FANTASY OR STRUCTURAL DEFECT?

T H E BORDERLINE DILEMMA AS VIEWED FROM

ANALYSIS OF AN EXPERIENCE OF
NONHUMANNESS

h.i ELV1N SI NGEK, hl .D .

The experieiice of 1ioiihiii~iaiiiiess,a cruciul aspect of the filienoin-

enal self of borderline states, is studied in two cases to test assuinp-
tioils concerning tlie ab)licatioii of the classic ego-ksyliological or
object-relations and se!f-psycliological inodels. A re these experiences
to be seen as faiitasj a i d treated as iiian fest conteiit, ruith djnain-
ically active uncoiucious conflict aiid weaning, requiring interpe:
tation, or as a developwental arrest in wliicli structural disturbances
are atneliorated through clarfiing arid einpathic interoentions?
The first case is of a patient with a neurotic depression and
hysterical and obsessional character traits, treated in .a .classic psj-
clioanabsis. Even though djadic oral and nnal fantasies were
strongly i n evidence, tlie ego was well integrated.
The second case is of a severe borderline patient who shouied.
depressive panic and agorophobia. Her major ego disturbances,
poorb integra t ed and differentiated self- and object representations,
and primitive defenses prevented effective psjclioanaljtically ori-
enfed treatment. Internentiom were used to consolidate self-rekre-
sentations, internalize tension-regulating structures, promote adaptive
egofunctions and reality testing. These clarifications were necessary
to move the patient to where she c o d l tolerate facing unconscious
dynamic conjlicts. Only at that point could repression be lifted,
memory emerge, and interpretation be utilized.

-T HE FIRST TRULY CoXiPREHENsIvE formulations in the realm

of borderline theory and practice (Kernberg, 1967, 1970,
1975) led to an initial embracing enthusiasm, but now a number
of major conceptual and clinical problems are recognized. This
paper is organized around one of them: how to assess the core

Director of Residency Education, The Institute of Pennsylvania Hospital,

Philadelphia, Pennsylvania.
Accepted for publication hiay 6, 1986.

31

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32 MELVIN SINGER

conscious cxpcrience of feeling nonhuman. Other terms used

to express related subjective states include riot feeling alive or
real. These cxperiences are usually associated with bodily sen-
sations of an inner void and profound emptiness as well as a
sense of one’s personality devoid of substance. ‘Tliese are not
acute, trarisicnt, or necessarily reactive to a n external stress,
although they can be, but are usually continuous and more a
fact of life. They are not part of expressed character, but are
personal inner experiences of “being.” Should thcse self-states
be conceptualized primarily as reflecting a fantasy and thus
treated as manifest content, whose meaning is to be understood,
or as an expression of developmental arrest in which the struc-
tural disturbance is best ameliorated through notiinterpretive
modalities?
This problem, narrowly focused, is but one of many that
fit into the broader questions that confront 11s regarding pa-
tients with so-called borderline pathology. ‘The polarization
within the psychoanalytic community concerning theoretical
and clinical constructs is strikingly displayed in thc recent book
by Abend et al. (1984). Review of this book ;IS representative
of the classic drive-ego psychological point of view (Singer,
1985), as ivell as the critiques of Kernberg’s work, perhaps the
most representative today of the object-relations model, reveals
the following challenges (Heimann, 1966; Calef and Weinshel,
1979; Abcnd et al., 1984).
Kernberg has been highly acclaimed for synthesizing the
literature and explicating the metapsychological structure of
borderline pathology while still retaining a conflict model. He
has also been criticized for being too broadly inclusive in his
diagnostic criteria and neglecting basic concepts considered es-
sential for the structural theory of neuroses. Thus, he deem-
phasizes the importance of the Oedipus COIII~ICX, guilt, and
repression in the etiology of Gorderline pathology, and by em-
phasizing developmental arrest at the stage of the split inter-
nalized self arid object world, as well as pregenital aggression,
he also effectively minimizes regression and libidinal conflicts.

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 T H E BORDERLINE DILEhihjA 33

Equally disquieting, Abend, et al. (1984) conceptualize bor-

derline pathology as one would the group of severe neurotic
character disorders. Their cases were, by their own admission,
at the upper end of the borderline continuum, tolerated the
analytic procedure with few parameters, but had especial dif-
ficulty in the realm of their sadomasochism. These writers were
primarily impressed with the quantitative rather than qualita-
tive differences between their patients and patients with classic
neurotic character disorders, and they could find no usefulness
either in Kernberg’s structural analysis utilizing object-relations
theory or his list of specific primitive defenses. They even con-
cluded that there are no “primitive” defenses per se, merely
typical defenses played out in a less integrated and autonomous
ego and personality organization.
Themes of loss and abandonment evolved into triadic oe-
dipal constellations, precluding the full emergence of dyadic
and pregenital maternal transferences in their cases. Unfor-
tunately, these cases do read like severe neurotic character dis-
orders. They displayed none of the cardinal features which are
the core borderline dilemma, i.e., feelings of being unreal, in-
animate, nonhuman, empty, or dissolving away associated with
desperate clinging, intolerance of being alone, and agonizing
loneliness (Singer, 1979, 1981). These problems of identity or
sense of self are never addressed, yet, this is the crux of the
catastrophic borderline experience which every contemporary
diagnostic classification considers central (Stone, 1984). Our
lack of understanding and resultant treatment failures in these
severe borderline disturbances have created the gap in theory
and practice and thus the divergent points of view. The main
criticism of the excellent book by Abend and his colleagues
(1984) is that in order to preserve an acceptable analytic data
base, core borderline pathology is neglected, and more has been
sacrificed than salvaged (Singer, 1985).
Because of this all-or-none climate, this paper was written.
Two cases were chosen which presented somewhat similar dis-
turbances in the realm of the self-experience, and also obvious

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34 hlELVIN SINGER

differences. The first patient was seen in classic psychoanalysis

and was considered as suffering from a severe neurotic char-
acter disorder. The second patient was seen in psychoanalytic
psychotherapy. Her case clearly resides in the core to lower end
of.the borderline spectrum. Rather extensive reports are in-
cluded, in the hope of addressing one of the major criticisms
of the object-relations literature, i.e., its lack of extensive ana-
lytic data that can give the reader the opportunity to judge the
material for himself.
Certain preparatory remarks are in order to set the stage
for what follows. Highly abbreviated outlines of the basic thc-
oretical paradigms available to us in organizing our clinical ob-
servations regarding these phenomena are presented. These
are purposely polarized for emphasis, to distinguish the dif-
ferences rather than similarities best reflecting the theoretical
climate. The many object-relations and self-psychological models
are compressed into one composite theory.

