should be formed until after a series of initial sessions. Lacan approaches the problem of diagnosis through an extensive series of preliminary interviews, where the analyst allows him or herself to wonder about the patient, to allow a transference to be established and, most importantly, to listen to the unconscious at work. Lacan’s preliminary interviews are considered a trial period in which the work of the patient is to produce speech, i.e. to speak of whatever he wishes to speak about. The beginnings of a diagnostic picture will be drawn primarily through the analysts’ careful listening to the patient’s choice of words rather than through the content of the patient’s discourse. From the utterance of

Lacanian Psychoanalysis


the patient’s words a particular structure will appear. One question that underlines and directs the importance of the analyst’s attention is, “What is the position of the subject, in his discourse?” or “What position does he occupy in relationship with his desire of others’? Let’s examine an illustrative example. A patient, (a fashion designer) at the beginning of her analysis makes the following statement: “I believe that it is possible to be a man and a woman at the same time.” We listen to that statement from the Lacanian diagnostic premise: Why did she utter these particular words in the form of a statement that expresses her presenting problem to the therapist? What is the position of the subject in her discourse? On first observation, she enunciates a clear ambivalence at the level of gender, and following her words, something that reminds us that choosing to be something also implies losing what is not chosen. We can start thinking that the patient has an issue in the realm of the imaginary, in her struggle to be one or the other. We suspend judgment here to find out more from her own account. In a later session, she discusses her job and she says that her work is to produce an image of a woman and she keeps thinking of the image of a pregnant woman that imposes itself on her drawings more than any other image, in spite of her believing that it is not a marketable idea. How is it that she came up with this choice of words and images? Does her mother populate her thoughts by being together with her? Is her image of a male/female fusion the way she resolves the issue of sexual difference? It appears that the direction of her treatment will be directed to a problem that is connected with her image, perhaps the way her mother saw her. It is interesting how in clinical work we can almost see the way the words trace a circle around the major, unconsciously determined, structural issues. There are a multitude of words that she might have chosen to express her concerns; however, we create hypotheses on the basis of the language she chooses to express her suffering.

Structure and Diagnosis Psychic causality is very difficult to determine since its laws, if any, are not, according to Lacan, manifest in fixed, and predictable ways. Even when we are aware of the subject’s dynamics and we understand his intrapsychic and interpersonal vicissitudes we cannot make an


Borderline Personality Disorder: A Lacanian Perspective

immediate logical correlation between his psychic structure and the nature of his psychological symptoms. Our clinical practice shows us that psychopaths have sadistic behaviors without possessing the structure of perversion, and even an obsessive-compulsive personality can have a strong histrionic component in his presentation, yet remain essentially obsessive in his structure. Therefore, we are not justified in making a diagnosis based on symptom manifestations. Lacan modifies Freud’s famous phrase about dreams by calling “speech the royal road to the unconscious”. This formulation allows us to understand Lacan’s statement that his theory is essentially “a return to Freud”. The psychoanalytic experience “finds in the unconscious the whole structure of language” (Lacan, 1954). Lacan, like Freud, holds that symptoms, are always overdetermined, that is linked to the primary process, via displacement and condensation. Lacan states, “A symptom is a metaphor, a signifying substitution and a metaphor is a signifier that stands for another signifier which represents the subject” (Lacan, 1954). The chain of associations continually substitutes one signifier for another in the very manner Freud had described in his Interpretation of Dreams (Freud, 1900). The choice of words is left entirely to the fantasies of the subject. And no matter how clear a subject is in his communication, the fact that he utilizes language and must choose one form of expression rather than another, assures that he will be misunderstood. As Lacan constantly reminds us, we, as subjects, are alienated by language. So, if the symptom has no fixed meaning, what is the analyst relying upon? He/she is relying upon listening and observing the way the subject handles his desire, which will reveal a particular psychic structure. This operation occurs in the presence of the analyst, as desire is put in motion in the transference. Lacan’s understanding of the transference is one of his unique contributions to psychoanalysis. The analyst is invested by the analysand with what Lacan designates as the “place of the supposed knowledge,” in which the analyst is presumed to know the causes of the patient’s pain. This supposition, which exists only in the mind of the analysand, is, according to Lacan, the motor of the transference in analysis. This is an interesting observation in light of Lacan’s insistence that the analyst has no special knowledge to give to her patients. According to Lacan, this paradox exists in all human relationships, parents and children, lovers, teachers and students, etc. One supposes that the other has something to give. Lacan’s view here is

Lacanian Psychoanalysis


particularly opposed to the common idea of a psychoanalyst as someone who objectively has a particular expertise on psychic problems and moreover, as a model who the patient can emulate. It should be clarified that Lacan does not believe in the concept of mental health or normality, but like Freud, holds that all individuals exist in varying degrees of disease. For Lacan, “disease is not something that happens to living things but is the very condition for life”. There are no “normals” to be contrasted with, but a variety of “pathologies.” On Lacan’s view everyone is neurotic, psychotic or perverse. These three categories are essentially those that were formulated by Freud. According to Lacan, the subject’s desire is involved and expressed in different ways in each of these structures. Throughout the interviewing process, through careful listening of what is said, the manner in which it is said and, moreover, “what is not said,” the analyst follows the subject’s own desire, in order to induce the patient’s cause of his desire, his efforts to have his desire fulfilled, and the factors that stand in the way of that fulfillment. Lacan conceptualizes the three main categories of diagnosis through the particular mechanism of negation that determines what he calls “the position of the subject,” rather than through a classification via symptoms. The mechanism of negation functions differently in neurosis, psychosis or perversion. Lacan leans in part on Freud’s description of repression in the neurotic versus disavowal in the pervert. Lacan describes a third mechanism of negation in the psychotic, which he terms “foreclosure,” and which, for Lacan, represents the impossibility of accepting or rejecting that which is negated. This method of arriving at a diagnosis, i.e., by the way someone negates something, is the single defining characteristic of Lacanian diagnostics. (Fink, 1997). Lacanians do not look favorably upon the multiplication of categories and subcategories that continues to grow in the American psychiatric literature on diagnosis. This system utilizes literally dozens of pathological categories such as “dysthymia”, “polysubstance dependence”, “panic disorder”, etc, each of which can be combined with other features such as personality traits, psychotic traits, etc, in specifying a diagnosis. This is essentially the system adopted in the various editions of the DSM. The method that psychiatrists use in order to make a diagnosis is to break down each part of a patient’s presentation into its constitutive parts and then bring them back together to form a syndrome. Lacan is critical of this tendency of the medical model that arrives at overly specified diagnoses by considering human beings as mechanisms which can

the psychic structure that refers to psychosis is produced by foreclosure of the Name-of-the-father (Lacan. and his controlling approach in his relationship with his employees and wife. For example. the child knows he carries that name and the name situates his place in the family and society as a whole.84 Borderline Personality Disorder: A Lacanian Perspective then be treated with mechanically designed and “approved” remedies. a child who never met his father but carries his name will have a “mark” of the father. the fundamental function of . However. Later interpretations made by his mother and family about his father can resignify the “name of the father”. Lacan’s conceptualization of psychopathological structures is far broader. the paternal function involves separating the child from the mother when the child’s independence is threatened by the mother’s desire or by the perception of the child that he is “everything for the mother”. on Lacan’s view. Psychosis For Lacan. which can be effected in the presence or absence of the real father. Lacanians hold that it is universally the case that a restriction. their essential structure does not change. Foreclosure involves the rejection of the particular element that. as an authority and as the carrier of the law of prohibition. then we understand that the role played by the drug use in his adult years may be the same as his defiance in early school years. 1955). which can be carried out by another person who is not the father of the child. and this diagnosis is evident in the fact that he uses certain drugs with a particular frequency. this refers to the absence of the symbolic function of the father. The paternal function does not refer to the real person of the father but rather to that which is symbolized by the father’s name. and which can even function beyond the death of the father or his disappearance. the paternal function can even operate with only a “name”. a man may be diagnosed as a substance abuser. and with them the role of the father. As has been elaborated in previous sections. For example. As we have seen. anchors the entire system of the symbolic order for the individual. Indeed. however. Although cultural norms differ and change over time. if we conceptualize his psychic structure as that of an obsessive. etc.. Although the number and presentation of symptoms can vary throughout the life of a person.

for Lacan. and even those who have their first psychotic break later in adulthood have always been psychotic. in the sense that the paternal metaphor either enters into the child’s language as a symbolic function or does not. in which the symbolic father overrides. a paternal imago which reflects the child’s experience of the father according to his imagination. in some ways it is irrelevant if he is present or not. The child does not grasp the idea of a real father until much later. what he receives is the imaginary father. the symbolic father is a signifying effect within the oedipal dialectic that produces a new structure: a child inscribed in castration and therefore. According to Lacan. there are those with a psychotic structure who often remain undiagnosed by virtue of never having had an overt break. and further. for the child. no room for “borderline” structure.(Dor. . Psychoanalytic treatment can help to make psychotic symptoms recede but. There is. However. 1987). of signification. via the way the mother speaks of him.Lacanian Psychoanalysis 85 “no” must come from a third element that is inscribed beyond the relationship between mother and child. the one who is the actual. Lacan uses a particular linguistic image to indicate the function of the paternal metaphor. The real father is the father here and now. Lacanians assert that an individual either has a psychotic structure or does not. the imaginary father and the symbolic father in the theory of Lacan. the desire of the mother: Name of the father Mother as desire So far we have seen that the real father has no (direct) implications in this process. if he is deficient or not. Thus. there is no cure for psychosis. This is because it is only the father who is imagined and signified that enters into the child’s psychic structure. coupled with the idea of father given by the mother. this is the role of the imaginary father. When Lacan discusses the paternal function in relation to psychosis he holds that it is an all-or-nothing occurrence. this real father is never the one who operates directly in the course of the Oedipus Complex. biological father. a claim that we will examine carefully in later chapters. in the world of language. on this view. Issues pertaining to the real father do not affect the entrance of the child into the symbolic order. It is helpful to make a clear distinction between the real father.

Further. although reporting a vision or having heard someone who was not present. Returning to our discussion. used very early on by the infant and which play an important role in ordinary daydreams. he also signals what belongs to his child. borderline states. What is structuring for the child is that his father is the origin of the child’s words. Such individuals. and. and that the child is able to fantasize a father. we can say that his view implies that the absence and/or behavior of actual fathers will impact upon the development of psychotic (and other psychopathological) structures. what are the tools that Lacanians rely upon to confirm a diagnosis of psychosis? Although the best indicator of psychosis in American psychiatric circles is always the presence of hallucinations. While the father may deny something. the law of the father is also fairly distributive. He was surprised but at the same time questioned this vision. Fink (1988) reports on a patient who believed he saw his ex-wife at the end of a corridor in his home. malevolent or inadequate fathering may contribute to psychotic structure. However. In fact. be a stretch to argue that Lacan’s theories suggest certain empirical hypotheses: one of which is that. Lacan’s observations with respect to the paternal metaphor is that as much as this function regulates certain aspects of life from sexuality to responsibilities and obligations. It would not. it is important to differentiate between true hallucinations and voices and visions that non-psychotic people have. fantasies and dreams. without questioning Lacan’s view that it is the child’s signification and experience of the father imago that is relevant to his theory. hallucinations are a form of primary process thinking. This example recalls Frosch’s .86 Borderline Personality Disorder: A Lacanian Perspective it is the relationship of the child with the imaginary or symbolic father that will have important consequences. This means that while the father signals what is his. may be surprised and wonder about these phenomena. Lacanian analysts suggest that the presence of hallucinations is not definite proof of the presence of psychosis. One reason for this is that the actual father provides an occasion or opportunity for fantasy and signification. thinking that he had to have noticed her entrance or the possibility that he let her into the house. he gives something else in return. all other things being equal. in my view. absent. the question arises. by extension. Lacan’s insistence on the primacy of the imagined over the real father in the structure of psychosis would seem to close off hypotheses regarding the absence or failure of actual fathers in the etiology of psychosis. He did believe he had a vision but did not believe in its content.

uncoordinated perceptions and sensations). (Indeed. The certainty of their statements is irreversible for the psychotic. Therefore. has a meaning and that the meaning involves her or him. the clinician has to explore this phenomenon conscientiously. Further. As described above. this . many hysterics have the most elaborate fantasies that are so hypercathected that they appear to be real. which again speaks to her intact reality testing and the ruling out a psychotic diagnosis. symbolic and real. according to Lacan. noise. In both Fink’s and Frosch’s cases. These other criteria are focused around language disturbances. we must make sure that language disturbances exist” (Lacan.. vision. if there is no conclusive evidence one way or another. or The CIA is reading my thoughts” are found in psychosis. The psychotic patient is certain that reality in the form of a thought. However. the capacity for reality testing is intact. “My wife is trying to poison me”. Doubt is a characteristic of a neurotic process. As we have also seen. in the end. and are made without hesitation or doubt. The psychotic thought is without error or misinterpretation. other criteria should be employed. Lacan goes so far as to say. Statements such as. hysterics and obsessives always doubt. “Before making a diagnosis of psychosis. but who later postulated that this trembling was a projection of her own orgasm. the characteristic most salient in psychotic thinking is that of certainty. etc. the diagnosis “hysterical psychosis” was at one time quite widespread—such patients may be classified today as dissociative disorders). the hysteric will be doubtful about the veracity of his experience. the symptom of hallucinations and the whole question of “reality” is not a foolproof guiding principle for diagnosis since it is difficult to distinguish socially-constructed reality versus psychic reality. For Lacan. In sum.Lacanian Psychoanalysis 87 patient (discussed on chapter I) who felt the floor tremble and asked her neighbor about it. In spite of the hallucinatory symptom. when hallucinations are reported. 1955). they see and hear things that are not present to others and experience them as if they were palpable. the imaginary. In order to fully comprehend this assertion it is important to again think in terms of the registers mentioned earlier. On the other hand. his fragmentation. the imaginary register is the first structure that organizes the chaos within which the child lives (i. the patient hallucinates but is able to recognize the phenomenon as part of his or her psychic reality. He states that the psychotic’s relation to language is quite different from that of a neurotic’s. and the diagnosis of psychotic structure is not substantiated.e.

This supremacy of the symbolic over the imaginary is instrumental to the formation of subjectivity. In psychosis there is no symbolic process overriding the imaginary order. the psychotic person lives in an imaginary world where even language is “imaginarized. etc. between the father’s law and a specific meaning to particular words (socially constructed reality). (Lacan. According to Lacan. law. The symbolic order. which. with the establishment of the symbolic order several interrelated factors are put into motion: the function of the paternal metaphor. the individual’s self-image is fluid. through their gestures. according to Lacan. which represents a somewhat primitive organization. actually pre-exists the child. the creation of desire (for that which is prohibited will be desired). for there is no precedent for him to even consider. yet one that is still not developed to the point where the child becomes capable of uttering the word “I”. The idea of “foreclosure of the name of the father” is rooted in the notion that the psychotic has no chance to reject or accept a symbolic function. the overriding of the imaginary world. if this initial knot is not tied. therefore. voice and words.e. The earlier formation of the mirror stage. achievement. If this does not occur. indeed he will create his own language. Without an ego ideal to rely upon. transient and ephemeral. as the child internalizes his parents’ values and expectations.. in the symbolic order the child is organized around different criteria: guilt. i. leading to the language disturbance that is evident in psychosis. on the other hand.” For the psychotic. their approval of and recognition of the child. initiates this new order for the child.. this initiation occurs in neurosis and perversion but not in psychosis.88 Borderline Personality Disorder: A Lacanian Perspective register provides an image of the self that is invested libidinally by the child. The symbolic order is linked to the castration complex. the separation of the child from the mother. 1955). Therefore. performance. the individual will have no anchor point in a public language. On Lacan’s view. Later his parents and other caretakers will provide a better definition of this sense of self. as he is immersed in it by being subjugated to his parent’s language. he himself sees his actions in accordance to what his parents have seen. the paternal function “ties a knot” amongst the three registers of the real. language is not assimilated but rather imitated. Freud discussed this process in relation to the concept of ego ideal. is finalized through a symbolic act that comes from outside the child. Psychotic patients will have difficulty . and the immersion of the child in the world of language. ratifies his mirror identification. The language of the parents. imaginary and the symbolic. Where aggresivity and rivalry were the main affects in the imaginary order.

Lacanian Psychoanalysis 89 producing a whole sentence. The anticipatory and retroactive movements involved in producing meaning (that is. This lack of hierarchy in the drives’ organization is a result of the failure of the symbolic order. as Lacan puts it. In the psychotic person. 1999). Whereas the neurotic organizes his libido. Thus these terms do not refer to others in language. Neologisms are the most salient evidence of psychosis. as they will be unable to punctuate. anchor and convert the chain of signifiers. Sadock B. Lacan discusses the predominance of imaginary relations. rather. The body is literally.. according to Lacan. They are untranslatable. overwritten with signifiers. we can usually hear in our clinical work “the extreme sensations of the body”. However. Lacan holds that because there is no true access to language the psychotic is directly related to the imaginary world. While the neurotic generally has conflicts derived from his struggle with the symbolic order. refocusing it from his body as a whole to his erogenous zones. according to Lacan. the psychotic typically presents with conflicts related to someone approximately their own age usually in the figure of a peer or a lover. a positive diagnosis is. the psychotic feels invaded by libido. we cannot infer any meaning by association or contiguity. by creating new words with an idiosyncratic meaning known only to the psychotic himself. only possible when language disturbance is present. The formation of neologisms in psychosis replaces the metaphoric function. the possibility of the metaphoric substitution) are absent in the psychotic person. according to Lacan. The issue for the psychotic is not manifest in terms of obtaining parental approval. our body slowly gets “emptied out” of its libidinal contents. One interesting aspect of Lacan’s theory of psychosis relates to the notion of the drives. Words become things (Fink. biology is for the most part lost. 1994). psychotics have the experience that someone is usurping their place. according to Lacan. We have seen that. as we enter language and the process of socialization is initiated. The phenomenon of paranoia is typically encountered in psychosis as a type of imaginary relationship. only maintained in the erogenous zones. “the ecstasy of the body” or “the unbearable pain in the body” for which no medical problem is found (Kaplan H. his body is taken over by it. touches upon the register of the real. such as conflicts with parents or other authoritative figures. social expectations or issues of self-esteem. while this relation to the imaginary is an important feature of psychosis. however. Among other criteria of psychosis. according to Lacan. also associated with a lack of morality . and is. This.

guilt is not present in these patients and when they are hospitalized for a criminal act towards others they do not feel genuine guilt for their actions. A final note on the issue of diagnosis in psychosis is provided by Lacan in his discussion of the absence of self-questioning in psychotics. by giving himself certain rights and bequeathing others to the child. The psychotics’ phrases are always the same. it is usually intermittent and of short duration. Lacan adds. A father may act in an authoritarian. This thought evolved into the belief that he was the wife of God.90 Borderline Personality Disorder: A Lacanian Perspective or conscience. the paranoiac who Freud discussed in his initial study of the psychotic process. 1911). psychotics are characterized by inertia of movement. This important aspect of the paternal function does not occur in psychosis. For Lacan. whereas the psychotic person feels invaded by a feminine identity that he cannot escape. Another symptom that is present in psychotic men is a slow process towards feminization. express his or her lust or aggression overtly. antagonistic or aggressive manner towards his child. in their thoughts and interests in general. This means that the psychotic is prone to. the attitude of the father towards his son is to delimit a space for the child. 1953). In clinical practice some psychotic patients claim to feel like a woman and they sometimes request sex change surgery. Schreber (Freud. At this point the child may take the feminine position before this dominating imaginary figure. he may feel that this feminine position is imposed on him. The failure of desire is seen in the failure of movement in the psychotic’s language. Therefore the presence of feminization appears to be the result of identification with an imaginary father but not a symbolic one. desire is missing as well” (Lacan. . “where repression is missing. initially related how the rays of God were penetrating him. in a distributive way. presented in a cycle of repetition without end. If and when the patient later becomes psychotic. Because there is no repression. He could also be an all-demanding father whose son’s behavior is never good enough and who is unable to set limits for himself or his children. in the face of any slight provocation. While neurotics ask themselves about their desires and those of others’ and they change in the course of therapy. Although this feminization may take place in a neurotic person as well. especially when no triangularization is possible.

in the conversion symptoms of hysteria. However. 1915). as he/she cannot control all language. other things will be repressed by association. are interpreted by Lacan to perform the function of filling an absence with words. things that remain outside of signification. hysterics have an overabundance of feelings without thoughts. the neurotic may experience emotions that he cannot link to any knowledge. From this moment on. in repression (which characterizes neurosis) reality is initially affirmed in some way and is later pushed out of the realm of consciousness. provoking an excess of pleasure. according to Lacan. the unconscious is formed by thoughts that can only be expressed in words or signifiers. a most painful pleasure. one that is tied to the lost promise of being the phallus of the mother. and positions himself in the discourse. The child inserts himself in language. This loss is what he denominates “primary repression”. However. At that time the unconscious is constituted in a singular way for each particular individual. whereas obsessives have a profusion of thoughts that evoke no feelings. which. Therefore. in this immense world of signifiers. that is “beyond the pleasure principle”. According to Lacan’s reading of Freud’s (1915) “On Repression”. and this disconnect is the source of neurotic symptoms. In contrast to the psychotic’s foreclosure where a thought or a perception is never even granted entry.Lacanian Psychoanalysis Neurosis 91 For Lacan the defining mechanism in neurosis is repression. the object that will be lost forever. where all signifiers exist. As mentioned above. the position that the subject occupies allows him a place but also represents a loss.” or the naming of the child’s demands in words. primary repression effects an individuation of the unconscious in the individual subject. the different neuroses have specific modes of repression. For example. Repressed thoughts and affects reveal themselves in what Freud denominated “the return of the repressed” (Freud. in the Other. even his own rationalizations fail to explain his emotions. for example. Repression impacts upon the connection between thoughts and affects. Further. the “fort-da. for example. According to Lacan. may be expressed as bodily symptoms . but throughout life we keep looking for it. a pleasure that is at once sexual and traumatic and about which the patient consistently complains. this object never existed. some things escape the child.

since all neurotic symptoms. the key to distinguishing neuroses is to understand how the neurotic is linguistically or significantly situated in connection to what he calls “the locus of the other. According to Lacan the individual’s reaction to separation from the primary object constitutes his/her fundamental fantasy and as such constitutes the basis of Lacanian structural diagnosis. all neurosis is rooted in the symbolic order. etc. by pleasing the analyst. the analysand is always recreating his or her fundamental fantasy in relation to the analyst. obsessive and phobic. and in this transference the patient always recreates his position in his fundamental fantasy. Lacanians have long affirmed that these three categories are extremely useful in clinical work and that there is no need for further classifications. the “a” stands for “the cause of desire” (in the “other. even those that appear to be somatic.” in French autre) and the diamond is the relationship between them. making her anxious or neglecting her.” This “locus” refers to the fundamental fantasy of how the subject positions himself in relation to the other in the imaginary realm. that we are about to describe are. (Fink. Lacan utilizes this formula to clarify how the subject imagines him or herself in relation to the Other. 1997). Lacan writes a formula to depict this relationship: ($ ◊ a) where the barred S denotes the division of the subject’s unconscious and conscious experience. according to Lacan. Why is it that there aren’t more than three categories? The positions of the hysteric. obsession and phobia. Lacan describes three sub-categories of neurosis and thus three fundamental fantasies: hysteria. According to Lacan. are governed by the laws of language. simply the three positions that clinical experience has shown analysands take up in the transference. In analysis. . Lacan studied and worked with these three fundamental neuroses in a manner that neither Freud nor other analysts had ever done previously. Hysteria and obsession can be defined as radically different ways in relation to the Other. The more interesting question from a Lacanian point of view is the differentiation of one neurosis from another. Further. Psychoanalysis is concerned with the position of the analyst in the transference as a means to orient the interventions with different patients.92 Borderline Personality Disorder: A Lacanian Perspective For Lacan.

his position in the discourse (in relationship to the others and the analyst) and the problematic of the phallus for each particular individual. therefore. both male and female hysterics have the same fantasy: the conquest of the phallus. The possibility of castration is based on the idea that someone “has it” and someone “does not have it”. this idea of having it.” the one who is supposed to “have it” carries the enigma of what the hysteric’s desire entails.Lacanian Psychoanalysis The Hysterical Structure 93 In Lacanian practice. (1905) what she wants is the answer to the question: what does a man want from a woman? This question presupposes that Mrs. in order to diagnose a structure we need to assess the subject’s economy of desire. the “other.” the symbolic father will be established as the vehicle through which the child is brought to the third and final phase of Oedipus. but that he does not possess it. or a male hysteric who is unsure of his virility). the hysteric always finds a . being a woman who pretends to be a man. This other serves a very important identificatory function and is the key to all meaning that emerges in analysis. That is why the hysteric’s main question has something to do with sexual difference. Many hysterics find themselves in love triangles in which they identify with the man’s desire and thus. that she has the key to the enigma of what constitutes a woman. is the quest of the hysteric.” The quest is always to complete the object of their desire. what is termed the “register of castration. The hysteric makes herself into the object of the other’s desire so she can master it. desire the “other woman. It is important to note that the hysteric can also take the position of the male partner and desire as if she were him. Am I a man or am I a woman? This question has a direct connection with the dual identification of their desire. K knows the answer. as long as the mother can realize the presence of the father and let him “lay down the law. (e. This quest for the possession of the phallus.g.” The child will then realize that not only is he not the phallus of the mother. in the famous case of hysteria analyzed by Freud. As we have explored in our discussion of Lacan’s theory of the Oedipus Complex. be an all fulfilling object for her. The hysteric’s assumption is that he/she has been unfairly deprived of the phallus and must re-appropriate it. In the case of a satisfied couple. Although sexual difference is an important determinant of the way hysterics behave. K. Thus. and cannot. and it is on this tacit assumption that Dora pursues her endlessly. When Dora pursues Mrs.

beauty equals femininity and in that sense. Therefore all of their efforts tend to be drawn towards a phallic narcissistic identification as a way of avoiding the issue of castration (or the lack thereof).94 Borderline Personality Disorder: A Lacanian Perspective way to provoke a desire for something else that her partner does not have. How does the hysterical woman approach this encounter? Curiously. The ideal object is an impossible object. she does not spare any efforts. This position assures that the hysteric will forever be linked with the mother. or having the phallus by identifying with the male partner. Therefore. the hysterics’ desire is always unsatisfied. The phallus could be represented in the arena of the image. his looks etc. or through their speech or in their bodies. by displacement. It is a typical scenario to hear a hysteric speak about the highlights of her partner’s life: his achievements.e. they see themselves as devalued and unworthy objects. The hysteric is very critical of herself . but the hysteric never ends the cycle of aspiring to be one. Their sense of identity is always deficient and unfulfilled. and as a result of this stance. with ideas based on stereotypes supported by the culture. Hysterics always feel that they have not received enough from their mother and this comes through via their identification with the phallus. to produce an enigma. In the hysterical woman. This is the most important aspect of hysteria. Hysterics are capable of self-sacrifice and self-abnegation in order to fulfill what they imagine as the other’s desires. When they “put on a show”. to delay their satisfaction. Throughout his/her life (and within the psychoanalytic transference) the hysteric will maintain a posture of being the pleasing object for an Other imbued with knowledge and power. they put themselves in the other’s gaze as the embodiment of the ideal object (Dor. defined by the other) is her goal. 1997). The way they do this. They are to be “the cause of the other’s desire” (Seminar IV) by identifying with this perfect object (the phallus). The hysteric always manages to keep the other unsatisfied so as to ensure a permanent role as an object of the other’s desire. This position appears to be a reflection of an earlier residue in hysterics’ relationship with their mothers. This search for the ideal is viewed through the eyes of the models of beauty and femininity that are purported in the media. The search to become the perfect object is always present. we can encounter hysteria at the level of “being the phallus” for the other’s desire. This characteristic is a subtle way of shining through the other. is to keep the other in suspense. the “hysteric method”. instead of being an ideal object worthy of total love. as perfection as it is culturally defined (i.

she tries to cover up her “lack of knowledge” as in her mind.” In this way she imagines that she overcomes her deficits. The choice of lover plays the most important role in the hysteric’s life. more charming. according to Lacan. she would not be interested in him any longer. etc. As a result. more intelligent than the one she has. if she could get him. The difficulty the hysteric has in making up her mind is very acute in relation to a choice of lover. by becoming an unconditional supporter of “the wise one. we have the emergence of a hysterical homosexuality that is not related to a choice of love object but to an identificatory process. the hysteric wants to think like her. Many times the hysteric will “steal” the other woman’s man. knowledge has to be absolute. for example. In the area of sexual encounters the hysteric has a discourse of claim or demand usually surrounding phallic potency. therefore. The hysteric woman will try to gain access to people’s knowledge in various ways. The search for perfection is related to another characteristic of hysteria: the identification with a woman from which she will learn what femininity is all about. What is important to address is that the man she pursues is always unattainable. Hysterics are plagued by indecision and doubt. This is why hysterics appear to be “phonies. Perfection is that to which she aspires. As the ideal cannot be attained. actually incidentally “constitutes her only pleasure. be like her. we usually hear self-descriptions such as “I have too little of this.. her behavior and speech will reflect a permanent state of indecision and doubt and at a later date she will voice regrets. As a result of this identification. love like her.” . etc. Her indecision is a reflection of her imperfection.Lacanian Psychoanalysis 95 and attempts to erase all of her imperfections. and intellectual remarks. Either you know everything or you are totally ignorant. as if the other woman has somehow achieved a perfected state of femininity. as she needs to remain unsatisfied at any cost.” they have an emotionally labile and inauthentic aspect. to have her men. the man trying to desperately prove his virility and the hysteric constantly disappointed. In this case. masking her doubts with the most sophisticated “moves”: speeches. “My face should look like that”. role playing. clothing. In many cases. She will pick a lover but continue to be absent in the intimacy of the relationship. and she will do many things to cover it up. The quest of the hysteric is to continuously claim dissatisfaction which. This challenge to men usually starts a cycle of continuous misunderstandings. I don’t have enough of that”. there is always a man better equipped.

