The current paradigm:
Psychoses and neuroses are structural variations of “rock crystal” that is the personality, according to the design system and Arcane representation of the human psyche advanced by Freud and his heirs, proponents of psychoanalysis. Psychoanalysis is the basis of the most common reading grid for mental disorders but it is, at present, virtually silent on the subject.
The wealth of clinical personality disorders and their behavioral pathological expression is no longer satisfied of this reductive dichotomy.This led to postulate the existence of a third structural entity of personality, potentially autonomous by the arrangement of its determinants psychogenetic and its inner workings are visible through the clinic.
From the mid-twentieth century, faced with the question of the limits of these structural concepts, clinicians have proposed intermediate names to mitigate the contradiction between theory and clinic. This third entity suspected empirically is neither a schizomanie or pre-schizophrenia or an incipient schizophrenia, these three terms referring to a fundamental close to psychosis. She would not return to more simple forms of insidious passage between the two poles, which would be incompatible with the Freudian binary theoretical model. It would be a third structure if not a third state or a third-world of psychiatry as subjects which fall within it are “marked by misfortune.” Conceptualizations intended to transcend the dichotomy psychosis / neurosis are many and this number sign precisely the theoretical difficulty of the problem. Today, the term limit state remains a vague term and from these considerations, we see that this notion of limit state was called “hollow”, by elimination.
However, although built using theoretical references and clinical intuitions belonging to the psychoanalytic field, this disturbing premise gives meaning to psychobehavioural enriched atypical disorders and relieve other logical resolvent that psychosis and neurosis. Thus, it subverts the model to which it refers and actually burst consistency. Therefore, even many psychoanalysts refute today.
Apart from this neo-explanatory context, many current clinical picture, would be to admit, by default, such as diagnostic errors, mixed states or hybrid forms, coincidences or the usual comorbidities. The evolution of nosology is full of attempts to make sense of these atypical tables, depending on the variation of their social visibility. We discussed the schizomanie but there has been talk of “psycho-neurosis” (Freud, about obsessional neurosis) or even “hysterical psychosis”, which was a theoretical nonsense since it was a term appending two elements owned opposable psychic structures.
Reality can bend to the theory, it is bound to draw, by its intractability, other hypothetical fertile slopes or revealing itself be therapeutic impasses since the purpose of any theory in this area remains to illuminate the practice, both in understanding the phenomenon or in the creation of original treatments.
Referring to the fact that they come from states psychic borders, rich precisely by their instability, Fineltain L. (1996), named styxose this limit provision but autonomous from psychosis and neurotic personality. This terminology has the merit of putting on an equal footing the three entities without subordinating one to the other two.
Taking into account that many people had psychological problems without completely “pour into mental illness” (that’s another sense of limit state) one could postulate that the concept of limit state corresponded to serious personality disorders.
Indeed, these “serious personality disorders,” to kind of limit states (Racamier 1963; Bergeret, 1970) constitute a significant part of a clean intrapsychical base to result in psychobehavioural specific disorders, sometimes violent and spectacular .
These problems exist both in individuals considered not pathological, but immersed in intense mental suffering chronic position if their defensive mechanisms are prevalent fail, as proven among patients treated in psychiatry, or in the great beyond of social deviants usually the psychiatrization and attending repressive places as the prison.
Thus, the field covering the borderline has gradually widened, from psychopathology to sociopathology, because, precisely, that the involvement of these intra-psychic disorders is likely to call lasting in the established order, nosography as social peace. Paranoid delusions acted in a schizophrenic is not able to be a fact of life, it will help just in negative, to facilitate the determination of the contours of a psychobehavioural normalcy and reassure “normal” on their mental health .
A neurotic remain easily into normal operation and if it goes wrong, it’s the law, as an emanation of social consensus and expression of attitudes that sanction his act. However, the fact that most borderline subjects strongly question their world makes them more readily insterticiels, even undermine the structures between which they operate. They are rejected. Their behavioral disorders patents stand the ordinary world but their lucidity (which is never in default), their obvious suffering and intelligence, bring them constantly on the side of “normopathes”.
Therefore, their behavioral visibility and impact on the world are of the order of sociopathy. They, more than any other, the distinction of being sensitive to the social context despite the fact that part of their troubles spring from the field of psychodynamics. This explains why the symptoms they present is so scalable.
