“The central phobic position”

André Green’s paper “The Central Phobic Position: A New Formulation of the Free Association Method” was published in Part 3 (IJP, 81, pp. 429–451), and was made available some weeks prior to publication on the International Journal of Psychoanalysis’s website for discussion. This chapter is based on a commissioned review of Green’s paper for IJP and the discussion that took place over the Internet. The review and discussion were published in IJP and Key Papers on Borderline States (Williams, 2002). This chapter examines the clinical utility of Green’s identification of a core phobic response in a certain type of borderline patient. I suggest that where there exists an incapacitating core confusional state deriving from a multiplicity of disturbing and traumatic experience (these may be inchoate, unassimilable part object relationships, psychotic anxieties, traumatic memories, or psychosomatic symptoms), the individual fears that the breaching of systemically organized defenses at any vulnerable point may lead to a “cascade” of overwhelming, traumatizing experiences leading to insanity or other mortal catastrophe. In this type of borderline organization, conflict and the use of aggression (so prevalent in borderline mental life) serves to defend against fears of concatenation leading to collapse of the ego into what is feared will be a psychotic (schizophrenia-like) state. Such patients are likely to exhibit the central phobic responses described by Green, and attention to chronic fears of engulfment and disintegration is necessary if the patient is to relinquish reliance on the systemic armor of continuously proliferating, overlapping defenses. Following a discussion of Green’s paper I illustrate the nature of this clinical problem by referring to the analyses of two patients and their phobic responses to the analysis, which were designed to ward off fears of collapse.