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

Integration of the patient's mental organization is an important part of al l psychotherapeutic experiences. Generally, it is welcomed and thought well worth the effort needed to achieve it. However, there are some patients wh o feel terrified by this process. They seem to think that integration invol ves a loss of the self: they feel it is dangerous and even resist it with p sychotic-type defenses. This was certainly the case for the patient describ ed in this paper; who was affected from an early age by brittle diabetes. F or her; this reaction was always activated by separation, and it also appea red prior to arty developmental step she needed to take-e.g., in recognizin g 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 thr ough the mistreatment of her diabetes. The issue of integration, seen to ar ise with the concomitant loss of omnipotence, presents itself at different levels of development of the self and of the drives.