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Dr. Michael Stone, in his final summation of his book on the borderline syndromes, writes, “psychoanalysis has progressed from its origins as an id psychology to an ego psychology, and in recent years to a more interpersonally oriented object-relations psychology. The time seems now at hand to push on further to a psychoanalytic psychobiology — in which the newer genetic, biochemical, neuroendocrinological, and neurophysiological data are also integrated into a still broader theoretical framework. This kind of integration is particularly necessary in the realm of the Borderline syndromes.” This statement brings to mind an idea we have heard since our early training days. Freud said that behind the psychoanalyst is the man with the white coat holding a syringe in his hand. That syringe is reminiscent of Erlich's “magic bullet,” a biochemical advance that will cure mental illness.
This hoped-for holistic approach to disease has been discussed by many others, such as George Engel, Herbert Weiner, and Maurice Greenhill. The systems psychosomatic approach is truly a way of understanding disease. However, we must differentiate between disease and illness. As the quip goes, disease is what the patient has, illness is what we treat.
Dr. Stone's work on the borderline syndromes is encyclopedic in nature: it covers description, diagnosis, genetics, various theories, and clinical examples. The book reflects Dr. Stone's background at Columbia's Psychiatric Institute. There, together with genetic research, adaptational psychoanalysis, and a new school of psychopharmacology led by Dr. Donald Klein, there is an atmosphere of precision and rigorous questioning. Spitzer's group and DSM 111 are examples of this precision. In this atmosphere, with all its richness, Dr. Stone has been able to bring together a wealth of information.
For those who have not read the original papers and the many writings about the borderline syndromes through the years, Dr. Stone's book serves as an excellent