ABSTRACT
Prior to referral for analysis, Ms. B, age 40, was assessed by an experienced analyst in whom she confided her crippling, lifelong feelings of depression and loneliness. During a painful assessment the analyst made a simple statement that has stayed with the patient: “You seem to have no people in your mind.” By this I believe the analyst meant that no good object of either gender had been internalized. Ms. B’s subsequent analysis has shown this to be largely the case. This chapter seeks to show how Ms. B’s capacity for sustaining object relationships has been severely compromised by unresolved immature identifications, the origins of which lie in her early relation with her mother. It also shows how an ensuing, profoundly damaging incestuous relationship with her father was constructed on the basis of her disturbed identifications with her mother. I shall describe Ms. B’s borderline pathology and the significance of anorexia nervosa in it. Ms. B has been diagnosed psychiatrically as suffering from a paranoid psychosis, to which she remains vulnerable. A pathological narcissistic organization (cf. Rosenfeld, 1964, 1971), to which the patient has given the name the “Director,” and through which her psychosis found expression, has controlled much of her mental life leading her to try to take her life on a number of occasions. The difficulties involved in analyzing the transference in such a disturbed patient led to certain modifications in technique, which I shall describe. Finally, I consider whether the patient’s shifting identifications and difficulties in distinguishing between fact, memory, and fantasy constitute a discernible pattern or syndrome.
