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Journal of Infant, Child, and

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Panel 4: The Pathology of the

Self: The Fragmented Self,
Disorders of the Self, and the
Dissolution of the Self
Mary Target , Linda Mayes , Sheldon Bach & Judy
Ann Kaplan
Published online: 02 Apr 2012.

To cite this article: Mary Target , Linda Mayes , Sheldon Bach & Judy Ann Kaplan
(2000) Panel 4: The Pathology of the Self: The Fragmented Self, Disorders of the
Self, and the Dissolution of the Self, Journal of Infant, Child, and Adolescent
Psychotherapy, 1:3, 63-72, DOI: 10.1080/15289168.2000.10486359

To link to this article: http://dx.doi.org/10.1080/15289168.2000.10486359

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 h a p Vol. 1, No. 3

PANEL4: THE PATHOLOGYOF THE SELF:THE FRAGMENTEDSELF,DISORDERS

OF
THE SELF,AND THE DISSOLUTION
OF THE SELF
Mary Target, Linda Mayes, and Sheldon Bach
Moderator: Judy Ann Kaplan
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0 ur panelists will attempt to define the concept of the self and its rele-
vance in our understanding of pathology.
Question Four: What does it mean to have a fragmented sense of self?
Are all personality disorders disorders of the self?

MARY TARGET
The notion of a fragmented self probably first appeared in Pierre Janet’s
(1989) book L’Automatisme Psychologique. Janet assumed that some kind
of “psychological feebleness” dramatically reduced the capacity of the per-
sonality to synthesize more than a certain number of emotions and ideas,
and therefore personal self-consciousness could not form. Morton Prince
(1914), in his book The Unconscious, distinguished two processes involved:
dissociation and synthesis. He suggested that fragmentation of the self was
simply “an exaggeration of normal mechanisms” (p. 226). Perhaps the
words of both Janet and Prince suffer from a tendency to reify personality
and its subsystems, encouraging a mechanistic view of dissociation and
splitting, as though these were actual spatial, physical phenomena. It is
interesting to note Breuer and Freud’s (1895) comment in Studies on Hys-
teria: “It is easy to fall into a habit of thought which assumes that every
substantive has substance behind it. We find as time goes on, that we have
actually formed an idea which has lost its metaphorical nature, and which
we can manipulate easily, as though it were real” (pp. 227-228).
Of course, Freud rejected the deficit theory originally proposed by Janet,
and introduced psychic conflict as the cause of fragmentation (Freud 1894).
As he elaborated his model, he saw an increasingly limited role for the notion
of a “vertical split” (Kohut 1971), preferring instead the “horizontal split”
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 M. Target, 1. Mayes, S. Bach

of repression. Subsequently, he explicitly rejected the notion of a fragmented

self, and considered the concept of splitting of consciousness to be a sign
of resistance on the part of philosophers against the idea of an unconscious
(Freud 1912). He wrote, “The cases described as splitting of consciousness
. . . might better be denoted as shifting of consciousness-that function, or
whatever it be, oscillating between two different psychical complexes which
become conscious and unconscious in alternation” (p. 263). Nevertheless,
he remained aware of the difficulty that even the structural model faced
in connection with the notion of a fragmented self. In “A Disturbance of
Memory on the Acropolis” (Freud 1936), he acknowledged that the notion
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of double consciousness had been “little mastered scientifically” (p. 245).

