I Hate You--Don't Leave Me: Understanding the Borderline Personality

by Jerold J. Kreisman

many patients who seemed just beyond the reach of psychoanalysis. The Kleinians focused on psychological dynamics as opposed to biological-constitutional factors. The term borderline was first coined by Adolph Stern in 1938 to describe a group of patients who did not seem to fit into the primary diagnostic classifications of “neuroses” and “psychoses.”2 These individuals were obviously more ill than neurotic patients—in fact, “too ill for classical psychoanalysis”—yet they did not, like psychotic patients, continually misinterpret the real world. Though, like neurotics, they displayed a wide range of anxiety symptoms, neurotic patients usually had a more solid, consistent sense of identity and used more mature coping mechanisms. Throughout the 1940s and 1950s, other psychoanalysts began to recognize a population of patients who did not fit existing pathological descriptions. Some patients appeared to be neurotic or mildly symptomatic, but when they engaged in traditional psychotherapy, especially psychoanalysis, they “unraveled.” Similarly, hospitalization would also exacerbate symptoms and increase the patient’s infantile behavior and dependency on the therapist and hospital. Other patients would appear to be severely psychotic, often diagnosed schizophrenic, only to make a sudden and unexpected recovery within a very short time. (Such dramatic improvement is inconsistent with the usual course of schizophrenia.) Still other patients exhibited symptoms suggestive of depres...