Tfieoretica 1 Models
Drive theory, anchored in psychobiological maturation, origi-
nally described the sequential unfolding of the psychosexual
stages through bodily zones which acted as organizers for fan-
tasy elaboration. Tension reduction was the primary need, and
helplessness the primary fear which arose from stimulus over-
load without adequate discharge mechanisms. The shift to the
object as a need and its loss as a fear followed secondarily upon
the recognition not only of the object, but that it alone could
facilitate the satisfaction of the need (Jacobson, 1964). Of
course, the object in conjunction with the “source” and “aim”
was always considered a necessary constituent of drive theory,
but never existed in its own right as a prime motivator for
behavior, only as the locus for the discharge of the vicissitudes
of the drive. To quote Freud (1915), “The object of an instinct
is the thing in regard to which or through which the instinct
is able to achieve its aim” (p. 122).

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 T H E BORDERLINE DILEMMA 35

Associated with tlie drive, arose the unconscious idea that

was incompatible with the conscious cultural demands of reality
and led to frustration atid the irreconcilable conflict within tlie
topographic model. Structural theory followed and recognized
the ego as that organ of the mind having reconciliatory prop-
erties mediating the opposing voices of passion, conscience, and
reason, which interlaced the entire spectrum of the topographic
grid between unconscious and conscious conflict. Ego-psycho-
logical advances, combined with drive a i d topographic theory,
are neatly incorporated to form the classic approach as we know
it today, which maintains that the cornerstone of the neuroses
is the oedipal solution with its crystallization of all that preceded
it.
Object-relations theory is anchored more in psychobio-
logical development through stages of relational fit, and orig-
inally gave greater emphasis to the attachment or bonding to.
the object itself as a primary psychological need and motivation
for action (Fairbairn, 1954; Bowlby, 1958). The ensuing strug-
gle to engage, separate, individuate, and then integrate into a
consolidated self in conjunction with a libidinally constant in-
ternal object lies at the heart of object-relations theory. In more
recent formulations (Jacobson, 1964; Kernberg, 1976; Mahler
et al., 1975), the drive and the object stand on more equal
footing and are viewed as two aspects of a primary need. Self-
psychological theory (Kohut, 197 l ) , a necessary offshoot of this
model, posits self-cohesion in relation to a self-object as a pri-
mary need and central organizing force in the various forms
of narcissistic psychopathology.
In conceptualizing the structure of a patient’s psychopath-
ology aIon$ classic lines, emphasis is placed on component con-
structs within a relatively closed, yet highly dynamic and vital
system. Conflict bktween the major intersystemic organizations
establishes an internal danger situation necessitating repression
and regressive alteration of drive derivatives. If it fails, super-
ego-induced signal anxiety, depression, and neurotic symptoms
may ensue or be transformed into distortions of character
(Freud, 1926; Arlow, 1963; Rangell, 1959; Brenner, 1979).

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36 MELVIN SINGER

The painful psychic experiences are viewed as one views

the manifest content of a dream, i.e., to be understood once the
latent content or derivatives via free association are obtained.
Working through the conflict once the “mutative interpreta-
tion” (Strachey, 1934) has k e n made is analogous to the mourn-
ing process. The “inner world” of self and object (Hartmann,
1939) have a constant and stable pool of representability and
are relatively nonvariant frames of reference. The variables
that move, in a dynamically meaningful sense, are the deriva-
tives of the internal world of drives and defenses. The rule of
abstinence is upheld as a theoretical baseline to continually draw
at an optimal level on the frustrated drives so that the ensuing
psychic elaboration will ultimately yield the derivatives of the
Oedipus complex, not stop short at a preoedipal juncture. The
analyst as an actual object remains as a relatively fixed point of
reference to allow for displacement and projection of the in-
ternal representations of affects and ideation in this partially
closed system. Self- and object representations, although subject
to shifting images, retain their separation and autonomy in spite
of the regressive pull of the drives, and thereby have a stable
background function.
In recent object-relations and self-psychological models,
the accent falls more on an open mechanistic, and much less
dynamic system. Component constructs include interpersonal
frustration and then conflict, which establishes an external dan-
ger situation resulting in fear of deprivation, inconsistency, or
overstimulation. This leads to developmental arrest or distor-
tion of the ego organization, archaic drive fixation and so-called
“primitive defenses.” Especially prominent and distinguishing
is the ego disturbance in the formation of the self- and object
images prior to what Hartmann (1953) called object constancy.
Or, following Freud’s (1914) formulation, a disturbance may
be said to reside either .in one of the early stages of the need-
satisfying object, the stage of narcissism, or before, but prior
to object love. This disturbance in the inner world resides in
a failure of a neutralized cathexis of the boundary and three-

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 T H E BORDERLINE DILEhihlA 37

dimensional space as well as the actual autonomy of the body

and mental self- and object images and their capacity for cohe-
sion and integration. The resultant readiness for reinstinctual-
.ization of these coordinates of the inner world draws them into
the realm of conflict between drive and defense and thus adds
an additional contribution to the form and possible content of
fantasy formation that expresses the compromise solution. This
is the present explanation, as I understand it, for the eery twist
or surreal quality that is added to their life struggles. The field
of battle over the primitive drives serves not only as the back-
ground terrain for the conibat to take place-it now enters into
the struggle itself and becomes part of the foreground.
If these primitive defenses fail, the ego is overwhelmed;
then basic or automatic anxiety (Freud, 1926; Greenacre, 194I),
anaclitic-type depression, and ego as well as drive regression
can ensue and revive a possibly unrecognized fixation, espe-
cially in regard to the integrity of the self- and object repre-
sentations. The corresponding core conscious experience has
usually been described as a fear of annihilation of the self-state.
Neutrality is upheld as a theoretical baseline in conjunction with
a wider application of the use of empathy and introspective
data as way statiofis to restore unity of the self and an optimal
polarity with the object. The possibility of correcting what is an
assumed failure in differentiation and integration of the prim-
itive personality organization through internalization of libi-
dinally toned binding and tension-regulating structures is
implied.
Thus, the classic theory gives precedence to interpretation
of what Rappaport (1957), borrowing from Hartmann (1939),
called the “internal world” of forces and conflict, while object-
relations theories give precedence to correcting what Rappaport
called the “inner world” of representability and mental schemas.
Is the basic equation: drive/conflict/danger/anxiety/defense, or
should we add: drive/conflict/loss of representability/
danger/anxiety/defense? When clinically applicable, enlarging
the theoretical umbrella dictates not only a tilt in the balance