Broadly speaking, his (1923) account was in terms of multiple identifica-
tions. Erickson and Kubie (1939) combined Freud’s notion of multiple iden-
tifications with the notion of a vertical split of the personality into “two
more or less complete units” (p. 508). It was not really until Fairbairn’s
(1952) refocusing of metapsychology from structures to objects that the
notion of a fragmented self could be properly reintroduced into psychoana-
lytic theory. Fairbairn explicitly returned to Janet’s model of dissociation,
and used it as the basic mechanism for understanding schizoid states.
What can we say about fragmentation of self, in terms of our model?
Surprisingly, our ideas have much in common with those of Janet and Prince.
The self is formed around a physical core. “The ego is first and foremost a
bodily ego.” At this level, it is not possible to have a fragmented sense of
self. It is, however, possible to have little by way of reflective capacity, which
is required to oppose the pressure for coherence of self-perception. It is only
when an individual is capable of reflecting upon the incompatibility of self-
states that the pressure for coherence of intentionality gives way to another
mode of perception. In the absence of this encounter, we suggest that the
need to perceive self-states as consistent with one another can lead to a form
of disorganization, whereby islands of the self are formed, each internally
consistent but each unrelated to the others. At an extreme, this can mani-
fest as Dissociative Identity Disorder. More commonly, patients experience
rapid changes in self-state, without the transitional experiences and buffer-
ing that the mentalization of these states provides.
The mind finds various ways of abolishing itself, for a variety of pur-
poses. AndrC Green (1987) talks about this perhaps more eloquently in his
book Narcissisme de Vie et de Mort. He discusses the divergent aims that
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 THE PATHOLOGYOF THE SELF

drive the individual with negative narcissism. The anti-narcissist, as Chris-

topher Bollas (1989) terms it, opposes his own destiny. He “forecloses his
true self, refusing to use his objects to articulate his idiom” (p. 159). He
negates his destiny and refuses to nurture a sense of self. Such patients, Bollas
maintains, may come to analysis precisely in order to defeat the aims of
analysis. Within our frame of reference, we would understand Bollas’s and
Green’s descriptions as something more of a disavowal of reflective func-
tion, perhaps even its active destruction.
Such individuals create a false self, one that is created to destroy the
true self. Perverse pleasure is experienced in the destruction of authentic in-
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terpersonal experience. The root is in the primary object relationship. The

infant, perhaps totally rejected, or mindlessly adored, internalizes an alien
other that occupies the total space available to a self. Any experience in
the context of an attachment relationship that is suspected of the potential
to enhance the self is therefore actively, sometimes sadistically and viciously,
attacked and destroyed. What is most noticeable about these patients is that
they may start a therapeutic relationship with apparent commitment to the
process of understanding. As attachment to the therapist develops, the re-
lationship comes to be experienced as highly dangerous. The representa-
tion of themselves discerned in the other has to be eradicated. The differ-
ence between such a negative false self and the more compliant variety is
that, whereas the latter hides and sustains an enfeebled true self, here the
self as a whole is experienced as an enemy within.
These ideas have much in common with Bion’s (1959) description of
the ego-destructive superego. The superego is experienced as inside the self,
and destroys all attempts at linking because these could lead to the strengthen-
ing of the self. The analyst is easily destabilized by such a negative self-
representation. Such patients cause one to question oneself because it is
precisely at what are normally moments of greatest therapeutic effective-
ness, flashes of true understanding, that the patient’s attack is at its most vigor-
ous. The extent to which such patients are able to evoke role-responsiveness
(Joseph 1989, Sandler 1976) is likely to be very limited. They cannot suc-
cessfully externalize a self-representation, true or false, and they can only
protect themselves through destruction. While paranoid distortions to the
transference may suggest the externalization of an alien, hostile other from
within the self, these leave the person without resources, and for the most
part such treatments end in failure.
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 M. Target, I. Mayes, S. Bach

