The beginning of heartache in character disorders: On the way to relatedness and intimacy through primal affects and symbolization

This paper studies the interaction of the clinical theories of two major British theorists, Melanie Klein and Donald Winnicott. Through three clinical examples, we see how the “Klein-Winnicott dialectic” operates in a significantly developmental fashion to advance and fulfill clinical work. Winnicott’s “object survival” is looked at in developmental conjunction with Klein’s “mourning” as a primary clinical and developmental process. This interaction also captures the essence of working with the aggression of a self that has been traumatically disrupted within its early development. This paper demonstrates how such work leads to the assimilation and grieving of primal object loss, evolving into a “developmental mourning process.” This developmental mourning includes the working-through of an “abandonment depression” in the character-disordered patient. A clinical example in a 1989 essay on “psychic pain” by Betty Joseph is used to set up the clinical challenge of going beyond the symptomatic clinging behavior of developmental arrest, into full psychic birth as a separate other, an Other who can relate to an Other. Conclusively, the subjective visceral affect noted and monitored in its clinical dimensions here is that of human “heartache,” which can also include regret.