Neurotic, Psychotic Or Borderline Personality Structure: The Possibilities Of Psychoanalytic Therapy

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

"There are no healthy people, there are under-examined" - the famous joke of psychiatrists is no longer a joke, but a reflection of modern reality. Almost every person in modern society by a certain age falls into a zone where his psyche is faced with the impossibility of rethinking and adequately reacting to a problematic - "unbearable for him here and now" - stressful situation.

As a result, a person develops neurosis or psychosis, depending on the type of personality organization - neurotic or psychotic. That is, getting into an unusual, extreme, extraordinary situation, it depends on the type of personal organization how a person will react to what happened to him.

How is the type of personal organization formed, in other words, the structure of the personality, and what influences its formation? Consider this in the context of psychoanalytic theory.

First, constitutional predisposition plays a huge role;

secondly, the course of pregnancy and childbirth in the mother;

thirdly, the presence of experiences that are subjectively perceived by the child as stressful, the presence of psychological trauma in early childhood and the fixation of the psyche on such events and experiences;

fourthly, the invention of individual ways of responding to stressful situations experienced - psychological defenses that a child develops in childhood, and then a person unconsciously uses his entire life.

The typology of personality structure is the most important characteristic of a person. Thanks to her, the psychotherapist understands the thinking strategy of the person who asked for help, learns how and by what means the person ended up at a given point on the system of his life coordinates and, in accordance with this, can skillfully plan the course of providing psychotherapeutic assistance and predict the possible end result.

It is possible to determine the type of personal organization during a diagnostic interview according to several main criteria (according to Otto Kernberg):

1. The degree of integration of a person's identity - the level of development of the ability to perceive the positive and negative aspects of one's personality and other significant people as a whole, the ability to correlate oneself by gender to a particular sex, the ability to give oneself and others a full detailed description.
2. Types of habitual defense mechanisms - people use various psychological defenses to adapt in society, to live in an unusual or unexpected, unpredictable situation for them; the leading individual defense mechanisms are the most important way of human interaction with the outside world and with events that occur with it.
3. Reality Testing Ability - understanding what was really, and what was completed by their own imagination; the absence of delusions, hallucinations, the ability to distinguish between one's own and other people's thoughts, to separate oneself from others (I and not-I), to distinguish the intrapsychic from external sources of experiences, the ability to critically relate to one's affects, inappropriate behavior, illogical thinking, if any, have observing and experiencing I, that is, the ability to reflect.

Based on these criteria, one can notice a huge difference between the organization of neurotic, borderline and psychotic personality structures.

People with neurotic personality structure have an integrated sense of identity, their behavior has some consistency, integrity. They are able to describe and understand themselves and the other people around them as whole images, including both negative and positive characteristics, disadvantages and advantages of both temperament and character, value orientations, etc. In their perception of themselves there is a clear boundary between their own sense of themselves and the feeling of others, as people separate from him. To be able to cope with experiences and stresses, neurotics choose mature defenses, such as repression, rationalization, intellectualization, isolation. They retain the ability to test reality, and the ability to assess themselves and others realistically and deeply. They are not familiar with hallucinations and delusions, there are no clearly inappropriate forms of thinking and behavior, and they experience empathy and understanding in relation to the experiences of other people. They perceive their symptoms as problematic and irrational. They have observing and sensing parts of their own "I", that is, they can reflexively observe the states they are experiencing. Neurotics have the ability to question their beliefs, they are in a constant search for truth, they try to live and be useful to other people, earn the love and understanding of this significant other person for them, conscience and moral values dominate their true desires, which they can ignore or displace. The conflict arises in the plane of their desire and those obstacles that block the path to its implementation, but are, in their own opinion, the work of their own hands.

People with a psychotic personality structure inwardly much more devastated and disorganized than others. It is not difficult to distinguish those who are in a state of acute psychosis from others - psychoses are manifested through delirium, hallucinations, illogical thinking. However, in modern society there are many people who are at the psychotic level of personality organization, but their inner confusion is not noticeable on the surface, if they are not subjected to severe stress. Therefore, it is important to understand what makes these people different from the rest. Psychotics have serious identification difficulties - so much so that they are not completely sure of their own existence, they cannot coherently describe themselves and other people they know and be critical of their own characteristics. They are characterized by primitive defense mechanisms: withdrawal into fantasy, denial, total control, primitive idealization and depreciation, splitting and dissociation. But the main distinguishing feature is the lack of reality testing, that is, a lack of understanding of the questions being asked, inappropriate feelings or behavior towards the therapist or other significant people and events, the presence of hallucinations in the past, delusions, and an inability to be critical of them. The boundaries between external and internal experiences in such people are blurred, and there is also a clear deficit of basic trust. Those who are prone to psychotic disorganization experience a sense of insecurity in this world and are always ready to believe that disintegration is inevitable. The nature of their main conflict lies in the plane - life or death, existence or destruction. Therefore, in order to survive, psychotics have to go into a fictional world that is not subject to doubts, they are logically very grounded and very strongly protected from outside criticism and interference.

People with a borderline personality structure are in the middle of the neurotic-psychotic continuum, so their reactions can be characterized as swinging between these two extremes. Their sense of self is full of contradictions and ruptures, however, unlike psychotics, their sense of inconsistency and discontinuity is not accompanied by existential horror, but is associated with separation anxiety. Also, despite problems with identity, unlike psychotics, they know that such exists, they retain the ability to test reality, that is, there are no delusions and hallucinations, although a tendency to magical thinking is inherent. Unlike neurotics, they rely more heavily on primitive defenses such as splitting, primitive idealization, denial, and omnipotence. The central conflict in borderline clients is that when they feel close to another person, they panic out of fear of absorption and total control, and when they feel separated, they feel traumatic abandonment. The situation when neither closeness nor remoteness is satisfying, exhausting them and the people who are next to them. The ability of border guards to observe their pathology is greatly weakened. Panic attacks, depression, or illnesses that the patient believes are stress-related characterize their specific complaints.

Based on the above, it is a competent and timely diagnosis of the type of personal organization that makes it possible for a psychotherapist to provide qualified and substantiated psychotherapeutic assistance.

NS sychoanalytic therapy with a neurotic aims to soften his defenses and to gain access to unconscious repressed desire so that his energy can be released for more constructive activity. In other words, the goal of therapy in this case can be considered the elimination of unconscious obstacles to obtain complete satisfaction in love, work and entertainment.

Against, psychoanalytic therapy with a psychotic patient should be aimed at strengthening defenses in order to cope with primitive impulses, as well as developing the ability to more easily experience real stressful circumstances, that is, to adapt the thinking of such a person to specific life situations.

The goal of psychoanalytic therapy with borderline patients, is the development of a holistic, reliable, comprehensive and positively meaningful sense of ourselves. Along with this process, there is a development of the ability to fully love other people, despite their flaws and contradictions.

Summarizing all the material presented, I would like to emphasize that each person has a certain personality structure: neurotic, borderline or psychotic, which is formed in childhood and does not change throughout later life.

Each specific structure limits each specific person in his ability to manifest and exist in this world, to resist negative life situations and mentally react to them without collapsing

Psychoanalytic therapy enables people from any of these structures to understand their uniqueness, to understand the root cause of their own pain or suffering and, through the prism of their individual life experience, make a choice of a further strategy of existence

Literature on the topic:

1. Nancy McWilliams "Psychoanalytic Diagnostics"
2. Otto Kernberg "Severe personality disorders"