The lacunose:
That is why the interest of researchers vis-à-vis this type of enigmatic personality has never wavered from originator descriptions: Hugues (1884) (quoted by L. Fineltain, 1996) as a border state madness before Freudian theory, N D. Stern (1985, 1989) and
H. Searles (1977, 1994).
We saw that this interest, guided by a heuristic clinic is focalisa just turn on the various behavioral manifestations of the disorder as many tracks to decipher its inner meaning, not always able to clearly bring them to a specific underlying provision of the psyche since it would (or could) get out of psychosis duality / neurosis.
Thus were claimed as autonomous entities sociopathic or even mental illness random or syndromic groupings as diverse as witchcraft in his time but also psychopathy or mental imbalance, alcoholism, addictions, anorexia / bulimia or sexual perversions and a nebula of small clinical pictures that are just few are aggregated into a coherent whole: Ganser syndrome, Munchausen syndrome, Lasthenie syndrome Ferjol. We shall return to these syndromes. Under separate appearances, one could see, at that time, a deep clinical entanglement beyond simple comorbidity, admitting forms of transition or succession of “disease” known to develop in a single individual at As that he grew older.
Furthermore, depending on the angle of analysis of psychic process, most of these clinical entities are potentially integrated into the group of addictions or perversions, or even pseudo-psychotic features, or “focales1 psychoses.”The same behavior can also be described as a mixed form, due to its diachronic course or its existential meaning: scatophilie include the telephone in his report to erotomania, kleptomania as perversion and addiction; the rule being systematic coexistence of several of these problems in the same person (Abel, et al., 1988). We will address these behaviors in terms of perversions.
This superficial clinical dismemberment, useful for fine semiotics, helped in identifying potential drug targets or therapeutic biophysical symptoms hoped. By its logic, it nevertheless contradicted any comprehensive analytical approach to an underlying personality alone can, however, generate a set coherent perspective to exceed their juxtaposition taxonomic simplistic, but didactic. He forbade the prospect of a consistent psychotherapeutic approach.
Experience shows that these patients, many (30% of consultations according Fineltain L., 1996), they are often exciting for the psychic economy of the caregiver, are not the easiest to deal with because they s’ prove confusing, literally. It therefore appears legitimate to seek to better remove the inner workings of their morbid behavior, sometimes spectacular, repulsive by their iteration, or endearing. This will provide relational approach or therapeutic strategies beyond simple feedback and medical social sanction, we shall inevitably reinforces the pathological behavior to freeze in a sociopathy. Yet the social sanction intervenes often still, when the deviations become too disruptive to public order and morality.
Psychogenesis of these personalities is eloquent. Their therapeutic approach is not yet codified and remains empirical, sometimes underpinned by a negative transfer-cons, both disorders and their interindividual variability as intra-individual are disturbing and often touch the blind spot caregivers reactivating positionings transactional buried in these derniers1.
It is not surprising that, apart from the extreme pathological cases related to adverse developments or caractéropathes predominant, subjects with (gifted?) Know a borderline personality emotion. They come with ease to flush out the complementary partner who manage to appease or contain them, the time of life sometimes the time of care often referent.
This potential partner is initially more or less willing, he quickly found irremediably caught up in the history of borderline subject, desubjectivated, much like some paranoid passion process that prove moreover, analysis, more often borderline psychotic that (thankfully!). They live a passion in the philosophical sense of the term.
Hypersensitivity and chronic pain subjects with BPD often prove highly complementary vectorization psychoémotionnelle their partner, that it is itself engaged in an operation or repair borderline masochistic, or is closely fitted with a neurotic personality based culpabilité2, compassion and dedication. The intimate psychology of the designated partner is obviously in question because sooner or later, after the honeymoon, when his restorative illusion will vanish when the false self of the subject 1 is borderline weaken when the primary fault will expand narcissique2 under the blows of the inevitable frustrations of ordinary or extraordinary existence, the issue of coexistence and separation will arise for both subjects. It is the sense of repetition of problems and dropout among subjects with BPD and their entourage.
It is found that abandonic questioning inherent narcissistically failed subjects will push them to explore (or explode) tolerance of their partner, often knowing where to press to make it worse, cause inevitably sometimes lead his rage or
his reaction violence and exposure to risk, once again, of being abused or abandoned. This acting out partner, such as the family environment, institution, society (Conrad Schneider, 1980) – because we are here in fractal dimensions of the subject’s environment “borderline “- confirm and validate, once again, the previous acting out, pushing the patient in his abandonic problematic by low self-esteem in a victimhood destiny. This is why we must prevent as soon as possible (in the education and healthcare field, as in the family or marital field).
