Thread by @500livesasafox

People tend to think about psychiatric diagnosis in terms of symptoms. In this thread I explain the idea of structural diagnosis, which puts relationships front and center, in order to suggest how animism and re-enchantment could be potent tools for psychological health. 1/45

Thanks to the vast influence of scientific psychiatry, most people categorize psychological troubles in terms of overt symptoms such as low mood, anxiety, hallucinations, dissociation, sleep disturbance, and so forth. Hence the DSM’s grab bag of superficial categories. 2/45

A lesser known idea, though one prominent within psychoanalytic theory, is that of structural diagnosis, which is a higher-order way of thinking about levels of personality functioning that puts how we represent relationships between self and other center stage. 3/45

Structural diagnosis derives from object relations theory, a branch of psychoanalysis concerning how we internalize and internally organize representations of self in relation to others. To a first approximation, object relationships are mental templates of relationship. 4/45

Object relations is also primarily a theory of development that aims to describe how human infants integrate experiences of caretakers to construct and populate their internal world, while managing the anxiety and helplessness of being a powerless, hungry creature. 5/45

(It should go without saying, but this is going to be a whirlwind tour of a very complex theory. Interested readers can check out the works of Melanie Klein, Ronald Fairbairn, D.W. Winnicott, Joan Riviere, and Thomas Ogden, among others, for further information.) 6/45

Infants who can’t feed or fend for themselves depend on mothering—the rhythmic provision of attention, holding, feeding, etc. (as Winnicott noted, ‘mothering’ is a function that need not essentially be gendered)—and have to make sense of their experiences of mothering. 7/45

Taking feeding as our pinnacle exemplar of mothering, infants have good experiences if the breast (or bottle) shows up to provide nourishment when they are hungry, and bad experiences if the breast is absent when they need it or when feeding is disturbed in some way. 8/45

Feeding can misfire in all kinds of ways. In addition to deprivation, infants can be anxiously force fed when they are not hungry, angrily jerked about by a disturbed caretaker, passively disattended to and fed without devotion by a preoccupied caretaker, etc. 9/45

In an infant’s nascent mind, how could the frustrating bad breast be the same as the gratifying good breast? Object relations theory posits that early on, we split our internal objects in two, representing one all good part-object (breast) and one all bad part-object. 10/45

We initially split object representations into good and bad part-objects due to the mind’s lack of integrative capacity, but also to preserve relationships: if there is a good and a bad object, the bad object receives all our anger/hate, which keeps the good object safe. 11/45

What gets represented is thus not just a thing among things, but a configuration between self, other, and affect: in simple terms, early life represents an angry/hateful self in relation to a frustrating bad object, and a satisfied/loving self in relation to a good object. 12/45

This is related, by the way, to the characteristic self-hatred of people abused and traumatized in childhood. Debasing the self can be a way to preserve an image of caretakers who are needed but also feared, and thus a way to hang onto and make sense of the relationship. 13/45

As the psychoanalyst Ronald D. Fairbairn evocatively put it, “it is better to be a sinner in a world ruled by God than to live in a world ruled by the Devil.” 14/45

Because object relationships represent self in relationship to other, splitting of the object into good and bad part-objects corresponds to a split in the self/ego, and it is a major task of development to integrate the divisions of the ego caused by infantile splitting. 15/45

Splitting is a pervasive defense mechanism of early development that becomes gradually replaced over the first years of life by higher order defensive operations such as repression, reaction formation, etc. that protect the ego in different ways (that’s another story). 16/45

With good enough mothering, infants experience optimal frustration that allows for separating out self images from other images, as well as the integration of the self and other images that built up separately and were kept apart as all good and all bad objects. 17/45

Excessive gratification can disrupt this process: a “perfect” mother that responded with feeding exactly when the infant becomes hungry would not allow for experiences of frustration that would signal to the infant that they are not omnipotently meeting their own needs. 18/45

More commonly, however, excessive frustration of basic needs disrupts object relational maturation, since severe frustration forces the infant to rely on grandiose fantasies to ward off an unbearable world, rather than to make sense of and gradually join in with it. 19/45

Under conditions of chronic or severe frustration or deprivation, infants continue to rely on idealized “all good” and “all bad” object images, and this correspondingly leads to unrealistic idealized and debased self-representations. 20/45

This is where structural diagnosis comes in. Otto Kernberg, one of the preeminent object relations theorists, identified three general degrees to which the process of differentiating self and other images and integrating good and bad self and other images succeeds. 21/45

