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In this paper I hope to show some of the ways in which an adolescent boy tried to defend against acute anxiety states, of a rather psychotic nature, and against any awareness of psychic pain, and to link this with some ideas about borderline states of mind. The concept of a borderline state or borderline personality is not new in psychiatry or psycho-analysis but it has become very fashionable in the last decade. It is used as an umbrella term for a large group of patients usually referred to as suffering from schizoid narcissistic or unspecific personality disorders. One hears it said that there are no nice neurotics any more coming from treatment. If this is true, then we are dealing with large numbers of patients who, if we agree with Kernberg (1971), Rosenfeld (1977, 1978) and Joseph (1981) and many other writers, are very difficult to reach and resistant to change because of the nature of the organisation of their defences. They are described as being narcissistic in their object relations and there is a massive preponderance of projective identification.
Steiner (1979) summarises the field as follows: the term “borderline” has three distinct but related meanings. First, it refers to a clinical category of patients, borderline between neurosis and psychosis, who, while not frankly psychotic, tend to use psychotic mechanisms. Second, it refers to a metaphor representing the subjective experience of these patients who are unable to find a permanent identity but feel themselves “sitting on the fence” between a variety of different identities in a borderline position. Third, it can refer to a theoretical formulation of the level of development at which these patients function. He believes they function as if on the border between the paranoid-schizoid and depressive positions as outlined by Melanie Klein. More recently (1985), he has suggested some of the ways defences are organised into a pathological organisation which is called into play to protect th