This is why we must defuse much as possible (short-term perspective psychotherapeutic) that must be considered in the aftermath, sometimes contextualize an acting out (and criminological perspective victimological).
Pluralistic approaches the borderline phenomenon: the important link
Now we will place a link between state and limit, which is not found in the usual definitions. In our view this trait confers additional consistency to the expression, therefore, is not the simple juxtaposition of the two terms. Thus, one is more adjective to the other, but each individual becomes co-substantive, able to define a neo-term exceeding the meaning of its two components.
After seeing the way was born the conceptualization of a third entity from the clinic, we will address how the entity limit state has been able to clear, too, from the social context and psychodynamic theories.
Although the limit states traditionally are formal contraindications to psychoanalysis
– Since returned to the sphere
prohibitive (in psychoanalysis) psychoses
– These are theorists belonging to current psychoanalytic an interest to it throughout the second half of the twentieth century, if only to diagnose before any abusive initiation of a slice of psychoanalytic treatment, but because these positions and these psychic organizations, because of their distinct appearance, offer a wonderful insight into the neurotic and psychotic dynamics which disclaim the heart of analytic psychotherapy praxis and its theoretical base, has always hinged on the Oedipus complex.
O. Kernberg (1977, 1989) and Klein (1948, 1975) spoke, themselves, limits of personality organizations, as organizations stable, specific, mobilized, characterized by the importance of archaic defense mechanisms, traditionally seen as included in the register psychotic: denial, splitting, projective identification. O. Kernberg went further by talking about it “primitive internalized object relations.”
This ambiguity helped to strengthen some theorists, and it persists in the idea that what was not clearly neurotic could belong only to the field of psychosis, even develop the hypothesis of a gradation of severity between neurosis and psychosis made, psychosis may be as much a process as a stable state.
The difference, we believe, is that defensive mechanisms étatslimites even psychotic nature, if identified, may be sensitive to the analytic interpretation, which is neither obvious nor operating in psychosis.
According to O. Kernberg, subjects with borderline personality organization have undergone early real situations that resulted in frustration; this hypothesis is therefore not opposed to the concept of early trauma disorganizing, highlighted by J. Bergeret, and that we will develop later.
Are mentioned as the characteristics of this organization borderline personality:
– A lack of adequate primary autonomy;
– A low tolerance for anxiety and frustration, which refers to the temperamental reactions;
– The presence of aggressive impulses;
– The limits of me are still insured, which differentiates the ego
psychotic determined as fragmented or pulverized;
– The status of the object is generally ensured but the object investment is volatile, random;
– The ego itself unstable in its volume and its functions, is cleaved, weakening all the play of other bodies set up according to the model of Freud’s second topography.
The concept of splitting of the ego echoes the defensive mechanism of cleavage.
It is not contradictory with the design of a lacunar me potentially filled by a false self in the sense of DW Winnicott, the cleavage line passing then between the false self and lacunar me, much like in modern bimetallic coins. In theory, one could also imagine a flaw not following the contours of the cleavage or false individualizing chokes cleavage games or aggregates “multiple personalities”.
These are clinical entities rare, almost theoretical (James 1999 and Carroy, 1993). They are now traditionally associated lack of anything better, psychosis and characterized by alternating chronological juxtaposition or not integrated into a single identity equivalents personality (the identity of an individual is conceiving as the result of the interaction dynamics of his personality, his character, his economic, developments of his temperament, his social status and his idea of it) separate over a period ranging from days to years, the component biological surajoutant it.There is the notion of human beings as “biopsychosocial being.”
Conversely, psychogenic amnesia, which is a rare condition, although traditionally attached to the hysterical constellation, that is to say without organic cause suspicious, could be seen as a brutal identity failure, paroxysmal white identity making for, but in the same register, identities and multiple personalities.
A diagram shows various theoretical forms of self.
The notion of multiple personality is to an earlier part in psychiatry and psychoanalysis. Magnetism (Mesmer), spiritualism and occultism (V. Hugo) became interested because the phenomenon could enter their fields of understanding and cultural concerns of the time. Despine P. (1840 and 1875 if Estelle, 1880) and Azam (1887, if Felida X) helped her so released medicalized description of a mystical or occult reading, with a view of the approaching prémonitoirement hysteria, psychoclinique entity that does not yet exist. Psychopathological debate opposed at that time, the organismic theories (the idea of a hemispheric separation causing emotional dichotomy) and associationists.