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38 hlELVIN SINGER

between optiiiial frustration and partial gratification, if only

symbolically and momentarily, h i t also tleductively in the an-
al ys t’s assu m p tio 11s of causality. ‘TI1i s is not ni ere1y t h co re t i cal
sparring. These a priori constructs establish a set that frames
our focus of attention, channels the organization of o u r clinical
data, and guides our clinical interventions.
T h e ultimate unconscious conflict and clynaniic incaning
as well as the nietapsychological striictiire of a number of synip-
toiiilikc complaints, characterologic traits, and resistances seen
in neurotic as well as borderline patients are still not at all clear.
This problem in assessment persists not only iri the early going,
but for years in the course of an analysis. Some examples are
certain character resistances, such as vagueness, that resist re-
duction to inore basic cletnents; confusion, blankness, or silence
that remain unaltered; and a hapless crippling incptitudc. Likc-
wise, chronic dissociative states of dreamlike floating; chaotic
and manipulative life styles; symptomatic experiences of ago-
nizing emptiness; absolute iritoleraricc and dread of aloneness
and loneliness; and the incapacity to feel human, alive and real,
all reside in the never-never land between defensive regression
and fixation, the metaphor and the concrete-literal, but espe-
cially between fantasy and structural deficit. Are these feelings
the reactivation of rcninants of archaic experience and nicniory
that are regressive, transient, and reversible, o r are they the
conscious sensing of an internal catastrophe in psychic structure
that has bccn reanimated through a regressive disintegration
to a fixation point that may be permanent and irreversible?
Failure to resolve these states may prompt suicidal longings and
attempts, or self-mutilation and addictive behavior, to bring
relief at any price. T h e conclusions weigh assessments of o u r
patierits’ associations as residing on one o r the other side of the
theoretical divide.

Case 1
A highly ambitious and industrious thirty-five-year-old woman
entered analysis because of a depression which she attributed

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 T H E BORDERLINE DILEMMA 39

to her failures in every aspect of life-marriage, friendships,

sexual enjoyment, and career. At the beginning of her analysis,
while lying on the couch unable to see me, she complained of
a distressing emptiness. Periods of silence and being seen from
behind overwhelmed her. She felt something horrible was about
to happen if she could not see or at least hear me during these
silent periods. As the silence increased in duration, what even-
tually emerged was the conscious fantasy that she was “disap-
pearing,” but this was not accompanied by any corresponding
bodily experience. She would then leap off the couch and look
at me with great distrust and panic for not interrupting the
silent periods.
The transference was predominantly paternal and negative
for many years. She felt her analyst would humiliate and reject
her along the same lines as her father and uncle. Memories of
being shamed over her exhibitionistic tendencies were pre-
sented. She was mistrustful and guarded, viewing me as ex-
ploitative and hurtful. She stubbornly withheld and resisted
associating freely as she feared revealing her inner thoughts
and feelings to me. But with all these preconditions, her per-
ceived instability in the self remained a minor motif and did
not alter the basic conduct of the analysis in any significant way
except on those few occasions.
For many years, the analysis focused on working through
many derivatives of her pregenital regressive conflicts, espe-
cially anal-sadistic and retentive. Her career was experienced
as a “painful hardship.” She always felt the “strain” and “pres-
sure” of deadlines and the burden of the “workload” on her
back. Likewise, in the transference, 1 was perceived as poten-
tially controlling, always “on her back,” pushing her “to open
up” and give up painful memories in a torturous ordeal. Even-
tually, her revived fears of constipation and evacuation led to
her realization of anal fantasies involving rectal and bodily in-
jury and fecal persecution. Interweaving were themes of an-
nihilation through explosions from the relentless tension build-
up of anal gas and then its violent release; or, through anal-

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40 hlELVIN SINGER

incorporative fantasies and identification with the fecal stick

itself, she fantasied being buried, forced to suffocate within the
anal womb. Her need for absolute control was understood at
this time in relation to these fantasies, and substantially dimin-
ished over time. The development of a positive paternal trans-
ference ensued, and the softening of her tough unyielding
character resistance. Parenthetically, she was also much less con-
stipated.
Gradually, unmistakable evidence emerged for the fantasy
of an illusory penis hidden deep in the vaginal cul de sac. The
proposition of castration anxiety based on guilt reactions for
her forbidden Fantasied pliallic acquisition was supported by
her fears of vaginal penetration and injury of a special erotic
area; her inordinate ambitions and competitiveness with her
husband; her relentless pursuit of acclaim; agorophobic and
claustrophobic fears of attack, mutilation, and rape; and inces-
sant symptomatic loss of her keys. Additional evidence that
implicated the primal scene as the stage for her absolution in-
cluded associations to repetitive dreams in which the manifest
content involved scenes of combat in which planes, ships, and
trains collide head on. Collision followed by annihilation of the
projectile weaponry usually related to day residue involving the
battle of the sexes, whether played out in the marketplace or
domestically. All this required that she institute protective de-
vices, e.g., absoliite control over the exact timing and position
of the penis for vaginal entrance during intercourse.
The analysis extended into. the eighth year. The transfer-
ence had beconic increasingly competitive. As a result, my com-
ments were accepted grudgingly and our cooperative effort was
forcefully resisted, while her husband intensified his bitter com-
plaints over her denying him a sexual life and reducing him to
a weak, inadequate man. She then presented the following
transference dream, which provided material revelatory of her
initial perplexing complaints.
I was above and in front of you, poised in the air,
naked. You were positioned at my rear, looking up at me

