Academic journal article International Journal of Psychoanalysis

Sense of Reality, Reality Testing and Reality Processing in Borderline Patients1

Academic journal article International Journal of Psychoanalysis

Sense of Reality, Reality Testing and Reality Processing in Borderline Patients1

Article excerpt

Although borderline patients are suitable for it, they often undergo repeated testing of phantasies against objective reality without success. A reason for these partial failures is that subjects have not been able to build a solid sense of reality and have found many difficulties for processing reality demands and possibilities. The author puts forward some thoughts on this question, such as the importance of working through the depressive position and the Oedipus complex in the process of building up a solid sense of reality. A sense of reality also favours continuous reality processing. When reality processing becomes as continuous as life itself, the repetition of individual reality tests becomes less frequent and necessary, and more satisfying. The author also presents some recommendations for the psychoanalytic treatment of such patients, stressing the importance and the difficulties of the introduction of the borderline patient into the triangular situation because primitive defences-such as disavowal and denial-are mobilized.

Keywords: borderline patient, reality test, sense of reality, depressive position, Oedipus complex

Introduction

Some authors, e.g. Kernberg (1975, 1980), maintain that borderline patients are different from psychotic patients because, among other reasons, they can do reality testing, whereas in psychoses 'loss of reality' is prevalent. This hypothesis has been borne out in our clinical experience. Nonetheless, we have also noticed that patients' reality testing does not enable them to learn with experience and grow emotionally. Quite to the contrary, reality testing can open the door to extremely turbulent episodes and promote a strengthening of the repetition compulsion. Their discrimination between phantasy and reality, inner world and outer world, never seems entirely satisfactory. Of course, when one is dealing with healthy psyches, such discrimination can never be, nor should be, definitive. This is why some authors, e.g. Robbins and Sadow (1974), speak of 'reality processing' and not just 'reality testing'. Nonetheless, an absence of such discrimination is endemic in more disturbed individuals. When they manage to discriminate, their discrimination is not only temporary, but also, when it happens, creates intense disturbance which can bring on furious and impulsive states, accentuated disavowal and isolation, and even intense depression. Still, they often go on successfully testing reality. In view of this, it is worthwhile questioning the validity of reality testing in borderlines. And, beyond this, what is to be thought of the reality testing that a healthy psyche engages in?

That given, three objectives orient the present article. The first is to deepen understanding of borderline patients, following on from Figueiredo (2003, pp. 77-108, 109-26) and Figueiredo and Cintra (2004). The second is to re-examine the notions of sense of reality, reality testing, and reality processing by examining their nature and conditions in both healthy and pathologic psychic constitutions. The third is to articulate and elaborate the central thesis of this article, namely that borderline patients repeatedly and unsatisfactorily perform reality tests precisely because they do not have a firm sense of reality. This situation obtains because they cannot overcome the depressive position, and in their inner world they cannot establish triangular relationships that would allow them to share reality. Such an impasse is caused by strong defences against the 'third element'-negation and refusal-because the introduction of a third element is experienced in an excessively traumatic fashion during a time in which the dyadic relationships are dominant and exclusive. Fundamentally, what we have here is early exposure to the primal scene, which seriously hampers later abilities to understand and think. These abilities can only be developed by entering and passing through a depressive position on which the resolution of the oedipal situation hinges. …

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