Subsequently, hypnosis, as a major way of approaching the unconscious, his association with psychoanalysis and the concept of schizophrenia introduced by E. Bleuler in 1911, shook the initial descriptions. It is found more clinical case!Become obsolete, the “multiple personality” entity is found dismembered and connected
in other neuropsychiatric disorders (sleepwalking, psychotic mental automatism). Everything happened as if the mental condition had then crossed the Atlantic in the luggage of psychoanalysts. In the US, the increase in cases as the number of personalities can coexist, (up to sixty in the same individual), was remarkable but the tables remained rare in other countries.
Some psychiatrists are today, the United States, specialty: FW Putnam (1989) as a new Charcot?
The fact that the outbreak of the transition from one to the other personalities is closely correlated with psychosocial stress, existential nondialectisation conflicting personalities and the presence of concomitant dysmnésies did speak of “chameleon personality” to reconcile again to traditional clinical hysteria (Tribolet, 1998). In other times and other places, we could talk about witchcraft or demonic possession on these clinical pictures.
It is in this sense that the sociopathology and ethnopsychology affect the psychopathologie1. It is only recently that it has clarified the clinical and therapeutic features of this multiple personality:
– Very early development, from childhood, coexisting personalities.
– Significant childhood history severe trauma, with frequency of sexual abuse, which overlaps with the concept of early trauma disorganizing J. Bergeret and revives disturbingly with the first theoretical insights of Freud applicant etiology of sexual seduction turned into hysteria before this hypothesis, politically incorrect for the social order of the time, is found shelved (Freud, 1905).
– The possible healing, using the Narcoanalysis or oriented interviews. The therapeutic objective is to promote abréaction secondary personalities and their (re) integration into a single personal entity.
– The need to simultaneously treat other personalities, “as if they were real people” (Girardon, 1998).
– The orthodox psychoanalytic theorizing taking precedence over the other models, the concept of multiple personality found himself gradually marginalized and this despite the syncretic option underlying the marginal and controversial notion transnosographic hysterical psychosis we mentioned more above. It never constituted an effective reading grid of the phenomenon “multiple personality” nor mixed forms psychoneurotic found clinically.
Place multiple personalities in the social imagination gives them a special dimension and a cultural aura and specific metaphorical. It can be psychologically protective design, in itself, the possibility of a dual personality facet, one of them is responsible for seeing the dark side, probably the most interesting; there is always a Mister Hydde in us!
It’s fantastic literature, and artistic creation in general, which offer us the most eloquent descriptions of these clinical cases of duplication and dichotomy of personality, or risk having to consider, possibly, some of these genuine dissociation-duplication identity as induced or strongly colored by the cultural, as a historical avatar of hysteria while perhaps it was an avatar of narcissism: CS North et al. (1993) identified nearly twenty biographies of “multiple personalities” some of which have become bestsellers and blockbuster movies. The concept of multiple personality will find perhaps one day a new breath, less tinged with mystical and emotional considerations, thanks to limit states. In a context promoting mental contagion is still hysterical personality dimension (suggestibility, histrionics) that will be proposed again as a criterion for understanding the most clinical cases especially as the concept of split personality returns as the illusion demiurge slumbering in every human being.
Create a man of flesh or vivid appearance is nothing technical perspective. The first Magdalenian statuettes and Egyptian statuary, realistic, painted, were designed to best represent the formal appearance of a living being. This anthropomorphic object or theomorphic, mineral, needed to be animated by the powers of shamans, rituals priests, or the power of the imagination.
This magical-religious dimension is the sociocultural negative individual perverse problematic, as we will describe later, gradually drifted to an aesthetic component of the representation “of art for art’s sake.” Yet who can say he has never been troubled by a statue, a picture, a photo or even a suggestive text?
By what mechanisms polysensorial (or suprasensoriels) a human being can he and convey an emotion or idea to one of his peers?
Conversely, sculpt and transform his own body and make it a work of art (body art) is to integrate both as a Autoconstructeur fulfillment (or autodéconstructeur!) Staff, performance art, sometimes claimed as such ( Lolo Ferrari at Orlan, 19781) and as to, if not acting out of an autoerotic delirium, at least one evocative passage narcissistic act or parthenogenetic equivalent recreating oneself.
