The dread of integration. Integrative processes in a chronically ill borderline patient

Integration of the patient's mental organization is an important part of all psychotherapeutic experiences. Generally, it is welcomed and thought well worth the effort needed to achieve it. However, there are some patients who feel terrified by this process. They seem to think that integration involves a loss of the self: they feel it is dangerous and even resist it with psychotic-type defenses. This was certainly the case for the patient described in this paper, who was affected from an early age by brittle diabetes. For her, this reaction was always activated by separation, and it also appeared prior to any developmental step she needed to take--e.g., in recognizing self-boundaries, sexual identity, and facing the oedipal conflict. On all these occasions her reaction was to run away from treatment in a state of deep regression, feeling suicidal, and liable to seriously harm herself through the mistreatment of her diabetes. The issue of integration, seen to arise with the concomitant loss of omnipotence, presents itself at different levels of development of the self and of the drives.