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The author of this book attempts a conceptual and diagnostic reassessment of borderline phenomena as he understands them. He frankly admits that the results do not fully satisfy him. This is totally understandable, in view of the complexity of the subject.
In very scholarly fashion, Meissner has performed an extraordinary feat in reviewing the extensive, multifaceted literature relevant to the borderline personality. He places considerable emphasis on the ideas and works of Kohut, Kernberg, and Mahler. One important focus seems to be to synthesize their observations and to coordinate them with some of his own ideas to produce a relatively unified conceptual understanding of what he terms the "borderline spectrum." Meissner's substitution of the term "spectrum" for "syndrome" is acceptable, since it is more compatible with a developmental perspective and supports the viewpoint that the concept of "borderline" embodies heterogeneity phenomenologically, developmentally, etiologically, and structurally. The "spectrum" is viewed by Meissner as "disorderly" and labile, undergoing changes in the course of therapy which alter internalized representations, drive derivatives, and ego and superego structures.
Meissner is quite frank in pointing out that there are divergent opinions concerning not only the behavioral phenomena characterized as borderline, but also the structural and developmental considerations that pertain. There have been numerous attempts to define "borderline personality," but its distinction from other diagnostic categories remains ambiguous, although there is general agreement that borderline psychopathology lies somehow between neurosis and psychosis. I personally feel a certain uneasiness about this "geographical" positioning of "borderline," though there is widespread adoption of this view in the psychiatric and psychoanalytic literature. At this time, however, there does not appear to be a better way of characterizing these conditions, unless w