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I have attempted a new description of the salient clinical phenomenology of the primitive personality disorders (borderline, narcissistic, paranoid and schizoid), focusing in particular on absence of personality integration, sensori-motor-affective thinking, and an inability to recognize and to own significant emotional predispositions and institute appropriate behavioral adaptations. I conclude that these phenomena cannot adequately be comprehended either from the classical intrapsychic perspective and the cognitive and affective capabilities assumed to exist in normal and neurotic individuals, or from the perspective of self psychology. I propose an alternative model in which pathology of cognition and affect is postulated to be both the contemporary cause and the historical result of pathological adaptation. For these individuals, analysis of cognition and affect must occupy the central position that analysis of conflict and defence occupies in the treatment of the neurotic.

The paper examines the controversy in object relations theory between Kernberg and Kohut from two vantage points, one historical and the other contemporary. By striving to be critically equidistant from both theories we hope to avoid either-or thinking and to address larger questions about the state of object relations theory. Historically the controversy reincarnates a seemingly forgotten schism between Klein and Fairbairn from the preceding psychoanalytic generation. First Klein and now Kernberg has contributed to our understanding of developmentally and pathologically primitive states characterized by absence of integration, incompleteness of self-object differentiation, and prominence of aggression. In so doing they fail to make sufficient distinctions between the neonatal psyche, the more mature psyche, and the neurotic and psychotic psychic apparatuses. First Fairbairn and now Kohut has brought to our attention the importance of the pre-object relationship in early development and primitive psychopathology, but neither has conceptualized meaningful psychic events prior to subjective integration. Their theories, like those of Klein and Kernberg, also condense more and less well differentiated phases of development. For example, Kohut postulates completely separate development of the self and of object relations. The polarization of the current controversy need not force us to choose between theories. We might better aspire to a more comprehensive theory which includes elements from each but which makes clearer distinctions between normal development, pathological development, normal adult functioning and adult psychopathology.

I have attempted to integrate our theoretical understanding of a particular group of borderline and narcissistic personalities and to relate their development to mother-infant failure to form a normal symbiotic bond, and pathological efforts to compensate. I have attempted to preserve and to integrate some of the valuable contributions of Kernberg and Kohut while, hopefully, avoiding the pitfalls of each theoretical system. The result is a theory of dissociated possession configurations and their actualization in relationships. This is neither a theory of nature (innate rage) nor of nurture (maternal failure) but of the pathological form of adaptation in which objects are used as possessions in order to compensate for absent structures. Whereas the primary introject of the borderline personalities is unmitigatedly self-destructive, the narcissistic personalities have formed a more complex introject including a conditional symbiotic representation, the maintenance of which involves active dissociation of object related needs. The conditional symbiotic relationship, in turn, is a stabilizing and constructive force in his relationships.