Toward a New Understanding of the Borderline: Reflections
THE BORDERLINE, WHOSE very name connotes indeterminateness, once dwelled in the penumbra of psychoanalytic thinking, being consideredwhen it was considered at all-but a waystation between neurosis and psychosis. The cursor of the Zeitgeist has changed. Patients whose personality, affects, and relationships are disturbed by primitive but nonpsychotic mental disorders do not neatly fit into the old categories, but demand rethinking of our nosology. Empirical psychiatrists, particularly researchers, press for more rigorous diagnostic criteria to establish homogenous patient populations and higher interrater diagnostic reliability; some even deny the relevance of the category "neurosis" itself. Old definitions and categories of psychopathology are further challenged by the need to integrate new data from such other disciplines as neurobiology and infant observation research. The borderline emerges from many such nosologic revisions as an important entity, located in the mid-portion of a spectrum of disorders ranging in severity from the upper border of higher functioning personality disorders to the lower border of psychosis.