İn this article, paranoid, obsessive-compulsive, and borderline personality disorders are interpreted from the viewpoint of Kohut’s self psychology. These disorders will be evaluated in terms of fragmentation of self. Fragmentation of self means a sense of dissolution in the self. Fragmentation may be in the form of different severity levels. For example, it may be a momentary disruption of the self which is less severe or may be a prolonged disruption which is more severe.
The short description of the paranoid, obsessive-compulsive, and borderline personality disorders can be given like that: in paranoid personality disorder patient’s life, hyper alertness to potential danger predominates all the time. Borderline patients can be explained as thinking in extremes, like good vs. bad, powerful vs. defenseless and so on. These patients always have unstable relationship patterns, identity diffusion and mood swings. Obsessive compulsive personality patients use inflexible behavior patterns when unwanted, distressing obsessive thoughts appear. According to the inter subjective self psychological viewpoint, the basic reason of these disorders is the fragmentation of self-cohesion. These kind of fragmentation-prone disorders have in common a dominant organizing principle; that is to detect and counteract perceived threats in order to preserve self control or resiliency. Kohut presents two terms in this point. The principle organization of such patients’ experience of self and others is called self object dimension, and the experience of their expectations of others’ reactions or intentions is called repetitive dimension. For example, a caregiver’s insufficient capacity to understand, reply and calm distressed child may give harm to the mutual affect regulation between the child and the caregiver. This kind of prolonged asynchrony between the caregiver and the baby leads to faulty expectations (organizing principle) about other people’s reactions and intentions.
In paranoid personality patients, the crumbling self perceives the whole world as an attacker hypersensitively. Because the self is so fragile and vulnerable, they always protect themselves. According to the self psychological model, this disorder develops because of nonresponsive caregiver, asynchronic mutual affect, caregiver’s lack of empathy to comprehend the needs. Self object environment in childhood does not provide adequate reassurance to patients. Thus, hypervigilance, and hypertrophies become such patients’ most workable mechanism.
In obsessive-compulsive personality disorders, Kohut especially focused on the self and its cohesiveness. He saw the self cohesion as the primary phenomena to be understood and treated. He proposed that obsessions and compulsions as symptoms representing disintegration products. For example, counting obsession is an attempt to hold and control at least a group of objects to be certain about at least something in such an uncontrollable world. These attempts are the representation of controlling the fragmented self and defensing the self in order not to be perseverated.
Kohut did not ignore the classical psychoanalytic view of Freud. Actually he expanded the classical view by giving emphasis on the self psychological explanations. He proposed that the self and its cohesiveness have an effect on the level of management success of intrapsychic conflicts. He regarded the self as a superordinator that influences id, ego and superego’s functions and interconnections. Their properties and functions are filtered through the self. Freud considered the function of the defense mechanisms as a strategy to protect the ego in the face of danger whereas Kohut considered the function of the defense mechanisms as a way to protect the self and its cohesion.
Referances:
Disorders of the self book. Chapter 6
Makaleyi özetleyen: Funda Kaçar
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