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Fluctuations in self-state are a feature of severe personality disorder. This chapter concerns a particular category of changing self-state, one that involves pathological identification and that I am calling a “reversal.” This phenomenon, though not uncommon, has received relatively little attention and has generally been conceived in terms of defense. An alternative explanation, given here, depends upon a psychology of self.
In order to approach this subject I figuratively conceive the experience of self in relationship to the other, at any instant, in three dimensions. The first of these dimensions is vertical. On this axis self experiences can be placed up and down along the chronology of the individual's life. A second axis is horizontal and consists of a range of selves of the individual at a particular point in development. The third axis, also horizontal, is orthogonal to the second and reflects the process of identification. It consists of the back-and-forth oscillations between self-experience and the experience of the self as other. The subject of this chapter lies in this dimension and focuses on sudden, salient, and often perplexing “reversals” of the relation between self and other. I begin with two examples.
The first case is of a woman of 19. She has a history of multiple suicide attempts. She is talking with a trainee psychiatrist who has recently