Personality Organization
The theory on borderline personality organization was conceptualised by Otto Kernberg. He is a psychoanalyst and professor of psychiatry at Weill Cornell Medical College. His integrative writings were central to the development of modern object relation theory, a theory that is perhaps the most important achievement in the development of modern psychoanalysis.
The concept of personality organization in Otto Kernberg:
The organization types of neurosis, borderline state, and psychosis are reflected in the dominant personality characteristics of the patient, especially with regard first of the degree of identity integration, 2 of the types of defenses, that he uses common, 3 of its ability to test reality. I believe that the neurotic personality structure, in contrast to the structures of borderline states and psychosis, an integrated identity implies.
Personality Structure
The neurotic personality structure has a defense organization that is centered on repression and other defense mechanisms of the middle or higher level. In contrast, on to structures of borderline states and psychoses in patients who dominate primitive defense mechanisms, center in the mechanism of cleavage.
Reality Check
The reality check is in the personality organization of the neurotic and borderline patients received, in that of the psychotic but is significantly affected. These structural criteria can complement the usual behavioral or phenomenological descriptions of patients and contribute to greater accuracy and differential diagnosis of mental illness, especially in hard-classifiable cases.
Other Criteria in Differentiating BPO from Neuroses
Additional criteria that help differentiate the borderline personality organization of the neuroses, are the presence or absence of non-specific manifestations of Ichschwäche, particularly of anxiety tolerance, of impulse control and ability to sublimation and? for the differential diagnosis of schizophrenia? the presence or absence of primary process thinking in the clinical situation? The level and quality of superego integration are additional, for the prognosis important structural features contributing to differentiate between neurosis and borderline personality structure. “
In the following interview explains Otto Kernberg his view on the psychoanalytic concept of personality disorders and psychoanalysis.
The Seeds of the Self
An interview with Otto Kernberg by Susan Bridle
Introduction
….
We were delighted when Otto Kernberg, one of the primary engineers of the theory squeezed an hour into his busy schedule to speak with us. Kernberg, who at age seventy-two still works a seventy-plus-hour workweek, is a renowned psychoanalyst, clinical researcher, developmental theorist, psychiatric treatment innovator?and a legend in the annals of psychology.
Otto Kernberg’s Biographic Note
A native of Vienna, he immigrated to Chile with his parents during the Second World War. He earned his undergraduate, medical and psychoanalytic degrees in Santiago, where he began his professional and academic career in the 1950s. Dr. Kernberg is not only a principal architect of object relations theory but is also widely regarded as the world`s leading expert on borderline personality disorders and pathological narcissism.
Current President of the International Psychoanalytic Association, founded by Sigmund Freud in 1908, he is also Director of the Personality Disorders Institute and the Cornell Psychotherapy Program at The New York Hospital, Cornell Medical Center and Professor of Psychiatry at the Cornell University Medical College. He is the author or coauthor of thirteen books as well as dozens of research papers.
In his more than forty years of research, including clinical work with severely disturbed patients, Dr. Kernberg has inquired with laser-like precision into the subatomic components of the psyche and identified what he believes are the most fundamental building blocks in the construction of self-identity. In our conversation, as he walked me through the basics of object relations theory, I was drawn with him into looking at human experience through the piercing clarity of the object relations microscope.
Sense of Self
I began to grasp intellectually, intuitively and even experientially his intricate vision of how the separate sense of self gradually takes shape from the moment of birth? How undifferentiated fragments of raw experience eventually cohere into emotionally charged images of self and others, and progressively coalesce into an integrated, internalized sense of self and an integrated inner “representational world” of others. Indeed, after a course in object relations from Kernberg himself, or after reading the books in which he outlines his theory, it`s hard not to be convinced that selfhood is not inherent in human experience from birth, but is in fact entirely a mechanically constructed phenomenon.
The Nature of the Ego
Speaking with Dr. Kernberg about the nature of the ego was meeting a visionary, encountering a mind with rare quality of attention, expanse of perspective and subtlety of discrimination. He possesses an unusual flexibility and originality of thought that easily embraces subjects normally beyond the scope of traditional psychoanalytic thinking, making him not only a defender of Freud`s genius but a Freudian revisionist with a mission for psychoanalysis in twenty-first-century society and culture. I was honored to have the chance to explore the mystery of the seeds of the self with one of modern psychology`s foremost pioneers.
