Psychotic Developments in a Sexually Abused Borderline Patient: Commentary on Paper by Paul Williams

This is a first-class description of a psychoanalytical odyssey reaching over a period of seven years. The patient, Miss A, was aged 40 when she started psychoanalysis with Williams. She had been diagnosed as suffering from paranoid schizophrenia. She worked as an operations member of a branch of military security that involved recurrent risk of injury or loss of life. Her performance at her work was held in high regard by her seniors. It became apparent that her good work performance was poised precariously on the quicksand of a much-abused infancy and childhood and that there was serious turmoil “betwixt damnation and impassioned clay” going on all the time in every aspect of her life. She appears to have been grossly traumatized by her and father, who abused her from the age of five by masturbating her and getting her to practice fellatio on him. Later there was genital contact without penetration, but from the age of 10 there was penetration. This went on until she was 14, when she stopped it.

She had been rejected by her mother and more or less handed over to her father while her mother seemed to be besotted in her relationship with her first child, a boy a year and a half older than the patient. Five years later her younger brother was born. His birth seems to have coincided with the sexual deprivation of her father, who took on his daughter as a little wife. The five year-old was flattered and “honored” by this role but was pinned down in it for years. Refusal of father's overtures aroused his anger and sometimes violence. It is easy to see how a change toward more normal emotional development was impossible for the child. Her dangerous work later in life might very well have been both an expression of her problem and a lure to her. But it did not help her to cope with a highly split intrapsychic situation.

The fantasy personification, which she called “The Director,” was an omniscient, sometimes omnipotent figure. Her image of father was