Answer to Dr Robbins' Commentaries

Albeit recipient of the highest praise Dr Robbins can offer and most thankful for that, as well as for his clarifications on the contributions made by Fairbairn and Ogden, I nonetheless wish to make three remarks about his comments.

1. Dr. Robbins seems to make a sharp distinction between normal and pathological ways of being, making the category of “borderline” patients necessary to his approach. This is the subject of his concluding question. For my part, I do not draw such a clear line between normality and pathology, and thus do not feel the need to identify “borderline” patients, in any case not as much as Dr. Robbins seems to. The notion of “position” that a human being can occupy all through his life seems to me to be largely satisfying to our understanding and clinical work.

   The discussion about a schizo-paranoïd position in normal human development is as old as psychiatry. Kant wrote that a man with delusions is someone who dreams while awake. Certainly psychiatrists keen on formal distinctions would not accept that definition. I would say that any perception or set of thoughts where splitting dominates tends towards schizophrenic thinking and that schizophrenic patients, when they are intelligent and sensitive, have very realistic perceptions and thoughts. I have been working with this kind of patients for the last thirty years, both in mental health institutions and in my private practice. I follow these patients as they move from one position to another, as I have shown in Jeremy's case history. But I do agree with Dr Robbins that Melanie Klein probably never treated real psychotic patients, even though I do not think that the reason for this is the fact that she never had “medical training”. Nobody has ever proved that mental pathology could be better explained or treated by people with such a training rather than by philosophers or anthropologists. Indeed I believe that medically trained people without a proper philosophical or anthropological interest wil