Interview
Susan Bridle:
Could you please define the word “ego” as you have come to understand it?
Otto Kernberg:
The ego is an invention of the English translation of Freud`s “Ich.” “Ich” in German means “I,” and it refers to the categorical “I,” or to what also is called the “self,” insofar as it has a subjective quality to it. Sigmund Freud never clearly differentiated the impersonal, structural quality of what “ego” means in English from the subjective quality that the word “ich” signals in German. James Strachey, in his translation of Freud, tried to make him sound more scientific by bringing in Latin terms and making everything more precise. In the process he decreased somewhat the fluidity, humanity, warmth and flexibility of Freud`s terminology and the poetic aspect of Freud`s writings.
It is true that Freud in 1923 started to describe his “Ich,” his “I,” his “self,” as a structure of the psychic apparatus in contrast to the id and the superego. And this was then picked up by the ego psychologists, particularly in this country. Many characteristics of the ego have been defined. The ego is the seat of consciousness; it`s the seat of perception. The ego controls motility; the ego controls unconscious defense mechanisms; the ego is the integrating agency that brings together the demands of external reality and the superego. While all of this sounds a little mechanical, they are impersonal functions, and classical, pureego psychology went in that direction, losing touch with the subjective quality of the self-concept. So this is why nowadays there has been a reaction against this.
Object relation theory is a contemporary psychoanalytic theory that puts the emphasis on the importance of earliest relations with significant others as the building blocks of the construction of the tripartite structure of ego, superego and id. More specifically, from birth on, our relations with significant others, under the impact of strong affects [emotions], are internalized as affective memory. These basic affective memories contain the representation of the self, the representation of other called “object” in object relations theory?and the dominant affect linking them. There are many of these dyadic structures of self- and object-representations that eventually consolidate. All the self-representations are eventually integrated as an integrated self. And that integrated self practically corresponds to the “I,” to the categorical “I” or categorical self of the philosophers.
In simple terms, one might say that from birth on we have an inborn capacity for perception, for memory, for establishing representations of what is perceived, and gradually we develop symbolic thinking and the capacity for abstract thinking and intelligence. We absorb what`s going on around us, our relationships with things and with people.
The ego is like a computer, absorbing information, integrating it and learning how to sort out what is important from what is not; what is good, what is bad; what is helpful, what is damaging. We learn the control of our own body, and we gradually learn to differentiate what`s inside from what`s outside. And eventually, an internal world is built up. Part of this remains in conscious memory, in consciousness?a small part. And a large part goes into unconscious memory, into what is called the “preconscious.”The preconscious is like a reservoir of information that we don`t think about all of the time, but that we have access to. And part goes into a still deeper level, the dynamic unconscious or the id.
Now, what`s in that dynamic unconscious or the id? All of that which the ego or self cannot tolerate in consciousness. It`s just too intense; it`s too dangerous, and it tends to get forbidden. Freud said that what are particularly intense and tend to get forbidden are early sexual impulses and desires and early aggressive impulses and desires.
So the ego has the double task of general learning as well as setting up an internal world of representations of self and others. And these representations are gradually integrated, so then the ego develops an integrated sense of self and an integrated sense of significant others?an internal world of the people we love and who love us?or what Joseph Sandler called the “representational world.”
The ego, in short, is the seat of consciousness, of perception, of motor control, of conscious memory, of access to the preconscious. But also?and very fundamentally? it`s the seat of the world of internalized object relations and an integrated sense of self.
SB:
Many spiritual traditions define the ego very differently from the way that the psychoanalytic tradition usually speaks about it. In fact, the ego is seen not as something that we would want to cultivate or develop, but as the very force within us that we must do battle with and ultimately extinguish if we want to evolve spiritually. In these traditions, the ego is understood to be the force of narcissism and self-centrism and as the insatiable and fundamentally aggressive need to always see ourselves as separate from others. These traditions see the ego, in this sense, as the enemy on the spiritual path?as that which thwarts our higher spiritual aspirations. In your work, have you encountered anything like this within the human personality?
OK:
I`m familiar with this approach to spirituality; one finds this particularly in Eastern religious movements. However, it seems to me that there are semantic problems here. There is a psychoanalytic concept of narcissism. At the clinical level, “narcissism” refers simply to self-love, self-esteem and, at a more theoretical level, to the investment in the ego with libidinal energy. When Freud coined the concept of narcissism, he assumed that libido was first invested in the self and then later displaced onto others. And eventually, a certain equilibrium is established by which one invests both self and others with libido or love.