” It is in the role of the martyr that the hysteric and the obsessive find the most pleasure. Lacan sees it as refusal. this is not really the case. The versagung was taken by the post Freudians as frustration. It is not only important to sacrifice but to let the others . however. 1987). According to Lacan. Usually we find hysterics dating men of importance. Along these lines. their country. the pimp. powerful men. their husbands. As we will see.96 Borderline Personality Disorder: A Lacanian Perspective It is important to underline a common error that clinicians make when they presuppose that the hysteric is looking for a man who can be a substitute father figure. we have a woman who can offer herself for money to all men. from the exterior. It relates to the operation that Freud (1912) referred to as “versagung” and later adopted by Lacan. This position allows the hysteric to keep her desire unsatisfied (many of the protagonists in opera portray this aspect of hysteria quite well). The sacrificial position of the hysteric is a very important topic. A good example of this occurs in the case of those people who become ill when they are successful. Versagung is the renouncing of that which is the essence of one’s self. it is common to hear the fantasy of prostitution in hysterics who are in treatment. we must ask ourselves. whereas the term versagung suggests an act of relinquishment. In analysis. the idea of sacrifice is noteworthy in the obsessive individual as well. insofar as she can give herself to only one. This man does not really possess any special talent but the assurance of lacking something. The term frustration implies that the subject is frustrated passively. In the figure of a prostitute. Pontalis. etc. The more she pays. The word versagung implies a relationship in which there a refusal of the demand of another (the root sagen implies “saying) (Laplanche. where there appears to be a mechanism by which the person refuses the satisfaction of his desire. He needs her and her money to be complete. In the name of that renouncing we constantly hear in the clinical work how people renounce their own pleasure in favor of that of their children. the more she completes him. Hysterics are looking for a man that is complete. These types of men will make up for the deficiencies of her imaginary father. what could be represented as an ideal father. In the name of his sacrifice he will give up everything to keep his desire impossible and unattainable. full of knowledge. what is the subject renouncing when he presents to the analyst an endless list of possible motives for his sacrifices? What benefits does this sacrifice have? Lacan answers “pure jouissance. one’s desire.

and later obtain secondary gain for having them. in the effort to obtain or be the all-satisfying object. the position of the hysteric male resembles that of the hysteric woman. the men’s complaint is typically directed to the whole body. and on the other. Regrets and complaints regarding what he does not have are plentiful. However. Like their female counterparts. these substances provide a compensation for a sense of not feeling adequate as a . Joel Dor (1987) states that traumatization (such as war traumas and post-traumatic stress disorders) are good examples of means for camouflaging male hysteria. Although these frustrations involve every day events. particularly those who parade their traumatic symptoms as trophies in the eyes of everyone who gazes at them. In the context of male hysterics. These men exhibit the following presentation: 1) major outbursts of rage as a result of frustration. the environment supplies apparently reasonable explanations for men’s behaviors.Lacanian Psychoanalysis 97 know about one’s actions. 2) the presentation of somatic. external causes are found to explain the male hysterics’ behaviors. In every other sense. thus the hysteric is continually drawing attention to her sacrifice and martyrdom. it appears that these men are prone to exaggeration and pathetic efforts to call for negative attention. conversion symptoms and hypochondria. Instead of looking for explanations within the psyche of a man. hysteria concerns men. This rage appears to be the expression of some impotency that is mainly repressed. Lacan will describe a particular group of men who share similar characteristics that resemble the hysteric presentation. A belief in his “incapacity” also leads him into trying to compensate for his impotence by using alcohol and drugs. Hysteria in Men Hysteria in men is difficult to diagnose because of the way it is concealed by our culture. His pleasure in “unfulfilled satisfaction” usually sets the stage for self-defeating behaviors. from the psychoanalytic point of view. hysterical men pursue dissatisfaction and always desire that which they don’t have and which appears “so much better” in their eyes. which are typically manifest in the hysteric’s professional activities and love relationships. In contrast to the women’s presentation (which usually evokes a part of the body). On the one hand we have a refusal of the medical community to recognize it.

it is important to underline that this perception is not entirely correct. they are “really manly men” but in the intimacy of their bedroom they cannot satisfy a woman (which in their mind is the phallic test they are suppose to pass or fail). hysteric men (as hysteric women) place the feminine other in an idealized place that is totally unattainable. Clinical work with these men reveals that they are generally impotent with the women they select. Obsessional neurosis Although it appears that most obsessive neurotics have a special or privileged relationship with their mothers. In the area of sexuality. When we take into consideration the oedipal vicissitudes and the position of the four elements of the process: mother. other males. Under the influence of alcohol the hysterical male feels more at ease picking up women or ridding himself of a male competitor. In psychic terms the confusion is based on equating the phallus with the penis (the organ) and the impossibility to be the phallus leads him to present himself as “not having a functional penis”. This type of hysteric male men is not a true homosexual since his choice is not for a male love object but is rather based on an avoidance of women.98 Borderline Personality Disorder: A Lacanian Perspective man. In the case of impotence and in the related cases of premature ejaculation. they never experience women as desiring subjects. 1987). There are several typical cases that Lacanians conceptualize as hysteric men: one is the playboy or Casanova. This man searches for one woman after another as trophies that he shows off to everyone. hiding behind a mask of homosexuality or impotence. in part. in particular. Therefore. child. we can understand the way the obsessive has arrived at a resolution of his own that carries the mark of obsessive traits: an emotional distancing from all relationships. phallus and the father. Further. we have a subject who “confuses virility with desire” (Joel Dor. In the eyes of the others. because the only women who can mobilize their desire are their mothers and in part as a function of their rivalry with other men (who in their mind possess the phallus). . the hysteric male avoids women as much as possible. but rather view them as challenges to their virility.

such as a boss. However. the child may still believe that he can fulfill her in spite of the father’s intervention. but rather to constantly erode the value of his power. the appearance of the symbolic father should produce an identification with the phallus in the figure of the father. Further. In obsessive neurosis. the fear of castration is always an imaginary threat that haunts the obsessive. the obsessional . a trainer. constantly wishing to take his place (the same situation occurs with any other person who occupies a place of authority and who symbolically represents his father. This interminable struggle is displaced into different routes of libidinal investment. he cannot but feel extremely guilty. obstinacy and defiance being typical. in which an interminable struggle with the representative of the Law is always at stake. the child realizes that he has the possibility “to have the phallus” someday (in the sense of having a special knowledge about what can satisfy a woman.e. Because of this particular relationship with the mother. The law of the father is always present in the obsessional’s desire. A space of dissatisfaction is created in which the child perceives himself as a possible supplement in providing the mother complete satisfaction. if the mother fully colluded in this idea) we would have a perversion instead of a neurosis. and because of his privileged position with his mother. Since the paternal figure is always present. the future obsessive will have difficulties accessing the father’s law and therefore will subsequently have difficulties with all authority figures. This is the scenario of obsessional neurosis.” If that would actually be the case (i. the mother’s desire turns to the father but she does not seem to get everything she wants from him. This is clearly seen in the erotic fantasies that obsessives have: they are plagued by passive-aggressive fantasies with respect to women who seduce them and at the same time. whatever that may be). If the mother appeals to the child to supply that which she is missing. abuse them. with perseveration. Thus. or a professor). if the mother is enigmatic about her desire. the child may be libidinally charged by her. The child cannot articulate his own desire as it is tied up with his mother’s. he also has feelings of rivalry and competitiveness with him. Only after accepting that a certain place belongs to his father. one in which the child continues to believe he can “be the total satisfaction for the mother. What is the position of this child with the father? We find here the key to what Freud called the “anal character”. The obsessive does not want to dethrone the father.Lacanian Psychoanalysis 99 Typically. to repeat the scenario by which he is captive of his mother in the presence of his father.

Obsessives want to master everything to make sure they will lose nothing of the other. As a result. Any loss is equated with castration. This sarcasm is designed to neutralize the other’s feelings. The fear of castration in obsessive neurosis is what is at the basis of the obsessive’s intolerance for loss. Rather. we see the rigidity and constant attempts to control the behavior of others that characterize the obsessive personality. obsessives have difficulty free-associating. It should be noted that generally obsessives are unlikely to seek analysis. On the surface. The obsessional cannot manage to find his desire. obsessives are law-abiding citizens. They prefer conducting their “own self-analysis” or writing their dreams in a journal. They usually explain to themselves that it is better to work out their problems by themselves. Obsessives use their words as tools of control of the other and in the process they acquire a secondary gain of discharging affect. However. Undoing. of achieving a global experience is a compensation for the obsessive’s castration anxiety. The abrupt and intense emotional opening of someone close. Such passivity puts him at risk to be sadistically mistreated by others. It is in this area of transgression of the law that they deploy their defenses most consistently. What makes them come to therapy? Usually an intense manifestation of the other’s desire that the obsessive cannot manage to control precipitates anxiety and serious self-doubt. This is because the emergence of desire is absolutely threatening. in which an act or a thought is treated as if it never occurred. speech becomes the vehicle for rigid control and detachment of feelings. The experience of totality. . they prefer to express themselves in long speeches filled with rationalizations. is another defense that obsessives use to neutralize contradictory affects such as love and hate. They also make use of “black humor” or sarcasm both in therapy and in the public arena. to the point of becoming preoccupied with legal matters and of exhibiting a rigid adherence to rules.100 Borderline Personality Disorder: A Lacanian Perspective person has difficulty articulating a demand to express his desire. When in treatment.. or an imminent loss of a dear one could disarm the obsessive and prompt an analysis. this is a reaction formation or a way to defend themselves from the wish to transgress. The use of isolation is manifested in their rituals and pauses of speech. which is experienced as threatening to their self-control. In this way. even when they are on the verge of a crisis. and sometimes asks others to do so for him.

Frequently in long term relationships. insisting in that she adopt a prudish and morally correct appearance. the obsessive can continue to control a being who has no desire of her own. will immediately be experienced as a loss that the obsessive will go to great extremes to prevent. desire is organized predominantly around the symbolic phallus. her clothing. give or offer to keep his lover in place. The lover is thus. Lacan’s position seems to be that in Western society. the condition for a relationship is that his partner is passive. If. Pleasure cannot be experienced without his authorization. not in touch with her own desire. His few comments on the process by which an individual becomes a hysteric or an obsessive suggests that social causes are involved in the maintenance of these structures. any threat of abandonment on the part of the lover. The relationship resembles very much a jailhouse in which everything is provided to the lover on the condition that she will relinquish all subjective desires that do not include her partner. the partner of an obsessive is turned into an undesirable image by which the obsessive guarantees “the death of he own wishes”. sometimes imposing conditions on her looks. “play dead” and not desire anything for herself. and will. lacking in nothing. but only indicates that repression is its primary mechanism. . There is nothing that the obsessive is not willing to provide. he interprets that fact as a reflection of his own value and prides himself on his possession. 1997) Since the obsessive’s core issue is his fear of castration. It is noteworthy that Lacan does not discuss the question of the etiology of neurosis. In this way.Lacanian Psychoanalysis 101 For the obsessive a relationships becomes an all and nothing situation (Fink. on the contrary. These men can treat their partners like a trophy. On the other hand. another of their personal belongings. erotic object. in effect. the obsessive views his partner as an attractive. experienced as complete. It would be interesting to record differences or changes in neurotic structures as social roles vary within the cultures and as a result of changes in contemporary society.

Further. As Hans’ father does not fulfill the symbolic function of castration. which has no connection to our reproductive function continues throughout life and is unrelated to the diagnostic category of perversion. for Lacan. As the paternal metaphor is diffuse or precarious. phobia is closer to hysteria than to obsessional neurosis in the sense that the subject is placed in a situation where he must constitute himself as an object of completion for the other. For Lacan. it is clearly a neurosis as it successfully addresses triangularization by providing a symbolic solution. neurotics or psychotics. (Ferrari. a horse phobia is marshaled by Little Hans to perform the paternal function (Horse = Name-of-thefather). In phobia we have the presence of a weak father function and a strong attachment between mother and child. the child has to instate it him or herself by replacing it with a symbol that substitutes for the father’s failure to cancel out the mother. He also considered it to be the most extreme form of the problem of the establishment of the paternal metaphor (Fink. he experiences an excess of sexual pleasure that he cannot tolerate. Such “perverse” behavior.102 Borderline Personality Disorder: A Lacanian Perspective Phobia Lacan considered phobia the most radical form of neurosis. 1960). who by descriptive criteria are diagnosed as perverse. Hans was usually allowed to sleep in his parents’ bed or to watch his mother change in the bathroom. however. are. to be the object of the other’s desire. . 1997). The case of Little Hans in Freud (1909) clearly illustrates how the child creates a limit to his engulfing mother. for Lacan. 1999). Lacan did not consider phobia to be a separate structure. Thus. all human sexuality is descriptively perverse and polymorphous as we come to this world as pleasure-seeking beings with neither a fixed object nor a higher purpose to guide our sexual drive. Perversion Most patients. as his father is unable to separate mother from son. one that would create a limit to the child’s pleasure. In Lacanian psychoanalysis the so-called “perverse” sexuality is a position of the subject’s desire produced as a result of his oedipal vicissitudes. As his mother forces the child into placing himself as her imaginary phallus. (Lacan.

However. according to Lacan. For Lacan. In order to understand what is at stake in the diagnostic structure of perversion we must. as each of these are dependent upon the subject’s thinking or signification. as the oedipal vicissitudes become the stage for a triangular relationship the child will have to relinquish part of his jouissance with his mother. Freud had made this distinction in 1938: whereas repression relates to the putting out of mind a perception of the internal world. Lacan is critical of the idea that we can distinguish internal from external dangers. So. and in the neurosis a reinstatement of the law in fantasy. for Lacan the barrier between outside and inside is more equivocal. the subject struggles to bring the law into existence.” According to Lacan this is the very same negation that Freud had distinguished from the repression at work in neurosis. He refuses to do so. However. neither of the two mechanisms involves perception. However. This occurs as the paternal metaphor institutes a distinction that will bring about an identification with the father and with it. Lacan agrees with Freud (1938) that repression involves pushing away a thought related to a drive (which gets dissociated from its affect and returns as a symptom). 1938). the law. in perversion. who accepts the father’s law and who refuses to do so? Perversion usually occurs in the context of a very strong relationship bond between a mother and a male child who provides . and that with negation. Actually. (Freud. as the latter negation/disavowal is connected to a thought. As we have seen. disavowal clearly involves the father and all the themes related to him. the barrier between inside and outside is broken. some part of which is related to the psychic reality of a subject. 1909).Lacanian Psychoanalysis 103 “perversion” is not a derogatory term to designate a deviation from the norm but a structural category in its own right. (I am using the pronoun “he” in the context of perversion as Lacanian psychoanalysts consider perversion a male diagnostic entity). the hope to enter the symbolic world. the pervert will not relinquish this pleasure (associated with masturbatory fantasies with the mother or mother substitute). (Freud. negation involves a disavowal of a perception in the external world. threats and anxieties. and each is applied to thoughts. Whereas in psychosis there is an absence of the law. a thought related to a particular perception of the real world is put out of mind. Lacan terms the negating mechanism at work in perversion as “disavowal. the father’s name and the father’s desire. keep in mind the questions of the mechanisms of negation and the Name-ofthe-father.

He will be that “which completes the mother” forever. we need to remind ourselves that mothers will somehow make a demand (by naming it) regarding her dissatisfaction (either with herself or with her husband). there is no signifier provided by either parent that will articulate the mother’s lack at the symbolic level. This situation is coupled by the presence of a weak father (who is unsure of his own desire) or a father who is confused about his role and is overpowered by the child’s mother (who has a secret pact with the child). When the mother names what she lacks she creates a desire in the child to sort out her enigma: “What does my mother want?” Desire is put in motion in the search for the answer. in these cases the child himself supplies the paternal function through a fetish. This contributes to a situation in which the child narcissistically invests his penis with an erotic power that he is not willing to relinquish. therefore she is complete. and nothing is missing. symbolic castration is not permitted to disrupt the dyad as there is no rival in the mother-child relationship. however. Although the first stage of the oedipal process was achieved successfully (the child is placed as the imaginary phallus of the mother). However. At this point. to bind the anxiety that he feels by being engulfed by this “overwhelming Other”. She is completely fulfilled with her child. cannot accede to the symbolic register in the same manner as a neurotic can. this oedipal victory or denial of the paternal function is unsettling for the pervert who fears being engulfed by the maternal object. or collusion between mother and child to deny the father’s power. no demand has been named. the second stage which renders separation from the mother. he knows what she wants and that is the child himself. We sometimes see these cases in mothers who experience their child as a narcissistic extension of themselves. in fact. This is what in other contexts might be called an “oedipal victory” on the part of the child. The child. In the mother’s pervert. does not occur as the paternal function is not strong enough to name the mother’s lack and separate her from the child. . As such. the child does not actually have to wonder what his mother wants.104 Borderline Personality Disorder: A Lacanian Perspective her with sexual pleasure. The denial of the symbolic father and the denial of the sexual difference represent a disavowal based on the fact that the mother does not lack anything. a shoe or a punishing act in an attempt to separate himself from the mother and at the same time. as an object of their desire and cause of their bodily pleasure and we may view them as attachment disorders. who is identified as the phallus of the mother at the imaginary level. This mother constantly demands that her child satisfy her. This is the oedipal vicissitude of the future adult pervert.

they can reverse a “terrible feeling” and feel absolutely nothing (disavowal of pain). as no one-single-event can resolve the situation for the pervert. When faced with these circumstances. it is very difficult for a pervert to be in analysis. 1997) . The presence of the element of perversion. if started. From one day to the next. Moreover. Although the suffering of the pervert at times resembles that of the melancholic. instead of the analyst being the cause of his desire. whether it be a fetishistic object. humiliate him/her and try engendering castration anxiety in the analyst. perverts tend to e acting-out behaviors in which they diminish the analyst. needs to be repeated ad infinitum. They usually start treatment after having suffered a significant loss or if they are facing death in some way (like suffering from an incurable illness). The topic of “death” is usually in the pervert’s vocabulary. making the transference almost impossible to be established. a ritual. or a severe depression.Lacanian Psychoanalysis 105 This is the function of the perverse object in the fetishist’s scenario. is that the pervert wants to be the cause of his analyst’s desire. (Fink. Table 2 incorporates some elements that help us in the diagnosis of the three main diagnostic categories. representing the only inscription of time. Another difficulty for the progress of treatment. or a sadistic activity. he must engage in a scene that must incessantly be staged same way to fulfill its function. perverts suffer from agitated anxiety.

The pervert brings about the law to bar the mother in order to exist as a separate object of her desire The pervert’s real penis is required by the mother. psychotic never becomes a separate subject. Neurosis. Neurotic achievements are required but never suffice as the mother always wants something else. Goes through three stages of Oedipus with the focus on the Other’s ideals which render different types of neurosis. Mother’s desire Oedipal stages Psychotic never grows out of the imaginary level. Jouissance Mother Avoidance Barred by the name of the father. The psychotic tries to provide this function by creating a metaphoric delusion. Psychotic whole body and being is engulfed with the mother Neurosis Exists in all cases Perversion Must be made to exist. . Total invasion Never barred by the name of the father. Perversion Psychosis Symbolic Order Is lacking. due to the inability of the name of the father to name the lack of the mother. He is trapped in alienation with the mother. He is seduced by setting limits to it.106 Borderline Personality Disorder: A Lacanian Perspective Table 2: Psychosis. Neurotic emerges as a subject. It is brought into existence by the subject enacting his own law. Pervert does not go through the second stage that is the separation from the mother. thus does not exist as such.

Chapter Four The Case of “Katherine” I n this book I have proposed a theoretical and clinical dialog between Kernbergian and Lacanian schools of psychoanalysis. psychoanalysis has provided a satisfactory account of the borderline personality disorder to justify its existence as a distinct diagnostic entity. for example. Central to this dialog is the question of whether psychiatry. has provided an adequate diagnostic and therapeutic characterization of this structure. Otto Kernberg and Jacques Lacan. Finally. In Chapter One I introduced the problem and the Borderline personality. come into sharp focus when one considers the so-called borderline patient. . reaches its most controversial moment in the topic of the borderline personality disorder. Psychoanalysis. distinct from the neurosis and psychoses. as several important issues including. (1) the relationship between psychoanalytic and psychiatric diagnosis. requiring a conceptualization and treatment that is. as opposed to ego and relational. one might say. and moreover. The borderline diagnosis has implications for psychoanalytic theory as a whole. as the whole body of psychoanalytic thought is relevant to this issue. (2) the meaning of psychoanalytic "structure". I presented the points of view of two psychoanalytic thinkers. and (3) the controversies surrounding the question of whether psychoanalysis is essentially a study of unconscious. as the pre-eminent proponent of a psychoanalytic theory of the borderline. Further. Subsequently. if Borderline Personality Disorder is indeed a viable and distinct diagnosis. the question arises as to whether Otto Kernberg. the question also arises as to how patients considered by Kernberg to be borderlines are handled both clinically and theoretically from a Lacanian psychoanalytic point of view. processes. and potentially stands to be revised in the process.

108 Borderline Personality Disorder: A Lacanian Perspective who have interpreted the main tenets of psychoanalytic theory in what appear to be radically different ways. The case of Katherine serves as a test case only in the following sense: that it permits us to consider Kernbergian and Lacanian conceptualizations in the context of actual clinical material. In this regard. and the analysand's responses to certain early interventions. provide a description of the basic therapeutic problems that were encountered. Both Kernberg and Lacan hold that the course of the initial interviews. from the outset. However. but also to consider the implications for clinical/therapeutic practice in the differing conceptualizations of Kernberg and Lacan. the procedure I am about to use is illustrative as opposed to probative. Kernberg and Lacan agree on the importance of the first meetings between analyst and patient as a means of maximizing the value of the interview as a tool for clinical diagnosis. As such. to illustrate some of the issues in differential diagnosis. I will begin by describing the history of the patient. outline the presenting problems at the time of her entry into treatment. The procedure of altering and fictionalizing this case was utilized in order to protect the identity of the patient. it is my intention to structure much of the subsequent "dialog" between Kernbergian and Lacanian points of view around a clinical case. As I will discuss in more detail later in this study. the entire thrust of this work being one of hypothesis generation as opposed to hypothesis testing. I believe. . at all points to retain the essential features of the clinical presentation and treatment. and to a certain extent composite and fictionalized version of a case that I treated over a three year period. I explored their roots in Freudian thought and how they were influenced or (in the case of Lacan) largely rejected the post-Freudian developments of the past 40 years. not only further clarify the dialog between contrasting Kernbergian and Lacanian positions. To this end. every effort has been made. derived from my notes of the early interviews. At the same time. but also provide clinicians working with severe personality disorders an opportunity to clarify their thinking regarding clinical interventions with severely disturbed patients. The clinical case I am about to present is an altered. I will occasionally use excerpts of the case. and describe diagnostic considerations based on the two different approaches (Kernbergian and Lacanian) to clinical interviewing. was not only to provide a basis for understanding the theoretical issues raised by the borderline diagnosis. The presentation of such a case will. My goal. can provide extremely valuable diagnostic information.

The Case of “Katherine” 109 I should point out that my work on this case was conducted during a period (which continues to this day) during which I was struggling with the conceptualization of severely disturbed patients from both object-relations (Kernbergian) and Lacanian points of view. as she reported in other sessions. When Katherine entered treatment. sometimes for days. and that she was unable to recover from such upset. experiencing severe family conflicts and feeling misunderstood by her boyfriend. where I will discuss this case from each of the dual perspectives that have been the subject of this book. Michael (age 23) and half-sibling. In presenting the case here I have attempted to be as descriptive as possible. Sessions. Christian. As is quite common amongst chronically unstable individuals. as dictated by the needs of the treatment and the capacity of the patient to tolerate more than one weekly session. and were scheduled for one to two times per week. She was seen in psychodynamic treatment with the writer for three years. at times. Just prior to commencing treatment she had “run away” from home for two days and had made several phone calls to family members in which she accused her father of abusing her. limiting any theoretical intrusions for subsequent chapters. depressed and isolated. The setting of the treatment was a university-based psychology clinic. She was also concerned that her aggressive thoughts might. it later became clear that Katherine had . the family had initially been offered “structural” family therapy . including feeling fatigued. make people fear her and therefore make her as she put it “undesirable in the eyes of others. her sibling. and of rejecting her boyfriend and calling him a "bum. "Katherine": The Presenting Problem Katherine is a 25-year-old single woman living in New York City." As a result of these incidents. Susan (age 30). she presented a long list of complaints. Early on in the treatment Katherine expressed feelings of uncontrollable rage towards her father. which were paid for by the patient on a minimal fee/sliding scale basis. including her boyfriend.” She related that the smallest slight or hint of rejection would be extremely upsetting to her. However. she experienced similar rage in connection with several other significant others.