Plastic or cosmetic surgery, today certainly trivialized by technical progress and individualistic claim of compliance with guns in strengths should be taken into account that the psychic risk ultimately resides in the update, in reality , severe psycho-identity alterations induced by transforming appearance. This problem, linked to the psycho dialectic culminates in drastic surgical procedures aimed at compliance sexual identity claimed by a transsexual and her body habitus, but it is also present on the occasion of a “simple” correction of nasal bridge, as when placing a silicone esophageal ring to restrict calorie intake, or during the implementation of a piercing, a tattoo or an exogenous implant.Surgeons are increasingly driven to seek psychiatric advice before action and advise psychological counseling tight thereafter. It became, recently, a forensic imperative for certain procedures and we see tumble in consultations for a difficult review as few argumentable, men and women with no psychiatric history before the possible placement of a gastric band as a remedy for a recalcitrant obesity. During these interviews, these individuals have no obvious mental disorder but what will it be after losing fifty kilograms or worse, after the failure of the intervention?
What alterations of body image and self-esteem caused by such changes?
It is technically possible to consider, soon, the transplant of a face (cadaveric) on a facial bones previously prepared to receive it. Nerve micrografting would roughly revive the graft mobilizing muscles and tendons and so transform radically the appearance of the recipient. The recipient should (ideally?) The face of the donor. Besides mutilation unequivocally that represent the physiological preparation of the recipient – a real skinning alive, although this plasty only concern for the moment that Burn – does one has thought of all the identity alterations to manage postoperative ?It is far from a simple facelift, or the use of Botox®.
This is to be currently an experimental basis in the reconstruction of facial burn but said that drifts infiltrated narcissism and eumorphisme standard setter, will not be possible in the future?
now advances in genetic knowledge and make feasible the living things that were formerly agenda miraculous or divine. Today revive an irreversible coma by subject is no longer a medical performance. But it is nevertheless, literally, fry among living individuals already engaged in the tunnel, with all the renarcissisante dimension that it can induce in the “miracle”, we will see in Chapter 5 of this book.
Allowing a barren woman of childbearing in itself is a fantastic crossing natural boundaries, a new look at the history humanoids whose psychobiological range of the species is not yet fully assessable. But to clone a living from a stem cell and multiplies transcends the theme of the double and that of affiliation, to lead to the absolute incest (having a child of oneself) and “crime against order of generations. “
This technique will, too, inevitably, term implications on collective psychological dynamics; one is in the borderline to social dimension.
In contrast, in exceptional cases Siamese twinning, beyond the human tragedy that fascinates the human conscience, that two bodies, almost distinct, may have the same personality and intertwined destinies (there are troubling case this view in which one of the Siamese begins the sentence and the other ends), dissociation personality / identity determines other questions on the psychogenesis. In some circumstances, it is the sacrifice by surgical dissection of one of the bodies that saves the personality of the surviving (and at what cost!), As to the expected development of this personality?
If this is to create (or edit) a personality that remains the most difficult and which ultimately is the ultimate transgression, the psychotherapist, “physician of the soul”, is it not then the most transgressive doctors?
Golem, cyborg, fantasy creature and Dr. composite Frankenstein or chimeric creatures of Dr. Moreau, contemporary animal clones or human procreation beyond natural limits, eventually only the ethical consensus in social and historical connotations may propose a temporary limit and dialectization between delirium and deviance these two concepts being constantly re-examine. In all the works of fiction narrating such experiences, the story ends badly and this issue, always tragic, is related to the fact that the personality of the creature escapes its creator and is not like him pas1.Analysis of the film foundation shows that if the creature of Dr. Frankenstein skids behavioral point of view it is mainly because it does not like (does not feel loved!) And, in all films of the genre , cyborgs, like all offspring, permanently escape the control of their designer: these artistic and cultural creations are metaphors articulating the desire nightmare in borderline problematic.
We see here that the issue of double remains with the problem of split personality and it is a question of engendering without fertilization, re-registration in a dynamic, a time advance after being frozen. But this process will clear a historicized past. There is talk of a new original time and iteratively re-creation of the world, which brings to delirium parthenogenetic as to issues of transgenerational disease transmissions, at work in some dysfunctional families. We are in the perversion of natural limits.