These are cases in which we would see the absence of self as a critical
part of the clinical formulation. In many other cases-autistic people,
perhaps individuals with multiple handicaps-the key problems are else-
where, the weakness of the sense of self is secondary, and not central to
a formulation.
In response to the question of whether all personality disorders are dis-
orders of the self, we would say that since the most persuasive definitions
of personality disorder are in terms of chronic disturbances of interpersonal
relationship patterns, and since the definition of self is, in our view, insepa-
rable from that of object relationships, it is axiomatic that the one must
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entail the other. The substantive question is how this comes to be true. In
our view, different patterns of personality disorder entail quite different
deviations of the development of self-organization, and sometimes radically
different strategies for maintaining a self-structure of adequate integrity and
coherence. As we have said, in borderline patients we expect gross limita-
tions of reflective capacity, consequent splitting of self-structure, and a
predominance of a teleological mode of experiencing internal reality. In
schizoid patients, there is a withdrawal from the external world, a focus
on self-reflection but at the expense of representation of the psychic reality
of the object, which is fearfully shunned. In Hysterical Personality Disor-
der, there is a reflective function that may be hyperactive in the absence of
the symbolic binding of primary representations of internal states (cf. Bollas’s
concept of the experiential self 1992).
The question of whether there are different pathologies of self-representa-
tion in various clinical presentations, such as borderline, hysterical, and nar-
cissistic disorders, addresses the urgent need for a matrix of self-dysfunction
arranged in diagnostic groups. This is a worthy aim but somewhat distant
from the current state of the field. There are not only many different
pathologies of the self, but different theories of the self for each of these
pathologies. At the moment too many psychoanalytic theories are “nested”
within certain clinical groups. Let me illustrate. Kohut’s theory of self func-
tion is tied in with his theory of narcissism. His notion of the self is actu-
ally hard to fit with our theoretical approach (although some would say
this may be associated with what Freud called the “narcissism of small dif-
ferences”). Kohut’s thinking seems to take its origin from Hartmann’s for-
mulation: the self has its origins in narcissism at the same time that narcis-
sism is a cathexis of the self. To resolve this Kohut suggests that the self is
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formed out of archaic primary narcissism, as nuclear narcissistic structures

of the grandiose self and the idealized parental imago. In Kohut’s later
writings it is hard to distinguish between the psychology of the self and the
content of the mental apparatus. The self is seen not just as a specific con-
tent but as a superordinate constellation. The pathological self is attributed
to the inadequacy of early object relations (as in Winnicott). The distinc-
tion between self and ego disappears. But the most significant problem with
the approach was pointed out by Meissner (1986): Kohut’s notion is ex-
cessively tied to narcissistic concerns. In our view, the self is neither limited
to the vicissitudes of narcissism, nor can it be adequately defined in terms
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of narcissism. The structural, developmental, and dynamic events that under-

pin the creation of the self with its specific aims and goals (Gedo 1979)
have been, by and large, ignored by many Kohutians.
Similar problems arise with structural-object relations theories of border-
line patients (eg., Kernberg 1983) or schizoid phenomena (Fairbairn 1940).
Otto Kernberg has come closer than anyone else to providing a compre-
hensive matrix, but his framework is also far from generally accepted. An
excellent book that went some way toward addressing this problem was
Salman Akhtar’s Broken Structures (1992). He succeeded as far as any have
in providing an integrated review of the field but, of course, could not truly
resolve the underlying theoretical differences.
From our perspective, we are committed to empirical research as the way
the matrix between diagnoses and self-dysfunctions will eventually be com-
pleted. Our own developmental work has been on borderline states and in
so doing we have become acutely aware of the complexity of the nosological
systems in current use from the standpoint of theory development. DSM-ZV
yields too many co-morbidities to be helpful in identifying specific psycho-
pathological models. There are theoretical models for which we have some
limited empirical support in connection with reflective function deficits in some
cluster B patients (particularly those who meet borderline criteria). We sus-
pect that antisocial personalities have negative false self-structures (as described
above) and some hysterical personalities manifest pseudo-reflectiveness. In
violence, we suspect that externalization of colonized parts of the self may
be implicated. There is a need for a gender-sensitive perspective on self de-
velopment, and as we have heard today, this may be some time in coming.
In sum, I don’t believe that any of the models, including ours, is ready
to answer your question. More research, both clinical and empirical, and
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 M. Target, 1. Mayes, S. Bach

more theoretical development will be required on all our parts for a com-
prehensive model of self-pathologies across diagnostic groupings. In the
meantime, it would be helpful if diagnostic categories were also somewhat
clearer.

