Madness and the Borderline

In a paper appearing earlier in the Journal, Arnold Mitchell (1985) argues that the chief obstacle in understanding so-called borderline syndromes proceeds from the uncertainty that these represent true nosological entities. For Mitchell, the notion of borderline originates largely from our tendency to reify and organize rather than to presume a spectrum of possibility in severe personality pathologies. Numerous clinicians fail to find sufficiently distinguishing characteristics to establish borderline as a separate, identifiable entity. According to Goldberg (1986), there is no conclusive data from psychological test results supporting a distinction of borderline from other nonpsychotic conditions. Nevertheless, the currents of contemporary psychoanalytic thought have carried us so far in this direction that now it falls to the skeptic to justify his doubt, not the other way around.

The concept of the borderline as a particular means to organize fact and fancy has brought renewed interest to the familiar phenomenologic, dynamic, and therapeutic questions of severe pathologies. These were known by other terms, none of them satisfactory, but in the aggregate healthily attesting to the uncertainty of our knowledge.

In approaching these questions, Mitchell turns to the conceptualization set forth by Kernberg of the borderline personality organization, a notion far more encompassing than the DSM-III diagnosis, borderline personality disorder. Yet in the end, Mitchell parts company with Kernberg by distinguishing the borderline who engages the world, however angrily, from the schizoid who withdraws from the world.

Mitchell provides the Horney clinician with a basis in theory for thinking about the borderline: he emphasizes that the borderline struggles to find meaning in the world, desperately taking what he needs in order to feel unified. It is in this intensity, this rage to survive and engage, that is often manifest in treatment situations as overwhelming transference an