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 T H E BORDERLINE DILEhIhlA 41

from below. My legs were spread wide open and you were
peering into my vagina. You began to go down on me. But
after a time, rather than move toward intercourse, you
l>ccamtiincreasingly more vigorous in your eating of me.
I awoke in horror afraid that my vagina was being de-
voured.
The day residue included an incident which made her aware
of her absolute necessity on eating a rich meal to set the stage
for responding sexually. From this and her varied associations
from the past as well as present and subsequent sessions, the
deeper dynamic meaning on this phallic-oedipal level of her
fears of the silent void, feelings of emptiness, being seen, and
disappearing became clear.
What she had displaced onto the mental contents and body
self-images originally referred to her illusory penis which she
had, in fantasy, stolen, eaten, and then hidden within her va-
gina. As absolution for her fantasied crime in deference to her
superego, first her ego induced a turning against her self
through failure in life pursuits; second, by projection, now her
analyst-father surrogate, following the talion law, would devour
her previously stolen paternal penis, making it disappear, and
thereby emptying out her vagina-silencing her weapon for-
ever. The castration complex with all its anxiety and guilt was
regressively expressed, at least partially, in this cannibalistic
fantasy through the oral-incorporative mode, which included
the merger of self- and object images experienced as fear of
annihilation of the self.
The structure of this group of symptoms was ultimately
seen as neurotic, hased on intrapsychic conflict, organized
around oedipal fantasies regressively revised at first, but with
mitiitnal invasion into the self-state. Understanding its meaning
as tnanifest content led to its ultitnate resolution. Surprisingly,
the rule of abstinence was essentially upheld; minimal param-
eters were introduced or ever needed for the analysis to pro-
gress satisfactorily to its conclusion. Interventions in terms of
drive and defense alone were necessary, and elegantly led to
the solution of the tnystery arid to the end of the complaints.

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42 MELVIN SINGER

As a postscript, this patient had difficulty in termination,

achieved only after a highly resistant and prolonged phase in
which she struggled to reach the negative maternal transfer-
ence. Eventually, she began to v i y me as cold, detached, and
cheating her of any real relationship. M y silence irritated her.
Yet, she was the one who was cold, stiff, and withholding of
associations, releasing them in bits and pieces in classic anal-
retentive style. She then stopped regular payment of her bill.
Gradually, through one or another mishap, the unpaid bill ex-
tended to six months. Paralleling this “withholding and extract-
ing” from me, she required ever more rescheduling of sessions
as her career became increasingly harried and unpredictable.
The more she would accuse me of being unavailable, frustrat-
ing, and inflexible in accommodating to her needs, the more
I experienced her as draining and frustrating me. I clarified
and questioned her need for this reversal of roles and affect
once it was fully elaborated and literally, as Waelder (1939)
once said, “spoke for itself.”
Memories of her mother’s coldness, stiffness, and unyield-
ing character emerged, The transference became maternal and
apparently dyadica she now recognized reluctantly and sadly
her noiv aged mother’s perceived awkwardness on closeness
and inability to show emotions. Slowly, she became able to tol-
erate contradictory feelings toward her mother, not just toward
her analyst, husband, and children. Her impulsive acquisitive-
ness could noiv be additionally explained not only as an attempt
at restitution for her frustrated phallic-oedipal strivings, but
also as revenge for her mother’s withholding of emotional con-
tact and obsessional doubting and ruminating which preveri ted
her from taking any action. The patient’s frustration toward
her mother had been continually denied and reversed by com-
plimentary identification with its opposite, i.e., an impetuous,
greedy, character trait. Working through some of this appar-
ently dyadic material put an end to the negative transference-
countertransference experience as she developed more pa-
tience and felt genuinely less cheated. She also became more

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 T H E BORDERLINE DILEhihlA 43

giving, flexibly open and responsive. Orgasmic responses in-

creased moderately and her usual fleeting vaginismus on pen-
etration disappeared. She described the penile thrusting now
more as caressing or stroking, comparing it to back rubs which
she demanded from her boyfriend in adolescence and which
she received from her father in childhood.
During this period of heightened awareness of her longings
for maternal attunement, a repetitive dream from childhood
came into sharper focus and could now be better understood.
She was trapped in a round, small chamber. She found an exit
covered by a thin-laced curtain with a split in the middle. She
rushed to escape, but, to her horror, as she opened the curtain,
she was sucked into a black void. The interpretation was now
clear. The exit was really the entrance into her mother’s entro-
itus; the dream represented her wish to return to the womb
with the restoration of maternal-infant oneness as well as its
consequence, the fear of annihilation of the self through falling
forever into this black oral abyss. Although, the body-penis
equation was obviously presented, interpretations to that effect
were not made since associations derived from phallic-oedipal
strivings and castration anxiety were not retrievable.
Although the transference was presented as dyadic and
maternal and she had actually induced a corresponding emo-
tional reaction in her analyst, her personality organization was
sufficiently integrated, her defenses firmly structured, and the
derivative material elaborated in a gradually emerging fashion
to conceptualize it more as projection and identification with
the aggressor than the more primitive projective identification.
Likewise, conscious memories that had remained for the
patient in isolation and compartmentalized, could now be in-
tegrated in terms of the maternal transference. Memories of
her inability to nurse her first child, a daughter; of her envy
and lifelong rivalry and estrangement with her younger sister
of five years, by whose name she would frequently call her
daughter; the family legend of her intense preoccupation and
interruptions of her mother’s nursing of this sister; her present-

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44 hfELVIN SINGER

day morbid fear of sexual fondling of her breasts associated

with visual imagery of mutilation with knives-all could now be
better understood, integrated, and worked through. In addition
to their reconstructive use, these memories and present-day
symptoms were conceptualized as regressive expressions of her
phallic aggressiveness and of an intense oedipal love as well as
envy and rivalry with the mother presented in a dyadic pre-
genital mode. But due to the intense pressures of termination,
no interpretation upward was possible. The pregenital aspects
remained the primary focus of attention.

