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DISCUSSION: Dr. Herbert Pardes stated that while clinically the term, 'borderline state', is used widely, there is not a clear enough view of it to allow general psychiatric texts to give it much attention or to discuss it with precision. This failure results from the inherent complexity of the phenomenon, and we are presented with substantially different views by various authors. While recognizing that all mental illnesses may not be unitary in their etiology and may not fall into a single continuum, Dr. Pardes wondered if psychogenetic or functional illnesses could not be best understood and explained with the idea of a continuum, which seems to fit neatly into much of our clinical observation.
Dr. William Niederland emphasized that the diagnosis of psychosis is not meant to be pejorative. He spoke of the 'survivor syndrome' found in victims of the Nazi holocaust. In these cases, etiologic data showed that exceptional and prolonged trauma can lead to a syndrome which is not demonstrably psychotic yet has to be considered 'borderline'.
Dr. George Wiedeman observed that the psychotic nosology is becoming more rigid, in spite of the fact that it remains mainly descriptive; except in organic states, it lacks etiologic classification. He felt that the problem of 'borderline states' might best be conceptualized in the same way as the problem of anxiety, which in more disturbed conditions is quantitatively increased to bring into play a qualitatively different set of defenses.
Dr. Richard Drooz suggested that the concept of a 'borderline' category need not conflict with the continuum theory, and that it might be analogized to the phylogenetic tree. Dr. Otto Sperling stressed the practical consequences of sound classification. He