An object relations approach to borderline pathology focuses more on the role of aggression in this pathology than do some other formulations (Beck et al. 2004; Linahan 1993; Young 1994). Other approaches, including some psychodynamic approaches (Bateman and Fonagy 2004; Buie and Adler 1982/1983; Kohut 1971; Masterson and Rinsley 1975), may see aggression as the anger experienced in response to mistreatment without describing a role for endogenous aggression. In fact, our approach is sometimes charac-terized as overemphasizing the role of anger and as portraying borderline individuals as bad people. To clarify our position on aggression: we see it as a constitutional component of every individual, a product of evolution that is embedded in our neurobiology (Pankseep 1998). Furthermore, it is sim-plistic to equate aggression with “badness.” Evolutionarily, aggression has contributed to the protection of the young, the provision of resources, and territoriality. In a more civilized setting, aggressive drives can be mastered and applied to self-affirmation, creativity, and leadership qualities. A corol-lary of the simplistic notion that aggression is all bad is the notion that the all good side of early psychological development is a desirable state. Since the all good representations of self and other are no more realistic than the all bad ones, they too must be surpassed in order to allow the individual to
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adapt to the reality of life. A final note on our overall position on working with aggression in the treatment of patients is that one must often help the patient acknowledge, understand, and integrate his or her aggression in or-der to move on to a fuller development of the capacity for love, which may have been blocked by the unmetabolized and unintegrated aggression.
In normal development, the split-off good and bad segments of the psyche become integrated. This integration leads to the development of an internal world that is no longer characterized by this split—but rather by representations of self and other that include both good and bad character-istics—and allows for a flexibility in the personality that is more adaptable to the complexities of the real world (see Figure 1–4). In effecting this in-tegration, the individual moves from the realm of ideal, perfect providers and sadistic persecutors to the more realistic position of the “good enough”
other. This integration of internal images is driven by two factors. The first is cognitive development—that is, most individuals’ ability to perceive that the split model of extreme opposites does not fit the complexity of real peo-ple. The second factor is the prevalence of good, satisfying experiences over bad, frustrating ones in the personal development of most individuals; this prevalence of good experiences helps the individual tolerate some bad with-out the extreme reaction of hatred. This stage of development corresponds to Melanie Klein’s (1957) depressive position, so named because the indi-vidual mourns the loss of the primitive ideal provider while gaining access to the possibility of real human love with its imperfections, and because the individual experiences guilt for the aggressive hatred he or she previously directed toward the “bad object” when that object was the recipient of pro-jected aggression before becoming part of a more complex integrated rela-tion. The affect corresponding to this more complex other of the depressive phase is also more complex—not the simple all-love versus all-hate associ-ated with the earlier split psychic structure.
This more primitive split psychic structure is the paranoid-schizoid po-sition, in which the individual’s internal world is organized on the basis of split-off representations of all good and all bad objects (and corresponding representations of the self). The paranoid position protects the unrealistic, idealized image of the perfect provider from contamination with imperfec-tion or destrucimperfec-tion by splitting off all “badness” onto the equally unrealistic persecutory object. The individual exists in a world where he or she feels subject to persecution in order to maintain the internal images of the per-fect other and the perper-fect self, which are never encountered in reality. This model corresponds to the internal world of individuals with BPO. The de-sired evolution in therapy is toward the depressive position. In the course of this evolution, the patient comes to terms with the loss of the primitive,
ideal object and gains the possibility of true relatedness in the real world as he or she becomes aware that others may offer genuine—albeit imperfect—
love and concern and that nonexploitative, mutually caring relations are possible.
If the psychological integration that leads to the depressive position in normal human development does not take place, the individual is left with the split internal organization that, in later life, corresponds to borderline personality. Identity diffusion stems from the fragmented nature of this split internal organization. Multiple unintegrated self-object dyads vari-ously determine the individual’s subjective experience at any given moment, creating a sense of discontinuity of experience and difficulty in committing to relationships, meaningful work, goals, or values.
Libido and aggression—the life-and-death drives in Freudian metapsy-chology (Freud 1920/1955)—constitute the integration of affects of either a pleasurable, rewarding, positive series (libido) or a corresponding nega-tive, aversive, painful, and aggressive series (aggression) of feeling states.
Within this formulation, sexual excitement is a fundamental, gradually evolving affect derived from the early erotogenic potential of the infant’s body, the affect of elation, and the pleasurable stimulation of body surfaces and mucosal junctions. This sexual excitement represents the core affect of libido as a drive.
In contrast, rage, another early and basic affect, constitutes the central affect of aggression—although it is not by itself the central affect when ag-gression becomes pathological. Rather, the pathological form involves the transformation of rage as a temporary affect into hatred, which is a chronic, structured affect involving a specific internalized object relation that takes a central role in the psychopathology of aggression. The original function of rage is to communicate a basic message to the caregiver to eliminate a source of irritation or an obstacle interposing between the self and gratification.
Within this context, hate can emerge with the consolidation of the image of a bad, frustrating object, or more specifically, an internalized object relation between a suffering self and an object that willfully induces that suffering.
At a most primitive level, hate reflects the desire to destroy the bad object.
At a more advanced level—when a certain fusion between early aspects of sexual excitement and hate has taken place—the objective of hate is to in-duce suffering in the object. In this latter case, a structured, sadistic relation-ship to the object has been established. Finally, at still more advanced levels, where hate becomes more circumscribed, it represents the wish to dominate and control the bad object as a precondition for the self’s safety.
Hatred always involves intense suffering, fear of the danger of a poten-tial attack from the bad object, and primitive projective mechanisms,
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ticularly projective identification. Projective identification deals with difficulty tolerating a painful affect: a vicious circle is established by the pro-jection of (in this case) aggression, the increase of fear of the object onto whom aggression has been projected, an increased counteraggression to that fantasized aggression from the object, and unconscious efforts both to induce the object’s hateful response and yet to control the object perceived as hateful. The activation of hatred in the clinical situation usually involves concomitant efforts at omnipotent control that are linked to the sense of a threat—implicit or explicit—of violence and to the patient’s confusion about its source.
This formulation regarding the relationship between affects and drives facilitates a sharper focus on the relationship between genetic and consti-tutional contributions to the activation of aggressive affect on the one hand and the mechanisms by which early traumatic circumstances induce in-tense, chronic, repetitive rage and the vicious circle of the internalization of hate-dominated object relations on the other. The genetically deter-mined and inborn dispositions to intense aggression in some individuals are probably mediated by abnormal neurohormonal systems and result in pathological affect activation. The growing knowledge about abnormality of dopaminergic, adrenergic, noradrenergic, cholinergic, and particularly serotonergic neurotransmitters and their influence on the hypothalamic-pituitary-adrenal axis represents contemporary developments in the study of the biology of affects and of temperament—that is, the inborn disposi-tion to intensity, rhythm, and thresholds of affect activadisposi-tion (see Kernberg and Caligor 2005).
At the same time, the cumulative information about the influence of early, severe, chronic physical pain on infants’ aggressive behavior, and of chronically aggressive, teasing interactions between infant and mother on the development of intense and pathological aggressive behavior in infants and children, has enriched the earlier studies of the battered child syndrome and the findings that battered children develop increased dependency on battering parents, with reproduction of battering behaviors in their adult-hood (Kernberg 2004). The specific affect-laden relationship between self-and object representations, in which the simultaneous identification with victim and victimizer within that relationship may be reactivated with alter-nating roles, is often central to borderline personality disorder.