One implication of this early formulation is that if there is too much self-love, there is not a lot left for loving others. And if there is too much altruism, there is not much love left for self. This early formulation, however, has been questioned in the light of later findings. Now, the dominant psychoanalytic thinking is that the loving investment in self and in others occurs simultaneously and that under normal conditions, self-love and love of others go together. Those happy natures who have been treated well are at peace with self, can be very secure, love themselves?and at the same time be very committed to others.
This is very different from abnormal conditions in which there is abnormal self-love. Pathological narcissism is what is usually called an “ego trip.” This is an individual with an exaggerated love of self and in whom there is a devaluation of others. There is an impoverishment of that internal world of significant others, the representational world that I described to you. So these individuals who are very full of themselves at the same time don`t have an internal world of representations of significant others nor the richness of an internal moral world, and they are excessively dependent on being admired and accepted by others.
On the one hand, these people are very grandiose, yet on the other, they are easily hurt, feel easily rejected and easily can get very envious and resentful of other people who don`t suffer from the same hypersensitivity that they do. When you have somebody with what`s perceived as a very great ego, that usually indicates the existence of abnormal narcissistic structures, where the love is invested in self with a kind of grandiosity, entitlement and ruthlessness.
There is also a sense of emptiness that goes with this because the richness of life comes from our gratifying intimate relations with significant others as well as from our appreciation of ideals that are outside of us, for example, in the area of truth or science, or the area of aesthetics or art, or in the area of religion and moral values. People with an abnormal grandiose self-sense cannot invest normally in these values, and their life is impoverished.
So from the psychoanalytic viewpoint, the idea that spirituality implies an effort to reduce the importance of the ego, of narcissism, in order to open oneself up to religion, to art, to truth, holds true for narcissistic pathology, but not necessarily for normal self-esteem or self-regard. That should be harmonious with spiritual development. And there is a natural religiosity that is part of normal development, reflected by all of the trends toward developing an integrated internal moral system.
Psychoanalysis has nothing to say about the existence of God that`s a philosophical problem, not a psychological one. But certainly there`s something to say in the sense that religiosity is a profound human need and that the religions?or universally organized moral systems directed to protect what is good against evil?make eminent sense from a psychological viewpoint because evil exists. It exists in the sense that primitive aggression is always there as a potential in the human mind. It shows up not only under abnormal conditions of the individual but it also shows up when there are what we call “regressive group situations,” regressive mass psychology situations in which aggression can rapidly take hold and, therefore, represents concretely what we call “evil.”
SB:
Traditional religious or spiritual perspectives tend to see these matters as more absolute; there is not a distinction between “normal” and “healthy” narcissism and, in fact, “healthy narcissism” would be seen as an oxymoron because, from this point of view, anyform of narcissism would be seen as a negative expression of self-centrism and failure to show awareness of and concern for others. From this perspective, the seeds of narcissism are the seeds of corruption and evil. Based on your experience as a psychoanalyst, do you think that it is possible to uproot all vestiges of negative narcissism within the self? Is this an ideal that you would even encourage people to strive for?
OK:
Well, again, the idea that spirituality and narcissism cannot go together I think is a mistake, because it does not properly differentiate between normal and abnormal narcissism, as I have explained. Secondly, by the same token, one cannot say that the evil in the world is constituted by narcissism. But it is significantly constituted by pathological narcissism. And I would add even further, it is constituted not just by any pathological narcissism but by the most severe forms of it?in which there is a particular malignant development that consists of a return to primitive aggression and an idealization of the self as an aggressive self with power over others.
This pathological idealization of the self as an aggressive self clinically is called “malignant narcissism.” And this is very much connected with evil and with a number of clinical forms that evil takes, such as the pleasure and enjoyment in controlling others, in making them suffer, in destroying them, or the casual pleasure in using others` trust and confidence and love to exploit them and to destroy them. That`s the real evil that synthesis between pathological narcissism and primitive aggression. And we find that at the level of individuals and in groups as well. Sometimes we find it in organizations. We find it in certain fundamentalist ideologies; we find it in certain aspects of mass psychology. That`s the real evil.