Case 2

A nineteen-year-old girl suffered a remarkably severe and last-

ing decompensation on her first amorous experience during
her freshman year at a local college. Prior to this evanescent
courtship, she described herself as functioning with a modest
degree of independence. In truth, this was only possible pro-
vided she lived a short distance from her home. Following what
was a remarkably mild amorous encounter, her anxiety mounted
to overwhelming levels. She then withdrew to her parents’
home, unable to leave for years. Thereafter, she was chronically
preoccupied with suicide, felt deadened, nonhuman, and un-
real, and complained of an agonizing emptiness associated with
the fear that she would literally disappear if left alone. Fur-
thermore, she perceived the world as unbearably treacherous,
and was fearful that some “unspeakable horror” would also
befall her if left alone at its mercy. She presented herself as
hardened and cold, and her face and attire were formless.
Only a few people were chosen to provide the necessary
protection and safety, and they were kept unmercifully within
reach either through extreme and direct forms of demand and
control,’or if that failed, indirectly through guilt-induced coer-
cions and outrageous manipulations. Episodes of binging in-
terspersed the above behavior, while total and massive shifts in
attitude toward her protectors occurred over the slightest re-

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 T H E BORDERLINE DILEhlhIA 45

buffs. She could rarely perceive another person’s needs as sep-

arate from her own, and felt totally justified in making
unlimited requests for attention. She required that her every
thought, let alone action, be shared (see Winnicott, 1945) as
well as checked out for any possible danger to herself or others.
It goes without saying that at times, within the transference,
she had inordinate difficulty separating fantasy from reality,
attitudes originating from her self or analyst, the literal from
the metaphor. All too frequently, she required that her analyst
be an auxiliary ego to test reality. Her continued requirement
for emotional contact and cooperation from these few chosen
people, whom she treated as though they had no life of their
own, revealed the extensive narcissistic aspect of her attach-
ments as well as her need for emotional sameness and attune-
ment.
Her “personal myth” included a tale of trauma which began
at least at birth with a breach delivery, blood transfusions for
erythroblastosis fetalis, and a prolonged period of hospitaliza-
tion and separation from her mother. This was followed, so the
legend has it, by her secretly witnessing an embattled parental
couple in which the father was terrorizing, paranoid, control-
ling, and sexually overstimulating, while the mother alternated
between excessive warmth, closeness, and self-sacrifice, and
then sudden shifts to coldness and abandonment as she fre-
quently and desperately, in vain, tried to escape from her mar-
riage and self-imposed overburdening responsibilities (see
Winnicott, 1960, p. 147). Sadistic primal-scene episodes were
frequently overheard and remembered. A series of nursemaids
acted as maternal surrogates throughout her childhood. T h e
loss of one nurse, in particular, who abruptly left toward the
close of the patient’s first year of life, was considered an es-
pecially traumatic event.
This patient only experienced a measure of feelings of
aliveness in the visible presence of her mother or analyst, and
then only if she transformed the relationship into one in which
she had total and absolute control. She was seen in face-to-face

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46 hIELVIN SINGER

psychoanalytic psychotherapy five times a week for the first ten

years, followed by three times a week for seven years. For many
of these years, she considered herself, felt and acted subhuman,
displaying few redeeming qualities. Only scientific curiosity
proved sustaining for the analyst. She could not tolerate, nor
did she admit to any conscious sexual thought or feeling, let
alone behavior, for the first seven years. Therapy was preoc-
cupied with controlling her suicidal inclinations and fears of
annihilation or “disappearing” and being alone. Issues of sep-
aration and lack of autonomy predominated. She always at-
tempted to draw her analyst or mother into participating in
every decision, action, and thought, and then would drive the
other away by increasing her demands to an inordinate level
(see Winnicott, 1945; Modell, 1976, regarding the concept of
the “holding environment”).
If her mother agreed to take her shopping on one occasion
per week, the patient escalated it to daily; or if the mother
agreed to nurse her when she was bedridden for an injured
back, she would carelessly reinjure it so the mother could not
leave her bedside. T h e ante was continually raised. Any prog-
ress on her part was seen by her as the potential opportunity
for abandonment; any demand by her mother for separation
or greater autonomy mobilized suicidal panic and helplessness
until there was a restoration of togetherness. Likewise, when-
ever she became less dependent, her caretakers would unfor-
tunately become less available, which only proved the accuracy
of her worst fears, and she instituted countermaneuvers of in-
creasing dependency and demandingness (see Mahler et al.,
1975; Masterson and Rinsley, 1980, in regard to the rapproche-
ment and practicing phases).
There was a continual need to integrate the contradictory
views she held toward her relationships. Either one complied
and was viewed as a protector, or one resisted and was viewed
as an enemy. Her aggressive impulses were blatantly and mas-
sively projected, and then by provocation she created a com-
bative scene which corresponded to her defensive fantasy. She

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 T H E BORDERLINE DILEMMA 47

could, on one occasion, with absolute confidence, resolve to stop

gorging, lose sixty pounds, and become “the world’s most beau-
tiful woman,” only to follow this with massive binging and in-
difference to her appearance. Any questioning of the
improbability of maintaining either position, let alone a re-
minder of her frivolous talk, mobilized outrage and fury over
this seeming betrayal and lack of confidence (see Kernberg,
1967).
On another occasion, she would vehemently disown an act
forever, warning me of ever encouraging her because of its
disastrous consequences to her life. Within even a day, she could
then perform the act, e.g., sing in public or have sexual wishes.
The demand to stabilize the therapeutic process might persuade
me to introduce reality or integrate her extreme versions. Thus,
I might mention the need for caution, reminding her of her
own strong doubts the prior day. Her switch was never remem-
bered (see Adler and Buie, 1979, on the failure of “evocative
memory”), and her analyst became her persecutor. My attempt
at integration mobilized .her fear of my perceived controlling,
frustrating, sadistic qualities. Of course, there was some truth
in her accusations since she induced a fair measure of these
qualities in her analyst, but it was primarily projection of her
own negative side. My acquiescence then resulted in a resump-
tion of her warm protected feelings toward me. She displayed
an all-encompassing idealizing maternal transference when it
was positive. Every thought required a hearing as empathic
understanding seemed life-sustaining (see Winnicott, 1960, on
the “subjective object” and Kohut, 1971, on the “merger” or
“primitive mirror transference”).
Any attempt to extend her associations beyond the surface
or penetrate deeper into the substratum of her fear of being
alone, empty, or feeling nonhuman, or her total absence of
sexual thoughts or feelings were met with an impenetrable wall
of blankness. Action and interpersonal difficulties dominated
her conscious focus. When sexual ideation did eventually
emerge, bit by bit, she would rapidly retreat to a state of utter

