A SELF PSYCHOLOGICAUINTERSUBJECTIVE APPROACH TO THE BORDERLINE PATIENT

A Discussion of Dr. Mitchell's Paper

Harry Paul

It is a pleasure for me to discuss Arnold Mitchell's paper, "Self Structuring of the Borderline Personality" (see p. 106). He and I have had numerous dis- cussions about the nature of our work, its similarities and differences. My per- spective in discussing Dr. Mitchell's paper will be from a self psychological/ intersubjective perspective. That is, I will draw from the work: of Kohut, Atwood, Brandchaft, Lachmann, Stolorow, Ulman, and myself.

In reading through Mitchell's paper the first time, I often found myself say- ing, yes, yes--I agree with that. In fact there are numerous points of consensus between us. However, as I came to understand the central theme of Mitchell's paper, that the borderline is organized around disorder, or, as he states, that the borderline builds a sense of unity around disorder and chaos, I realized that he and I are taking different paths to understanding the need for self cohe- sion and maintenance of the self representation for the borderline patient.

Mitchell says that as one lives within a consistent pattern of behavior, a sense of unity will be fostered, even if the resultant activities are ultimately self-defeating, even if one hates oneself for being this way. From a self psycho- logical perspective I can agree with this formulation. However, an understand- ing of how the borderline finds him or herself in this position, what prevents one from reaching beyond it, and the nature of treatment are different from a self psychological/intersubjective perspective.

I will direct my comments principally to two different areas. First, I will discuss Dr. Mitchell's central idea that the borderline is organized around disorder, that disorganization and chaos are his conduits for dealing with the world. I do not agree that the borderline organizes around chaos and confu- sion per se in a purposeful way, but that the confusion and chaos are the result, are secondary to the inability of the borderline to find and maintain

HARRY PAUL, Ph.D., is a Staff Psychologist, F.D.R. Veterans Administration Hospital, Montrose, N.Y., and faculty member, Training and Research Institute for Self Psychology.

Address correspondence to: Dr. Harry Paul, 1045 Park Avenue, New York, NY 10028.

The American Journal of Psychoanalysis © 1988 Association for the Advancement of Psychoanalysis

Vol..48, No. 2, 1988

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stable selfobjects to whom he can become archaically connected. Chaos is not the result of conflict between the wish to move towards and the wish to move away, but chaos is the result of a tie to a failing selfobject, that is, persons or activities that only partially substitute for needed and missing psychological structure. What Mitchell sees as chaos from a self psychological perspective is the borderline's struggling attempt to connect to failing self- objects, the only ones he has available to him.

This leads to my second point. The same dynamic of a failing self and fail- ing selfobject exists in the treatment situation. The psychological condition called borderline is not a pathological condition located only in the patient. Rather, as Brandchaft and Stolorow (1984, p. 342) state, "borderline symptom- ology refers to phenomena arising in an intersubjective field consisting of a precarious vulnerable self (the patient) and a failing archaic selfobject (the analyst)." A failure of the analyst to understand and recognize archaic self- object transference wishes in the borderline patient leads to the chaotic liv- ing anid to the chaotic treatment situations mentioned by Mitchell.

What makes my understanding of the borderline condition different from Dr. Mitchell's in both areas of my discussion is the concept of the selfobject. Kohut (1971) defined the selfobject as an archaic object that would be noth- ing more than the embodiment of a psychological function that the patient's psyche could not yet perform for himself. The selfobject is an object or an activity that a person experiences as incompletely separated from himself and that serves to maintain his or her sense of self. Without this concept, Mitchell is left to defining chaos itself as binding and unifying. With this concept we can understand the borderline's struggle to maintain self cohesion and resulting chaos as reflecting a desperate search for the selfobjects that will help to make him whole.

Dr. Mitchell states that the borderline is attempting a solution, that he is pulled between two imperative and uncompromising solutions, caught be- tween the absolute, morbidly dependent move of having to merge, and the absolute resigned move of having to isolate from others. The resulting border- line disorganization, he states, is a purposeful attempt at maintaining a unified self system. I agree that the disordered life of the borderline is a purposeful attempt, not at maintaining chaos, but at maintaining a sense of self with any and all available selfobjects that are available.

