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September 23, 1974. THE CONCEPTS OF BORDERLINE STATES: AN ALTERNATIVE PROPOSAL. Robert Dickes, M.D.
A wide variety of opinions exists concerning 'borderline' patients who exhibit psychotic symptoms as well as symptoms that resemble those of the neurotic patient, the latter termed 'pseudoneurotic' by Hoch and his co-workers. Many of these opinions are irreconcilable. After presenting examples from the literature and from clinical material, Dr. Dickes suggested that such patients be considered as a conglomerate, composed of several syndromes of differing etiologies. He also suggested an alternative approach to the unproven hypothesis that health, neurosis, and psychosis exist on a single continuum. He presented material in support of the view that mental illness not be regarded as unitary in origin but rather as having different etiologies and courses. Work being done by geneticists, endocrinologists, and neurophysiologists is consonant with available clinical studies. Dr. Dickes also pointed out that in some borderline cases the so-called neurotic symptoms actually bear the hallmark of psychoses. Finally, he suggested retaining the term 'pseudoneurotic' to apply to the so-called neurotic symptoms and placing such patients under the diagnostic category of 'psychosis, type undetermined'.