Borderline Patients, the Psychosomatic Focus, and the Therapeutic Process

In this work, Giovacchini traces the cultural transition of the borderline disorder from its transformation from the hysterical patients who confronted Freud, Breuer, and other psychiatrists a hundred years ago. He employs the hysterical ancestry of the borderline to sort out some of their important symptomatic characteristics, such as dissociation, conversion, and pain intolerance.
Giovacchini's focus on the psychosomatic aspects of borderline patients is unique. The somatic conversion of the hysterical patient became the hypochondriasis of the borderline patient, and he ultimately states that they are due to psychic lacunae or areas of emptiness that are devoid of psychological content, thereby predisposing the patient to develop somatic disruptions of mental pain. These hypochondriacal preoccupations, he states, serve as a defense organizer for these patients.
Giovacchini also deals at great length with the importance of the holding environment and of phenomenological interpretations - in contrast to transference interpretationswhich help to develop the holding environment atmosphere. He also deals with the importance of transitional objects and transitional phenomena in the symptomatology and treatment of these patients.
This work is suitable for mental health workers from the lowest to the highest level of sophistication. It is a highly useful textbook, manual, and guide to the understanding, handling, and treatment of those disturbing patients who more and more constitute our patient load.

Peter L. Giovacchini, M.D., is Professor Emeritus, Department of Psychiatry, at the University of Illinois College of Medicine.