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Psychoanalytic thinking is currently riding the crest of a wave of intense interest and discussion of the borderline syndrome. Despite the extensive and extremely productive work of Kernberg (1966), (1967), (1970), (1971), (1975), there remain significant areas of ambiguity, uncertainty, and confusion regarding the diagnosis and treatment of these conditions.
The term 'borderline' has enjoyed wide divergence in use (Rosenfield & Sprince, 1963) and has been applied rather loosely in a variety of contexts (Maenchen, 1968). Despite Kernberg's clarifications, we still have difficulty in knowing where to establish the borders and how to determine the lines dividing the borderline syndromes from closely related diagnostic entities. There is general agreement that the borderline pathology lies somehow between the neurotic and the psychotic conditions, but the question remains, in view of the variety of manifestations and the degree to which individual patients manifest both neurotic and psychotic characteristics, whether these conditions can be drawn together into a single diagnostic entity.
To some degree Knight's (1954) observation that the category serves as more or less of a waste-basket diagnosis, since it applies to patients who cannot be clearly classified as neurotic or psychotic, seems to be justified. Not only is the diagnosis often made in negative terms (Zetzel, 1971), but the diagnosis also tends to include those difficult, problematic and undesirable patients who seem to inhabit the 'border land' on the fringes of psychiatry, society and the penal system (Chessick, 1966).
The confusion has been amplified and prolonged by the tensions and ambiguities latent in the diagnostic process, particularly the descriptive emphasis on symptoms and symptom patterns as opposed to more psychodynamically and developmentally orientated considerations (Masterson, 1972). Thus, as Mack (1975) notes in his excellent historical review of the development of the borderline concept