Activities like perversions, masochism, and substance abuse, to mention a few that Mitchell mentions, are utilized as "remedial stimulants" (Kohut, 1972, p. 626) to try and replace the missing psychological structure that the borderline does not possess, defending against the fragmentation of the self. An individual debilitated by an absence or a defect in psychological struc- ture may activate one of three primitive narcissistic configurations to try to main- tain and sustain a sense of self cohesion replacing the missing psychological

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structure. This may be achieved through merger with an omnipotent idealized selfobject, or with a selfobject that mirrors back reflections of his grandiosity, or a selfobject that reflects twinship or sameness. The activities of chaos repre- sent attempts to activate one of these three narcissistic configurations to maintain a unified sense of self.

From a self psychological/intersubjective perspective, how might we under- stand the function of addictive activity and perverse enactments, two forms of Mitchell's chaos, in consolidating the structural cohesion and stability of the self and selfobject representation? Ulman and Paul (1987) state that the addictive person imbues substances with fantasmagorical unconscious mean- ing that is actively experienced as providing selfobject functions. Again, behav- ior mentioned by Mitchell as related to random chaos, like gambling, spend- ing money, masturbation, and chemical and eating disorders, can become habitual and take on selfobject functions. The individual is unable to perform these necessary selfobject functions because of failure in empathic attune- ment which disrupted the normal transmuting internalization of these func- tions. Instead, they are either only partially internalized in the form of fragile and vulnerable psychic structures, or are not internalized at all, and are there- fore missing. The borderline personality then might establish quite early in life a primary selfobject relationship with a variety of different activities, inani- mate objects, and substances. The ~Jse of a substance provides the borderline with a desperately needed sense of relief from depressive emptiness or deple- tion (issues related to the need for mirroring) or fragmentation and disintegra- tion (the need for an idealized selfobject). Such a person is compelled to depend on such objects or activities as a substitute for a human selfobject.

Mitchell states in comparing a borderline patient with a neurotic patient that the neurotic patient through insight was able to overcome her masochism but that in comparison the borderline patient will take a path towards chaos, in this case masochism when given an opportunity to mowe towards meaningfulness.

From a self psychological/intersubjective perspective, the more archaically organized the individual, the more he or she will be preoccupied, and in the case of the borderline, imperatively focused on his failing self and failing self- objects in his struggle to keep himself whole. Kohut (1971) maintains that perverse activities can be seen as primitive attempts of an individual who is Coping with structural deficits and defects in dealing with inner deadness (related to the activation of mirroring fantasies) or fragmentation (the activa- tion of omnipotent, idealizing fantasies). This individual will desperately cling to any activities, including masochistic ones, as Mitchell's patient did, that provide needed but temporary selfobject functions. Conversely, the less struc- turally deficient individual who utilizes masochistic activities is not threat- ened with the same sense of self dissolution as is the borderline patient. The

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function of masochistic activities then varies dependent on the level of psycho- logical organization of the patient (Stolorow and Lachmann, 1980).

Therefore the capacity to let go of such an activity will mean something very different for the borderline than for the neurotic. Neurotic patients may be able to utilize fantasy or dreams as opposed to concrete enactments to provide a boost to self-esteem and self cohesion, as Mitchell's neurotic patient was able to utilize her dream. This patient did not experience the same terror of disintegration as the borderline, which was the reason for the borderline's urgency and intensity of action in restoring the self, through enactments (Mitch- ell's chaos). It is very different for the borderline to begin to trust the self- object analyst to take over these archaic functions, as opposed to the neurotic, who can more easily pass over to the analyst the role of selfobject. It is not that such a person cannot give up chaos, but that for him the formation of a human selfobject relatedness is a precarious and long process. Such an indi- vidual would not give up what presently though only fleetingly maintains some sense of self and selfobject.

