December 1972

Externalization and Existential Anguish in the Borderline Patient

Author Affiliations

From the Department of Psychiatry, Northwestern University Medical School, Chicago.

Arch Gen Psychiatry. 1972;27(6):764-770. doi:10.1001/archpsyc.1972.01750300036006

This paper relates the conscious experiences of existential anguish and existential despair and the unconscious defense mechanism of externalization to one another and traces them to a disaster in the mother-child relationship, characterized by defective "holding" in Winnicott's sense of that term. This represents a common clinical situation in borderline patients. It is illustrated by examining the life of Kierkegaard, one of the founders of existentialism, and by a clinical case report from the author's private practice, a case that also demonstrates the serious problems involved in the psychotherapy of such patients.

When the child has grown big and must be weaned, the mother virginally hides her breast, the child has no more a mother. Happy the child which did not in another way lose its mother. S. Kierkegaard

There is a land of the living and a land of the dead and the bridge love, and the only survival, the only meaning. By Trudy