Temporality 2: The relevance of the Heideggerian concept of time to the treatment of borderline conditions

Paul Cammell

doi:10.7565/landp.2014.007

Abstract

In this article I attempt to demonstrate the relevance of the philosophy of time to psychiatric, psychological and psychoanalytic theories of development and therapeutic action. In an accompanying article I established a range of relevant temporal concepts, emerging from the philosophy of Martin Heidegger, with links made to Freudian concepts of time, in particular Nachtraglichkeit, developed in the writings of psychoanalyst Andre Green and philosopher Jacques Derrida. In this article I proceed to explore this philosophy of time through a consideration of the developmental theories and clinical approaches of Donald Winnicott, Jean Laplanche, Andre Green and Hans Loewald. I conclude by establishing that the temporalizing function of therapeutic action can be seen to be a core or essential element of work with patients presenting with socalled borderline conditions. I demonstrate how a range of problems or ambiguities that coalesce around this condition (including dissociation, traumatization, self harm and brief reactive psychosis) can be understood in temporal terms.

Highlights

During therapeutic dialogue and interaction, both patient and clinicians are drawn to look back at questions of origin, cause and developmental formulation, at the same time as look forward to a future in terms of progress, outcome, resolution and so forth
I have chosen this field of clinical work because, I will argue, the “borderline” concept as it is adopted in notions of “borderline phenomena”, “borderline personality organization” and “borderline personality disorder”, is ambiguous and problematic for the clinician because the prevailing theories of psychopathology that adopt it are excessively individualistic, categorical, intrapsychic and atemporal
Hysterical psychosis could be described as involving forms of splitting and fragmentation that lead to personal modes of expression which rely on fragmentary experiences, descriptions or expressions which seem narrow and limited, often with a literal and concrete quality, which can be overcome through the kind of therapeutic work I am describing

Summary

Introduction

During therapeutic dialogue and interaction, both patient and clinicians are drawn to look back at questions of origin, cause and developmental formulation, at the same time as look forward to a future in terms of progress, outcome, resolution and so forth. Hysterical psychosis could be described as involving forms of splitting and fragmentation that lead to personal modes of expression (acting, speaking, self-interpreting) which rely on fragmentary experiences, descriptions or expressions which seem narrow and limited, often with a literal and concrete quality, which can be overcome through the kind of therapeutic work I am describing Often these presentations seem to relate to an event of re-traumatization, sometimes with a “determined” feel to it (linked to repetition compulsion) in which the subsequent decompensation may have psychotic elements (persecutory and grandiose) as well as more dissociative elements related to a disjointed sense of self, time, others and so forth. This recovery is facilitated by the reciprocal process of dwelling together which facilitated mutual awareness (what Heidegger called doubling or empathy) something recovered after relational events in which doubling or empathy do not feature

Conclusion

Biographical Note