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CLINICIANS ARE WELL AWARE of the dilemma regarding classification and diagnostic labeling of a group of patients which seems to be conspicuously seeking help for all-pervasive misery. This group is particularly disconcerting because it cannot be fit into any of the familiar categories, that is, diagnosed in conventional terms. Often one hears the word, "character pathology, " "borderline state" and even "psychotic character" loosely used and, therefore, being somewhat meaningless in helping us to gain a picture of a patient's emotional state.
I hope that my attempt here will not add to the present confusion. It is simply a method that I have found useful in ordering my thinking about patients and to help me distinguish between various types of character structure, the recognition of which my have some bearing upon how difficult I may find countertransference factors. In other words, having some idea as to what to expect regarding the patient's unfolding of the transference may make it easier for the therapist to deal with what is projected into him.
In this paper I will deal principally with the borderline patient, but I will attempt to view him in a perspective that will place him in context with other conditions that have been included under the rubric of character or ego pathology.
To emphasize my orientation regarding diagnosis, two questions become of immediate relevance. First, it is important to establish the basis one uses for making a diagnosis, since classification based purely on behavior, or the enumeration of symptoms, is extremely difficult at best. It is almost impossible when dealing with patients suffering from characterological problems.
The second question is a pragmatic one. Apart from statistical and heuristic purposes, how does a diagnosis actually help? For the