Susan (from a former relationship of Katherine’s mother) who lives in a Buddhist community in South Dakota. This stood in stark contrast to her brother's professional success. her sister and her parents had their own bedrooms.00 a month. Katherine’s brother Michael. who was originally from South Carolina. age 57. The family resides in a middle class section of Brooklyn. but managed to arrange for her own food stamps. Katherine also reports that Susan had been treated with psychiatric . Katherine found her inability to achieve a career or sustain a creative outlet. Katherine describes her as reclusive and non-communicative. Katherine also has a 30-year-old half-sister. is a computer engineer who recently graduated from a small west coast college and who has obtained a job in a major corporation. lives in Virginia. and her situation in her parents' home was far from stable. Katherine’s stepmother. and reports that she has been diagnosed with depression in the past. As later became clear. as well as briefly into the homes of several “other new nice people” who she had met while out in the streets. she did not have her own bedroom and was sleeping in the living room with no privacy. Katherine reported that she was unable to earn enough money to rent her own apartment. Katherine’s mother. 23. Michael had always lived with his biological mother and moved out of her home when he went to college. including group psychotherapy and psychopharmacological treatment. She continued to live with her father and stepmother. She further complained that although she paid rent to her father every month. Katherine had episodically moved from her parents’ home to a neighbor.110 Borderline Personality Disorder: A Lacanian Perspective a history of varied and multiple treatments. Katherine’s mother has never remarried and complains in her weekly phone calls to Katherine that she is terribly lonely. stating that she had very little money left over for her own use. Family Structure and Childhood History Katherine’s father (age 55) is a construction worker. in a two-bedroom ground floor apartment. as well as welfare benefits. in the amount of $150. She reported that her father insisted that she pay “her share” of the apartment rental and she complained bitterly of this. By way of contrast. works as a housekeeper in the neighborhood. Betty. where she is currently employed as a hotel receptionist. very stressful.

As an adult. Katherine was born in New York City and lived with both parents until the age of ten. Katherine spoke about her father during almost every session and this relationship and the intensity of her rage towards him. calling her every week at home. explosive man who would vent his anger on the women around him and constantly ridicule them. she (Katherine) would be left alone on the sidewalk while her mother went inside their home. She depicted her father as a domineering. She also relates that her mother is extremely moody. Katherine also relates that her mother was "like two different people in one. Katherine has had very little contact with this half-sister. With regard to her mother’s cold and aloof stance. as the treatment progressed it became clear that Katherine believed that her mother was aloof only in regard to her. returning home very late almost every evening. Katherine did not blame her for this.” she also describes him as violent and abusive towards herself and her mother. Katherine described her father as a chauvinistic second generation Italian-American male who was “all talk. and suffers from extremely low self-esteem. However. was the major theme throughout at least the first year of treatment. has an unpredictable temper. However. Katherine recalls that as a child if she would upset her mother. Katherine initially stated that her mother is a woman totally lacking in maternal instincts. behaviors which enraged Katherine. When her parents divorced. and not.” and although she remembers him as “her primary caretaker. for example. and offering justifications regarding how difficult it must be to be “a mother”. Katherine relates that her mother seemed to be uninterested in her role as a parent and that she worked all day. Katherine felt a certain responsibility for her mother’s well being. Based upon Katherine's descriptions it appears possible that her mother suffered from an affective disorder. preferring to feel sorry for her. The tense relationship between Katherine’s parents ended in a separation after her father left the home. For example.The Case of “Katherine” 111 medications but after a few years had stopped taking them in favor of meditation. Katherine at times describes her mother as cold and detached. Her mother met Katherine’s father (who is of Italian descent) in a bar in New York City where she was working as a cook. leaving Katherine in a state of extreme emotional distress. A court battle ensued between the parents and Katherine and her brother . Katherine's mother took the children to another state without the father's consent. in regard to her brother. and constantly urging her to seek treatment for her depression." at times behaving in a “crazy” manner.

and after a semester of excessive absences she decided to leave school without completing any of her courses.” At the age of 23. and. However. with the therapist herself. This pattern was observed to occur with friends. frustration and disappointment were the characteristics of the encounters with people in Katherine’s adolescence and continued to be reflected in her interpersonal relations as she became an adult. She was constantly concerned about not being able to pay her tuition. she returned to New York to live with her father in spite of her perception that he. where she was treated as another child in the family. most clearly. at one point she moved into her boyfriend's home. it soon became apparent that in spite of her above average intelligence. almost immediately after Katherine would start a relationship. she would start lying and (sometimes stealing) in the new home until such time that she outstayed her welcome. she lacked both focus and motivation to remain in school. Katherine had a series of short-term jobs that ranged from an attendant in a geriatric home. like her mother. On another occasion.112 Borderline Personality Disorder: A Lacanian Perspective became a negotiating chip between the couple. her father was always providing for her and she would turn to him in moments of crisis. At such times she would find another person or people who would become the “new good parents. However. taking care of her pets. She later confessed that she had outstanding loans from previous attempts to begin college. Katherine herself came to realize that in spite of her hatred for him. she became friends with an older widow who took her in and she spent six months living with her. she quit . Work History During the first year of her treatment Katherine was pursuing a degree in communications at a public College in New York City. However. to a boutique salesperson. as she put it. A pattern of idealization and later. complaining that the financial aid office was denying her the help she needed. employers. Katherine became so upset about the conflicts between her parents that at age 14 she ran away from her mother’s home and lived in various homes where she was taken in. as a “daughter. She explained that this combination of circumstances rendered her incapable of continuing her studies. a florist. was a neglectful parent. a tour bus guide and a belly dancer. in particular her boyfriend.” For example.

She described what she referred to as “her imbalanced hormonal state” which she said led her to experience very painful pre-menstrual pain and periodically rendered her unable to function.g. Katherine would generally leave her job after she had been out several days as a result of “somatic symptoms” (pre-menstrual cramping. However. wrongly judged and finally driven away. each time she would fail in a job. and requested that the examiner ask her more direct and specific questions about her condition. digestive problem) that exhausted her. it became clear that her decisions to accept employment were always impulsively undertaken and never well thought through. she would single out certain elements of the job (e. Typically some superficial aspect of the job had appeared to offer her a sense of meaning and/or financial opportunity.The Case of “Katherine” 113 one job after another. The interviewer inquired about this discomfort. in which she would feel she was being overly observed by her employer. She stated quite openly that the idea of freely discussing her concerns made her feel uncomfortable. after which Katherine immediately began discussing her depressive feelings and how her “body” was affecting her mood. knowledge and ability. Katherine felt singled out by her supervisors and she engaged each of them in heated arguments that at times led her to threaten them with lawsuits. or the job location) and add them to a list of “to avoid” factors in any future job search. a demand that initially appeared to both express her need to feel more in control of the interview and to serve as her means of evaluating the therapist’s own experience. In sessions. disillusioned and more pessimistic regarding her prospects of becoming a self-supporting adult. Course of Treatment During the initial interview session Katherine was asked to describe the nature of her problems and how they impacted upon her life. headaches. each after only a few weeks of employment. Katherine expressed discomfort with this openended inquiry." . She presented these somatic preoccupations in the context of her depression and she wondered if she might be "contributing to her pain in some way. A common scenario was a conflict with an authority figure. asking Katherine to explore its origins. type of setting. working hours. Each of these experiences left Katherine tired. number of employees.

” “mean” with other family members.114 Borderline Personality Disorder: A Lacanian Perspective At the time Katherine entered treatment she was already being seen by a hospital psychiatrist on an outpatient basis and had been prescribed Prozac. her actions appeared to be designed to re-establish control over the environment by evoking guilt feelings in significant people in her life. in this regard. she early on acknowledged periodically engaging in episodes of self-injurious behavior that took the form of making superficial cuts on her stomach and/or her arms. At such times Katherine would typically complain about some medical or physical ailment that accompanied her emotional suffering (mostly focused on her reproductive/genital area). social isolation and withdrawal from nearly all of her activities. decreased energy. However." Katherine also asked this interviewer if it would be useful to bring the family in to help her clarify her emotional issues. In one of these meetings Katherine had voiced the opinion that her father and stepmother believed she was “mentally challenged. 20 mg. characterized by sleeping late in the mornings. In addition. or phone calls) threatened to reinforce and encourage further negative behavior. was not the most severe type. however. the self-mutilation although serious. a day. With the passage of time. as any increase in attention (number of sessions. These episodes would mobilize her boyfriend and her parents and would typically lead either to a brief hospitalization or a period of at-home care where her stepmother would continuously “watch” her. boredom. Yet. the therapist learned that the patient was honest about the severity of her intentions and . I suggested leaving the family out of her individual therapy until this issue could be explored further. and could have been managed on an outpatient basis. She reported that her psychiatrist had found it helpful to bring in her father and stepmother to discuss her mental and emotional status. Although Katherine described these as “suicidal” acts. The issue of management of potential self-destructive behavior. These episodes would invariably be followed by a period of severe depression.” Her gestures – which suggested serious deficits in frustration tolerance and impulse control emerged at times of intense rage. and had caused them worry and constant concern. Katherine reported that during her “suicidal” episodes she would feel “out of control. Katherine denied any history of alcohol or substance abuse. Her stepmother wanted to bring the whole family into therapy but her father refused on the grounds that Katherine was “again playing tricks. lack of motivation. was a delicate matter. it soon became apparent that they largely functioned to prompt others into providing her with attention and concern.

her psychiatrist and an on-call resident each described Katherine as someone who engaged in “acting out behavior” and sought the attention of the medical community to enhance her “victimization role. In addition to her severe menstrual cramping. While she reported that she also had aggressive fantasies towards others. who had indeed diagnosed her as a borderline personality.The Case of “Katherine” 115 did not actually have suicidal intent. Katherine's own concern in this regard underlined the vivid aggressive fantasies she expressed in regard to her parents. experiencing tightening in her chest. She explained that her physical activity was very important to her and that she would try to “push herself” as much as she could. and her early childhood experiences. she reported that certain memories returned in connection with her sexuality. her family history. She was also an avid swimmer and reported that she had taken several parachute jumps. As treatment progressed. and (when at work) her clients. psychology and self-help books. However. employers.” Katherine complained that the hospital doctors appeared not to be concerned about her pursuing an actual act of aggression directed towards herself or others. which was generally accompanied by the sense that she had lost memory for certain periods of her life. However. She explained her illness as “a depression caused by a chemical imbalance in her brain”. none of these visits to the emergency room resulted in her being admitted to the hospital. As Katherine related to the therapist. her incessant somatic complaints contrasted markedly with her involvement in various sports and her investment in developing a powerful and trim physique. Katherine revealed that she had made numerous previous visits to a local psychiatric emergency room due to suicidal ideation. and difficulty breathing. Katherine was a strong bicyclist who spent several hours per day on the road. Katherine complained of being overweight (an evaluation she initially attributed to her boyfriend). . she was always trying to find a causal relationship between her physical illness and her depression. Katherine reported she was well known to the oncall hospital staff. which typically “disabled” her for several days just prior to her menstrual period. One salient symptom that Katherine reported was a sense of depersonalization. she denied any plan or intent to act on them. She was an avid reader of psychiatry. often riding to the point of exhaustion. but she insisted that at such times she was really “very dangerous.” Although she never actually hurt or attacked anyone directly. Indeed.

for example. etc). so a new schedule was set for a once a week. When treatment began. Several themes soon dominated Katherine's associations. Katherine’s father would be completely oblivious to Katherine’s requests or demands. She had a strong ambivalence regarding her family and boyfriend. An agreement was reached that in time there would be an increase in the number of sessions if that seemed appropriate. and the cycle would begin again with another argument. She would scream at him until the neighbors would threaten to call the police. when driving with her father in his car. Katherine's acting out was usually directed at her father or her boyfriend Christian. it was directed against an authority figure (e. Katherine was also highly conflicted regarding her relationship with her boyfriend. an institution such as a school. Katherine accused him of being an abuser and not providing for her. as reflected in the depth of the material and her willingness to share it. 45-minute session. friends in college or a man she would meet . Her demands for attention took a toll on their relationship. begging for his forgiveness to the point of becoming obsessed with the loss. to the point of indifference (from Katherine’s point of view). as shown by her continually expressing a desire to be closer to them yet at times. Once. Her commitment to the therapy increased over time. On the other hand. the subway system. Katherine’s father made terrible scenes whenever she brought a young man home. she went so far as to jump out of the moving car in protest against his indifference to her. A cycle would ensue in which Christian would leave Katherine and then she would follow him. of eavesdropping on her phone conversations and controlling/restricting her use of the phone. frequency. but at times. The schedule. the police. At the same time.g. They would finally make up. acting out against them in ways that assured their distance. she requested that she be seen twice weekly. and length of sessions varied throughout the treatment. He was particularly harsh with her boyfriend. Christian.” On other occasions. Her father regarded Christian as “an adventurer with no prospects. mostly as a result of her doubting his feelings for her and the genuine nature of his love.116 Borderline Personality Disorder: A Lacanian Perspective Katherine’s treatment lasted nearly three years. However. Katherine would seek the attention of other men. He would make fun of his education and his pursuit of a career in fashion. usually after an intense sexual encounter. Father and daughter would argue intensely. she would frequently be excessively late or cancel her appointments.

she would often become resistant trying to upset the therapist. and assure her of my presence in spite of distress. and her step-mother was awakened by her moaning." A similar pattern was clear in Katherine's relationship towards the therapist. and she attempted to hold on to her own fragile sense of being during this period by having encounters with other men. Yet in the session immediately after such a sharing. she allowed other men "to touch her. she came to trust the therapist enough to share deep and intimate thoughts and feelings. Although she reported not being aroused by these encounters. appearing at the wrong time or openly devaluing the therapy. When the therapist returned her repeated phone calls Katherine was agitated and unable to calm herself. After two weeks of not hearing from her boyfriend (who had taken a trip). She explained that late one night while everyone was sleeping in her family's home.The Case of “Katherine” 117 bicycling in the park. convinced herself he was never going to return. During the first year of treatment Katherine had a quarrel with Christian that resulted in his requesting a temporary separation during which time they would both have time to think over their relationship. . and she was brought to a local hospital. Katherine acknowledged that the theme of loss and separation was very difficult for her. Katherine made a suicide gesture/attempt by swallowing 25 aspirins. felt betrayed and lied to. her acting out and the expression of negative affect towards the therapy. she became more and more thoughtful about Christian. stating for example. She reported that she would not have sexual intercourse with them. that she absolutely could not wait to talk until her next session. and had the urge to "do something to herself" in order to alleviate her pain. The treatment initially centered on the development of trust and the working alliance. Katherine was very needy at that time. the family became very concerned. at times by missing sessions. After Katherine swallowed the aspirins she developed stomach pains. but allowed them to “touch her” as she passively enjoyed being "physically manipulated". My position during these phone calls as it was throughout the early phases of the treatment was to provide some containment for Katherine’s anxiety. Katherine confessed her act. calling the clinic frequently and at all hours to talk to the therapist. On one hand.

40 mg. I would communicate to her by phone and send her a postcard when I was on vacation.118 Borderline Personality Disorder: A Lacanian Perspective The emergency admitting psychiatrist concluded that Katherine was indeed very depressed and admitted her to the hospital. had made frequent visits to hospitals and psychiatrists. These feelings were discussed in my supervision and personal analysis. allowing the transference to become more firmly established. with continued psychotherapy sessions. and a group psychotherapy at the hospital from which she was discharged. The psychiatrist diagnosed Katherine as suffering from a Borderline Personality Disorder and it was agreed that her psychiatric aftercare would consist of psychopharmacological treatment (Prozac. at the beginning of treatment. Katherine either idealized or devalued the therapist and the treatment. Feelings of being suffocated by this patient along with fantasies of terminating her were at play as well. . It was important for her to conceptualize that I was not lost forever. as a result of the patient’s frequent and intense demands. At this time. Katherine took up the recommendation and joined a women's psychotherapy/support group. However after a few months she left the group reporting that the other women thought she was monopolizing their time and had confronted her about this. I spoke with her treating psychiatrist several times to discuss her aftercare. a day). in order to facilitate my own growth and clarify my stance with this patient. and fancied herself something of an expert on therapy. She was discharged a week later against her wishes. Strong countertransferential feelings were evoked in me. Transferentially. only when the therapist placed limits on her intense demands did Katherine actually become interested in the therapeutic process. and began questioning herself and her actions. in her view. For example. it became clear that the patient's and therapist's earlier goals would need to be scaled back in an effort to stabilize her acting out and regressive behavior. It also became apparent that it was important to establish short-term goals and be prepared for serious regressive behaviors when Katherine was confronted with separation and loss. In addition she felt that they were jealous of her as she was the youngest and. the “healthiest” of the group members. She had previous therapeutic experiences. We explored issues of trust and separation at great length and took certain steps to minimize the risk of a psychiatric decompensation when I was away. However.

. A theoretical exploration of the two techniques and how they could bring about therapeutic change evolved as my work with Katherine proceeded.The Case of “Katherine” 119 As the case progressed. I began to encourage Katherine to engage in free association. Over time a dialogue between Kernbergian and Lacanian perspectives on treating this patient began to emerge in my own mind.

In contrast. as will be described more fully in Chapter Seven. without recourse to a "borderline" diagnostic category. In Chapter Seven. according to Kernberg. I will show how from Lacanian point of view Katherine can be conceptualized within a neurotic structure. Kernberg’s technique has been influential in differentiating between neurotic. . psychotic and borderline syndromes. Lacan would assert that the call for a borderline structure is the result of a failure to conduct a subtle and comprehensive analysis within the diagnostic categories of neuroses and psychoses. For Lacan. Kernberg’s analysis involves a re-labeling of descriptive criteria as structural personality features. As we have seen in Chapter Two.Borderline Personality Disorder: A Lacanian Perspective Chapter Five Katherine as a Kernbergian “Borderline” T here can be little doubt that Katherine can be understood as a “borderline” within Kernberg’s understanding of this term. The strengths and limitations of each of these approaches will then be considered. I will show how from a Lacanian perspective. in spite of the claim to go beyond descriptive psychiatry. In this chapter I will review Kernberg's diagnostic procedure and demonstrate how the use of the interview techniques he prescribes reveals Katherine to have both the "presumptive" and "structural" characteristics that. descriptive diagnosis is of virtually no psychoanalytic value. define borderline pathology.

3) Identity disturbance markedly and persistently unstable self-image or sense of self. 4) Impulsivity in at least two areas that are potentially self-damaging e.Katherine as a “Kernbergian Borderline” Katherine as a DSM-IV "Borderline" 121 As discussed in Chapters One and Two. Note: Do not include suicidal or self-mutilating behaviors covered in Criterion 5. reckless driving. 5) Recurrent suicidal behavior. spending. but are in many ways compatible to. the criteria for Borderline Personality Disorder set forth in the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association (Fourth Edition. 6) Affective instability due to a marked reactivity of mood (episodic dysphoria. it will be instructive to briefly examine Katherine in DSM-IV-TR terms. gestures. substance abuse. Kernberg's criteria differ from. Text Revised. or threats or self-mutilating behavior. Even a cursory review of this case reveals that Katherine meets the DSM-IV-TR criteria for Borderline Personality Disorder. We can here recall the DSM-IV-TR criteria for Borderline Personality Disorder: …”a pervasive pattern of instability of interpersonal relationships. 2000). and marked impulsivity beginning by early adulthood and present in a variety of contexts. sex. binge eating). As these criteria have become prevalent in a majority of clinical settings.g. irritability. Note: Do not include suicidal or selfmutilating behaviors covered in Criterion 5. 2) A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. self-image and affects. . as indicated by five (or more) of the following criteria: 1) Frantic efforts to avoid real or imagined abandonment. or anxiety usually lasting a few hours and only rarely more than a few days).

which even if they are not part of a structural diagnosis. During the introductory (diagnostic) sessions at the beginning of Katherine's treatment. including paranoid. frequent displays of temper. They include one or more of the following: (1) pan-anxiety. and.g. b) multiple and severe conversion symptoms. it became abundantly clear that she met at least seven. Kernberg's diagnosis of the borderline condition involves a twotiered process (Kernberg. her inability to form and maintain a stable self-image. and her brief paranoid episodes in connection with each of her employers. 9) Transient. Her desperation and suicidal gestures in the face of the threatened abandonment. are descriptive features that a clinician should observe (and even elicit) while interviewing the patient. Initially a "presumptive" diagnosis is made on the basis of certain symptomatic features. her idealizations regarding boyfriends. the extreme reactivity of her mood to various interpersonal and bodily events. schizoid. d) hypochondriasis. employers. including: a) obsessive-compulsive symptoms. and job opportunities which invariably turned to devaluations. her sudden displays of temper. c) dissociative reactions. 1984). (4) “pre-psychotic personality traits. stress-related paranoid ideation or severe dissociative symptoms.122 Borderline Personality Disorder: A Lacanian Perspective 7) Chronic feelings of emptiness. hypomanic and the cyclothymic personality features. Kernberg's Presumptive Criteria As will be recalled. recurrent physical fights). especially in conjunction with paranoid or hypochondriacal themes. (5) impulse neurosis and addictions. constant anger. clearly qualified Katherine for a DSMI-IV diagnosis of Borderline Personality Disorder. 8) Inappropriate intense anger or difficulty controlling anger (e. (6) lower level and/or narcissistic personality . her feelings of emptiness in response to perceived abandonment. (2) polysymptomatic neurosis. (3) polymorphous perverse sexual trends. if not all nine of these DSM-IV criteria.

hypochondriasis (pre-menstrual cramps. 1984). 1975). diffuse anxiety accompanied by bodily concerns. Katherine also presented a preoccupation with obesity and weight loss that became evident later in treatment. digestive problems) and paranoid trends (expressed in her relationships with others. according to Kernberg. but also with the interviewer). at times to excess. as when she allowed strange men to fondle her without sexual intercourse. She presented several neurotic complaints and symptoms such as inappropriate preoccupations and obsessions. intense envy and ego exhibitionism (Kernberg. As described in Chapter Three. Although in the initial interviews Katherine had denied use of alcohol and drugs. the presence of hypochondriasis in combination with paranoid trends is. She insisted on taking a submissive. The presence of impulsive behavior was evident in several contexts. the most noteworthy being her suicidal gestures. Kernberg suggests that this is another form that addictive behavior can be manifest in borderline patients (Kernberg. Kernberg's presumptive criteria are easily met based on the clinical data.Katherine as a “Kernbergian Borderline” 123 features (including shallow affect. Again. . masochistic role in the context of aggressive/sadistic sexual encounters. which she had in conjunction with brief dissociative episodes (periods of memory loss in connection with her bodily experiences). her episodic and often ego-dystonic sexual acting out. particularly suggestive of a borderline personality organization. Katherine also presented with certain perverse sexual trends that became the focus of considerable attention in her treatment. limited empathy. Katherine's need to substantiate a "chemical imbalance" as her explanation for her problems may have helped her rationalize an underlying addictive tendency. mostly with authority figures. in Katherine's case. During the treatment I wondered whether she might not be "addicted" to her psychiatric medication. it later became clear that in her adolescence she had used marijuana and alcohol. Katherine presented with chronic. Although this presentation was not bizarre it involved the replacement of genital pleasures by partial ones. as she became extremely distressed when she could not get her prescriptions filled and would sometimes wait for hours in the waiting room of an emergency psychiatric service for a prescription renewal from her psychiatrist. and her sudden rages against family members and employers.

as described by Mahler (1972). according to Kernberg. a lack of developed sublimatory channels. and the presence of certain identity issues (Kernberg. (7) a primitive and unintegrated superego corresponding to a fragile ego and self. projective identification. according to Kernberg often signal the presence of an underlying borderline organization.124 Borderline Personality Disorder: A Lacanian Perspective Finally. his/her defensive organization. the structural inquiry involves a sophisticated level of listening and . (6) excessive pre-genital aggression. in spite of intact reality testing. point the clinician in the direction of a diagnosis of a borderline personality. including: splitting. including poor anxiety tolerance. such as her intense envy and exhibitionism. according to Kernberg. Katherine exhibited features of several "lower level character disorders" that. 1975). as were certain narcissistic features. Katherine's masochistic. Any or all of the above-described traits may. and in general. a lack of impulse control. (5) identity diffusion. However. primitive denial. and a blurring of ego boundaries (2) a shift toward primary process thinking. Rather. These features are: (1) certain manifestations of ego weakness. the diagnosis can only be confirmed by a careful assessment of certain structural characteristics that involve the quality of the individual's object relations. In addition. primitive idealization. impulsive and infantile personality traits were unmistakable. The Structural Interview For Kernberg (as for Lacan) the diagnostic interview is not simply a gathering of information. (4) a pathology of internalized objects. the presumptive diagnosis of borderline personality is only confirmed when a structural interview reveals certain features that are characteristic of the borderline personality structure. Kernberg describes the borderline as having differentiated self and object but having failed to achieve a sense of libidinal object constancy. omnipotence and devaluation. (3) specific defensive operations. Kernberg's Structural Diagnosis As we have seen in Chapter two.

utilizing his/her own emotional reactions as a means of clarifying the nature of the patient's object relations and use of defensive operations.Katherine as a “Kernbergian Borderline” 125 observational skills. the classical interview as performed in most outpatient settings. This cycle follows a path from neurotic symptoms to character traits to the major marker of borderline condition (identity diffusion) and then to psychotic symptoms (reality testing and functional symptoms) to the more organic brain syndromes (based on an evaluation of sensorium. as it permits the clinician to move to a more classical format (what is referred in clinical settings as the Mental Status Exam) in cases of organic and/or functional psychosis or back towards a more structural approach if more neurotic or borderline characteristics appear. intelligence and judgment). A further advantage of the structural interview is its flexibility. hypothesis formation. etc. and her expectations regarding treatment. 1981). he/she needs to assess the nature of the interaction. Only by implementing such techniques can the interviewer gather the data necessary to form a "structural" diagnosis based on an assessment of ego functioning. At the start of the interview the patient will be asked for a description of her symptoms and difficulties. Although the structural interview poses a risk of raising primitive defenses too early in the treatment. Kernberg encourages clinicians (and particularly those who have limited experience with this type of interviewing) to perform a systematic search by following “the cycle of anchoring symptoms” (Kernberg. making it easy for the patient to "adapt" to the questions and mask important personality traits. The diagnostician faces simultaneous tasks during the structural interview. interventions and other techniques that are part of the psychotherapeutic process (Kernberg. Technically. while generating hypotheses regarding her symptoms. Kernberg proposes specific challenges to the patient's defensive structure that will permit the structural hallmarks of the borderline conditions to emerge. At the same time. her reasons for seeking therapy. . an initial interview extends from one and a half to two hours. observing her behavior and listening to the verbal communications. First he/she needs to keep his/her attention constantly on the patient. object-relatedness. has the disadvantage of allowing the patient’s defenses to go underground. In contrast to the classic psychiatric interview. typical defenses. The open-ended nature of the initial contact has great value for the diagnostic process. while at the same time decreasing anxiety and blocking early transference developments that would themselves be of diagnostic (and later therapeutic) significance. 1984).

showing signs of disabling anxiety. It is at this point that Kernberg begins more active efforts to clarify those aspects of the patient's presentation that appear incongruous. or psychosis. Almost immediately Katherine herself attempted to control the interview. As the interviewer challenged the patient to talk freely about herself. inadequate and confusing communication was evident in spite of otherwise strong verbal skills and a level of intelligence that. at the same time. This helps the therapist focus attention on a major cluster of symptoms. classical interview. and was quite vague regarding both her symptoms and conflicts. was. at . but now emphasizing their appearance in the current interviewing situation. the interviewer would have indeed shifted to the more classical mental status/history examination. This is done by confronting the patient with that material (verbalizations. Katherine: The Diagnostic Interview The initial phase of the interview with Katherine provides an illustration of Kernberg's ideas regarding the structural vs. affects and behaviors) around which the patient is clearly ambivalent or confused. monitoring the quality of reality testing. As the therapist continued to press her. Had she become more disorganized. based upon an assessment of her vocabulary and linguistic style. acute paranoia. Katherine became vague and "off target" when trying to pinpoint her problems and complaints. requesting that the analyst move away from her open-ended (structural) approach and ask her a series of questions (perhaps corresponding to the more classical history gathering and mental status format) that she was expecting. This anxiety is judged by the clinician to be intense but manageable. Katherine became more intellectualized and avoidant. and by being attentive to how the patient handles the interviewer’s query. It is clear from the outset that Katherine had difficulty communicating in the therapeutic setting. Further. the therapist. especially in the context of regression. defensive operations accompanied by an increase in Katherine's anxiety became obvious.126 Borderline Personality Disorder: A Lacanian Perspective As a clearer picture emerges from the interview the clinician should focus on the exploration of significant symptoms and traits. Her vague. moves constantly from clarification to confrontation when the patient’s incongruities arise. ideas. following Kernberg’s procedures.

