To the Editor

Arnold Mitchell has made an important contribution to the literature in his fine paper, ‘The Borderline Diagnosis and Integration of Self” (Am. J. Psychoanal., 45: 234-250, 1985), by placing the borderline diagnosis in holistic perspective. Mitchell's review and elucidation of the confusions and pitfalls surrounding the diagnosis hone in on questions that merit further discussion. His paper prompted me to reflect on some of these.

Mitchell implies in his “continuum of maladaptive defenses” that as a result of psychic conflict, we may move from relative health toward neurosis and then to borderline symptoms and defenses. He follows Horney in describing moves away from wholeness. Yet, if Horney were writing today, as a dialectical thinker, it's quite likely that she would accept the plausibility of another process which occurs simultaneously, in the opposite direction, toward integration, and would incorporate the work that has been done in this regard into her theory. Of course, Horney did just this in positing constructive forces and the real self. But I am referring specifically now to developmental psychoanalysis, which Horney addresses indirectly: While we may start out whole and healthy, paradoxically, we cannot be all that we are capable of becoming. We are, in a sense, ever incomplete, with tasks to master and developmental milestones to achieve. We begin in infancy with limited abilities. As we develop our capacities, we become more and more complex and highly organized. I think that a complete theory must encompass Horney's foundation, as interpreted by Mitchell, plus the process of separation and individuation as described by Mahler, the development of the self as elaborated by Kernberg, and allow for the work of many other theorists in understanding how human beings grow.

I find myself at variance with Mitchell on the matter of the borderline experience of self. Mitchell indicates that borderline phenomena “manifest to the degree one has moved along a path t