This brings me to my second point, as to the nature of borderline symp- toms in the clinical situation. Borderline symptomatology is due to the fail- ure of the selfobject analyst to empathically comprehend the patient's archaic subjective states and needs. Brandchaft and Stolorow state:

if the analyst allows the revival of archaic idealizing or mirroring ties, which had been traumatically and phase inappropriately ruptured during the patient's forma- tive years, and upon which he now comes to rely on for the restoration and main- tenance of his sense of self, and for the resumption and completion of his arrested psychological growth, then borderline symptoms will recede and eventually disappear. (1984, p. 335)

What Mitchell sees as chaos I believe is an iatrogenic consequence of a clinical approach that does not recognize the validity and functional necessity of the selfobject. Within the analytic relationship the borderline patient will attempt to reestablish an archaic selfobject relatedness. If this developmentally appro- priate need is again rejected as it had been in childhood, the patient will expe- rience this misunderstanding as a recapitulation of a developmental sequence that in the past and present leaves him or her struggling to maintain self cohe- sion. If a patient begins to revive an arrested selfobject need within the analytic relationship, and she finds that the analyst responds with the same unempathic responses of early caretakers, she will then react with Mitchell's chaos. When developmental requirements reexperienced in the transference are rejected, it is understandable that rage, hostility, and other enactments are produced (Brandchaft and Stolorow, 1984). These responses are a breakdown product, a reaction to the analyst's not understanding the meaning of the patient's archaic wish to establish a selfobject transference.

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Therefore the chaos that Mitchell suggests is organizing to the borderline exists only in an intersubjective context in which the patient feels consistently misunderstood. The transference and countertransference, that is, the subjec- tivities of both patient and analyst, then continually shape the intersubjective context, and the subjectivity of the analyst can either facilitate or obstruct the unfolding of a selfobject transference.

Atwood and Stolorow state:

whether or not a stable selfobject bond can be developed and maintained, which in turn shapes both the apparent diagnostic picture and the assessment of analyzability will not only depend on the extent of impairment and vulnerability of the patient's nuclear self. It will be codetermined as well by the extent of the therapist's ability to decenter from the structure of his subjectivity and to comprehend empathically the nature of the patient's archaic subjective universive as it begins to structure the microcosm of the transference.

Such is the nature of the intersubjective context, with the constant inter- play between the subjectivities of both patient and analyst. Selfobject ties with such patients are primitive, and when such ties are ruptured the patient's response is quite intense since what is being threatened is the basic sense of selfhood. However, if the archaic needs are understood, the chaos recedes and disappears. At various times in his paper, Mitchell uses the terms, claims on others, morbid dependency, and need for merger. These wishes may either be the result of an already occurring selfobject failure, or they are encapsu- lated codes for the desperately desired selfobject functions that the patient feels is not forthcoming.

Mitchell states that as much as the borderline needs closeness, he also needs to avoid the danger it entails. Mitchell says that as this patient moves closer, or as he becomes aware of the therapist's empathic humanity, he must then flee into isolation. It is often true that patients become fearful of entering into an archaic relationship with the therapist, as he is afraid of repeating a genetic scene with the analyst that will yield the same disappointing results of child- hood. The dread to repeat (Ornstein, 1974) is a powerful motivation to avoid the pain of the past. If one conceptualizes selfobject needs as solely patho- logical, patients then wil l flee closeness. As a selfobject transference germi- nates, and the hope for an archaic selfobject relatedness unfolds, the patient soon realizes that this archaic relatedness is not allowed to bloom. The ana- lyst does not support the unfolding of the selfobject transference, and it is at this point that borderline patients again begin exhibiting borderline symp- tomology. That is, as the patient moves away, he does so because he sees that his archaic selfobject needs will be rejected again.

It is clear that the action of psychoanalysis is different for Homey and Kohut. For Kohut, the transformation and transmutation of archaic narcissistic structure,

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in the context of an archaic selfobject relatedness, produce psychic change and growth. In such a context, empathy and introspection provide the only data of psychoanalysis, not behavioral, interpersonal, or social events. This per- spective in combination with the concept of the selfobject makes the self psycho- logical approach to the borderline patient different from the one taken by Mitchell.

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