It is here useful to examine the criteria used by Kernberg to define self-integration. characterizes neurotic individuals. 1984). it was evident from the description of the jobs she held and the sense of self she attempted to forge around them how porous Katherine’s ego identity was. wanting to be of assistance to others (even volunteering in a homeless shelter). Kernberg states “…there should be a central subjective integration of the self concept on the basis of which the interviewer can construct a mental image of the patient" (Kernberg. I will examine each of these areas as they apply to Katherine's case. At one time. (Kernberg. on his view. evidence of emotionally lability with respect to self and others and a flat. borderlines as a distinctive feature in differential diagnosis. However. impoverished personal and interpersonal perception in which the patient cannot convey a clear and adequate idea of himself and others to the clinician. However. she saw herself more as a performer who attracted men and felt a “sense of being” when she was on the stage being looked at. At other times." As we shall see later in connection of our discussion of Katherine from the perspective of Lacan. in the average range. speaking enthusiastically about serving people in disadvantaged circumstances. 1984). In Kernberg's style of interviewing. which. probing and even confronting the patient regarding any verbalizations about self and others that are contradictory in character. Borderline Fragmentation A lack of an integrated identity is perhaps the defining feature of borderline organization and manifestations of this lack are thus important markers for the borderline diagnosis. (a) Identity Diffusion: Neurotic Integration vs. as when she took a job as a belly dancer. For example. this criterion opens up a controversy regarding the issue of integration in neurotics vs. the psychoanalytic and psychiatric thinking and technique go hand in hand in an effort to collect data that will enable the clinician to make inferences regarding the major categories designated by Kernberg in his structural analysis. . the construction of such a mental image is impossible.Katherine as a “Kernbergian Borderline” 127 least. If after a reasonable period of time. Amongst such manifestations are the patient's complaints of emptiness. neither severe verbal disturbances nor bizarre thinking were noted. there is prima facie evidence for "identity diffusion. The therapist should evaluate the issue of potential identity diffusion in detail. she wanted to be a nurse.

1967). describing her lonely mood after spending many hours alone in the family apartment. Kernberg states that in borderline organization there is enough differentiation between self and others to maintain a porous ego boundary. yielding the possibility of a therapeutic interpretation. and to elaborate on the themes of that heated argument. . that as she began to regress. a physical trainer. The patient's historical account has a chaotic quality making it difficult to interpret or link past material with the present symptoms. and squirming). Kernberg theorizes that the origin of this lack of differentiation rests on a failure in the transition from a symbiotic to an individualized phase of development (Mahler. diffusion of the self allows the therapist to form an initial hypothesis. in contrast to a psychotic presentation in which the ego and the objects are fused and virtually no differentiation has been achieved. Kernberg emphasizes the issue of time management as a diagnostic marker of identity diffusion.128 Borderline Personality Disorder: A Lacanian Perspective this sense of identity did not last long. she instead related her suffering with him as a child. which may or may not be sustained through the current and subsequent interviews. and desire to be. and so on. this is an important marker differentiating borderlines from neurotics whose accounts of the past flow naturally and for whom dynamic links can be made quite easily. one that may result in a presumptive diagnosis of a borderline personality organization. thus. When Katherine was asked to describe in detail the argument she had with her father the day before a particular session. Soon after she spoke candidly about her skills as. as she remained oblivious to the therapist’s request that she speak about the events of the prior day. It is noteworthy. in Katherine's case. that it is mostly unreliable. The patient may be exhibiting poor self-concept formation within a range from a mild “identity crisis” to a full identity diffusion state. leaving the impression of an empty core about which nothing could be said. This was followed by a description of how abusive her father had been with her in the past. and she was unable to articulate her feelings or the position of herself in relation to others. This perspective on integration vs. The way borderline patients report their past history is so contaminated with the negative and confused experience of their present psychopathology. rocking. her anxiety was transformed into physical discharge (scratching. In his view.

and certainly without considering the series of events that might have impacted upon her experience during the years in between. However. the therapist is not so much concerned with data gathering per se. It is typically easier to make such linkages in the treatment of a neurotic (although in some cases the neurotic patient will be limited in her understanding by the repressive barrier of her unconscious). The borderline’s presentation not only express her intrapsychic conflicts. and of self and other. One looks for evidence of a contamination of the past with present events as a marker of borderline personality organization. When discussing a topic. The issue of identity diffusion is inextricably linked with that of the borderline's defensive operations. Katherine would interchangeably discuss her feelings as a girl and as a woman with little or no awareness of the temporal differences or the different qualities of affect expression and experience in the child and adult. the fluidity of her experience of space and time. as she is overwhelmed by the emotional intensity of the here-and-now (which extends into the past but cannot be articulated as such for the moment). in testing the limits. yet the presence of more adaptive defenses such as repression. but should be more attentive to the capacity of the patient to differentiate past from present and to forge a link between them.Katherine as a “Kernbergian Borderline” 129 By inquiring into the history of the patient. the therapist found herself confused about who she was referring to. This is because an attempt to do so may render the patient incapable of making such connections herself. The therapist’s perception of Katherine’s emotional experience was that of a wounded. (Kernberg. Katherine had difficulty differentiating her past boyfriends from her current boyfriend. and the failure to link present with past life events. Frequently. This lack of integration reflects the patient's poor comprehension of her “whole” life. was not psychotic in nature and that for the most part her reality testing remained grossly intact (see "Reality Testing" below). but also the fragile nature of her ego. fragmented in pieces. material is presented out of order. Kernberg does not advise pursuing the exploration of the past and its linkage to present material in the form of an interpretation in borderline cases. In borderlines. . vulnerable child. In neurotic individuals the exploration of conflict brings the defense mechanisms to the fore. reminding us of how a dream might be presented. 1984). it became clear that Katherine's blurring of past and present. the past and the present cannot be linked.

demeaning verbal communications in session and constant questioning of the format of the meeting and the payment for the therapy. She will also evaluate the patient's thoughts. affects not only the patient's verbalization but the whole interaction with the therapist which becomes distorted. Katherine reported that she started reading some letters that her father had sent her stepmother years ago when they were first dating. but when invited to attend a show with them. identity diffusion is clinically evident in a poorly integrated concept of both the self and significant others (Kernberg. in interviewing a borderline and particularly in the exploration of the patient’s identity diffusion. is a significant structural criterion for the diagnosis of borderline personality organization. she would reject the invitation even if it meant that she was going to spend the night alone. the activation of primitive defenses (such as denial. In sum. Although she felt guilty about the fact that she did not have permission to do so. affects and behaviors and judgment (as in a mental status exam). in one session. which will reflect the patient’s level of relatedness. the interviewer will evaluate the patient’s stance towards the therapist's needs and experience. capacity for . however. projective identification. If the therapist would ask to change a session time. she would not show up or cal to change or cancel her appointment. in spite of complaining about how everyone in her life was abandoning her. appearing in the verbal content but not generally affecting the therapeutic interaction. For Kernberg. she would agree. Lastly. Katherine also expressed little regard for others in her immediate environment.130 Borderline Personality Disorder: A Lacanian Perspective rationalization or intellectualization are difficult to pinpoint in the course of an early interview since these defenses do not immediately intrude on the therapist's work. altered and radically transformed.). Katherine’s chaotic interpersonal relationships were evident in her strong ambivalence regarding family members. 1984). She would complain about the warmth of the relationship between her mother and brother. etc. according to Kernberg. For example. This. However. she was more worried about being caught than by the fact that she was disrespecting her family’s privacy. The chaotic nature of Katherine's object relations was reflected in her interactions with the interviewer. with respect to the issue of identity diffusion the interviewer will attempt to arrive at a picture of the patient's self and object representations and their integration or lack thereof. and involved acting out behaviors regarding all aspects of the treatment.

Katherine as a “Kernbergian Borderline”


empathy and reality testing. By each of these criteria, Katherine showed clear evidence of identity diffusion as it is defined by Kernberg.

(b) Use of primitive defensive mechanisms - Projective Identification For Kernberg, the nature of defensive functioning is another important structural marker of borderline pathology (Kernberg, 1984). In contrast to neurotics who utilize such higher defenses as repression and intellectualization, borderlines and psychotics tend to utilize such primitive defenses as projective identification, splitting, primitive idealization, denial, omnipotence and devaluation. Contradictions in the patient's communications reflect the presence of conflict, and are typically accompanied by either adaptive (neurotic) defenses or the predominance of primitive defense processes (in borderline or psychotic states). For Kernberg, the function of primitive defenses in the borderline is to avoid intense experience of anxiety and severe conflict, an avoidance that is achieved at the cost of weakening the adaptive functions of the ego. One of the most salient of these defenses is the mechanism of splitting, which protects the ego from conflict by keeping self and others representations dissociated in such a manner that it becomes impossible for the individual to have contradictory (good and bad) experiences at the same time. When anxiety arises, one or the other ego state is activated and this serves to control anxiety that might otherwise overflow the ego (Kernberg, 1975). Kernberg asserts that the interpretation of splitting to a borderline patient can be tolerated and improves her functioning. By way of contrast, for a psychotic individual, where splitting protects the patient from a complete disintegration of self and other boundaries, interpretation of splitting promotes further regression. The use of defensive splitting was evident in Katherine's often contradictory descriptions of her mother. Katherine sometimes portrayed her mother as a plain and simple hard worker who cared for her children as she was subjugated by her husband's severe temper. At other times, Katherine portrayed her mother as a sadistic, unpredictable and domineering woman who was calculating and self-centered. The patient was unable to differentiate the times and events that led her to form such contradictory images of her mother. While she was indeed able to tolerate an interpretation of this contradiction she never achieved a single image of a mother with both good and bad qualities.


Borderline Personality Disorder: A Lacanian Perspective Another example of primitive mobilization of defenses is evident in the following excerpt

from one of the early interviews. An initial negative feeling towards the interviewer is here characterized by mistrust and detachment. As the interviewer continued to challenge the patient, further weakening of her ego functions occurred in the context of the interaction, and the use of paranoid defenses and projection, typical borderline defenses, emerged:

I: Have you noticed that you have remained vague when asked to elaborate the issues you have with your father?

(Patient squirms in her chair as she begins scratching the surface of her arms by reaching each arm with the opposite hand, leaving red marks everywhere). Silence sets in and the patient continues with the scratching, adding a rocking movement while looking down at the floor.)

I: I can see that you are certainly quite uncomfortable with this topic. However, I wonder if you can see my point about avoiding discussing the last interactions you had with your father that might have brought you to therapy?

K: I was trying to make a point about how bad my father has treated me all these years. Are you suggesting that it is all my fault?

I: It appears that my asking you what specific difficulties you had in the last weeks with your father has been interpreted by you as an accusation that you are to blame for something… Are you hearing that from me?

K: Well, I did not hear it, but I certainly feel that there is a possibility that I have done something wrong…something that he really hates from me.

In the above excerpt, Katherine's own guilt is projected into the person of the therapist. However, when this defense is questioned, Katherine is able to assimilate the interpretation and

Katherine as a “Kernbergian Borderline”


regain her reality testing. In making such trial interpretations the experienced interviewer creates a number of hypotheses related to defensive functioning, object relations, and anxiety tolerance. The following excerpt is a continuation of the previous one, and further illustrates the use of primitive defenses.

I: So, what I am hearing is that you become very anxious when something goes wrong and more anxious if you have to review it, no matter what it is, call it your father, your health….

K: Yes, indeed.

I: How are you feeling right now, here sitting with me talking about all of these topics?

K: A bit better now, but distressed. I had a therapist before but she disliked me very much. As a matter of fact, she terminated our treatment saying that I did not cooperate with it. I admit having difficulties to arrive on time, but with my depression it is very hard at times to get up from bed.

In this case, the interpretation of this defense led to a decrease of anxiety and improvement of the patient's functioning within the interaction, but at the same time, a displacement of her feelings of rejection and abandonment onto the figure of her past therapist. The use of denial was quite common in Katherine. In the early interviews it became clear that she denied the emotional implications of many of her actions in relation to both self and others. For example, she would calmly describe putting herself in a dangerous situation without giving voice to affects that would normally be elicited by such danger. For example, when the therapist inquired about Katherine's throwing herself out of the moving car, she just dismissed the event as her father "overblowing everything she did". She projected a nonchalant and at times callous attitude that actually reflected her denial of the emotional impact that her actions might have on herself and others.


Borderline Personality Disorder: A Lacanian Perspective Katherine’s primitive defenses were manifest not only in the way Katherine expressed

her problems (e.g. instead of discussing her difficulties regarding her father, she started somatizing and expressing them in body language), but also in the relationship with the therapist, who, as a result of the patient's projective distortions began to feel more restricted in her freedom to interact with her.

c) Assessment of reality testing Clinically speaking, intact reality testing is recognized by the absence of hallucinations and delusions, the absence of grossly inappropriate or bizarre affect, thought content and behavior, and by the capacity of the individual to empathize with others’ points of views. On a more subtle level, reality testing is grossly intact when the patient proves capable of responding in a generally realistic manner to challenges to her major distortions. For example, in the interaction with her therapist described above, Katherine distorts the implications of her therapist's questioning (regarding her avoidance) and says "Are you suggesting that it’s all my fault?" However, when asked if she actually heard blame from the therapist she responds: "Well, I did not hear it but I certainly feel that there is a possibility that I have done something wrong." To take another example, Katherine related that during her adolescent years she had an experience in which a few classmates tried to sexually seduce her in her room during a camping trip. She stated that she finally overpowered them and threw them of her tent. She reported to the therapist that she heard the voice of one of her girlfriends inciting the boys to this behavior. Upon exploration, however, the patient was able to cast doubt on her own beliefs about what she had heard (she stated that she was under a lot of stress that night). “The voice” was described as something she heard, coming from outside of her mind but which ultimately was experienced as an intrusive thought. In light of Katherine’s description of the event, the therapist again found herself with an unclear picture of what had occurred, how the patient felt, perceived the events and handled the situation. However, it was clear that Katherine was able to take a reality-oriented attitude even towards her own perceptual distortions. Based on this and other data as well as the overall clinical presentation of this patient, a psychotic organization could be ruled out. As Kernberg puts it: "The presence or absence of

according to Kernberg. She would quit a job out of anger and frustration with no other employment lined up. At one point she expressed interest in pursuing a sewing project and at another point. which are also present in borderline patients. in spite of her stated wish to do so. refers to a weakening of the ego as a result of the predominance of primitive defense mechanisms that renders the individual dysfunctional in spite of a façade of "tolerable social functioning Katherine had very low tolerance for frustration which interfered with her capacity to formulate and implement life goals. Yet in the first instance. each of which the patient has difficulty managing. and in the second instance she quit after an argument with her teacher following his attempt to counsel her on a particular technique. Her lack of sublimatory channels was reflected in her jumping from hobby to hobby and from job to job without ever committing herself to a sustained creative or career pursuit. It took several sessions in treatment before Katherine was able to examine the negative consequences of her impulsive behavior. and the presence or absence of reality testing differentiates borderline personality from psychotic structures" (Kernberg. both with others and in the transference relationship. Further. on one occasion she angrily packed her belongings and left her parents’ home only to realize a few hours later that she had nowhere to spend the night. d) Non-specific ego weaknesses The non-specific ego weaknesses in the borderline patient are. such individuals lack sublimatory channels for enjoyment and achievement. on one occasion she had an argument with her college financial aid office. . Further. Under circumstances that evoked anxiety. For example. She was offered a federal loan but she felt so angry that she walked out and never returned to the school. 1978). in taking a class in sculpture. she decided that her work was unacceptable.Katherine as a “Kernbergian Borderline” 135 identity diffusion differentiates borderline from non-neurotic character pathology. she made several important life decisions impulsively. reflected in the presence of anxiety and poor impulse control. after an initial effort. It is noteworthy that Kernberg differentiates specific from non-specific ego weaknesses. She had applied for a scholarship and it was denied. she would typically engage in an impulsive act that was undertaken virtually without any self-monitoring. Specific ego-weaknesses.

Impulsive aggressive acts also emerged in the treatment. Her impulsive acting out included stealing a pen from the therapist’s office. although severe. and along the same lines of a poorly integrated ego. Katherine's poor impulse control was also clearly evident in such acts as a turnstile jumping on the subway and stealing money from her father. 1985). the superego is thought to evolve out of the resolution of the Oedipus Complex. In borderline disorders. It could be argued that Katherine's extreme physical activity (i. It is often thought that because borderline pathology is mostly associated with preOedipal issues of development. critical superego that reproaches the ego regarding its wishes or behaviors and demands their modification. taking out food from her bag and beginning to eat in the middle of session.136 Borderline Personality Disorder: A Lacanian Perspective None of her hobbies or pursuits ever resulted in a finished work or a sense of personal achievement. the approach that the patient had towards these activities appears to have had more of a compulsive. the superego. typically reflects a lack of integration. is well-integrated. aggressive quality and might be better understood in light of her aggressive and self-destructive tendencies. in typical neurotics. working out in the gym) had a sublimatory function. the effect of superego is not particularly important (Goldstein. rigid. all had a selfdestructive quality. the superego of these patients.Excessive pre-genital aggression In classical psychoanalytic theory. Depression and obsessive-compulsive disorders are thought to be characterized by a punitive. Her excessive biking to the point of exhaustion. while variable in its effects. especially on occasions when the patient felt blamed for her feelings towards the therapist. (e) Lack of Superego Integration . .e. However. and to embody identifications with an ego ideal and the development of a moral conscience that reflects the child’s understanding of right and wrong. However. and cursing at the clinic receptionist when she was told that she had arrived early for her session. Kernberg asserts that in addition to. This lack of integration is manifest in the individual's contradictory attitudes towards self and others that swing from idealization to aggressive devaluation according to the patient’s mood. her pursuit of high-risk physical activities such as parachuting.

. you know the day of our first meeting. and although I know I suffer from chronic PMS. aggressive and self-punitive relation towards her own . making yourself sick. but I feel it’s more of abuse because it has been constant. When asked to elaborate on her thoughts. and reflects parental introjections and identifications: K: I think I am feeling quite ill today. very selfish and the least concerned about me. I: What sort of problems are you referring to? K: Since I was a little girl. I: If I heard correctly. This self-punishing quality of the superego is typical of borderline organization.maybe it’s me.. I: How is it that you experience this idea of making yourself sick? K: Well.. I am very depressed and I wanted to stay in bed today more than ever. intense aggression towards others. How is it that you do that? K: I just... The quality of Katherine's superego functioning indeed paralleled her wavering selfconcept and was manifest in an alteration between antisocial behaviors. you also think that there is a possibility that somehow you are able to put yourself in that situation. I have always wondered if I am somehow responsible for making myself sick. He is such a malicious man. My father used to scream at me for the slightest misbehavior and you see. she is unable to do so. some psychologists call it neglect. I just have a series of problems that have happened to me over and over and I thought. well.Katherine as a “Kernbergian Borderline” 137 The presence of a victimized self-concept is evident when Katherine initially suggests that she is to blame for her ailments. and an extremely harsh. I have been physically and verbally abused by my parents. and I just think that my sadness and lack of energy might be related to my PMS.

Kernberg invokers the concept of "excessive pre-genital aggression" in order to explain the complexity of symptom formation in the borderline patient. she angrily told me I was “petty and “narrowminded”. pre-genital aggression--one of the hallmarks of borderline structure--but also the primitive. even tearful. her deceits seemed to be motivated by the desire to punish others or herself. for example. This primitive aggressive core was transformed. Further. she would frequently devalue and attempt to negate any progress related to our work in therapy. she would become inordinately upset. On the one hand. at times with the ostensive purpose of gaining an advantage with others.” At one point. if the therapist announced a vacation or requested even a slight alteration in the time of her session. Kernberg theorizes that all the processes involved in the unconscious resolution of the oedipal vicissitudes acquire destructive . she would become enraged at those points when she interpreted the therapist's intentions as agreeing with “the narrow-mindedness of the authorities. At such times her masochistic. an act that both expressed her aggression towards the object (her therapist) and aggression towards the self (“I guess it is nice to talk to a pleasant woman about my personal life. However. An alternating cycle between masochistic/passive versus aggressive/sadistic superego features was reflected in aspects of the therapeutic relationship. but I do not see the value of being questioned so much”). While on one hand Katherine reported intense gratification in her aggressive fantasies. antisocial behaviors. She would lie and create fictional stories about herself. on the other hand. As we have seen. unintegrated nature of both her ego and superego functioning. When I explained to her that there was a simple written release procedure that applied to everyone. she complained about the clinic receptionist who would not immediately release her records to her treating psychiatrist. resulting in her feeling humiliated and depreciated. into paranoid ideation. (“This whole thing is a scam to steal people’s money!”) Kernberg traces the genesis of the borderline’s superego development to the internalization and identification of an overpowering parental figure perceived as omnipotent and cruel. This combination of sadistic fantasies and masochistic behaviors not only illustrate Katherine's primitive.138 Borderline Personality Disorder: A Lacanian Perspective self. which included cutting others. on occasion. however. Katherine presented a sense of entitlement that was expressed in egosyntonic. submissive attitude was converted into an openly hostile response towards the therapist and the treatment. shooting them or pushing them to their death. she could be totally manipulated by men in a sexual context. At other times.

father and the therapist. Kernberg underscores the idea that frustrated oral dependency needs expected from the mother are displaced onto the father. These fantasies typically. and under the guise of. These sexual features of the fantasy of the patient may not be accessible in the first interviews but appear in long-term treatment. suggests that Kernberg perpetuates descriptive psychiatry by importing its terms and criteria into. because of gender identity conflicts around the figure of the parents. From one perspective. Therefore. an alternative. psychoanalytic theory. a review of Katherine's case reveals her to meet both Kernbergian "presumptive" and "structural" criteria for the borderline diagnosis. It is possible to find distorted and severely aggressive versions of the primal scene that impact upon the future sexuality of the girl in her choice of love objects. As Katherine’s treatment evolved she discussed her fantasies of being raped by a man and/or a female. This was amply evidenced in her expressed feelings and attitudes towards her boyfriend. the possibility of idealization of a love object (because of its absence and longing) is rapid and total. or of being forced into performing oral sex. in the exploration of the sexual difficulties that the patient eventually acknowledges. .Katherine as a “Kernbergian Borderline” 139 and primitive qualities that are expressed later in masochistic-sadistic and paranoid tendencies. increasing castration anxiety in girls in the form of penis envy and severe superego prohibitions against genitality in general. Kernberg's structural interview is a multistep task that requires psychological. more critical point of view. It also demands psychotherapeutic experience on the part of the interviewer along with a substantial clinical background. there is a tendency towards bisexuality in the condensation of both sexes in both parents. Further. to total rage or withdrawal. also involved her as the seducer of her sadistic partners. In sum. the borderline can shift from total dedication to “an other”. this type of interview reflects a fusion between descriptive psychiatry and psychoanalysis in a highly effective form. As we shall see. and contradictorily. On the other hand. psychiatric and psychoanalytic knowledge.