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48 MELVIN SINGER

helplessness, anxiety, and proclaim that she had no ability for

decision-making. Her life was placed in my hands and all sexual
and aggressive thoughts, feelings, and actions resided outside
of our relationship. I was vicwed as all good, had all the answers,
and shared similar lofty aspirations with her.
Eventually, when these sexual thoughts could be tolerated
for more extensive periods, the fantasy that always emerged,
but unfortunately in an all-consuming and overwhelming fash-
ion, was of incestuous, perfidious relationships with married
men, especially her father and analyst. The compulsive per-
emptory quality, heightened level of the erotic pitch, and the
revealed personages of her blasphemous wishes had a double
effect. On the one hand, she felt truly alive for the first time
in her memory; but on the other hand, that was rapidly followed
by fears of suicide, or banishment and abandonment which she
urgently provoked.
During these long periods of unavailability of associations
and fantasy, rapid fluctuation of attitude toward her analyst,
instability of mood and poor regulation of self-esteem, a com-
bination of theoretical models was used, in tentative fashion,
to organize my conceptualizing and direct my interventions.
The classic drive-defense model was primary and at the foun-
dation, but bolstered when necessary by collaboration with se-
lected aspects of the theoretical models of Mahler, Kernberg,
Kohut, and Winnicott, all of which seemed to have aided our
work by strengthening her autonomous ego functioning and
a separate identity sufficiently to set the stage for what followed.
During one session in the fourteenth year, her analyst was
again encouraging her to tolerate just a modicum more of anx-
iety so that she could better associate to her fear of being alone,
in order to understand and eventually master it. Unbearable
anxiety emerged again. Usually this agonizing fear was accepted
as unsurmountable, at least for the moment, and the drive-
dcfcrise model again temporarily replaced by one or another
model, with the corresponding intervention. Within this pro-
tected and empathically understood experience, her anxiety

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 T H E l%ORDEKLINE:DILEhIhlA 49

would decrease arid she would feel safe and secure. 1-Iowever,
on the following occasion, I felt she probably knew enough
about my ability to gauge her anxiety and had internalized
sufficiently not only the memory of my basic reliability, but her
own tension-regulating structures, to push forward and chal-
lenge more so, but still delicately, this fear of being alone.
What transpired was a Kafkaesque scene. She first devel-
oped a transient paranoid delusional transference, convinced
that I was purposefully driving her t o suicide by pressuring her
to be alone, unprotected from sotiie unspeakable (latiger. She
experienced a loss of deep sensibility in her limbs, with the
visual perception, which reached hallucinatory vividticss, that
they were slowly disappearing. As frightening atid striking as
these fantasrnagoric bodily experiences were, equally striking
were their iinmcdiate disappearance, with the wave of a ma-
gician's hand, when I relinquished iiiy therapeutic position and
shifted to one of reassurance, visual presence, emotional avail-
ability, and positive protective support.
Gradually, the following sequence became elucidated, link-
ing her strange complaints with her unacceptable incestuous
and cuckolding fantasies. Suicidal ideation always reemerged
whenever her sexual feelings toward forbidden men returned,
only to disappear if she promised herself total sexual abstinence.
Abstinence, however, was not sufficient. Further sacrifice was
demanded. There then evolved a spiritual asceticism and love
for God in which her aim was desexualized and her object
elevated to spiritual levels. Her strict, self-imposed renunciation
of life continued and extended in a stepwise deteriorating fash-
ion. What followed her rejection of sexuality was the gradual
loss of feeling alive, which had just returned for this short
period; unfortunately this too was only to be replaced by the
experience of not feeling human or a person at all. But even
that was insufficient appeasement. She only felt truly safe when
the retreat coritiriued and reached bottom at the point when
she experienced herself as a nonhuman, totally dependent en-
tity, an extension of someone else. She had to be in the contin-

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50 MELVIN SINGER

UOLIS presence of a protective other, which I could now

understand as protecting her from her own wishes. She, of
course, now considered herself to have no original thought or
desire, which was a far cry from the passionate “Carmen” of
a few days past.
Further, shc could not acknowledge her need for absolute
control and possession over her exalted protector (a mere oral
shadow of her previous oedipal ambitions!). Her associations
now were more clearly understood: the only safe position from
her incestuous wishes was either nonexistence by suicide or
fantasied disappearance or vanishing of her active phallic self.
Thus, suicide ultimately meant total absolution, while fantasied
cxistence as a nonperson, an appendage of someone else, had
the meaning of not only ultimate nonresponsibility, but non-
acknowledgment of sexual, incestuous impulses or potential. In
word language, “I could not be responsible for sexual thoughts
and passions, let alone actions, since I have no feelings at all,
I am not even a person; I exist only through your imparting
life, thoughts, and feelings to me as you would an inanimate
thing.” The less human, the better! What better disguise from
such human passionate feelings than the masquerade as a de-
humanized automaton. This insight eventually led to her first
intimate human sexual experience, ~vhicliprogressed to a more
mutual give-and-take relationship.
Over a six-month period, concurrent with her new ability
to sustain a loving and sexual relationsfiip, there slowly evolved
two alternating fantasies dissociated from each other. Either
her boyfriend was trying to kill her, or she desired to kill him.
She came to realize that she was provoking him as well as her
analyst to become sadistic and wish to murder her. Likewise,
another group of persecutory experiences toward strangers
emerged, sequestered from her periods of satisfying love life,
but clearly a consequence of it. Exploration revealed that she
repeatedly provoked these fears of persccu tory attacks from
strangers by her increasingly competitive driving, i.e., “cutting
out” other cars by making turns first at lights and intersections.