LINDA MAYES
My response will be brief inasmuch as my clinical work is predominantly
with younger children. It is worth thinking about failures of a sense of self,
as in instances I’ve already cited, of very low-functioning autism or per-
haps very severe mental retardation. With the former at least, it is worth
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wondering whether or not this extreme social disability makes the creation
of a sense of self difficult or impossible. Severely autistic individuals have
difficulties with body-in-space issues as well. But it may also be useful to
define what we mean by a fragmented sense of self, both symptomatically
and theoretically. We may all think we agree, since it is a common phrase
in our field-but do we all look for the same clinical phenomena? We look
for a blurring of interpersonal boundaries, an uncertainty about the dis-
tinction between fantasy and reality, andlor an uncertainty about attribu-
tions and intentions. Included in the characteristics may be emotional la-
bility, a sensitivity to communicative failures and absences in another person,
and difficulty tolerating aggressive impulses. With children, a fragmented
self may be expressed more in anxiety, social impairment, and in the im-
poverishment of both the imagination and the capacity for fantasy play. In-
discriminate relatedness and/or poor capacities for full relatedness may also
be evident, as well as scattered developmental and/or cognitive delays or
impairments. Blurring or fragmentation of the self in terms of both related-
ness and self-regulatory abilities seems to cut across several diagnostic cate-
gories, and it may be more worthwhile to think about self-boundaries and
self-integrity as a continuum between maximum vulnerability on the one
hand and maximum flexibility on the other.

SHELDONBACH
Rather than answer this in a general way, I’ll start with two clear clinical
examples that I’ve used before and see if they can illuminate this murky
area.
One young woman complained of her difficulty having satisfactory re-
lationships, as indicated by her inability to have a mutual orgasm with her
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 THE PATHOLOGYOF THE SELF

lover. She said, “I can’t make the smooth transition.. . . I’m either me, to-
tally me, and so excited that nothing else exists, or else I’m Tony’s lover
and I can give him pleasure, but then I don’t have any pleasure myself.” In
this instance the patient was forced to choose between pleasing herself in
subjective awareness or pleasing her lover in objective self-awareness; she
seemed unable to make the smooth transition between these states and had
either not developed or was unable to use a more complex state that might
contain these dichotomies. One might say that she had difficulties integrat-
ing her narcissism with her object-relatedness, or her Self with the Other.
Thus this patient had problems in Winnicott’s transitional area; she couldn’t
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easily and appropriately negotiate between Self and Other.

Interestingly, we once had occasion to observe this patient’s mother
playing with her infant grandchild and to note that the mother, who was
so enthusiastically gazing at her grandson, experienced great difficulty when
he sought to diminish the stimulation by averting his gaze. She repeatedly
tried to force herself on him and eventually broke off all contact, as if she
had been personally offended.
From all the other information we had, it seemed likely that similar
events had repeatedly occurred with the patient as a child. So this was, in
a sense, a paradigm for the mother’s narcissistic difficulty in recognizing,
holding, and integrating the patient’s oscillating states, in allowing mutual
regulation, in permitting the child to separate from her, and in affording
her the transitional space in which a secure sense of self might grow. This
kind of behavior makes it difficult for the child to learn to recognize or
contain multiple states of self, to maintain continuity between them, and
to build up more complex states. This example, of only modest pathologi-
cal severity, is typical of narcissistic personality disorders.
A more severe disturbance was seen in a patient who was frequently
overwhelmed by totally subjective suicidal states in which the only content
of her mind was the urgent need to kill herself and her immediate plans to
do so. After these suicidal attempts or suicidal states had subsided, I could
talk with her about her children, whom she loved and did not wish to or-
phan; that is, after the attempt, she could assume a state of objective self-
awareness of herself as a mother that was unavailable to her when she was
suicidal. After many years that were very frightening for both of us, she
eventually began to get better but complained that the treatment had de-
prived her of her suicidal potential, because she could no longer enter a
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 M. Target, I . Mayes, S. Bach

state of subjective suicidality without also objectively remembering that she

was the mother of little children.
I understood this to mean that certain splits had been partially healed
and that more complex states of consciousness had developed in which
varieties of subjective and objective self-awareness, or of narcissism and
object-relatedness, had become better integrated. It was noteworthy that part
of her found this depressing and experienced it as a very real loss, by anal-
ogy with the way the rapprochement child may at times feel depressed at
his loss of practicing omnipotence, or the way the grasshopper might feel
depressed when he realizes that he is being viewed not as a unique Irving
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but as a member of a larger class of insects.