Borderline Personality Disorder: A Lacanian Perspective

Chapter Six

Katherine as a Lacanian Patient
The Demand for the Desire of the Other Having discussed Katherine from within Kernberg’s perspective on the borderline it remains for us to pursue a Lacanian interpretation of this case. The analysis I will provide will not only serve to illustrate significant differences between Lacan and Kernberg but will also document a shift in the direction of the therapeutic process in Katherine's therapy, as certain Lacanian notions were incorporated into the treatment. The interpretation presented here will draw upon several of the Lacanian concepts that were introduced In Chapter Three but is by no means meant to be exhaustive or complete. A Lacanian perspective takes its cue from the very first moments of the initial interview. Recall that in the initial interview when Katherine was asked to describe the nature of her difficulties, she expressed discomfort with this open-ended request, and answered this question with her own request that the examiner formulate direct and specific questions about her condition. From a Lacanian perspective, Katherine's request, in effect, her opening gambit, in the initial encounter with the therapist, provides important data regarding how Katherine chooses to position herself with respect to the therapist, as well as towards others in general. Whereas from a Kernbergian perspective the request for a more structured interview mainly signals a weakness or fragility in the structure of Katherine's ego, for a Lacanian, the request for an "interrogation-

Katherine as a Lacanian Patient


type" of interview can be understood as potentially suggesting something regarding Katherine's fundamental (unconscious) fantasy. When asked why she wanted to be questioned in such a manner, Katherine simply stated that the idea of freely discussing her concerns made her feel “uncomfortable.” An inquiry into the nature of this discomfort led not to a description of anxiety about a particular mode of questioning, but rather into a description of some of her core symptomatology. These included her depressive feelings, the impact of her bodily states on her mood, and reflection regarding whether she herself might at least in part be responsible for her own pain. This move into a description of her symptoms represents a subtle break in the associative chain, as the therapist's questioning of the particular interpersonal stance that Katherine "signs in with" leads to an expression of her core symptoms. Here, at least, either a Kernbergian (fragile ego) or Lacanian ("fundamental interpersonal fantasy") perspective fits the data, as each perspective can explain how it is that Katherine would become "symptomatic" in response to the initial patient-therapist exchange. At this point, it is not a question of eliminating one or the other point of view, but rather of recognizing the possibility for both Kernbergian and Lacanian perspectives. However, we should note that a "choice" on the part of the therapist at this very early juncture in the treatment--whether to see Katherine's behavior as an expression of the state of her ego or an expression of her fundamental fantasy will have ramifications that will ultimately pervade and condition the diagnostic picture, and even the therapeutic process. From a Lacanian point of view, Katherine's insistence that the therapist pose her own direct and specific questions can be seen as the patient's demand to know what the other wants or is looking for. In the previous chapter, we considered the possibility that this demand is a conscious attempt on Katherine's part to learn something about the therapist's techniques and abilities. Here, I am suggesting that it may well (also) be an expression of an unconscious pattern of interpersonal relatedness. From a Lacanian point of view, Katherine's request is not so much an expression of the ego's conscious goals, such as a need to control the therapeutic situation or a means of managing first-visit anxiety. Rather, it speaks of some profound style that the patient has developed throughout the years, which would be manifest not only in the here-and-now with the therapist, but with her family, her boyfriend and others: the idea that Katherine must figure


Borderline Personality Disorder: A Lacanian Perspective

out the nature of a demand coming from an external source which she feels prompted, even compelled to fulfill. This fundamental fantasy would, if verified in other instances and contexts, suggest for Lacan, the likelihood of a hysterical neurotic structure. So with one turn of the interpretive dial we have already moved from a way of thinking that is considering a "borderline personality" to one that may have no need for such a purported new structure, and which, at least for the moment, considers Katherine within the more traditional psychoanalytic category of a presumptive "hysterical neurosis." Of course, both the Kernbergian and the Lacanian perspectives are, at this very early stage of the diagnostic interview, simply hypotheses, to be refuted or confirmed by subsequent data that will emerge as the interviews and analysis proceed. There is, of course, a danger here of being locked into one's initial hunches and then seeking (and finding) only data that confirm one's theoretical prejudices. Katherine's hesitancy to take the lead in her own discourse may simply be an example of the resistance that nearly all psychoanalytic patients' have to their analyst's request to engage in free-association. More data is needed. Such a problem, however, is endemic to all forms of psychotherapy and is neither unique to Kernberg or Lacan, nor, for that matter, to psychoanalysis. So let us proceed and see where the Lacanian perspective leads us. As we will see, this patient's demand to be questioned by the therapist will indeed prove to be a key to the "Lacanian Katherine," for, repeatedly throughout the course of her treatment, asks of the other: "What do you want to hear, what do I need to be?" The patient, we will see, appears to be invested in questions (and answers) ready-made by others. For example, during many of our sessions, she would enter the office, sit down and ask, “What is the matter with me? Tell me, you know what is going on, what do I have that people seem to dislike me so much? How should I be so that I’ll be liked?” Early on in treatment, the therapist's response to these queries was to reflect the question back on Katherine herself; “What are your thoughts about what's wrong with you?” However, this approach yielded little if any insight or working through. In response, Katherine would resort to repetitive discussion of daily family situations and a therapeutic opportunity would be lost. Rather, it was only when the therapist shifted the discourse from what the other’s found wrong with Katherine, to querying more directly regarding the significance of her, “What do you want?” that Katherine was forced to move off her attempts to please others and examine (how little she was aware of) her own desire.

Katherine as a Lacanian Patient


Katherine would often inquire of the therapist “How are you feeling today? Is everything OK with you?” In spite of never having discussed or being encouraged to discuss any aspect of the therapist's personal life, she was intently invested in discerning the desire of the analyst and to position herself in such a manner as to become its cause. It might be said that rather than questioning herself, Katherine was in search of a question. During the interview process, when the therapist refused to meet Katherine's demand, and instead asked why she was feeling uncomfortable, Katherine began to describe her general symptoms, and inquired about the condition of her suffering, but eluded any self-questioning that could lead her to the condition of her own desire.

Identity or Desire? Indeed, Katherine is very astute in ascertaining what she presumes to be the desire of the other, but is almost without a clue with respect to what it is that she herself wants. She moves from school to job and then job to job, finding herself engaged in a varied matrix of "pursuits" without ever settling on what it is she "desires." She is a an attendant in a geriatric home, a salesperson in a boutique, a florist, a tour bus guide and a belly dancer, and each of these jobs ends in a conflict with her employer. From a Kernbergian perspective, we have a failure to consolidate a unified ego or strong identity along with lack of sublimatory channels (in what has been described as an "as if” personality). From a Lacanian point of view, we have a failure to understand and own one's desire. Once again, what for Kernberg is a structural weakness in the ego, for Lacan understood in terms of the unconscious. Lacan is uncompromising in his focus upon the unconscious. It is as if he is telling us, "Whenever you are tempted to understand the patient's symptoms or behavior as a manifestation of his or her ego-state, ask yourself how the behavior or symptom provides a clue to his or her unconscious desire." This, in essence, is Lacan's famous "return to Freud." Lacan states that “desire is the central point or crux of the entire economy we deal with in analysis” (Lacan, Seminar VI, 1959). When the desire of the patient becomes the center of the treatment, then both therapist and patient lose interest in a discussion of everyday social reality,

Thus. and her report that in at least one of her prior treatments she was in “analysis. when questioned about the . fleeting thoughts and fantasies. In a Lacanian analysis what is important is that the patient puts a particular aspect of her life into question for the analyst." Katherine is happy to be asked and to answer every question of an ordinary mental status or psychosocial evaluation. one can say that when the analysand begins to speak about his or her desire. The Didactic Phase of Treatment Since Freud. Following Freud's instructions on this. to being a subject of desire. from her side. along with blocked actions and misunderstandings. must continually and without fail encourage the patient to share her thoughts. unacceptable or insulting it may appear). Often therapists mistakenly take for granted that their patients. The analyst. Early on.” Katherine had not been taught what was expected of her in analytically oriented treatment. to teach the patient what the goal of an analysis is. and to provide him or her with a hint as to what kind of communications (manner of speech and subject matter) are useful in an analysis and which ones are not. Indeed. It appears that despite all of her previous treatments. she moves from being a patient describing symptoms and occurrences (making demands). the early part of the analysis is devoted to an explanation of the role of the analyst and the expectations of the work that the patient is embarking upon. especially those with prior experience in therapy. and also that she initially (though this must eventually change) experiences a desire for her symptoms to disappear. the patient needs to hear that any and all of her communications are important.144 Borderline Personality Disorder: A Lacanian Perspective as these are generally not reflective of who the patient is as a subject. know what is expected of them as an analysand. that she should speak everything that comes to mind (no matter how ugly. psychoanalysts have recognized that it is important to be somewhat didactic in the initial interviews and phase of analysis. forgetfulness. An emphasis is placed on the analysand bringing material related to dreams. and is uncomfortable or even unable to relate in the psychoanalytic "free-associative" manner that alone can provide the clue to her desire. As a "patient.

From Interview to Treatment One important technical milestone in any treatment is the sorting out of the therapeutic value of the preliminary interviews versus the treatment proper. 1997). Katherine’s anxiety would peak. (Fink. Lacanian Structural Diagnosis The goal of Lacanian structural diagnosis is to determine the correct position of the analyst in the transference. the specific interventions that can or cannot be attempted. it is not always possible to attain clarity in these matters in a few sessions. While it is true that the preliminary interviews are utilized to attain an overall life picture of the patient and to make a determination regarding the clinical structure. During the interviewing process the patient brings a presenting problem that she/he tries to explain by associating it with some present or past event that brought about a crisis which led her to therapy. The most important distinction that must be made (with due care but as early in the treatment process as possible) is . The therapist should not attempt to push the process beyond the patient's capacity simply in order to quickly arrive at a diagnosis. hence. the treatment approach that will be most suitable for the individual patient. Indeed. had Katherine's underlying personality structure been psychotic. the patient’s whole life is put into the question as the transference relationship is initiated with the analyst who “supposedly knows something that the patient does not. a persistent confrontation by the therapist could have resulted in a severe psychological decompensation.Katherine as a Lacanian Patient 145 possibility that she bears some responsibility for the production of her own symptoms. Further. In the treatment proper phase.” This starts the beginning of an analysis. Such inquiry when conducted too early or too forcefully may constitute a technical error as it may actually deter the patient from becoming motivated for treatment. the very process of diagnosis goes hand in hand with determining in a more refined manner what position the analyst must take with respect to the patient in question. and.

Lacan accomplishes this through a careful assessment of the defining mechanisms of "negation" that appear in psychosis (foreclosure). As we have seen in Chapter Three. In Lacan's view. these “imaginative inventions" are particularly common in hysterical “dissociative states". which. the therapist's tentative efforts to work with dream material can provide important insights that will help formulate both diagnosis and treatment (Fink. not just a characteristic of it.. the capacity of the patient to work with and achieve insight through free-association to dreams and other materials is a mark that he or she is conditioned by "repression" and therefore has a neurotic. fatigue. These mechanisms of negation are not to be confused with the ego's mechanisms of defense. 1997). neurosis repression). particularly the choice of words. and seemingly produce at will. and perversion (disavowal). What is the particular use of language that this patient brings to each of her sessions? Listening rather than observing becomes the most important part of this work. Thus. as opposed to a psychotic structure. according to Lacan. Obsessive patients also can be so persistent in their perseverations as to be confused with paranoid psychotics.) the clinician should not be led into producing a list of symptoms that can classify the patient in one or other nosological category. virtually any symptom imaginable. Patients with severe hysterical presentations have such a vivid fantasy life that they can relate. etc. an important diagnostic marker involves the use of language. 1953). (Lacan. headaches. since no particular form of negation is associated with it. It is important to note here that.146 Borderline Personality Disorder: A Lacanian Perspective between a neurotic versus a psychotic structure. while foreclosure constitutes psychosis and disavowal constitutes perversion. . repression is the cause of neurosis. For Lacan. Rather they are constitutive of the pathology. for Lacan. are a secondary development. Although the patient discusses numerous symptoms related to her physical conditions (her premenstrual pains. This strict way of conceiving diagnosis would seem to rule out the possibility of the borderline diagnosis.

She is horrified. The following week the patient brought a second dream to session. 2nd Dream: She is looking at herself in the mirror and she sees herself naked from the waist up. to her genital/reproductive organs. it is important to note that an important turning point in Katherine's treatment came as a result of two dreams she brought into therapy after she was released from the hospital subsequent to her suicidal gesture (during which she ingested 25 aspirins). The analytic work with these dreams gave the therapist a better picture of the meaning that Katherine gave to her body and in particular. the dreams provided both patient and therapist an entrance into several important aspects of Katherine's repressed desire. While she reluctantly agreed at that time. She turns around as she is frightened by an image she has seen in the mirror. At the time. More importantly. 1st Dream: Patient had a dream in which she was entering a deli with her mother and brother when she saw her friend Maria eating from the salad bar. she was eating with her hands and stuffing food in her mouth and swallowing it in great gulps. The patient tried to stop her and explain the correct and acceptable behavior but her friend looked puzzled and responded with incoherent speech. She was amazed at Maria's lack of "table manners". increased contact paid off with an intensification of productivity in the verbalization of her thoughts and emotions. which looks like a small red knife that is coming at her at a fast speed. She quickly moves away but the knife hits her in the wrist opening up a hole. Katherine was advised to attend twice-weekly sessions in order to help process and contain her intense affect.Katherine as a Lacanian Patient The Analysis of Two Dreams 147 In this regard. .

Katherine’s own associations led to the judgment that "needing something very badly" can be interpreted as "bad manners or bad behavior. Katherine had taken a special interest in this young woman who she described as a heavy smoker and as possibly mentally ill. (This conclusion pointed to genital identifications that were unfulfilled as well). Katherine had made her acquaintance in a shelter for women where she went twice a month to do volunteer work. wasn’t Katherine herself the hungriest of all in her need of a maternal figure? The patient's associations led her to conclude that she not only felt that she did not have enough of her needs fulfilled ("oral” needs in psychoanalytic terms) but that she had also been deprived of attaining an understanding of what it was to be a woman. and in fact had been quite loving. and her father was the one who was available to her. the first dream. it became clear that the dream image condensed a projection of Katherine's oral maternal needs and her feelings of sibling rivalry towards her brother. We should recall that whereas Katherine had described her own mother as completely lacking in maternal feelings towards herself. In the dream." After all. Katherine recalled that on the day she experienced her period for the first time.148 Borderline Personality Disorder: A Lacanian Perspective As will be explained in due course. became a marker of a new phase in her treatment. the patient dreams of a friend who is a 22-year-old pregnant runaway girl. In associating to “the bleeding” of the second dream. In the first dream. Katherine's associations to this dream revealed that she had projected her own conflicts onto this young woman. As we will see. eating habits. it is this dream that marks Katherine’s movement from an incessant aggressive posture towards males to an exploration of feminine needs and her relation to the maternal figure. marked the experience of a structural change. her mother was not at home. her mother had expressed a strong tenderness. Katherine was concerned about how poorly her friend took care of herself and she made various attempts to assist her in improving her hygiene. as her father had raised her and had taken on many of the roles that Katherine felt should have been taken by her mother. her mother and brother accompany Katherine. When her . and make-up. What follows is a condensed version of the associations and interpretations of three dreams that arose over several sessions. As the associations to Katherine's dream developed. The second dream. which Katherine reported at the time when her boyfriend abandoned her. which she reported a week later. in relation to Katherine’s brother. dress. She told her father what had happened and he sent her to bed to rest.

her brother grew up to be a successful young man who had achieved what he desired ("he was on top . Her brother's relationship with their mother had been very different from Katherine's. yet.Katherine as a Lacanian Patient 149 mother arrived home late that night Katherine told her about the change. in which she observes an object coming at her in the form of a red knife. In discussing her brother. in part. The second dream advances the working through and enabled Katherine to change her position. Katherine who was in the air. who is "on top". Her mother became so anxious about this incident that she not only brought her to the pediatrician but also demanded that he examine her for a possible “loss of [her] virginity. Her brother was sitting on the other side and at one point. Katherine views herself in this dream as "a failure" in comparison to the figure of the brother. One of them was to an accident that Katherine sustained as a child as she was playing on a seesaw. This had been a chapter in the family history that precipitated all kinds of blaming and self-loathing in her maternal grandparents. Is it herself or her mother? From a Lacanian point of view this dream involves a fantasy of the imaginary fusion between the self and the imaginary other. answers the questions raised in the first dream. the one that does not fall or bleed. detached woman did not seem to comport with her brother's experience. as she recalled other events in her life that were totally blocked from consciousness until she freely associated to them in session. but which she had not recalled for a long time. Katherine initially had feelings of satisfaction for being a grown-up woman and also experienced a need to be hugged by her mother. she wonders if this is truly her own body. Further. Her description of a cold. Katherine. lost hold of the seesaw and landed hard on the ground.” This incident brought a further association regarding an incident that Katherine heard about. The image of the mirror (process of identification) now is on the experience of the body. brought many associations. Further. Women in this family took pleasure in a masochistic stance. As the patient's associations continued. The incident related to her mother being seduced by a family member in Katherine's grandparents' home. Katherine explored in depth her feelings of jealousy and envy. Katherine questions who is in the mirror. Profound dissatisfaction ensued when her mother refused to discuss the subject. She started to bleed in her trousers. it became clear that the hole opened by the entrance of the knife established the definition of a woman and further the particular definition of what it is to be a woman in Katherine's family. The second moment of the dream.

an insight that. I would argue that the dream work described above permitted Katherine to profit from a genetic (i. Dream analysis as the analysis of primary process and the libidinal significance of linguistic structures is often avoided in the treatment of "borderline" patients. her relationship to her mother and with men. and it is Lacan's view that we simply cannot create a psychosis in a neurotic individual. However.e. is because they have a neurotic structure constituted by repression." Such clinicians are often concerned about "tipping the balance" of an unstable. historical) understanding of her conflicts. her structure was indeed neurotic in Lacan's sense.150 Borderline Personality Disorder: A Lacanian Perspective of the game"). in regard to Katherine's failure to acknowledge her own needs and assume her own desire. failure and loneliness. . These analyses also provided much insight into the inter-generational role and destiny that Katherine was repeating in each of these areas. as she was describing her feelings about her sibling. weakened ego structure and of pushing such patients into a psychotic break by asking them to free associate to such primary process material. and further. However. herself included. or even psychotic disorders. according to Lacan. Some individuals (such as Katherine) who meet descriptive criteria for borderline. before plunging headfirst into dream analysis and free-association. as I will discuss below. this cannot be accomplished through a descriptive diagnostic procedure. This. becomes possible within a Lacanian treatment. I should also point out that Kernberg (1984) limits interventions with borderline patients to interpreting defenses in the here and now and does not advise the use of genetic interpretation and reconstruction in borderline cases. Although it is important to determine. that they. are excellent candidates for analytic work. had difficulty enjoying a sexual relation. The work with Katherine's dreams seemed to verify that in spite of her florid borderline symptomatology. whether the patient has a psychotic structure. The analysis of these two dreams produced a turning point in Katherine's therapy. it became clear that women in her family had a destiny marred by depression. this material might not have been available given the limitations that psychoanalysts often have with so-called "borderline patients. one in which productive work began in several important areas. As such. and Katherine’s quest for personal achievement.

Katherine's father denied this when his wife confronted him. However. Katherine's father never admitted to the affair. When asked about the particularities of their divorce and the circumstances surrounding the separation of the couple and its impact upon the children. they seemed to share very little if any enjoyment. .Katherine as a Lacanian Patient Oedipal Vicissitudes 151 Another important phase in Katherine's treatment was marked by an in-depth exploration of her parent's marital relationship. her father would recriminate his wife for her greediness. and her parent's quarrels increased. However. Katherine expressed surprise that she had spoken about this "other woman" with the therapist. Katherine's father met his current wife a year later and married to her soon thereafter. It appears that Katherine's mother accused her husband of having an affair with a woman who Katherine did not know. Katherine explained that her mother was always very busy outside the home in an attempt to increase her income by working overtime. The interpretation of this pattern opened up a wealth of significant associative material. As such. although it lasted throughout Katherine's parents' marriage. common friends of the couple confirmed the veracity of the extra-marital relationship. after the couple's separation. Katherine stated that she was convinced that her mother was still in love with her father in spite of the years that they had been separated. Katherine grew up in a home-setting where there was an absent mother. Katherine's recollection of these sets of relationships is extremely important. Katherine's mother would leave early in the morning and return late at night. lack of sexual interest and her self-absorption. Katherine had brought into treatment concerns about her mother's bouts of depression. this woman became increasingly central to her parents' arguments. It appears that this affair. As Katherine would contact her mother weekly to "check on her depression" a pattern appeared that showed that most of the time these conversations between mother and daughter were closely followed with some of Katherine's most heated arguments with her father. a father who was fulfilling part of the maternal function. On those occasions. and where the shadowy presence of another woman signified the desirable qualities that her mother did not have in order to maintain her father's interest. In one session in particular. She then reported that as time went on. did not continue after the divorce.

according to Lacan. with her depression. For Lacan. However. ensured a faithful tie between them. Given this complex schema. By way of contrast. . an individual's sense of subjectivity is comprised of a very complex network of meanings that not only belong to the person in question but carry forth representations from parents and even earlier generations. for example. out of solidarity with her mother. to have a psychosomatic illness. Katherine's Subjectivity According to Lacan. Kernberg will discuss. Even the body is overwritten by language and this. her inhibitions in the enjoyment of sex. this process originates in the mirror stage. the child. is why it is possible. and the potential obstacles it places in the path of the child's becoming “someone. On the other hand. Kernberg's view is that at the root of the borderline disorders is an excessive amount of primitive aggression that fuels the borderline's rage against a mother-object who has not provided sufficient affirmation. the subjective human condition involves the interplay between at least four elements that are always present: the mother. the father and language/culture at large. Such a thought not only justified her "feeling abandoned" but also provided a new element in the circuit of desire: another woman. it helped us to corroborate Katherine's partial identification with her mother. the process of becoming oneself involves loss and aggresivity and in his model. For Lacan. Further. Lacanian thought does not place a unique emphasis on the dyadic relationship with the mother. In fact. and with the idea that "men are not to be trusted" since there is always another woman more interesting and desirable than oneself.152 Borderline Personality Disorder: A Lacanian Perspective It became evident from Katherine's statements about her boyfriend. at times. that she would scrutinize carefully his interest in other women. the aggresivity that the child needs to marshal in order to assert his individuality is not connected in any way with the aggression that Melanie Klein and later. Katherine's unconscious representations of her parents along with what has been “said” or “unsaid” in her family had enormous consequences for her process of individuation.” we can imagine how difficult it is for a child to achieve the process of individuation. she became convinced that he was cheating on her.

While aggression is associated with a violent act. We might here ask whether Katherine’s mother's neglect of her own daughter might be reflective of this painful experience that she herself never discussed with her own mother. This fundamental ambivalence underlies all relationships from then on and all future forms of identification (linking it to the development of narcissism) and leads. and. Thus the presence of ego-fragmentation in Katherine is not diagnostic of any disorder. who blamed Katherine’s mother for the incident. aggresivity refers to the tension present in all relationships which in Lacan’s view involve both love and its opposite. according to Lacan. And how did Katherine's . In the current case. but is rather endemic to the human condition. it has its origins in the mirror stage. it is not only the borderline who experiences this sense of threat. as ambivalence. In essence we ask what questions did Katherine carry for her mother and father that they did not address with their own parents. This tension is referred to. It is interesting to note that a key to understanding some of this material was derived from Katherine's dream associations. The topic of borderline pathology and the human condition is a matter that we will return to in the final chapter. It was in this context that Katherine first (and to her own surprise) expressed her recollection that her own mother had been sexually abused by a male relative and had never worked that problem through with her own mother. as the wholeness he sees in the mirror or in his mother is not reflective of the sense of fragmentation and disintegration that he experiences as a helpless human being. The child feels extreme tension. one must inquire regarding Katherine's understanding of her place in the fantasies of her mother and father.Katherine as a Lacanian Patient 153 Lacan makes a distinction between aggresivity and aggression. to aggresivity. fragmentation and rage but all humans. Lacanian Inter-Generational Analysis One of the most important tasks in a Lacanian psychoanalysis is to arrive at an understanding of the place of the patient in the generational representations of the family. According to Lacan. according to Lacan. Here I will underscore several of her associations/recollections to Dream #2 described above. especially in regard to her childhood “bleeding accident” and her mother’s response to it. in Freud.

Katherine not only made many references to her mother’s sense of revenge related to men (also reflected in her relationship with Katherine’s father) but also to a deep sense of “being a slut” in the eyes of her own mother. Katherine was taking “her mother’s badness” on her . This unprocessed identity was later foisted on the patient and she carried it throughout her life. In the process of working through her recollection of this event. she spent considerable time discussing this matter in treatment. The group had gathered in one of the hotel rooms and girls and boys were conversing. and afterwards she locked herself in the room and stayed awake all night long. her mother's neglectful and scornful attitude towards herself. Like some of the other students in her group she had smoked some marijuana and drank a fair amount of liquor. On further exploration Katherine explained that she had “overpowered” these boys “one by one”. As briefly mentioned earlier. As we have seen. and began to unravel her own puzzle in regard to the history of her family's encounter with femininity. of course. she found herself in a difficult situation. When the group dispersed after a school supervisor indicated it was time for bed. The next morning an enraged Katherine walked up to her friend and started a quarrel. fearful of their return. As Katherine proceeded with her work." This example is illustrative of how the core of an identification that seemingly appears to belong to a patient in question is often best understood as the residue of another person’s identification. during a High School weekend trip. Although it was relatively far into the therapy. As time went on. and her own self-image of being a "slutty woman.154 Borderline Personality Disorder: A Lacanian Perspective mother's early traumatic experience with a man impact upon Katherine’s father? Of greatest significance. Katherine reported that at the age of 17. Katherine eventually turned a questioning gaze upon her own casual encounters with men. and playing cards. she became convinced that one of her girlfriends had sent these boys to her room. she refused any further contact with these boys and requested that they leave. she formed a link between her mother having been abused as a child. a group of three of her male classmates entered her room and made sexual advances towards her. Katherine went to her room. is the question of how these events are signified and later re-signified in Katherine's own psyche. Not long after. but later came to doubt that this could have possibly been the case. Although she initially engaged them. After the above noted dreams. Katherine initially stated that she recalled hearing the young woman's voice urging these young men into her room.

This unprocessed enraged affect as a result of an identification with a depressed. ended up . How did Katherine deal with the passage from the first love object (the mother) to her father. who was always by her mother. Here again we see with a so-called "borderline" patient that it is only through a freeassociative analysis and an articulation of hitherto unrecognized (repressed) thoughts into speech that the patient can attain an insight that will enable her to move beyond the desire of the other and achieve her own individuation. was able to develop his own individuality without having to overcome major hurdles. We should here recall how Katherine referred to her mother in the initial interviews. Katherine’s father is not interested in his wife but he is invested in his daughter. and how was the inscription of “the name of the father” achieved? As the treatment progressed it became clear that Katherine experienced herself as a repository of her mother’s rage and self-loathing. Her brother. Katherine. characterizing her as lacking in maternal instincts but not blaming her for it. abused mother was now projected onto her father. On the other. we have a father who is the source of desire for Katherine’s mother but who comes to reject and abandon her. As noted above. in Katherine’s own view was her primary caretaker. The “Name of the Father” Having explored several of the vicissitudes in relation to Katherine's mother. the work that began with associations to Katherine's dreams revealed that this was the place that she had been assigned within the context of the family. we are left to ask about Katherine’s position in relation to her father. It is interesting that Katherine will become an important part of their negotiations in their conflicted divorce. On the one hand we have the presence of a father who is fulfilling some aspects of the maternal function. and was of little interest to their father. According to Lacan. who. such work must occur within the context of what is called the Symbolic Register in the presence of “the other” (analyst) who enables the recollection to be fully explored.Katherine as a Lacanian Patient 155 own shoulders in order to exculpate her and free her mother from any guilt. even justifying her aloofness on the grounds of the intrinsic difficulty of the maternal function. on the other hand.

Such meanings. Rather than interpreting these feelings. although identified. It is the analyst's response to this belief that is the motor of the treatment. In Lacanian terms. that in her relationship with her father. on the one hand. Lacan insists that the analyst must refuse to use this power of knowledge given by the patient. Therefore. The work of analysis. but a “process put in motion through language in the presence of the Other” (Lacan. treatment begins when the transference is established. Rather. including her inability to succeed as an adult.156 Borderline Personality Disorder: A Lacanian Perspective being cared for by her father all the time. As we have seen. this maternal figure is a man who desires a woman who is not Katherine's mother. every patient has to conceptualize his/her symptoms through his/her own words and articulate the particular meanings of his/her history that have hitherto resisted symbolization. her poor relationships in general. 1954). and proved unable to live as an independent adult. 1964). is not central to the relationship between analyst and analysand. several important psychological problems occur. According to this view. according to Lacan. the world of words themselves. Katherine identifies him with a maternal figure who can protect her. the only real tool that the analyst can count on in the process of the cure. becomes a reconstruction of a true identity by traversing the different meanings that have been placed upon us by others. first appeared in a "traumatic" fashion and thereby escaped representation and meaning. The symptoms related to Katherine. and her depression were ultimately put in motion within the transference. Lacan suggests that this aspect of the imaginary realm in transference. on the other hand. her somatic complaints. Lacan moves into the symbolic axis of the transference. and in particular with her father and boyfriend. and the belief that the analyst knows something that patient does not know. Noting this defect. for Lacan the unconscious is not a place somewhere in the brain. and further articulating it in the Symbolic Register is. this initial lack of symbolization places them in the so-called Real register. Indeed. thus. yet. The question of aggressivity or the intrinsic ambivalence in all relationships is also demonstrated in the negative transference. transference refers to "the subject supposed to know" (Lacan. There is thus a defect in articulation. This refusal thrusts the . a defect in symbolic transmission that appears as a formation of the unconscious. That is why it is not enough for an analyst to be an empathic listener and try to produce what Lacan might call imaginary reparation in the transference (as in a Kohutian analysis). It appears thus far. However. we might say.