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 T H E ISOKDERLINE DILEhfhlA 51

During a session, these more unfocused fears finally converged

into a fear of a menacing evil form or presence which she sensed
in front of her-a quasi illusion which in a moment of revelation
she realized was a fantasy of her father. Her present-day lover
as well as her analyst could now be seen in the transference as
displacements representing her oedipal father with whom she
fantasied a severe sadomasochistic castrating love affair ending
in a violent, but beatific immolation scene. Thus she staged her
own Gotterdumznzerutzg in no less epic proportions than Brunhilde
and Siegfried.

Concluding Reinarks
Both patients struggled with inordinate difficulty to reach oe-
dipal conflicts and face superego guilt. For the first, the re-
gressive retreat reached the familiar terrain of anal sadism; the
dyadic oral maternal transferences that followed were con-
tained by an integrated, differentiated, and autonomous ego.
Her guilt-induced fears of castration, loss, and humiliation pre-
vented her from ever tolerating the positive oedipal transfer-
ences sufficiently to work them through. Her fantasy of
annihilation of the self drew on intense oral and anal wishes,
contents, and associated self- and maternal object images, but
ultimately was understood as organized at the phallic-oedipal
level around the fear of retaliation by the father who would in
fantasy destroy her stolen illusory penis hidden deep within her
claustrum.
In the second case, the loss of the self-fantasy drew much
more heavily and persistently on an immutable ever-present
pull toward fusion, as well as on an absolute refusal to accept
a separate existence which the patient felt could never compete
with the bliss of uno mysho. However, the truly incredible push
away from the positive oedipal complex and superego retalia-
tions became the ultimately retrievable dynamic driving force.
Significantly, even though her guilt was enormous over her
positive oedipal wishes and murderous rivalrous claims against

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52 MELVIN SINGER

her mother, this still was less than the macabre twist that even-
tually emerged-guilt over a sadistic death pact between inces-
tuous oedipal lovers. Likewise, her ego was clearly defective in
differentiation, integration, and autonomy and could not con-
tain the force of the drives and superego pressures. Further,
the inner world of mental schemas and representations were
consistently drawn into the conflict. This ego distortion con-
tributed to the wish-fulfilling self-experiences of the drive to-
ward fusion and a tension-free state.
In partial agreement with the position of Abend et al.
(1 %4), the originally expressed nonhuman experiences could
ultimately be viewed as one views manifest content, a fantasy
whose meaning is to be understood. From a dynamic perspec-
tive, the wish to destroy and eliminate the rival oedipal mother
had to be repressed and regressively revised in reverse. The
patient’s only memories were, “my mother ruined me by always
leaving me. I never was loved o r understood.” She had to con-
vince herself and the world that her mother destroyed her by
failing to provide emotional supplies which would acknowledge
her existence. But in spite of this, her extremely harsh and
punitive superego knew the truth and, as a consequence of her
first attempt at a sexual relationship, directed her either to
suicide or a living death as absolution.
The patient then presented a projected and distorted ver-
sion of this intrapsychic situation, blaming it at first all on her
mother. Ultimately, the need for total and absolute nonre-
sponsibility for oedipal and preoedipal claims created the
repression, regression, and then splitting off and projection of
the negative, associated with the complimentary oral aims for
narcissistic union with the omnipotent need-satisfying object.
However, in compromise fashion, these oral aims were raised
to such an excessive level that she always hovered between bliss-
ful gratification and hellish frustration.
One critical observation was that the Oedipus complex,
superego guilt, repression, and regressive alteration were ul-
timately seen as causative factors, but only recognizable in the

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 T H E UORDEKLINE DILEhlhIA 53

second decade of analytic work. hloreover, equally Causative

and in consort with the archaic drives, was the developmental
defect requiring the use of many noninterpretive intervetitions
to bring the ego to the level of autonomy that could tolerate
facing derivatives of the Oedipus complex. Both were equally
necessary, but neither alone sufficed as an explanatory notion.
One could eventually trace elements of hidden oedipal fantasies
deductively all the way back to the initial split self-object units
of aggressive and libidinal drive derivatives, but expressed in
regressed guise. Equally true, one can now see the pregenital
drives and developniental defects indelibly stamped on the
eventually revived form that the Oedipus complex assumed.
Shifts of attitude persist, but they are less sudden and more
easily reversible because of the reduced intensity of the drives
and the presence of a self-observing ego. Likewise, it is more
an isolation of specific contents and affects and less of the more
massive dissociation of total ego states. Impulsivity, poorly mod-
ulated affects, and the propensity toivard primary-process
thinking persist but are much diminished. This integration,
taming and diminished intensity of both drives set the stage for
the now recognized awareness and dread of her murderous
impulses toward the same person she loves. Yet she continues
to tolerate these ambivalent attitudes toward the same love ob-
ject without again resorting to massive splitting of the self- and
object representations and projective mechanisms. She is def-
initely on the way to object constancy (hlahler et al., 1975), but
certainly not there. Narcissistic preoccupation is greatly re-
duced, genuine concern, consideration for others, and reci-
procity are in the forefront of her aspirations-probably her
greatest human achievement.
Kepression was finally recognized and gradually lifted in
brittle and spasmodic fits and starts in the presence of much-
attenuated splitting mechanisms and greater differentiation
between self and object. I t bccame abundantly clear that the
libidinally based stabilization of the self and object world as-
sociated with a building u p of reaction forniations allowvd the