But to answer your question: No, it is not ideal to divest everybody of narcissism because normal narcissism is a source of pleasure in living, of enjoyment of self, enjoyment of healthy self-affirmation, healthy aggression, enjoyment of sexuality, eroticism, love, intimacy. This is all part of normal narcissism. And what I am trying to say, in essence, is that I see no contradiction between normal narcissism and the spiritual orientation, although there is all the contradiction in the world between abnormal narcissism and spirituality.
SB:
Within many religious teachings, a central aspect of spiritual practice is rigorous self-inquiry, in which one looks deeply into the nature of one`s motivations. In this self-inquiry, one confronts and comes to terms with some of the narcissistic tendencies you were just describing?albeit in a much subtler form than these extreme cases. In the religious traditions, one is looking at this negative narcissism?it`s still negative or malignant narcissism rather than positive narcissism?but it`s at a subtler level, and it`s this that the spiritual practitioner is trying to root out from within their motivations and from within their psyche.
OK:
Yes, I understand that. In fact, the goal of psychoanalysis is to increase our self-knowledge of the unconscious motivations of behavior. Freud at one point said that there will always be objection to psychoanalysis, that he has brought a plague to humanity. What he meant was that we all have primitive, antisocial impulses, sexual desires, aggressive desires, that run counter to the needs of culture. Under the best of circumstances, these are transformed into culturally useful and positive elements. Under the worst of circumstances, they become evil.
What I`m trying to say is that the deepest, unconscious motivations have in them the seeds of both good and evil. I agree that self-reflection and an honest search for one`s unconscious motivations increases knowledge and meaning in life. It has been said that “only an examined life is worth living.” And psychoanalysis has helped with that. This searching self-reflection for unconscious motivations may provide not only greater knowledge of the self but also may help to free oneself?at least in part?of the destructive aspects of repressed conflicts. In this regard, self-reflection and an honest search for one`s motivations helps spirituality, but it does not necessarily bring happiness; it also brings the pain and sorrow of discovering that we are less ideal than we wanted to think ourselves.
SB:
In many Eastern religious traditions, the highest goal of human evolution is called enlightenment. One way of defining enlightenment is that it is a condition in which one is utterly awake and in touch with reality exactly as it is. It is a condition in which one is no longer motivated in any way to distort reality, to preserve one`s self-image, or to support any personal bias or agenda. In this view, the ego is seen as a distorting mechanism, as the colored glasses that must be removed if we are to be able to see things as they are and to respond to life with true integrity.
Now, one of the central activities of the ego is the screening or distorting mechanisms by which impressions or information that contradict or challenge one`s self-image or worldview are selectively ignored or distorted. Do you think it is possible to reach a state where one is no longer compelled to screen anythingout to protect one`s self-image or worldview? Do you think it is possible to attain a condition where one has no need or motivation whatsoever to distort reality in any way and, therefore, is able to be completely in touch with reality exactly as it is?
OK:
I think that there are certainly degrees of freedom from distortion, and I would say that a function of the normal ego is to try to achieve enlightenment in the sense of decreased distortions and being able to see reality?both external and internal?as it is. But it seems to me that this is an ideal state that is reached only partially by most people and most likely not as a permanent condition, but oscillating. In other words, there are always unconscious needs that influence us.
The shadow of our dynamic unconscious colors all of our perceptions, and it is almost inhuman to be able to free oneself completely from that. So I would say that enlightenment as you describe it seems to be a road, an aspiration. But I would seriously question that possibility in an absolute sense?except perhaps for extremely gifted, unique individuals whom we would consider saints. And even those probably have achieved such a condition only in a transitory way.
SB:
Harvard psychiatry professor George Vaillant, in his book The Wisdom of the Ego, asserts that ego defenses are not pathological or symptoms of mental illness, but are in fact ingenious resources of the psyche for adaptation and even creativity. He says, “At times we cannot bear reality. At such times our minds play tricks on us. Our minds distort inner and outer reality so that an observer might accuse us of denial, self-deception, even dishonesty. . . . But often such emotional and intellectual dishonesty is not only healthy but also mature and creative.” Do you agree that emotional and intellectual dishonesty is often not only healthy but mature and creative? Or do you believe that a truly healthy human being is one who is undefended?