Although the simplicity of the theory may appear to make matters easy to elucidate. The three mechanisms of foreclosure.Katherine as a Lacanian Patient 157 work of the analysis back onto the patient. who must ultimately surrender the fantasy that the secret of her being is contained in an “other”. boyfriend and therapist does not. The work of the therapist resembles the work of in inquirer rather than of an interpreter. 1956). this position reduces psychoanalytic treatment to a suggestive method and keeps the patient in the neurotic position of assuming that knowledge of her desire rests in the other. the analyst will address that part of the ego that is conflict-free. For Lacan. For Lacan. repression and disavowal provide the bases for neurosis. and that by interpreting her relationships in light of past ones. the particular mode in which a subject negates his/her desire or the law (“the name of the father” or castration) serves as the basis for Lacan’s distinctions within his structural system of diagnosis. While classical psychoanalysis takes the idea of interpreting the transference as one major means of producing insight in the patient. the determination of which mechanism is at work requires a great deal of clinical acumen. pointing out the difference between Katherine's aloof style towards the therapist (resembling her relationship with her mother) or interpreting the underlying commonalities of her anger towards her father. in the present case. Such interpretations rest on the belief that the analyst has a better grasp on reality than the analysand. the curative quality of interpretation in the context of the transference is illusory. it is better to question directly the content of the speech to produce more associations. Rather than interpreting the fact that Katherine might be angry with the therapist in the same way that she was angry at her father. The cure develops when the patient begins to shed her self-defeating identifications with the desire of the other. in Lacan's views helps produce insight. has rational understanding and is capable of restoring the patient to health. and assumes the direction of both her treatment and life. These particular modes are determined by the way the "name-of-the-father" (or what Lacan . and in this way begin to assume her own desire. Katherine as a Neurotic Individual As described above and in Chapter Three. Lacanians reject this view of insight. psychosis and perversion respectively (Lacan. For example.

original metaphors (e. Therefore. and it is in neurosis that the paternal metaphor or symbolic function has operated and separation from the mother has occurred On the other hand. neologisms) to the absence of "the essential (paternal) metaphor. When the Name-of-the-Father is foreclosed in a particular subject.g. Repression then occurs. his ego boundaries are totally non-existent. 1999). the world of the imaginary that of visual images. As described above. the predominance of imaginary relations is the predominant feature in psychosis. Although repression has a qualitative difference in both genders. the basic result is the same. it leaves a "hole" in the symbolic order that can never be filled. The psychotic individual is at the mercy of his imaginary structures and to use a non-Lacanian metaphor. When the Name of the father reappears in the “real”.e. where the paternal metaphor. This imaginary and later symbolic law produces a prohibition that neutralizes the mother’s desire for the child as well. i. Lacan links the psychotic's inability to produce new. how the symbolic order overwrites the imaginary realm of being. this initial prohibition is what ties social reality to language in a constitutional way and serves as the basis for all linguistic meaning." As the child matures. How did this mechanism work in Katherine? Repression certainly worked. his speech is “imaginarized” (Fink. even though the individual makes use of language. establishing a first “No!” According to Lacan. So the first meaning that the paternal metaphor introduces is that the longing for the mother is wrong for the child. In this way the cultural and the linguistic come to overwrite what is natural in the human condition. This marks the onset of psychosis. in psychosis. (Lacan. The predominance of symbolic relations through which the imaginary realm is subordinated characterizes neurosis. the subject is unable to assimilate it. mirror perceptions and fantasy is re-interpreted through the words or language provided by the child’s caretakers. and hence the symbolic/cultural order is "foreclosed". . olfactory sensations. Katherine had words for her symptoms (a description of her suffering). 1954). he/she is forced to give up a particular pleasure with the mother via the institution and representation of the paternal law. recovered memories in session (indicating the presence of repressed material).158 Borderline Personality Disorder: A Lacanian Perspective denominates the “paternal metaphor”) operates in the individual. the capacity to doubt her speech (she would wonder about her level of responsibility for her symptoms and she questioned their meaning). delusions and language disturbances. characterized by the presence of hallucinations.

in the actual course of therapy. As I have indicated. is evident in Katherine's recollection of the sexual scene on her high school trip. Many traumatized people going through an acute anxiety crisis. free-associate and make connections between the dream material and her early life. and adults in general. but the influence of the (symbolic) father had surpassed anybody’s expectations. in repression. it ultimately became clear that not only had the paternal metaphor been inscribed in the patient's psyche. was. but rather because her therapist is unsure in making a determination regarding the true (neurotic or psychotic) nature of her pathology. As it turned out in Katherine’s case. since the father occupied a space she yearned her mother to occupy. However. or even "hallucinations" that are common in psychosis do not suffice to make a diagnosis of psychosis according to the Lacanian model. many of Katherine’s communications could have been interpreted as suggestive of a psychotic formation. and a constant active listening to the verbalizations of the patient that would lead to this conclusion. However. and easily suggestible hysterics have experiences of this sort without possessing a psychotic structure. Katherine had great difficulty in free associating at the beginning of the treatment. Whereas in psychosis the reality of something is totally refused. where Katherine presented with so many "borderline" features. the diagnosis of a neurotic structure could not be achieved for quite some time." not because she has a borderline psychic structure. a difficulty which Kernberg tells us is typical of borderlines. in Lacanian terms. clearly indicative of the presence of neurosis. teachers. Further. . Indeed. which we have already referred to. the fact that she was able to bring dream materials into session. It was only in the unfolding of the therapy and its progress. Fink. in the early phases of treatment. the presentation of conflict related to authority figures. the reality in question has to first be accepted in the psyche and later pushed out of consciousness. 1999). From a Lacanian perspective. such as supervisors.Katherine as a Lacanian Patient 159 and the tendency to have pleasure in fantasy as opposed to direct sexual contact (cf. and at several points early in the treatment were hypothesized as such in the mind of the therapist. where she reported "hearing" a young female friend purposely sending a group of men to her room. Katherine’s management of dream material. A good example. Katherine can be considered a "borderline. indicates the presence of the paternal metaphor as having instituted repression as a mark for castration. such auditory perceptions.

which is identified with the mother.160 Borderline Personality Disorder: A Lacanian Perspective The next question from a Lacanian perspective is what kind of neurosis does Katherine's represent? Since repression is verified in the eyes of the analyst through the return of the repressed. but to retain the power of being the source of desire itself. but actually become the object of desire for her mother. it never appears in the form that was expected and thus. Katherine encounters the difficulties that define the precise nature of her neurosis. As we have seen in Chapter Three. according to Lacan. We have previously discussed the importance of the historical/familial network into which the child is born. her mother's absences and unavailability made her mother a sort of "enigma" and therefore an object of great interest. the search for "the object" is always unsatisfactory. for Lacan the issue of separation forces the child to experience the loss of the intense satisfaction characteristic of the infant-mother relationship. The child is confronted with the loss of the object of satisfaction. A space of being is thus guaranteed for her. Katherine now . In hysteria. When we encounter what we call satisfaction in an object. The hysteric's loss will be interpreted as the mother's loss. and we must here again raise this issue in order to arrive at an understanding of the fundamental fantasy of the subject. In actuality such a totally satisfying object never really existed. The peculiarities of Katherine's early family life. What does Katherine know about her parents? Why did they have her? What did she represent for them and at the same time. then the manifestations of such a return must take a particular form. Moreover. when the child is confronted with the initial loss he/she refuses to passively accept it. it always carries some form of disillusionment. As a result of divorce and a new life change. not only to ensure that she is not the loser. what is her significance in comparison to her brother? It is in the vicissitudes of the separation with her mother that. It appears that at the time Katherine was growing up. However. The mother's need for the daughter (who retains a grasp on the father's desire) leads to a reinforcement of Katherine's hysteric solution. Katherine's mother's depression also increased. this yielded the perfect scenario for Katherine to believe that she cannot only be there for. this separation from the object is what creates hysteric desire: "she will be the object" that the mother has missed. and thus the specific and complex nature of her oedipal triangle laid down conditions that were particularly conducive to the development of a hysterical neurosis. which is why. as there was another woman in her father's life. He or she will try to compensate for it in some fashion.

. as an alienated human subject. Thus in attempting to be the "phallus" for the mother. The father does not want the mother. as was repeatedly evident. however. In exploring the events surrounding the divorce. In effect Katherine's neurotic solution to her oedipal loss was to believe. It is no wonder that her own desire is so hard to fathom in treatment. carrying letters for him in which she would ask him to reconsider their marriage. in Lacanian terms. and. never showed much genuine affection for Katherine herself. This. Katherine described how at the time. and Katherine thus becomes a pawn in the vicissitudes of her parents’ desires. and that her mother would beg Katherine to go back to the city where her father lived. Katherine was doomed to play the part of one who is never genuinely desired but is rather "seen through" as a vehicle to the desire of another. but wants Katherine. to find out about her father. she was extremely concerned for her mother. It is buried under layer upon layer of the others' desire that defines her. that she is the object of the mother's desire. on some level. as the mother actually only desired the father through Katherine. was a particularly pernicious belief.Katherine as a Lacanian Patient 161 becomes necessary to the mother as a negotiating chip in the mother's effort to reclaim the father's interest.

even as it might be applied to the limited case in question. My analysis of the Katherine case is not an empirical demonstration. . and consider the possibility that certain aspects of Lacanian theory can be formulated as testable. Rather. the case of Katherine has been utilized as a vehicle for presenting two quite different approaches to diagnosis and treatment of an individual who presents with severe pathology. and who might be regarded as meeting criteria for a Borderline Personality Disorder. and (2) stimulating dialog on the issue of the borderline between those in the Kernbergian and Lacanian camps. My goal in the previous two chapters was the modest one of attempting to show that a patient who meets DSM-IV. nor is it a refutation of the Borderline diagnosis. The value of the exercise I have undertaken in the two previous chapters is far more hypothetical and theoretical than it is empirical or probative. without resorting to the introduction of the borderline category. empirical hypotheses. as well as Kernbergian (“presumptive” and “structural”) borderline criteria. but the more modest goal of providing an initial critique of Kernberg’s borderline concept from a Lacanian point of view. formulate aspects of a dialog on the question of the borderline. and it has been undertaken with the simple goals of (1) familiarizing American psychologists with the Lacanian perspective on diagnosis and treatment. In critiquing Kernberg’s concepts my goal is certainly not that of disproving his theory or eliminating his diagnosis. can be conceptualized and treated from a Lacanian point of view.Borderline Personality Disorder: A Lacanian Perspective Chapter Seven Lacan and the Borderline Conditions I n this Chapter I will discuss a number of broad theoretical issues that inform or underlie the Kernbergian and Lacanian approaches to “Katherine” that were described in Chapters Five and Six.

be conceptualized as hysterics in either classical Freudian or Lacanian terms. So we might reasonably expect that a certain percentage of descriptive or Kernbergian borderlines would end up. language. . of the borderline diagnosis. it was perhaps only an accident that our “borderline” (i. A Lacanian diagnosis and therapy of another so-called borderline might very well reveal the presence of another type of neurosis. that all of Kernberg’s “borderlines” are hysterics. from a Lacanian point of view. neurotic. more specifically hysterical neurosis. Before proceeding. It is thus worth considering the hypothesis that many individuals who exhibit “borderline” features might also. it will become clear in this closing chapter that a Lacanian perspective on borderline personality can lead to a questioning. these structures are in no way defined by symptoms. as a case of neurosis. the borderline concept was originally introduced in regard to cases that were difficult to diagnose from either a descriptive or psychoanalytic perspective. who is on the border (Lacan. it is my view that the rise of the borderline diagnosis shows an interesting correspondence to the decline of interest in “hysteria” amongst psychiatrists and specifically. Thus. As Di Ciaccia (1999) points out. As I will discuss momentarily. This does not. and not the patient. 1954). We must keep in mind that for Lacan. Katherine) turned out to be a neurotic hysteric. and the law).e. or a proper Lacanian view. The case of “Katherine” was analyzed herein from a Lacanian perspective.Lacan and the Borderline Conditions 163 This being said. mean that it is my view. or even by the nature of the patient’s ego and defenses. American psychoanalysts. ways in which the individual positions him or herself in relation to the other. however. and the Symbolic Order (the paternal metaphor. or perverse structure. but rather represent different. however. his/her own and the other’s desire. having a psychotic. mutually exclusive. if not a deconstruction. or a psychosis or perversion. or better. Indeed. it is important to clear up one potential source of confusion. such an assertion would be very far from Lacan’s own suggestion that in the case of the so-called “borderline” it is the analyst.

Amongst these insights are that nearly all of human behavior is comprehensible as a function of unconscious conflicts. and then by briefly examining certain aspects of Lacanian theory through what French analysts will surely seem to be a very foreign lens: the lens of empirical. Here I will only be able to map out the territory for further dialogue. first presenting the fundamental elements of a Lacanian critique of the borderline concept." .164 Borderline Personality Disorder: A Lacanian Perspective Elements of a Lacanian Critique of the Borderline Concept The task of bringing together the theories and practices of two giants of psychoanalysis such as Kernberg and Lacan is a difficult one. As we have seen in our discussion of Lacan’s critique of American ego psychology. 1999)." "inadequate. In formulating an ego-psychoanalytic theory of the borderline that accounts for this disorder in terms of "incomplete. Kernberg and others have imported descriptive psychiatric categories into the unconscious and discarded the essential psychoanalytic insight that symptoms are a symbolic manifestation of unconscious motives. and that therefore nearly all human behavior is interpretable in terms of the mostly unconscious intentions and motivations of an actor or subject who is defined by a cultural/linguistic web of meaning and significance. each theory is highly sophisticated and complex. The Merger of Psychiatry and Psychoanalysis From a Lacanian perspective. even experimental psychology. beginning with Hartmann and continuing through Kernberg have downplayed the significance of Freud’s initial insights regarding the unconscious. that they are the expression of a "wish. and each is based upon certain fundamental metapsychological and even philosophical assumptions that create an immense divide between American and French psychoanalytic thought.” “defenses” and “adaptations” of the ego." "primitive. the ego-psychologists. As I have attempted to show in earlier chapters." or "broken" structures. the problem of the “borderline” can be understood as resulting from an American psychoanalytic tendency to merge descriptive psychiatry and psychoanalysis (Di Ciaccia. by focusing on the various “functions.

held that there were certain symptom pictures that lay outside the frame of unconscious meaning and conflict. he or she may take on aspects of a neurotic structure. a shift toward primary process thinking. On the Kernbergian view. in his distinction between the “actual” and “psycho” –neuroses—(Freud. Defenders of Kernberg can point out that that even Freud himself (e.Lacan and the Borderline Conditions 165 Kernberg’s " borderline structures" are. a lack of impulse control. Symbolic and the Real. a maladaptive mechanism whose failure at adaptation is the result of various deficits in cognitive. and affective regulation. identity diffusion. rather than a desiring human subject in need of insight and understanding. From a Lacanian point of view the important question to be asked about identity is not whether it is diffused. Kernberg runs the risk of treating the borderline as a mechanism. on a Lacanian view. of ego weaknesses.g. A Lacanian critique is especially applicable to Kernberg's use of such "higher order" symptom complexes such as "identity diffusion" as structural criteria for a borderline diagnosis. etc. . more specifically. lack of developed sublimatory channels. from a Lacanian perspective. and at the levels of the Imaginary. Rather. Kernberg’s theory is not. motivations. poor anxiety tolerance. precisely because his or her psychic apparatus has not developed to the point where it is beneficial to make genetic interpretations (Kernberg. 1984). and thus become the subject of more traditional (interpretive) psychoanalytic techniques. 1895). perceptual. The Critique of the Role of the Symptom Lacanians are critical of the use of symptoms and symptom complexes in diagnosis.g. a proper psychoanalytic structural theory. As the borderline patient improves. intact reality testing. actually relatively abstract descriptions (e. the presence of specific defensive operations.) that remain largely at the same level of analysis as his presumptive (and the DSM-IV) criteria. one that would account for the existence of certain symptoms and behaviors by appealing to an individual’s unconscious intentions. and goals. but rather precisely how it manifests itself in contradictory ways at conscious and unconscious levels. the borderline is not analyzable as a neurotic.

1999). Within the Lacanian framework of diagnosis. takes a symptom or a manifestation of an ego structure (e. the person identifies himself exclusively as a man. For Freud and Lacan a symptom represents a substitution. identity diffusion) and makes a diagnosis without any reference to subjective meaning.166 Borderline Personality Disorder: A Lacanian Perspective For Kernberg. while in another subject. on the other hand. for Kernberg’s criterion of identity diffusion. Thus. as was illustrated most forcefully in the case of the Wolfman (Freud. a symptom that appears to be atypical within the general picture of one individual may belong to the imaginary order. at an imaginary level (at the level of the fantasy of the person about himself. a problem emerged for him when the symptom was atypical. For a Lacanian. the whole idea of identity is difficult to pinpoint and must be elucidated in the particularities of each subject’s analysis. This substitution is not a directly observable fact.g. American analysts have become seduced by defenses. in many cases. the issue of Katherine’s so-called identity diffusion amounts to a question of “what does it mean to be a woman?” While this question can be answered in an indefinite number of ways. 1918) (where obsessive and psychotic symptoms were present but the patient functioned well socially). levels of object-relations and adaptive mechanisms. whereas at the symbolic level of everyday life. For Lacan. This is how hysterical and obsessional symptoms can co-exist in the same individual. the Lacanian "ego") a man can have a feminine identification. While Freud originally held that a typical symptom was necessary for diagnosis. even failed to consider the unconscious. the subject of the unconscious takes one position and the self another one opposite to it. and have. This complex view “of who we are” has clear implications for the construct of identity and further. Kernberg. diagnosis does not begin with the identification of symptoms but rather from an understanding of typological organization (Di Ciacca. it is important for the analyst to ascertain what the unique answer is for Katherine. and how an interpretive perspective can be . i.e. but must be pursued at the level of meaning. For this reason. the same symptom is better analyzed as part of the symbolic order. The Treatment of “Borderlines” Lacanian analysts hold that since the advent of ego-psychology.

It is noteworthy that clinicians in general and psychoanalysts in particular share intense countertransferential feelings towards these “difficult patients. Psychoanalysis. that he discarded. Within this model. certain ethical questions arise: Who is to say what is adaptive or not? Who is a healthy individual and who is mentally ill? The importance of such an ethical context and the whole question of "adaptation vs.. essentially becomes an adaptive model of human behavior. Amongst such countertransference feelings are a sense of responsibility for the patient (experienced as a burden). the assumption of one’s own desire" provide the basis for a further Lacanian critique of the American perspective on the borderline. Kernberg and other American theorists argue that the therapeutic task with borderline patients is one of supporting. The Role of the Ego and the Ethics of Psychotherapy It is an implicit and at times explicit view amongst ego-psychologists that once Freud developed the structural model of the mind. including its various . As detailed in Chapter Three. feeling intruded upon. the ego. shoring up. and at times being devalued as a professional. further. the question of having contracts drawn with these patients in which they agree to “not kill themselves” or “go to the next emergency room”. at times. from a purely structural point of view. or at least downplayed the significance of the topographical model of unconscious. the issue of avoiding dream analysis and. one in which the ego is understood as forging an adaptive compromise between its drives (id) and the demands of society (superego). eventually. The question of face to face treatment versus the couch. In working with Katherine. I myself was impressed by the degree to which an interpretive psychoanalytic perspective was indeed applicable to her case. etc. the subject is lost. etc. for Lacan. and. may not be properly thought through.Lacan and the Borderline Conditions 167 brought to bear on many severely disturbed patients. preconscious and conscious. Lacan argues that by working only at the level of the Freudian structural model. may only reflect our deep countertransferential feelings towards these patients.” These attitudes reflect the aggressive and chaotic fantasies that patients have (in general) and leads the clinician to make recommendations that. building the patient's ego.

While Kernberg does not directly state that identification with the analyst is central to the therapy of borderline disorders. in Lacan’s theory. which the patient can incorporate through identification with the analyst. it would seem. of the other. reality testing and adaptation is an illusion that obscures the genuine psychoanalytic subject.and self-psychology are. are necessary for the development of and fulfillment of the self. some. according to Lacan. By centering their theory of severe pathology within the vicissitudes of ego-functioning the borderline theorists participate in and perpetuate the basic deception that.168 Borderline Personality Disorder: A Lacanian Perspective functions of defense. the analyst cannot serve as a model for the patient. To the extent to which borderline or other patients internalize the analyst’s ego characteristics. is a self-deceptive and alienating product of the mirror stage. a product of illusory identifications with. is at the core of psychopathology. Advocates of ego. for Lacan. Further. However. The question nevertheless remains. In discussing the case of Katherine. open to retort that not all identifications are as self-alienating as Lacanians would suggest. as to whether the psychotherapeutic process with borderlines and others should primarily be one that strips away identifications or creates new ones . and is responsible for the subject’s alienation from his own desire. and the objectifying gaze. The ego. from an ethical perspective. the use of ego-building techniques in the treatment of so-called borderline patients runs the risk of promoting an adaptation to the desire of the other which suppresses the subjectivity and freedom of the patient him or herself. It would also seem that the analyst/therapist cannot help but be an identificatory object for the patient. according to Lacan. we saw that even for Lacan there is a period of education/identification that must take place in order for an individual to become a psychoanalytic patient. as the patient must learn to identify and ultimately assume the analyst’s curiosity about himself. 1974). of course. and a modeling of a presumably more rational approach to one's relationships and conflicts. It is. the practical work with borderlines often amounts to an interpretation of their primitive defenses without genetic interpretation (Kernberg. such a patient becomes further enmeshed in the desire of the other and further from their own subjectivity.

their interpersonal conflicts. Further. focus on such pre-oedipal issues as separation/individuation prevents the Kernbergian analyst from gaining a full understanding of patients’ relationships to others. The goal of analysis becomes the working through of these various obscuring identifications so that the analysand can develop as a subject conscious of her own desire. to such an extent that (at the start of analysis) what the patient generally feels as her own desire. that are constitutive of adult (as opposed to infant) functioning. In this way Lacan’s theory adapts certain notions that are compatible with a family systems perspective on pathology and places them within a psychoanalytic and existential context. as was pointed out in Chapter 6. meanings and significance should make Lacan of interest to family therapists. is inevitably someone else’s desire that she has adopted through unconscious identifications. etc. it is clear that one could understand this patient’s pathology in terms of the pre-oedipal or narcissistic issues that resulted from her .Lacan and the Borderline Conditions Lacan and Family Therapy 169 Here I would like to point out that Lacan’s emphasis that the individual pathology can also be understood as an expression of inter-generational conflicts. Lacan shows a similar interest in the manner in which the patient’s parents. With regard to Katherine’s case. enter into and condition the individual’s psyche. Such theorists typically hold that the “deep structure” of an individual’s symptoms and pathology cannot be traced to the individual’s psychology alone. or wider interpersonal system. American analysts have again moved away from the intrapsychic conflict model and the theory of the unconscious that were the core theoretical constructs of Freudian psychoanalysis. those working outside of as well as within a psychoanalytic framework. One of these is that by emphasizing “pre-oedipal” developmental issues in their theory of the borderline. and relationship to their own and others’ desires. but is rather a function of events that have transpired within a family. grandparents. Oedipal Controversy Several other Lacanian notions that I will consider here in brief relate to the general critique of American ego-psychology. The Pre-oedipal vs.