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54 hf ELVIN SINGER

previous condition of massive separation of libido and aggres-

sion to be replaced by their coalescence in her murderous wishes
toward thc one she loves.
likewise, in conjunction with repression, the ego could now
be uriderstood ;is avoiding absolutely intolerable superego re-
prisals by four major subsidiary mechanisms to disown mur-
derous and sadistic impulses: (1) splitting of ego states, self- and
object images, and affects of love and hate in conjunction with
projection; (2) regression to the fantasy arid associated images
of narcissistic oneness; (3) experiencing the mental self as non-
human; (‘1) experiencing the body self as empty, or “I have
nothing inside me,” in order to further deny and reverse totally
insufferable human passions. ‘These conclusions support an
earlier opinion stated in a series of papers on “Emptiness”
(Singer, 1977, 1979,1981), in which I found that certain higher-
functioning borderline patients were defending against aware-
ness of murderous rage and anal- and oral-sadistic incorpora-
tive fantasies through this bodily experience.
Another theoretical assumption can be suggested from this
second case to help explain why the superego-induced aggres-
sion against the self for forbidden oedipal wishes caused a fur-
ther retreat than in neuroses, i.e., narcissistic vulnerability of
an intact self that is perceived as ugly and inferior. Why did
this fall in self-esteem and regression extend and infiltrate into
the realm of the stability of the self-experience and beyond to
the actual human experiences and continuity of physical and
emotional being? The explanation must include not only the
dynamic meaning for the symptom as described above, but the
basis for this spt@ic choice, persistence, and mode that express
the fantasy.
From the literature on neuroses, we are familiar with the
crossiveavirig of patients’ conflicts and parental contributions
that are used defensively to prevent an adequate sexual ori-
entation arid gender identification as well as self-representation.
We are less familiar with the possibility that, before the devel-
opment of a self-awareness and personality expression of being

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 THE BORDERLINE DILEhihIA 55

male or female (gender identity) and attracted to a person who

is male or female (sexual identity), there is a prerequisite need
to first feel like a person. Even before that, it is not a given that
one feels one exists as an entity-whether as a nonliving person
or nonperson, animal, or thing-with a sameness and continuity
of being in time and space. This is the reverse of animism
-attributing nonliving qualities to living things, i.e., the self.
Whether this is merely adultomorphism and a toxic degradation
product of an uneven regression or a close approximation to
an actual developmental state is not known (Bak, 1954). How-
ever, the complaint is so commonplace among severe borderline
patients that it suggests the latter (Singer, 1987).
We are not as familiar with this because we do not usually
see it in neuroses. But in borderline patients, it is especially
poignant because it is experienced without a formal ‘thought
disorder, in the classical sense, and with intact reality testing.
Attempts to reduce the explanation of these experiences to only
being mediated by complex defensive operations primarily sig-
nifying a fantasy to be understood, as in neuroses, reveals a
lack of appreciation of the extent of their developmental pa-
thology. Yet, to see only it as a direct expression of a primitive
mental state is denying the complexity in the evolution of in-
trapsychic elaboration and the enormous problems of pre-
verbal reconstruction, but perhaps more important,’ the major
unappreciated significance of the oedipal identifications and
superego formation in the internal regulation of the self-ex-
perience as well as self-esteem. The statement in the earlier
literature (Fenichel, 1945) that severe forms of guilt can be
experienced as annihilation can now be better understood when
we conceive of the interplay not only between drives and de-
fense, but add unstable representability of mental schemas.
The observations expressed in this paper suggest that the
absolute dread of oedipal conflicts can result in resignation,
renunciation, and regression-to all points in the self-experience
as well as the well-known drive fixation and ego dedifferentia-
tion for its solution. These regressive pressures may unlock

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5G hlELVIN SINGER

structural distortions in conjunction with possibly preverbal

memories of eniotional deficiency states that may have been
previously concealed behind higher secondarily elaborated de-
fensive and adaptive ego structures. Perhaps in these cases the
concept of drive/defense/defect is more appropriate (see Frosch,
1983, p, 345), for a defect can be defensively reactivated. Un-
derstanding and treating it require combining the classic with
aspects of current object-relations models.
Pathologic interactional forces within the matrix of family
life as well ;is developmental intrapsychic distortions and inter-
personal failures in the basic ministration of emotional needs
seem to have much greater importance here than in neuroses.
A systems approach that could bridge the complementary in-
terplay between these levels is required for an expansion of
theory to niost accurately explain these cases of severe psycho-
pathology.
Further, our time frame for treatment must also be
changed and extcnded to arrive at these conclusions. If severe
borderline patients are treated intensively, using a time span
applicable for neuroses, only selected material in pregenital
dressing will emerge, played out over regressive themes of self-
and object loss. Likewise, self- and object-relations models will
prove the most congenial to guide our interventions. Unrec-
ognized massive repression will delude the observer into think-
ing the material is primarily preverbal and mediated only by
primitive defensive mechanisms. Also, because of this massive
repression and/or uneven regressive reanimation of earlier ego
functions and self-states, the limited associational material of
these severe borderline patients fails to provide the analytic
observer with the same satisfactory sense of conviction that the
rich tapestry of current contents anchored to genetic memories
of neurotic patients can provide. Here, the context, counter-
transference, in its broader sense, interactional and intersub-
jective field must be utilized to augment what the content
anaIysis lacks. The ideal within the philosophy of science that
one model of the mind should have the explaining power to

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 T H E BORDERLINE DILEhlMA 57

encompass all the data may be the most elegant and parsimon-
ious, but it is only an ideal and not yet clinically applicable.
Clinically here, as in all applied sciences, more than one model
proves necessary.

Conclusions
Long-term treatment revealed that severe borderline states, in
addition to being based and organized on trauma that occurred
at early developmental levels, involved superego pressures and
intersystemic oedipal conflicts of enormous proportions. Su-
perego-directed regression forced a retreat and renunciation
of oedipal aspirations to a most distant point, so that the pa-
tients’ self-experience was nonhuman and an extension of
someone else, thus, allowing narcissistic disturbances to hide
the superego and oedipal aspects of the case. Likewise, repres-
sion and higher-order defenses, rather than being absent, were
actually so massively in force that they remained inaccessible,
allowing visibility and full sway only to the second level of in-
teractionally based defenses. This action-oriented, interac-
tional, chaotic, and intersubjective field gave the impression of
an apparent absence of a deep intrapsychic world.
Ironically, in the first phase of treatment, repression was
only apparently present by its absence (see A. Freud, 1936, p.
8). This is reminiscent of Freud’s 1911 theory of psychosis. In
that version, repression proper (the first stage), goes on silently;
what forces itself noisily on our attention is the restitutive proc-
ess (the third stage). The difference in borderline patients is
that the attempt at restoration of the lost internal libidinal object
representation is not the hallucination or delusion, but the des-
perate clinging to real objects that must be coerced to corre-
spond to what internally is insufficiently cathected.

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