Heterogene Patienten
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These patients, whom I would call heterogeneous, suffer from experiencing incompatible attitudes within themselves; on the one hand, they are capable of symbolising and of using secondary psychical mechanisms, and on the other, they resort to primitive psychical mechanisms such as disavowal, projection, massive projective identification and different forms of splitting. The extent to which these mechanisms are employed may hinder the functioning of their symbolic capacity, which they could otherwise make use of. I have chosen the term “heterogeneous patients” in order to avoid using psychiatric diagnostic labels; and I have tried to find a term that simply refers to the patient’s drive and defensive organisation as it can be observed by a psychoanalyst in the relationship that develops between himself and these patients. This is why I do not use the term “borderline patient” in the sense in which it is used by Kernberg (1984). Nor do I speak of borderline states, a notion introduced by Green who, from a different perspective, proposes that “the borderline be considered as a concept” (1999) and is interested in this frontier which is not just a frontier line but rather a frontier zone between two territories with its own characteristics (1986). I am purposely using a general descriptive term that is not part of a conceptual framework, but with which clinicians with different personal references may be able to identify. (Danielle Quinodoz, Int. J. Psychoanal. (2001) 82, 236.)