However. on the one hand. the distinction between oedipal and pre-oedipal issues is itself an illusion.170 Borderline Personality Disorder: A Lacanian Perspective mother’s failure to fulfill her maternal function. . universal) rather than accidental (occurring in some cases and not in others). The belief that one can focus on “pre-verbal” issues fails to recognize the allpervasiveness of language in the development of human subjectivity and the re-structuring of former psychic formations once language is acquired. since. The focus on attachment and so-called pre-verbal developmental issues in the theory of the borderline raises the question of the role of language and speech in the constitution of human subjectivity. he focuses mainly on objects (self and object representation rather than drives) while on the other hand he places a strong emphasis on the defensive structure of the ego. Before we have uttered our first word we are embedded in a maze of other’s meanings. immersed in and annihilated by language—a language that pre-exists the individual subject. superimposed upon this early “narcissistic” issue was the role that Katherine was forced to play in the triangle between herself.e. We are. The Critique of Objects Relations Theory Kernberg can be described as a theorist that blurs the distinctions between object relations and ego psychology. her father and her mother. A further criticism of Kernberg’s reliance on object relations theory (see below) relates to its shift of emphasis from oedipal issues to the mother-child interaction. as became clear later in the treatment. For Lacan all human subjectivity is constituted. Lacan views the subjects’ alienation in the Other as structural (i. born into a web of language and symbolic meanings that have existed for generations—it is not only when we learn to speak that we become conditioned by culture and language. and the way in which her experience of this triangle produced a new re-interpretation of her early childhood experiences. and the ensuing deficits in Katherine’s identity and object-relations. while disregarding the important factor of triangularization and the effect of the father. according to Lacan. as on Lacan’s view. the human infant is born into a world in which he or she already has significance in the wider family and culture. For Lacan. its autonomous functions and the concept of adaptation. conflicts and desires.

there are radical differences. it is not just borderlines who suffer from a division of the self. 1959). a universal human condition. the “object” of object relations theory is not the symbolized. It may well be that what is projected on to the borderline is. position that is dangerous in the field of psychoanalysis. Lacan follows Freud in holding that the human subject is essentially divided and unintegrated. Lacan’s polemic with object-relations theory has enormous consequences with respect to treatment. The broken. However. even moralistic. divided nature of human experience may be easier to contend with it is confined to a particular group of impaired individuals. The same can also be said with respect to the ego psychologist’s concept of “reality testing” which comes dangerously close to legislating for patients what they should experience and believe. and his needs and their satisfactions are channeled through the language of his family/culture. According to Lacan. For example. and community. Borderline Structure as Part of the Human Condition As we have already remarked in passing. even before the child himself begins to speak he is caught in the symbolic/linguistic web of his parents. the designations of "good object" and "bad object" involves an ethical. in fact. the notions that borderlines suffer from broken structures and an unintegrated self suggests that others are not broken and that their selves are integrated. such a division is the inevitable result of our immersion in a language and problem of identification with the other. psychoanalytic object." For Lacanians. 1953). For Lacan. for example. when analysts expect their patients to achieve "mature object relations" or "genital aims. for Lacan. without reference to any symbolic function. his bodily . there is no possibility of complete satisfaction between subject and object (Lacan.Lacan and the Borderline Conditions 171 While there are certain similarities between Kernberg and Lacan's approach to intersubjectivity. For Lacan reality is a construct. In Lacanian terms. a further critique of the borderline concept is that the particular difficulties that presumably characterize the borderline personality are endemic to the human condition as a whole. family. As we have seen. but also in their conception of the nature of the object and its relation to desire. not only with respect to their understanding of the ego. based upon the pleasure of the subject (Lacan. but rather the object of biology. as the infant develops.

have attempted to . The subject of the analytic inquiry is thus split. that we own our words. an idea that has important implications when compared with the holistic view of a bio-psycho-social integration portrayed by much of what goes under the name of personality theory (Harari. a belief that can be expressed as “I first think. Another of the effects of the mirror stage is the illusion of autonomy. and several borderline theorists. Indeed. then I select my words and finally I enunciate them. Thus an indefinite number of gradations of pathology are possible between neuroses and psychoses. However. Meissner (1978). in its study the acquisition of language as if it is one of the ego’s “cognitive functions. divided. 1986). whereby the ego hides its imaginary identifications and presents them as its own choices. according to Lacan. Any adult who is questioned about himself will insist that he knows that he is free. predicated on the ego-psychological (and common) illusion that there is a normal state of "wholeness" and "unity. as a distance is set up between need and its satisfaction. the ego-psychological construct of the borderline rests on the view that there is a continuum of psychopathology. For Lacan the subject is inscribed in a language that is hardly of his own choosing. on the other hand. taken away from the body. broken and divided is according to. is a function of our taking our “specular image” for the real subject. we also believe we know what we are saying. this view of the self is a narcissistic illusion. etc. Lacan’s way of thinking.” What was once pleasure becomes anxiety.. knows what he wants and he has to do. because he is his own person.172 Borderline Personality Disorder: A Lacanian Perspective feelings are gradually linguisticized. Moreover. The Continuum of Diagnosis A further criticism of the borderline construct stems from the notion that it appears to open the door to an indefinite number of new diagnoses. e. The idea that only "borderlines" are split." The belief in an integrated self. and the body is thereby “emptied out. The borderline is said to share certain ego strengths with the neurotic and certain ego weaknesses with the psychotic. rather than the other way around.” Psychology typically adheres to this view.” Lacan.g. believes that the subject is an effect of language.

limiting the subject to just one of three possible “illusory” life-strategies. For Lacan there is no continuum between the three basic structures.” The theorist who rails against any attempt to rob the subject of his freedom and to define the patient in mechanistic terms. psychotic and perverse. Lacan’s view is that once one has completed analysis one can. For Lacan. shed the identifications that obscure one’s own desire (Lacan. The continuum view actually undermines the very idea of structures. even hallucinations and delusions can each be present in the context of each of the three basic psychopathological structures. On the other hand. neurosis and perversion in Chapter Three—and several sub-strategies that define the various types of neuroses. For Lacan. according to both Kernberg and Lacan one cannot diagnose psychopathology on the basis of symptoms and behavior. Dissociative Identity Disorder. language. Here Lacan’s “existentialism” seems to come into sharp conflict with his “structuralism. Any symptom. a fundamental tension between the potential for liberation afforded by psychoanalysis and his structural analysis of the human personality. it may well be that it is precisely this tension between fixed structures and freedom that generates Lacan’s “dialectical” appeal. Here I would point out that hysterics and individuals who suffer from severe dissociative disorders (e. Whoever is neurotic cannot become psychotic or perverse. this is because most symptoms and behaviors can occur in the context of any of Lacan’s three basic structures: neurotic.Lacan and the Borderline Conditions 173 enumerate a number of them. holds a structural theory of the human psyche that appears to do just that. obsessions. poor impulse control. The Rise of the Borderline Diagnosis and the Decline of Interest in Hysteria and Perversion As we have seen. Possession states) can present with auditory hallucinations and delusions without having a psychotic structure in either . Indeed. Lacan himself can be criticized for holding an overly rigid view of the strategies that can potentially shape the human subject’s relationship to the other. there are only three major strategies—those described in our discussion of psychosis. phobias. 1981). but there remains within his thinking.g. culture and desire. to a certain extent.

those who have interests in the character pathologies. as Michele Tort has pointed out. A further thought. except as it is narrowly defined as a sexual deviation or paraphilia. Followers of Kernberg would typically classify such individuals as borderlines. and anti-social personality disorders. the question of patients who have psychotic symptoms but not psychotic structures is one that has emerged into prominence in recent years. and overly-entitled . particularly in America has all but disappeared. unempathic. for Lacan “perverse structure” is a position of the subject in relation to others rather than a sexual deviation per se. From a Lacanian perspective. “Anna O.” disavowal of the father and all the themes related to him: the law. fugues and other dissociative disorders that have recently become so common in certain psychotherapeutic circles. whereas Lacanians might give prime consideration to a possible diagnosis of neurosis. would be well to consider whether the dynamics of some of these patients can be accounted for in terms of the “perverse strategy” Recall that for Lacan. a woman who later emerged as one of the founders of social work and the women’s movement in Germany. also suggested by Tort (1999) is that as with hysteria there has been a progressive decline in interest in “perversion” within psychoanalytic circles. Perversion is a refusal to relinquish the pleasure associated with one’s (preoedipal) jouissance and thus a refusal to form an identification with the father and the law. possession states. in perversion. but. borderline. e. One can easily forget how “psychotic” Freud’s and Breuer hysterics were. one might question how a Lacanian would understand the various multiple personalities.174 Borderline Personality Disorder: A Lacanian Perspective Kernbergian or Lacanian terms. and may possibly be understood as a “reframe” of the hysterical patient. For Lacan the negating mechanism at work in perversion is “disavowal. Clearly. but who does not suffer from a formal thought disorder or broad and chronic disruptions in reality testing. whereas in psychosis there is an absence of the law.g. As we have seen.” who was later revealed to be Bertha Pappenheim. narcissistic. and in the neurosis a reinstatement of the law in fantasy. interest in hysteria. Such “hysterical” individuals were the common psychoanalytic patients around the turn of the century. the father’s name and the father’s desire. In this regard. new insight can be gained into the anti-social. Tort (1999) suggests that the appearance of the borderline diagnosis coincided with a decline of interest in hysteria. the subject struggles to bring the law into existence. suffered from all sorts of delusional and hallucinatory experiences (Freud and Breuer. Perhaps. 1895). who has certain symptoms that appear to be psychotic.

Lacan and the Borderline Conditions 175 presentation of many so-called borderline and other personality disordered patients by reconsidering them in the context of Lacan’s “perverse structure. (Here studies could be conducted regarding the language of psychotics. Amongst the Lacanian propositions that are most readily reframed as empirical hypotheses are: • Lacan's assertion of the critical significance of both the actual and symbolic father in the genesis and structure of psychopathology. a number of Lacan’s contributions can be reframed as empirical hypotheses that may be subject to clinical. a significant group of Lacan's claims fall more properly in the realm of philosophy. or what might be termed the conceptual foundations of psychology and psychoanalysis. testing Lacan's proposition that the psychotic patient exhibits unpunctuated speech. and even experimental study. on the development of psychopathology).) . sociological. and might be referred to as meta-theoretical.” Empirical. structure and treatment of psychopathology. a subset of these are correctly termed by Lacan as ethical propositions. for example. (Here studies could be reviewed --and conducted-regarding the image and concept of the father held by children and adults with various disorders. field. Other Lacanian propositions fall in the realm between empirical science and philosophy. Finally. Such a lack of punctuation might even be operationalized and measured. While Lacanians themselves would be hesitant to move in this direction. Philosophical and Ethical Considerations If we are to truly make an effort to create a dialogue between American ego psychology and Lacanian psychoanalysis we will do well to consider a Lacan's major contributions to psychoanalytic theory and practice apart from the idiosyncratic and polemical context and language in which he presents them. • Lacan's emphasis on the role of language and its inherent connection with law and convention in the genesis. etc. or regarding the implications of the actual father's absence. aggression.

176 • Borderline Personality Disorder: A Lacanian Perspective Lacan's views on the specific genesis of desire from need and demand. • The assertion that social and cultural forces are the major if not exclusive determinants of individual motivation. studies might be reviewed and conducted regarding the impact of paternal absence and familial discord. (Here such fantasies might be assessed in a variety of ways. in particular. (Here qualitative studies could be conducted regarding what individuals . (Each of these criteria could potentially be operationalized and efforts to describe "presumptive" Lacanian criteria for psychosis could be worked out). are present in those motives that he initially regards as his own. and that individuals with specific structural pathology engage in distinct "fundamental fantasies" in their interpersonal relationships. inundation by their own libido. • Lacan's thesis that psychosis involves a failure of the paternal metaphor. projective and qualitative interview studies could be used as a means of operationalizing this concept). and that these determinants are unknown to the subject and. • Lacan's views on the emergence of the oedipal triangle in the establishment of language and law in the family and society. e.g. and the individual's processing of such absence and discord on the use of language and internalization of societal norms in children).g. including hallucinations coupled with problems in reality testing. their inability to construct complete sentences). specific language distortions (e. a failure of the psychotic to internalize the paternal restrictions on the child's relationship with a maternal object. • Lacan’s “criteria” for the diagnosis of psychosis. absence of selfquestioning and the failure of desire. (Again. his claim that the child desires to be an all fulfilling object (what he refers to as the “phallus”) for the mother. (“Desire is always desire of the other’). (Here again. via an analysis of the individual’s images and ideation during masturbation and sex). that is. feminization in males.

. we are entitled to hold that his theory should make some. While Lacanians might argue that restating Lacan’s theses in empirically testable terms distorts their meaning.e. like the ideas considered below. grandparents. Lacan makes certain untestable assumptions. These. and their sub-culture). While it is difficult to see how such ideas can be formulated in testable terms. that language is always reinterpretable in terms of subsequent contexts. it is also difficult to picture Lacanian theory without them. • His notion that psychological defenses are best conceptualized as linguistic structures dependent upon metaphor and metonymy (as Lacan defines these terms). Operationalizing and testing specific Lacanian hypotheses is beyond the purview of this study. conflict free agency. have a certain philosophical moment. but it is reasonable to suppose that as Americans become more familiar with Lacan’s work several of the hypotheses I have enumerated above. and are likely to be subject to more conceptual debate and discussion than empirical testing. and that such ideas can only be properly understood within the context of the psychoanalytic situation. As is the case with all theorists. i. and his critique of the possibility of the ego as a reality oriented. • Lacan’s theory that meaning is always “after the fact” (apres coup). at least potentially testable. Among Lacan's more conceptual contributions are: • Lacan’s conceptualization of the ego as essentially linked with an illusory narcissism. and that (developmentally) early events are always re-signified at later points in the individual’s life.Lacan and the Borderline Conditions 177 identify as their own motivations in comparison to the values and motives that appeared in parents. will be subject to empirical and even experimental scrutiny. as well as others. predictions.

in Kuhn's The Structure of Scientific Revolutions (Kuhn. for example. Nevertheless. that at least some of its propositions be put in testable form. and only transforms himself in the context of language. His views have more in common with post positivist philosophy of science. a number of other Lacanian contributions are more properly philosophical or ethical. as we demand of any other theory in psychology. which he sees as promoting identifications with the analyst and adaptation to society. at the expense of the freedom and creativity of the individual. and those which are meta-theoretical or philosophical in nature. This thesis is the foundation of what Lacan regards to be the ethics of psychoanalysis. 1996). where it is argued that there are no facts independent of theory. lives within. . as exemplified. Lacan's view that reality is constructed is at odds with the fundamental logical empiricist position that until recent years dominated AngloAmerican philosophy. Because many of the differences between Kernberg and Lacan are best understood as theoretical and philosophical in nature. no data independent of interpretation. we cannot expect empirical research to settle all the differences between them (any more than it has settled the philosophical differences between other major theories and paradigms in psychology). It is important to distinguish between those aspects of Lacan’s thought (and his implicit critique of the borderline concept) that can be subject to empirical test. we are entitled to demand of Lacanian psychoanalysis. resulting in a debate with American ego psychology. • Lacan's theory that the human subject is essentially constructed. Amongst these are: • Lacan's view that both the imagination and language are critical elements in the construction of reality. • Lacan's ethical charge that the work of psychotherapy is to permit the patient to forge himself as a creative subject rather than to adapt him or herself to reality.178 Borderline Personality Disorder: A Lacanian Perspective As I have indicated.

In this context. that the diagnosis of borderline personality in childhood actually represents a re-labeling of children who suffer from Post-traumatic Stress Disorder (Famularo. for example. If the child can accept the reality of self and others. Mahler describes different stages in the development of individuation. Mahler (1958) identified children with severely impaired object relations but who evidenced a less severe presentation than psychotics. As such. It is not until the child is approximately ten months of age that he will differentiate his psychic identity as separate from his mother’s. the infant is not able to differentiate between self and object representations and experiences his or her primary caretaker in a symbiotic mode. According to her. (a process that takes place from 12 to 36 months) and which involves internalizing soothing mechanisms and acquiring the capacity to achieve affective equilibrium as the child eventually achieves an awareness of his/her position with respect to others and the environment. Mahler supports her findings with observational studies on the separation individuation process. the controversy regarding the existence of this diagnostic entity takes on significance in a child-psychological setting. it is important to recall that studies of early child development have had a profound impact on the evolution of the borderline concept within psychoanalysis. The process of separation and independence is long. and is accompanied by intense anxiety. In this section I will briefly review some of the direct contributions by psychoanalytic developmental psychologists to the theory of borderline personality disorder in children along with the problems that this diagnosis poses when it is applied to children and adolescents. something that has been recognized by a number of practitioners (Gualtieri. he will achieve “object . Koriath and Van Bourgondien. 1996). They were conceptualized as a mild or an attenuated variant of psychosis. Some practitioners have suggested. The reason for this is that to call a child or adolescent "borderline" clearly has a disparaging connotation which can have a negative impact not only in the mind of the child's therapist. as the child understands that he has very little control over his caretakers and the satisfaction of his needs. but upon the child's teachers and others in the child’s world.Lacan and the Borderline Conditions The Borderline Diagnosis in Children and Adolescence 179 The questions that have been raised in this study regarding borderline pathology take on particular moment when this diagnosis is utilized in connection with children and adolescents.1991). Kinscherff and Fenton.

tendency to withdraw into fantasy. good and bad object. one would expect to find evidence of such failures in separation/individuation at various points in both childhood and adolescence. the child’s aggression threatens the good object and splitting occurs to keep the good and the bad as separate as possible. etc. In particular the issue of subject and object as it is understood in object relations theory must be adequately contrasted with Lacan’s use of these terms. This defense is the protection that is necessary to keep the bad introjects away from the ideal good object. If this is indeed the case. maternal and paternal representations. pervasive intense anxiety. However. perceiving and feeling that endure over time and any pattern that becomes rigid. phobias. lack of structure. uneven developmental patterns. somatic complaints and sleep disturbances) suggested that they were on the psychological path predicted by the developmental account of borderline personality disorder. They further describe the type of . Clarification of terms such as introjects. low frustration tolerance. She states that children have particular patterns of thinking. The etiology of borderline disorders is thought to be related to a derailment of the normal developmental process described above. frustration or an inability to live up to the expectations of others. James Masterson and Donald Rinsley (1975) are also in accord with the view that borderline psychopathology in children is due to a particular pathological mother-child interaction that affects the separation-individuation process. Paulina Kernberg (1982) contends that the borderline diagnosis in children under 12 is indeed valid. aggression. are necessary in order to further a consideration of the problem of the borderline in children. rituals. According to Paulina Kernberg. as borderline today will be the borderline adolescents and adults of the future. primitive responses to stress (“primary process response”). only careful long-term studies can clarify if the children diagnosed. Mahler defined object constancy as the capacity to maintain relationships and evoke the loving and comforting image of the loved person in spite of separation or frustration. The bad introjects are activated by separation. Paulina Kernberg is largely in accord with the developmental views of Mahler and goes further to describe a particular affect in the borderline child: excessive aggression. chronic and maladaptive or produces subjective distress warrants a personality disorder diagnosis.180 Borderline Personality Disorder: A Lacanian Perspective constancy”. and multiple neurotic symptoms (such as compulsions. Indeed the psychoanalytic literature soon began to provide a clinical description of children whose impulsivity.

therefore experiences a sense of emptiness that needs to be constantly mollified with transitional objects such as food or. foremost of which is that a personality disorder is universally understood to be a relatively enduring and pervasively maladaptive pattern of experiencing. later. This pattern becomes particularly acute in times of psychosocial change and identity crisis such as adolescence. When the parent fails to provide a caring environment the child internalizes a maternal object representation that does not provide soothing and comfort when separation and distress arises. (1999) cite sexual abuse and parental criminality as the major factors discriminating borderline from non-borderline children. Criticisms of the Borderline Concept in Children The question of a borderline personality in children is riddled with conceptual difficulties. a number of authors have suggested a close link between so-called borderline pathology in children and post-traumatic stress. G. she is characterized as one who finds gratification in her child’s dependency. For example..Lacan and the Borderline Conditions 181 mother of a borderline patient. Guzder. As indicated above. et. Adler (1986) follows the theory of Donald Winnicott in utilizing the notion of the “the holding environment” as a theoretical construct useful in explaining the genesis of borderline pathology in children. Such mothers are warm and loving when the child is helpless and in close proximity but punishing when the child strives towards independence. al (1992) showed that "borderline" children have a greater prevalence of physical and combined physical/sexual abuse. et. Such children (and adults) also become angry and manipulative in order to call the attention of others. They argue that the behavior of such mothers fosters a split in the mother representation in which gratification is associated with dependency and punishment associated with autonomy. The child. Children and adolescents are involved in a fluid developmental process in which their . relating and coping. al. Goldman. Johansen (1992) has suggested that abused children develop symptoms of borderline personality disorder because they are rejected repeatedly when entering into various situations that would normally produce caring. drugs. rewarding clinging behavior and sanctioning any move towards autonomy. leading them to suggest that borderline personality may be in part a function of such trauma.

conduct disorder. borderline personality. It is associated with hyperarousal and panic and makes these children more vulnerable in the case of parent unavailability. when borderline and non borderline children (ages 6-12) after admission to a psychiatric hospital. and ADHD. argues that there is no data to support the assumption that there is similarity between the . poor school performance) (Aquino. conduct and eating disorders. in his article “ A critical review of the concept of the borderline child”. Koriath.1998). Other studies have focused on a present vulnerability to separation anxiety that is present in these children from birth. and externalizing behaviors. For example. and in some instances the negative impact of the label was actually detrimental (Gualtieri. . Berg.1992).(Bemporad.g. indicated that disruptions in foster care placement and neglectful situations produce behaviors that resemble those of borderline children (impulsivity. one can ask whether it is even valid to ascertain a distinct personality disorder in childhood.182 Borderline Personality Disorder: A Lacanian Perspective personalities are in formation. 1982) Joseph Palombo (1982). Van Bourgondien. 1992) associates borderline children with impulse control problems and emphasize the role of learning problems and neuropsychological problems in the disruptive behavior of individuals diagnosed with s conduct disorder. which examined this problem from a qualitative point of view. None of these symptoms are useful in distinguishing the borderline from the conduct disordered versus the antisocial child or the sexually abused child (Wood. As such. Arents. Further. For example.1997). irritable affect. Other researchers (e. D. such as Attention Deficit Disorder. the following variables were identified: self-destructive behavior. Although there appears to exist some overlap of these conditions. Some studies have suggested that "borderline" behavior in children can be produced on a transient basis by stress. In another study it was noted that the borderline label was not helpful for treatment planning or disposition. As they grow these children feel helpless and angry. there are well-known difficulties inherent in any attempt to distinguish childhood borderlines from children diagnosed with several other disorders. some studies indicate children with these problems often grow to become borderline adults. anhedonia. The rage appears as self or other destructiveness and their dramatic behavior represent a protection against their perceived neglect from others which confirms the unconscious affirmation of their inner badness. were compared in an effort to discriminate specific borderline traits.. defiance to authority. a study.

hypochondria.Lacan and the Borderline Conditions 183 concept of borderline in adults. as we know it. In short. while others are going through a difficult time in their normal adolescent crisis. al (1997) to assert that clear guidelines for this ambiguous and controversial diagnosis in child psychiatry were nonexistent. multiple phobias. He criticizes the explanation that the borderline condition arises in childhood as a result of poor nurturance or improper parenting. that is: the presence of free-floating anxiety. On his view. . reflecting their compensation for self-doubts and identity crisis. sexual perversions. Klosinki (1980) believes that most young people diagnosed with borderline personality disorder are in fact in the early stages of schizophrenia. as many of these young men and women will have a much more favorable diagnosis or none at all by the time they become adults. this author holds that some of the symptoms displayed by these children may be found in the presence of minimal brain dysfunction or a severe learning disability. depression. compulsions. This has led Gualtieri. and the concept of the borderline child. dissociation. each of the behavioral characteristics of the so-called borderline personality is also typical of the normal adolescent. there is as much if not more controversy regarding the etiology and nature of borderline conditions in children and adolescence as there is with respect to adults. Rather. impulse control etc. He concludes that making the borderline diagnosis and associating it with biological and developmental problems such as ADHD can itself lead an adolescent to become more vulnerable to problems in self-esteem. (1980) in his paper “Diagnosis of borderline personality organization in adolescents” criticizes the term “borderline personality” as a diagnostic category for adolescents. which in turn creates a series of negative responses. He finally advises to avoid the use of this diagnosis in adolescence. Gunther Klosinki. Both groups of adolescents alternate between their identifications with idols and feeling completely impotent. et. and loss of impulse control. affecting his self-esteem and his regard within the family and at school.

some of which are intrinsic to “hermeneutic” theories in psychology as discussed before. Criticisms of the borderline concept in children on the basis that borderline symptoms are actually common to many if not most adolescents parallels the Lacanian view that the “broken structure” of the socalled borderline adult is actually part and parcel of the human condition. In the present context this indefinite regress of interpretability not only applies to the case that I have used for illustrative purposes. at age 25. Indeed. appeared to have many characteristics of an extended adolescence. if not more useful approach in the treatment of more enduring features of adolescent's psychodynamics. but also to . the case of "Katherine" illustrates a situation in which a young adult manifests with both presumptive and so-called structural criteria for this disorder. In the present study. are very likely to exhibit the markers of "borderline personality" in a way that may mask their neurotic (psychotic or perverse) Lacanian structures. because of the turmoil and chaos associated with this developmental period. Such a situation can be expected to occur frequently amongst adolescents who. adolescent and school psychologists may wish to consider this possibility prior to settling upon a borderline (or equivalent) diagnosis and to consider the possibility that diagnosis and treatment in accord with Lacan's notions of the fundamental fantasy. The nature of interpretation is such that it is always subject to re-interpretation. Limitations of Interpretive Theory The limitations of the current study flow from several factors. Child. and it may very well be that it was these characteristics that were being manifest when she appeared to meet borderline criteria. the major forms of negation. and the alienation of desire may be an equally. but who can profitably be understood and treated from a Lacanian perspective as a neurotic.184 Borderline Personality Disorder: A Lacanian Perspective The Present Study and the Borderline Concept in Children and Adolescence The present study has only indirect implications for the diagnosis of borderline personality in children and adolescents. The Lacanian critique provides one more vantage point from which to question the utility of this diagnosis in both adults and children. Katherine.

more than make up for its shortcomings. Her own limitations in her understanding of both Kernberg and Lacan. indeed the selection process has already begun in the consulting room. is. As such. Further limitations of studies of this kind are inherent in the fact that the author herself was a participant in the case which serves as its main illustration. but conflicting interpretations of his interpreters. again. and the theory of the . that data would itself be colored by the direction that the therapist chose to bring the treatment. A psychological theory that takes as its starting point the interpretive nature of the human condition has this much to recommend itself: it considers people as they actually are. We are continuously interpreting. in the form of videotapes of all the Katherine sessions. In the case of Lacan. on the view of this author. and treated. in Lacanian terms without recourse to the borderline concept. The presentation of a case study is by necessity “selective”. What a hermeneutic psychology loses in precision it gains in scope and depth. understanding. the possibility of anything like a definitive reading of either a case. or even a theory about a case. its main purpose is to generate dialog on the subject of the borderline from a Lacanian point of view. and is conditioned by the clinicians own interests. etc. and the broader psychiatric and psychoanalytic scene within which these theorists.Lacan and the Borderline Conditions 185 my understanding of the theories themselves and their relation to one another. but even here we cannot be definitive. as I have repeatedly emphasized.g. misinterpreting and misunderstanding each other. One does not have to be a Lacanian to recognize that human beings are themselves interpreting agents who live in a world that is constituted as much by values. prejudices. its strengths. etc. not only are their conflicting interpretations of Lacan. which has been presented. and (according to psychoanalytic theory) ourselves. The case study. on the very assumption of a hermeneutic theory impossible. rather than what an operationally driven science dictates they should be in order to measure them and pin them down. available to check this author’s hypotheses and assertions. and even if such data were available. With regard to this particular study. There is no “raw data” so to speak. meanings and significance as it is constituted by things. according o her theoretical prejudices. While the limitations in terms of verifiability and consensus of an interpretive theory of the human psyche are obvious. perhaps provides some prima facie evidence that a Kernbergian borderline can be diagnosed. and she conducted the treatment. e.

will be overcome by future participants in what promises to be an interesting and fruitful dialog between American psychoanalysts and the followers of Jacques Lacan. and to place them into the beginnings of a dialog. limitations that.186 Borderline Personality Disorder: A Lacanian Perspective borderline are imbedded are also potential sources of confusion. it is hoped. As this study attempts to articulate the Kernbergian and Lacanian theories in some detail. limited by the author’s own limitations in her understanding of the theories presented and discussed. of course. . the value of this study will be.

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115.. 136. 106.. 10. 121. 46. 136. 26 alcoholism. 14. 23. 9. 33. 43. 38. 187 Adler. 68. 9. 123.. 188 Bleuler. 37. 122. 38. 111. 187 Arents. 182 anxiety. 183 après coup. 11. M. 121 affective organization. 182. 61 Attention Deficit Disorder. 165. 12 affective instability. 1. 26 atemporality. 27. 7 American Psychiatric Association. 57. 101. S. 187 American psychoanalysts. 14. 6 Bonaparte. 73. E. 164. 17. 22. 78 anthropology. 69. 31. 121. 6. 122. 13. 33. 26. E. 67. 183 avoidant personality. xiii Balint. 10. 68. 9. 35. 100. 41. 182.. 178 addiction. 12. 125. 100 Bleiberg. 139. 121. 37. 124. 133. 128.. 168. 164. 5 adaptation. 29 Azevedo. 32. 9. 125. 184 ambulatory schizophrenia. 28 alienation. 135. 12. 37. 156 Akhtar. 57. 135. 79. 187 Berg. 137. 152 aggression. 109. M. 90. 4. 75 black humor. 28 Adler. 145. 11. 122. 183 . 34. 139. 177 Aquino. 22. 167 aggressivity. 11. 63. B. 68. 133 Abend. 6. 19. 175. 53. 105. 8. 19. 30. xi. 59. 174 anorexic. 88. 64. 90. 14 aggresivity. 48 borderline conditions. 21. 14. 180 aggressive. 44 antisocial. M. 170. 141. 9. 50. 123. 198 as-if. 167. 188 Beyond the Pleasure Principle. A. 182. D. 16.... 58. 182. S. 32. 21. 1. 170. 23 being-in-itself. 56. 137. 26. 187 academic psychology. 148. 179. 26. 124. 18. 137. M. 187 Benveniste. G. 35. 44. 28. 12. 138. 10. 182. 159. 18. 14.. 126. 152. J. 172. 117. 36. 182.. E. 5. 15. 104. 5. 157 Anna O. 131. 115. 72 Bemporad. 180. 99. 163. 12..Index abandonment... 33.. 186 anger. 138. 181 affective disorders.