In the psychoses, this ego integration process goes severely awry, leading to catastrophic breakdowns in the boundaries between self and other/non-self that can contribute to massively disruptive experiences like grandiose delusions or paranoia. 22/45

Notice that from this perspective, psychotic personality structure is defined not by the presence of specific symptoms like hallucinations or delusions, but rather by basic defects in relational representations that can result in disrupt perception and thinking. 23/45

On the other end of the spectrum, when all goes reasonably well, self and other images develop distinctly, good and bad qualities can co-exist in whole object representations, and ego boundaries securely hold. This is known as neurotic personality structure. 24/45

Between the psychotic and neurotic personality structures there exists a wide range of experiences that fall under the umbrella of borderline personality organization (BPO). “Borderline” originally referred, as you might guess, to the border between psychosis and neurosis. 25/45

Borderline personality organization is a much broader idea than borderline personality disorder, which is just one specific way that BPO can crystallize into an individual character structure. Narcissistic and other personality disorders are also examples of BPO. 26/45

In borderline personality organization, self and other images are well differentiated, and so people whose personality is organized at the borderline level are not prone to the failures of reality testing (self-other boundaries dissolving) as people at the psychotic level. 27/45

In borderline personality organization, the primary trouble lies in failure to synthesize positive and negative qualities and experiences in a singular representation of oneself or other people. As a result, one only finds oneself in relation to all good or all bad others. 27/45

Kernberg attributed the failure of synthesizing good and bad object representations in BPO to the incredible anxiety aroused in some people by the severe intensity of aggressive drives and impulses, and the need to split these drives off to salvage internal cohesion. 29/45

People organized at the borderline level therefore tend toward idealized and demonized representations of others. Sometimes these extreme representations can be very rigid, as in the case of narcissistic disorders, and sometimes these representations can oscillate wildly. 30/45

Viewing personality disorders from this relational lens helps to contextualize personality pathology in terms of people’s fear and anxiety about how to hold onto needed relationships, rather than inviting condemnation of “bad” behaviors (itself a kind of splitting). 31/45

Much more could be elaborated about these three levels of personality organization from a psychological perspective. The point I want to underscore is how this theory locates psychological health in the quality of how we represent relationships between self and other. 32/45

Viewing relationship as the fundamental quality of mind allows for a massive shift away from what symptoms a person has to how a person links themselves up to other beings in the world and how they experience themselves within those connections. 33/45

Object relations also moves us away from a rationalistic conception of the mind in which concepts and perceptions are basic building blocks toward an understanding that how we conceive of and perceive the world is founded upon how we experience and think about relationship. 34/45

I have no data or research other than my own personal and clinical experience and theorizing to back this up, but I would offer that enchanted, animist perspectives can play a role in helping to salve disordered object relations. 35/45

A materialist worldview tells us that non-human objects are basically inert things to be used as we see fit. This tends to imply a view of the self as autonomous, relatively omnipotent, and unheeding to the context and nature of the things that we encounter. 36/45

To the degree that this is true, materialism inherently skews people toward a kind of borderline spiritual organization that relies on a rigid schema of powerful, gratified self in relation to debased, exploited other. The colonialist implications are rather obvious. 37/45

The empty, gray quality of self and world that so many people experience could stem from the flatness of our non-human object relations. If we relate to others as things among things, there is no verdant ecology in the non-human world and no texture to the ecology of self. 38/45

If instead we view ourselves as differentiated but equal and interdependent selves in relation to complex, unique, interdependent non-human others, it allows for a tempering of self-representations and a space for curiosity about representations of others. 39/45

I further imagine that animistic, enchanted worldviews allow for degrees of freedom in relating to the non-human world that we can then bring to our human relationships. 40/45

For people with disordered representations of their relationships to other humans, I imagine that relating with more care and vibrancy toward the non-human world could open up new spaces for entering into and deepening relationship with other people. 41/45

For people with materialistically disordered representations of non-human relationships, we could perhaps bring the curiosity, compassion, and stance of equality with which we aspire to treat other people to the people that happen to not be human. 42/45

Non-materialist object relating invites us to move away from asking “what use is this thing?” and instead to “who is this? what does this want? what does this call for in me? how can I best approach this?” In doing so, we open new ways of being with and within ourselves. 43/45

Although object relations theory is not an inherently enchanted theory of the mind, I see it as a springboard for entering into a deeper, more relational way of experiencing the world through the lens of psychology and psychoanalysis. 44/45

The fundamental point is that the psychological function of symptoms and the basic way the mind works find their roots in our representations of relationships. The rhythms and meanings of relationship must be at the root of how we think about people and the world. 45/thread