Thus, one of our goals in therapy is to enlarge both subjective and
objective self-awareness and to integrate these into increasingly complex
states of consciousness. In the psychoanalytic literature this problem has
been mainly discussed with reference to the inability of certain patients to
achieve objective or reflective self-awareness. For example, borderline pa-
tients are typically described as subjectively and affectively enacting their
conflicts, rather than objectively reflecting on their mental representations
to achieve insight. We have seen that objective self-awareness develops in
an intersubjective context as the child learns to see himself in the eyes of
his caretaker and then of the world, and that it is processed in the more
specific diacritic modalities, especially verbally. Because of this verbal and
intersubjective context, deficits in self-reflexivity and related symptomatol-
ogy are often quite visible, that is, we can tell relatively easily when a per-
son lacks insight into his actions.
But the pathological symptoms we find associated with problems of
subjective awareness are a lack of vitality, a defective sense of aliveness, and
feelings of self-fragmentation rather than self-cohesiveness, which are pro-
cessed in the more generalized, nonverbal, proprioceptive and coenesthetic
modalities and are consequently less noticeable to an outsider. Thus they
seem to have been overlooked more often by therapists, especially before
Balint, Winnicott, and Kohut drew our attention to them. Perhaps another
reason for this historical inattention has been the lack of a clear sense of
the origins and treatment for these symptoms, since they may well have been
present in such classic diagnoses as neurasthenia but could not then have
been translated into an intersubjective context.

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In an oversimplified way, problems with objective or reflective self-

awareness can be seen as originating from inadequate recognition of the
child as a separate person by the caretaker, but problems with subjective
awareness tend to originate through the inadequate libidinization of the child
by the caretaker. I mean that in the total absence of early maternal bodily
caring the child may die of marasmus (Spitz 1945). It seems that a suffi-
cient degree of body-loving and/or hating, of some bodily cathexis or ener-
gizing, of some kind of mother-infant sexuality is necessary to libidinize
the body and enable the child to have even the potential to feel alive and
whole, to love his own body, and to love someone else sexually. In the ab-
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sence of this, if the child manages to stay alive at all, we see the kind of
pathology so accurately portrayed by Patrick Suskind (1991) in his novel
Perfume, where the protagonist, who has no body scent of his own, first
becomes a perfumer and eventually a murderer of women in an attempt to
rob them of the scent of life that he feels is so lacking in himself. While the
ordinary patient that we see has not been literally thrown away after birth,
as was the protagonist of this novel, I have seen many cases whose prob-
lems with feeling vital, alive, and cohesive were traceable in part to some
cumulative environmental deficiency, such as not being sufficiently libidi-
nized by their caretakers.
I should perhaps at this point clarify that I do not view psychological
malfunctioning as traceable exclusively to environmental trauma, whether
early or late; and that I am a firm believer in both endogenous and exog-
enous forces and the equal and interactive contribution, in most cases, of
both biology and environment, of fantasy and trauma, and of psychic real-
ity and external reality. So when I say that some patients have problems
related in part to not being sufficiently libidinized by their caretakers, I am
using shorthand for a series of propositions that include the caretaker’s
character, the child’s constitutional givens, which are often extremely im-
portant, and the child’s inner life, in affect and fantasy, which becomes a
prime determinant of ensuing reactions.
From a clinical point of view it would seem important in every case to
work with both the environmental trauma, so that the patient may come
to understand his dependence on other people in his environment, and also
to work with the inner life and internal conflicts, so that the patient may
come to understand his independence from the environment and experience

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his own agency. Thus, in his own way, the therapist must also be able to
move between subjectivity and objectivity, or between his empathy with the
patient’s subjectivity and his recognition of the patient’s place in the objec-
tive world of reality.
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