95. 124. 14. 135 chimpanzee. 36. 45. 129. 71. J. 5 Di Ciaccia. 100. 77. 167 culture. 141. 102. 12. 179. 122 De Mijolla. 3. 41 Cartesian rationalists. 180. 90. 168. 87. 161. 26. 31. 114 Bourgondien. 157. 83. 152. 54. 37 Deutsch. 61. 174. 97. 27. 60. 181. 54. 94. 7 descriptive criteria. 102. 163. 11 core borderline. 80 Contradictions. 12. 178 dementia praecox. 11. 171. 169. 3. 104. 104. 134. 53. 13. 146. 120. 188 Dora. 183. 54. 163 defense. 151. 123. 100. 171. 5. 79. 155. 139. 26. 180 defense mechanism. 115. 78. 150. 12. 136. 183 dissociative. 10. 9. 99. 60. J. 45. xii... 78. 144 disavowal. 75. 26. 31. 28 Dor. 100. 121. 156. 152. 188 dialectic. 36. 167. 143. 23. 152. 57. 71. 13. 176. 82. 97. 78. 22. 33 developmental. H. 150. 85. 131. 5. xiii. 18. 41. 177 defensive mechanisms. 170. 107. 177 cure. 11. 169. 39. 21. 47. 28. 81. 69. 160.J. 33. 174 Dissociative Identity Disorder. 56 clarification. 34. 165 conversion. 89 character pathology. 118. 93 Borderline Personality Disorder. 131. 168 deterministic. 40.200 Borderline Personality Disorder: A Lacanian Perspective demand. 116. 173 dissociative disorders. 6 denial. 167. 103. 39. 94. 133. 79. 160. 6. 133 dependency. 32. 11. 97. 179. 157 cyclothymic. 13. 42. 96. 34. 57. 46.. 70. 163. 181 depression. 85. 26. 131 contradictory. 2. 184. 67. 85 didactic. 124. 164. 14 dereistic thinking.. 135. 63. 30. 13. 45 Casanova. 80. 58. 92. 97. 99. 53. 132. 31.. 74. 4. 2 . 173. 150. 157. 131. 29. 170. 58. 105. 113. 55. 40. 183 depressive position. 105. 130. 87 chain of signifiers. 133. 14. 104. 68. 149 dissociation. 158. 85. 110. 98 castrating. 41. 91. 156. 94. 64. 38. 163. 143. 96. 62. 16. 40 contradictions. 146. 142. 79. 56. 150 descriptive point of view. 105. 31. 98. 114. 138. 174 British empiricists. 52. 16. 59. 184. 171 Carr. 144. 18. 25. 40. 36. 146. 168. 164. 20. 14. 95. 39. 157. 78. 31. 166. 121. 104. 64. 142. 147. 100. 31 broken structures. 88. 18 Breuer. 62. 128. 176. 132. 83. 182 Bowlby. 103. 93. 100. 18. 118. 188 devaluation. 47 deconstruction. 104. 122 coping style. 174 dissatisfaction. 129. 33. 84. 97. 10. 37 Catell. 113. 173. 9 countertransference. 131. 122. 30. 27 desire. 9. 77. 14 defenses. 32. 136 Devaluation. 198 desire of the other. 195 developmental theory. 76. 58. 173 dissociative reactions. 39. 10. A. 18. 6 boredom. 64. 126 confrontation. 98. 11. 131 Dellis. 106. 101. 122. 76. 127. 125. 192 certainty. 45 British school. 162 borderline state. 1. 131. 111. 133.

171.. 171. viii.. 197. 167. 23. 122. x. 196 Girl Interrupted. 50. 57. 22. 53.. 41. 51. 31. R. 73. 181 Greenberg. 1 Feher Gurevich. 3. 35. 72 ecstasy of the body. 60. 103. 35. 150. 191 genetic. 11. 146. 15. 46 Fairbairn. 5. 29. 132 ego ideal. 13. 144. 34. 63. 169. 91. 71. 31. 96. 171. J. 191 dysthymia. 70. 86. 53. 138.. 33. 3. 76. 46 flooding. V. 16. 3. 54. 49.. 22 . 148. 154. 172 ego-psychology. 29. 136 good and bad. 89. 189 Fenton. 54.. 83. 78. 176 Harari.. 136 ego-fragmentation. 55 Heidegger. “da”. 70 empirical. 102. 9. E. 10.. 22. 168 genital. 83. 4. 198 Fromm. 165. 134. 183 guilt... 175. H. ix. 44. 19. 169 Elementary Structures of Kinship (LeviStrauss). 23. 103. 21. 23. 16. 192 Hegel. 50. 165. 42.. 73. 31. 165. 23. 27. 83. 64. 167. 159. 173. 23. 4. M. 46. vii. 47. 1. 147. 61. 177 gratification. 3. 66. 65. D. 58. 27. 4. 22. 33. 192 Hartmann. 180 good object. 41. 172. 22. 187 Ego. 18. 190 dreamwork. 158. 191 hallucinations. 21. 157 201 Formations of the Unconscious (Lacan Seminar). 32. 23. 46. G. 24. 21. 166. 87. 147. 25. J. W. 195. 191 Gabbard. 45. B. 48. 168 Famularo. 164. 188 existential. 150. 164.. 62 free association. 25. 88. 138. 83. 70. 182 Ecrits. 197. 30. 153. 148. 194. 167. 198 Frankl. 42. 86. 88. 21 Fink. 6. 114. 146. 12. 15. R. 4. 69. 188. J. 37. 191 Grinker. 166. 56. xi. 198 Freudian. 48. 46. 10. 35. 86. S. vii. 190.. 37. 191. 15. 155. 38. 54. 21 Frosch. 3. 36. 127. 54. M. 26. 8. 47. 38. 188 family Therapy. 75. 164. 167. 82. 14. 75. 178. 189 Ferenczi. 189. 91. 153 ego-psychological. 32. 178 emptiness. 44. xi. 188. 68. 26. 76. 49. 47 Freud. 25. A. 145. 163. 114. 60. 181 erogenous zones. 177. 179. 35. 45 Ey. 33. J. G. 74. 175. 100. vii. 55. 26.Index dreams. 162... 88. 42... 2. 170 DSM. 12. 90. W. 63 France. 1. 92. 22. 181. 56. 55. 66 "fort”. 102. 99. 7. 169 existentialism. 4. 136. 192 Gualtieri. H. 36. 196 empirical research. S. x. 124. 65.. 31. 149. 1 Goldman. 37. 162. 193 Fliess. 67. 41. 44. 188. 9. 146. 92. 84. 36. 4. 58. 41. 189 Fatal Attraction. 48 Freud. 33. 119 French psychoanalysts. 123. 44.. 191 Goldstein. 53. 83 eating disorders.. 45. 64. viii. 24. 144. 80. 44. 192 ego functions. 121. 89 ethical. 5. 182. 35. 132. 42. 19 foreclosure. 86. 57.. 61. R.. 14. 53 drives.. T. 73. 34.. 45. S. 180 grandparents. 74. 71. 189. 158. 55. 2. 22. 122. 86. 179. 29. 102. 23. 108. 7. ix. 89. 155 Gunderson. 66. 174. xi. 21. 88. 32. 24. 173 experimental science. 131.. 171 Gill. 167. 169. 22. E. 178 Evans. 26. 179. 29. 45. 82. 159. 93. 47 Hegelian. 14. 45. 90. 89 Efrain.

159. 42. 180. 130. 33. 23. 12. 37. 117. 169. 184 heterogeneity. 48. 24. 66. 82 intersubjectivity. 152. 181. 75. 145. 27. 34. 30. 37. 38. 165. 31. 135. 46. 124. 149. 160. xi. 81. 26. 45. J. 54 Jones. 154. 29. 173 Id. 45 Kaplan. xii. 125. 130. 88. 143. 154. 41. 47 hysteria. 85. 11. 97. 133. 57. 121. 35. 128. 142. 107. 156. 40. 118. 53.202 Borderline Personality Disorder: A Lacanian Perspective instinct. 59. 140. 90 imaginary phallus. 58. 31. 158 imaginary. 10. 89. viii. 13. 24. 58. 56. 104 impulsivity. R. 58. 63. 93. 127. 92. 40. 31. 129. 169 introjection. 14. 31. 145. I. 131. 168. 168. 158.. 68. 166. 39. ix. 160. 163. 26. 176 interpretation. 97. 48 jouissance. 14. 10. 28 hypomanic. 136. 22. 76. 26. 172. 174. 192 Katherine. 136. 66. 22 hyperarousal. 182 infant. 141. 8. 108. 93. 95. 123. 20. 140. 21. 30. 126. 88. 68 heterosexuality. 167. 128. 50. 34. 132. 33. 136. 12. 14. 38. 72. 53. 68. 14. 130. 174. 163. 64. 94. 94.. 161. 67. 39. 185 Husserl. 127. 127. 91. 33. 148. 140-162 Kernberg. 162. 111. 135. 66. 96. 7. 198 imaginary father. 120. 139. 144. 192 jokes. 150. 26. 93. 40 interpersonal relationships. 155. 36. xii. 179 . 24. 157. 122. 155 intrapsychic. 147. 102. 121. 153. 39. 75. 67. 150. 97. 45. 45 Kant. 71. 44. 151. 133. 10. 156. 155. 144. 57. x. 136. 121. 76. 152. 33. 43. E. 96. 86. 109. 170 interviews. 81. 95. 79. 89. 37 Hoch. 131. 9. 31. 13. 139. 129. 166 Identity disturbance. 4. 65. 3. 5. 127. 112. 103. vii. 10. 128. 183 hypocondriacal. 131. 98 Horney. 87. 35. 122. 139. 76 integration. 130.. 25. 169. 130. 15. 107. 94. 65. 125. 158. 104. 71. 56. 153. 143. 113. 134. 107-120. 138. 33. 139. 41. 108. 132. 21 human condition. 116. 40.. 80. 36. 85. 125. 38. 190 idealization. 185 Katherine. 165. 148. 32. 106 judgment. 174. 142. 149. 27. 136. 99. 137. 9. 94. 99. 91. 172 International Congress of Psychoanalysis. 81. 183 identity. 124. 90. hermeneutic. 139 identification. 76. 121 imaginarized. 112.. 124. 21. 182 hypochondriasis. 12. 178. 43. 192 Johansen. 137.. 108. 108. R. 55 interpersonal functioning. 184. 123. 179. 34. K. 115. 171. 25. 122. 121. O. 31. 14. 36. 95. 28. 15. 96. 143. 189 Jouissance. vii. 128. 62. 11. 138. 66. 19. 120. 8. 114. 183 identity diffusion. 129. 127. 160. 69. H. 87. 137 introjects. 55. 121. 128. 169. 73. 57.. 103. 131. 154. 20. 17. 184. 138.. 32. C. 129. 18. 148 Jung. case of. 135. 18. 17. 171. 22. 180 Jakobson. 90. 166. 86. 156. 192 homogeneity. 110. 122 Hyppolite. 88. 152. 163. 68 homosexuality. 15. 25. 131. 95. 130. 123. 142. 153. 26. 169. 126. 39. 12. 96. 134. 123. viii. 92. 30. 75. 34. 64. ix. 119. ix. 128. 45 International Psychoanalytic Association. 28. 130. 171. 39. 159. 106. 90.. 129. 102. 181. 172. P. 28. 124. 166.. 149. 158. 22. 198 hysterics. 67. 34. 157.

59. 109. 177 203 lack. 1. 70. 185. 188. 139. 38. 56. 101. 65. 62. 196 mental apparatus. 54. 80. 195 Levi-Strauss. 92. 78. 58 Mitchell. 44. 106. 46. 89. 176. E. 179 Kinscherff. 162. 48. 103. 103. 40 Merleau-Ponty. J.Index 152. 178. 194 Lacan. 103. 84. 184. 147. 85. 152. 176. 86. 159. 189. v. 54.. 20. 189 kinship. 53. 158. 153. M. 83. 185. 14. 21. 88. 78. 74. 198 Lacanian psychoanalysis. 128. 70. 191 moment of conclusion. 55 misrecognition. viii. 14. 156. 73. 76. 51. 129. 64. 196. 43. 160. 176 L'Evolution Psychiatrique. 167.. 180. 74. 61 moment of seeing. 57. 196. 81. 88. 95. 61 moral insanity. 60. 81. 182 Kraepelin. 93. 36. 178. 47. 54. 108. 179. 31. 180. M. 99. 74. 189 Lacanians. 186 Kety. 86. 89. 43. 70. 145. 192. 94. 44. 180 Kernbergian. 150. 33. 67. xi.. xii. 21 Kuhn. 102. 140. 107. 151. 165. 174. 175. 164. 193. 79. 51. 164. 70 Klein. 108. 140. 143. 156. 78. 22. 155. 57. 162. 22. 168.. x. 168. 108. 142. 150 linguistics. 194. 76. 177 metaphoric. 163. 81. 2. 173. 178. 107. 85. 44. M. 149 Masterson. 185. 99. 32. xi. P. 25. 143. 119. 180. 195.. 114. 174. 158. 95. 142. 57. masochistic. 150. 178. 60. 92. 163. T. 68. 79. 183. 22. 88. 99. A. 195 latent schizophrenics.. 56. 50. 23.. x. 30. 160. 84. 79. 58. 138. 55. 102. 92. 174. 6 mother. 69.. 20. 152. R. 137. 54 Little Hans.. 143. 139. 61. 53. 93. 63. 180 Laforgue. 37. 9. 84. 166. 104. 2. 51. 2. 195 masochism. 50.. 75. 68. 173. 85. 74. 34. 85. 102 Lowenstein. 67. 106 metapsychology. 174. 38. 165. 159. 83. 11. 169.. 53. 102. 178.. 72. 22. 18. 169. 89. 38 mental status examination. 60. 28. 37. 163. 46 Lagache. 66. 75. 22. 48. C. 124. 144. 123. 31. 9. 186. 82. 46. 45. 176. 120. 163. 19. 195. 73. 46.. 143. 165. 55. 195 Major. 86. 6 Kriss. 73. 170. 51. 48. 74. metapsychological. 82. 141. 42. 162. 146. 61 moment of understanding.. 120. 175. 167. ix. 83. 124. 136. 69. viii. 91. 14. 23. 193 Kohutian analysis. 86. 74.. 195 libidinal. 93. W. 87. 167. 189. 184. 22. 18. 74. S. 26. 49. 175. 119. 66. 18. 100. 91. 65. 159. 197 metonymic. 19. 170. 93. 46 Lemaire. 18. 37. 79 metonymy. xi. 166. 54. 96. 96. 198 Lacanian. 71. 25. 166. 128. 60. S. 140. R. 120. 57. 17. viii. 84. 177. J. 11 Kinscherff. 196 Meissner. 195. 77. 90. 156. J. 69. 38.. 149. 164. 127. 175. 48. 36. 35. 107. 71. 175. 72. 109. 172. 124. 158. 59. 192 Mahler. 54. xiii. . G. 97. 102. 67. 98. 50. 127. 157. 88. 94. 175. 106. 156 Koriath. 98. 162. 54. 50. xii. 71. 157. 71. 130. 31. 173. 47. 192. 80. 8 law. 47 metaphor. 193 Kernberg. 21. 173. 164. 177 Mirror Stage. 158. 171. 164. 24. 169. 193 kleptomania. 124. 135. 171. ix.. 61.. 102. 142. 179. xii. 65. 53. 59. 41. 185. 163. 180. 68. 32. 161. 103. 49. 71. 163. 196. 89. 36. 48 Laplanche. 168. 177. R. 21. 52. 171. 197. 152. 44. 28 Klosinki. 165. 21. R. 157. 188. 141. 51. 77. 71. 78. 86. 172. 124. 63. 63.

159. 29. 176 oral. 175. 68 obesity. 67. 10 need. 132. 96. 169 oedipal victory. 27. 76. 37. 54. 36. 57. 92. 72. 102. 57. 45. 178 philosophy. 82. 110. 33. 158. 39. 64. 98. 122. 154. 33. 113. 122 103. 141. 148 overwritten by language. 139. 165. J. 101. 115. D. 94. 177. 25. 88. 104. 43. 180 Object Relations Theory and Clinical Psychoanalysis (Kernberg). 111. 170. 161. 111. 149. 18. 77. 65. 54. 157. 148. 193 Nash.204 Borderline Personality Disorder: A Lacanian Perspective panic disorder. 104. 44. 49 Playboy magazine. 37. 38. 97. 102. 123 object relations. 14. 91.. 169. 76. 28. 22. 68. 138. 67. 174 paranoid. 65. 4. 135. 89. 133. 104 Oedipus Complex. 98. 68. 74 National Institutes of Mental Health. 124. 38. 26. 20. 84. 179. 22. 95. 55. 149. 95 perversion. 123. 179. 147. 73. 155. 190. 28. 172. 66. 20. 169. 84. 150. 160. 92. 18. 196 Muller. 35. x. 18. 50. 102. 103. 36. 146. 99. 22. 93. 160. 130. 65. 104 paternal metaphor. 102. 82. 178 phobia. 74. 152. 71. 149. 182. 40. 171 obsessive. 142. 181 parenting. 24. 100 paternal function. 93. 22. 125. 164. P. 12. 37. 187. 42. 100. 31. 136 oedipal.. 59. 101. 90. 79. 53 Polatin. 82. 70. 18. 33. 10. 60. 134 perfection. 69. 102. J. 174. 68. 110. 170. 104. 137. 102. 39.. 151. 172. 169. 52. 158 penis. 9. 48 Nasio. 47. 63. 131 operationalizing. 83. 118. 14 neuroses. 173. 33. 151. 44. 179 object-relations theory. 93. 1. 10. 148. 146 paranoid position. 54. 49 phenomenology. 66. 161. 196 negative therapeutic reaction. 166 obsessive-compulsive. 117. 6. 26. 15. 198 phallus. 139. 55 philosophical. J. 103. 52 Name of the Father. 4. 19. 59. 139 perceptual distortions. 176. 102 Phobias. 153. xi New York Psychoanalytic Institute. 88. 114. 137. 42. 191 points de capiton. 158. x. 26. viii. 27 phobics. 7. 94. 91. 25. 73. 67. 69 Piaget. 183 parents. 15. 174 parental. 88. 45. 69. 69. 131. 42. 96. 71. 98. xi. 176 phenomenological. 67. 7. 106. 34 pleasure. 1. 75. 174. 89. 28 polysubstance dependence. P. 23. 7 Polymorphous Perverse. 124. 138. 72. 24. 27 polysymptomatic neurosis. 106. 192. 105. 69. 78. 83 Pappenheim. 196 . 139. 104. 104. 123. 73. 122. 92. 130. 44. 152. xi. 176. 136. 83 Polysymptomatic. 19 mutability of the sign. 161. 159. 193 narcissistic. 45.. 18. 69. 139. 106. 174.. 71. 82. 99. 14 paraphilia. 36 object representations. 182. 151. 180. 130. 153. 124. 60. 122. 54. 163. 27. 177. 157. 32. 18 normative function. 26.. 152 Palombo. 198 passivity. 160. 78. 19. 99. 27. 177 Parmelee. 122. 136. 153. 35. 85. 171. 172. 196 multiplicity. 28. 19. 14. 155 narcissism. 85. 104. 171. 73. 136 omnipotence.

4. 32. 165. 31. 39. 152 psychotherapy. 26. xi. 8. 19. x. 3. 55. 17. 58 reality testing. 15 repression.. 88. 174 preschizophrenic patients. 92. 36.. 167. 184 presumptive criteria. 177. 164. 8. D. 118 Psychoanalysis. 2. E. 22. 54. 21. 9. 57. 148 projective identification. 97. 12. 166. 150. 126. 142. O. 7 . 42. 8. 30. 27. 7. 37. 18. 17. 87. 35. 173 post positivist philosophy. 26. 8 presumptive. 179. 134. 52 schizoid. 192. 195 Psychodynamic. 106. 102. 97. 4. 3. 158. 52. 91. 26. 124. 15. 148. 25. 143. 13. 9. 51. 44. 26. 11 rage. 185. 65. 96. 171. 192 Salpetriere Clinic. 86. xii Prichard. 128. 176. 152. 42. 108 Post-traumatic Stress Disorder. 178 post-Freudian. 111. 130. 37. 73. 87. 31. M. 124. 126. 69. 160 resignification. 8. 168. 9. 10. 157. 83. 82. 51. H. 103. 38 Psychopathology of Everyday Life (Freud) . 198 psychoanalytic. 101. 144. 146. 174. 180 projection. 189. 98. 131. 30 primary repression. 176 relationship with reality. 84. 71. 196 Rorschach. 15. 93. 197.. 136. 91. 140. 193 Rinsley. 103. 13. 139. 6. 195. xi. 178. 61. 152. 157. 60 resistance. 59. 30. 63. 15. 3. 139. 175. J. 120. 32. 179 possession states. 1. 6 primal scene. 183. 139. 114. 114. 169. 145. 142. 142. 168. 164. 68. 7. 26. 133. 17. 67. 180. 17. 50. 5. 18. 89. 196. 129. 88. 68. 62. F. 125. 155. 172 real father. 176. 158. 3. 30.. 50. 94. 72 pre-oedipal. 171. 82. 165. 138. 22. 180. 53. xiii. 124. 44. 128. 103. 82. 89. 33. 66. 62. 171. 67. 8. 68. 135. 28. 83. 1. 5. 179 pregenital. 107. 194 position. 90. 122. 17 psychotic-like symptoms. 24. 139. 163. 143. 9. 14. 132. 2. 47. 79. 14. 50. 142 return of the repressed. 18. 125. 45. 149. 9. viii. 9. 110. 85. 16. 193 psychotic borderline. 32. 23. 120. 33. 90. 59. 29.. 173. 178. 121. 45 sarcasm. 30. 36. 56. 55. 85 reality principle. 162. 46. 45. 123. 132. 84. 156.. 68. 174. 88. 43. 159. D. 16. 49. 78. 44. 16. 14. 99. 80. 159. 101. 124. 8. 196 real. 86. 14. 125. 7. 188. 30. 87. 33. 198 psychosomatic. 85. 122 schizophrenia. 34. 30. 16. 18. 167. 33. 4. 131 promiscuity.Index Porter. 135. 89. 62. 25. 165.. 150. 179. 27. 38 Prozac. 84. 118. 131. 197 Sadock. 21 Rapaport. 37. 6 psychosis. 91. 91 primitive. 17. 76. 130. 29. 18. 47. 5. 53. 131. 129.. 192 schizotypal. 164. 2. 165. 2. 14. 45 205 psychopathy. 174. 39. 18. 48. 27. 180 primary process thinking. 94. 157. 97. 18. 18. 86. 169. 150. 87. 38 pre-linguistic. 31. 107. 4. 100 Sartre. 174. 83. 134. 4. 62 resignified. 117... 15. 60. 50. 3. B. 40. 191 psychological testing. 127. 59. 26. 59. 38. 22 Saussure. 133. 45. 34. 92. 187. 11. 41. 163. 18. 55. 81. 155. 146. 26. 47. 9 psychotic character. 109. J. 160 return to Freud. 196 Roudinesco. 72.. 22. 15. 24. 139 primary process. 90. 166. 29. 124. 182 Rank. 80. 35. 47. 60. 63. 167. 157.

30. 197 Singer. 35. 52. 114. 44 65. 141. 58.. 162. 151. 178 . 68. 104. 198 Zilboorg. 55. 28. 38. 198 stress interview. 197 signified. 17. 88. 50. 65. 168 sexual. 181. 40. 66. 55. 71. 44 secondary process thinking. 69. 120. 136. 65. 61. 68. 15 suicidal. 92. 46 Society Francaise de Psychanalyse. 115. 92. 166. xi three registers. 87. 114. 11. 85. 12. 170. 59. 72. 73. 125. J. 159. 28. 157 self-destructive. 33. 157. 52. ix. 90 Searles. 7 Schreber. 3. 89. V. 172 Spitzer.. 66. 72. 82. 122. 67. 70. 80. 79. 26. 103. 74. 63. 97. 156 The Family (Lacan). 184 structuralism. 10. 167 Tort. 67. 84. 54. 136. 19. 82. 182 self-psychology.. 4. 138. 88. 26. 18. 4. 181 Treatise of Insanity (Prichard). 117. 74. Freud. 197 second topographical system. 4. 164. 78 Societe Psychoanalytique de Paris. 93. 187 Winnicott. 10. 21 superego. 41. 174. 46. 63. 4. 22. 166 Symbolic Register. 107. 54. xii. 174.. 25. 7. 49. 104. 126. 56. 137. 50. 63. 54 Structure of Scientific Revolutions (Kuhn). 40. 54. 37. H. 102. viii.. 44. 64. 79. 51. 44. 171. 165. 173. 145. 32. 124. 65 thought disorder. 13 splitting. 33. 69. 165. 92. 4. 102. G. 5. 103. 167. 118. 131. 53. 39. H. 139. 40. M. 65. 66. 23. 37. 62. 64 slips of the tongue. 81. 89. 51. 123. 131. 90. 8. 63. 2. 155. 18. 166. M. 14. 56. 59. 34.. 80. 59. 53. T. 51. 88 topographical model. 143. 9.206 Borderline Personality Disorder: A Lacanian Perspective subjectivity. 13 Stone. 122. 6 unconscious. M. 78. 50. 64. 173 structuralist. 158. 54. 64. H. 36. 125. 130. 121. 95. 56 Willick. 176. 158. 26. 75. 55. 197 three Freudian structures. 37. 3. 170 suggestibility. 85. 50. 143.. 91. 41. 58.. 156 trauma. 82. 65. 164. 29. 14. 50. 139. 96 Volkan. 139. 19. 74. 73. 49. 147 Sullivan. 198 symbolic order. 177 signifier. 9. 36. 156. 47. 51. 68. 71. 24. 81. 3. 127. 91. 183. 30 self-defeating.. 57. 88. 73. 124.. 159. 84. 152. 174. 151. 53. 76. 35. 145. 104. 168. 135. 92. 170. 180 Stern. 73. 66. 25. 66. 93. 1 sliding of the signified. 182. 11. 175. 76. 105. 62. 154. 101. 72. 70. 167 Sutherland. 138. 40. 60. 63. 191 sexual difference. 92. 67. 74. 129. 150. 116. 99. 64. 67. 94. 52. 29. 22. 192 Singer. 156. 189 transference. 53. 85. 32. 182 versagung. 51. 19. 60. 167.. 191. 152. 42. 23. 198 Wallon. 124. 122. 50. 79.. 169. 72. I. 138. 71.. 2. 2 Single White Female. 109. 166 Wood. M. 70. 62. 72. 104 Shapiro. 15. 23 symbolic. A. 29. 18. 31. 19. 33. 64. 148.. 181 Wolfman (case of S. 41 structural. 48 specular image. 154. M. D. 123.

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