OK:
I think that everything he`s saying is correct. I would just change some of the emphasis, in the sense that while it is true that self-deception may occasionally be life-saving, in general, the more severe forms of primitive defensive operations tend to weaken the ego. Denial, for example, is a defense that may be helpful sometimes. There are certain conditions, such as when an individual hears terrible news about a mortal illness, or about the death of a close relative or some other major tragedy and they react with a kind of a defensive numbness. This is a form of denial, but it may be a denial that helps survival. Defense operations may help survival and protect functioning under certain conditions. But, in general, it is of course true that the more we tolerate reality, the better off we are.
SB:
What is the ultimate goal of psychoanalysis? What do you think is the highest human potential with regard to ego health and development?
OK:
In very simple terms, Freud said that the goal of psychoanalysis was to help individuals to be able to work and to love. And to expand a little on it, I would say the goal of psychoanalysis is to free individuals from the restrictions of unconscious conflicts and the defenses related to them, as well as to resolve a lack of integration of the internal realm of object relations?in order to permit people to commit themselves to work, to creativity and to mutuality of love relations. Also, to open themselves up to the scientific, moral and aesthetic perspectives. And of course, more specifically, to resolve the symptoms for which the patient comes to treatment. But these would be the most general goals.
SB:
Object relations theory has been adopted by many contemporary transpersonal psychologists, particularly those with training in Buddhist psychology and philosophy, because it seems to support the Buddhist teaching that there is no self?that we are not born into this world as an independent entity in the way we think we are, but rather that our independent sense of self is actually a delusion, an illusory manifestation of mutually dependent coorigination.
Transpersonal therapist and teacher of Buddhist philosophy Jack Engler writes, “Both Buddhist psychology and psychoanalytic object relations theory define the essence of the ego in a similar way: as a process of synthesis and adaptation between the inner life and outer reality which produces a sense of personal continuity and sameness in the felt experience of being a `self,` a feeling of being and ongoingness in existence. . . . In both psychologies, the sense of `I,` of personal unity and continuity, of being the same `self` in time, in place and across stages of consciousness, is conceived as something which is not innate in personality, but is evolving developmentally out of our experience of objects and the kinds of interactions we have with them.
In other words, the `self` is literally constructedout of our experience with the object world. This `self` which we take to be `me` and which feels so present and real to us is actually an internalized image, a composite representation.” So, my question is: Are we now, the two of us having this conversation, two composite representations of the many internalized images that have arisen out of our encounters with the object world? Or, is there a self that exists prior to or beneath this process? Is there a self independent of the whole process of object relations development?
OK:
I don`t think that the self is an illusion. I believe that`s wrong. But it is true that the self is an entity of subjective experience, sameness, continuity and differentiation from others that is constructed out of our experiences with significant others from the beginning of life. That is true. From the beginning of life there`s a sense of subjectivity that develops in the context of relations with others whose representations or images we take in and that shapes our representations of ourselves. And those multiple representations of ourselves eventually coalesce to form an integrated self, which is a reflection of the integration of our subjective experiences in our interactions with others from the beginning of life. And it becomes a very important central agency in organizing one`s subjective life, one`s relations with others and one`s character?that is to say, the dynamic organization of habitual behavior patterns.
SB:
You said that prior to the whole process of integrating self- and object-representations, there`s a subjectivity that is present?
OK:
There is a capacity for subjective experience of pleasure and pain, for registering representations and establishing memories from birth on. That imagery gradually consolidates as multiple dyadic representations of self and object.
SB:
Could we in some sense say that this subjectivity, this experiencer, is the self? A self, in some sense, that exists independent of self- and object-representations?
OK:
No. I wouldn`t say that. I would say that there are fragmented self-experiences from birth on that gradually coalesce and are integrated. And, eventually, there is an integrated self that relates to integrated representations of significant others. The self is always in relation to significant others. Again, the experiencer, the person who experiences, has early self-experiences, and these are the self-representations that finally coalesce into an integrated, cohesive, subjective sense of self.
SB:
The subjective experiencer itself, prior to the content of experience?what would you call that?
OK:
Simply the capacity of the central nervous system to acquire a sense of subjectivity?subjectivity that has elements of pleasure and pain and that registers the perceptions of the external world in the form of memories.
Source: Enlightment Next Magazine
http://www.enlightennext.org/magazine/j17/kern.asp
http://www.enlightennext.org/magazine/j17/kern.asp?page=2