A metaphor for this is that I can't stop it raining, but I might be able to help people get a waterproof raincoat.

People with good ego-boundaries generally cope better with life's vicissitudes than people with poor or leaky boundaries.

What is an ego boundary? It is the line between Self and Non-self.

In a physical sense, my boundary is roughly my skin. Anything inside my skin is Me. Anything outside it is Not-Me. Easy.

But in a psychological sense, the issue is a bit more complex. The boundary of my Self lies in a psychological or cognitive space. In my thinking and the thinking of someone in my world about what is Me and what is Not-Me.

For many people language is for communicating. Some forget that it is also a tool for thinking. And the words with which we think about the Self boundary are the pronouns (I, you, he/she/it, we, and they).

Thus for a therapist to pay attention to pronoun use and misuse can give useful insight into the state of a speaker's ego boundaries, and, by extension, offer an opportunity to modify the boundary by teaching correct pronoun usage.

OUTLINE OF PAPER.

1) 'I'.

a) Ontological integrity. (MPD, splitting, schizoid position).
b) Ontological security. (RD Laing)
c) Ontological validity. (Accidental gatecrasher)
d) Introjection. (Bulimia.)
e) Retroflection. (Guilt, Narcissism, Suicide).

2) 'You'

a) 'I -Thou' (Martin Buber). Encounter. Dr Bedside Manner.
b) Generalisation.
c) Projection. (Paranoia.)

3) 'It' and He/She.

a) 'I - It' (Buber)
b) Dr White-Coat.

4) 'We'

a) I - to - We. Love. Belonging.
b) We - to - I. Separation, Grief.
c) Alienation. The Outsider. Little Match Girl.
d) Pathological confluence.

5) 'They'

a) Generalisation.
b) Paranoia.

Case study: Princess Diana's BBC interview. http://scoop.evansville.net/diana.html

NOTES

1a. Ontological integrity concerns the degree to which a self is one and integrated. Multiple Personality Disorder is one extreme. Melanie Klein describes stages in life when the self is more polarized as being the Schizoid Position. The split gets resolved into the integrated Depressive Position. This transition occurs in early childhood, adolescence, and at the mid-life crisis. See Elliot Jaques.

1b. RD Laing discusses ontological security in his book 'The Divided Self'. The insecure lives in fear of ceasing to exist in a personal sense, and develops various defensive manouvers.

1c. Ontological validity is my own concept. It basically means the sense that a person has the unconditional right to exist. People without it often act as if they were 'Accidental Gatecrashers' at the cosmic party, adopting one of a number of strategies to prepare for being spotted by a bouncer. Rescuers do the washing up. Flirts try to seduce a protector. The meek hide behind a curtain. The aggressive carry a bottle ready for a fight. Personality patterns and disorders based on the lack of Ontological Validity are difficult to dislodge without the discovery of an 'I' with the unconditional right to exist.

1d. Introjection is the boundary error in which the person identifies as belonging to ‘self’ something that is truly ‘non-self’. They misuse pronouns, and may say ‘I am/think/feel...’ when the truth is ‘You/he/she/they are/think/feel...’ Characteristically the introjector swallows indiscriminately other peoples feelings, thoughts and emotions. They tend to take other peoples problems on themselves. Commonly they show other features, such as eating disorders, substance abuse, and an ‘all-or-nothing’ attitude to sex in women or receptive male homosexuals. The mouth, vagina, and anus are three places where the abstract process of introjection is made concrete in eating or sex. They also commonly have episodes of unresolved grief, and difficulties with assertion and anger.

I think the reason introjectors have problems with grief is that they ‘swallow’ the people they love, rather than merely get close to them. When a person gets close to someone else, and the other dies or leaves, the survivor is left with a patch of ‘cold skin’. But an introjector holds the other in some sense ‘inside’ them so that when they die or leave they are left with an emptiness inside.

In a sense, I think introjection represents a failure to achieve the psychological task of ‘teething’. Teeth serve a dual function; they enable one to chew and break down ‘non-self’ food to permit it to be digested to become ‘self’ in the form of flesh. Teeth also are an agent of anger.

I believe that anorexia nervosa is not primarily an eating disorder. Instead it is an ego boundary disorder characterised by prepubertal introjection (the good girl phase of the indiscriminate ‘Yes’), the development of introjection phobia (particularly in relation to vaginal introjection), and then displacement from vagina to mouth (the stage of the indiscriminate oral ‘No’.) The eating disorder is secondary to the ego-boundary disturbance.

1e. Retroflection. This is where an outgoing emotion gets turned back onto the self. The classic example is anger retroflected as guilt, but others exist. Narcissism is retroflected love, and suicide may be retroflected murder or hate.

2a. Martin Buber's lovely little book 'I and Thou' is a poem to the mode of being in which a Self encounters another as a You. It should be read by anyone with the slightest interest in this subject. Buber's language is a bit giddy. Here are two samples:

The world is twofold for man according with his twofold attitude. The attitude of man is twofold in accordance with the two basic words he can speak. The basic words are not single words but word pairs. One basic pair is the word pair I -You. The other basic word is the word pair I -It; but this basic word is not changed when He or She takes the place of It. Thus the I of man is also twofold. For the I of the basic word I -You is different from that in the basic word I -It.

As long as the firmament of the You is spread over me, the tempests of causality cower at my heels, and the whirl of doom congeals.

I have found the I -Thou concept very useful in thinking and teaching about what it means to be a doctor. It is a role which I think requires that one oscillates between the two modes (I -Thou and I - It). Doctors who only do the first have a lovely bedside manner, but forget to measure the serum creosote or do a lumbar puncture. Doctors who only think in the Objective mode fail to establish any serious relationship with their patient as a person rather than a case.

2b. The word 'You' features in many generalisations. As NLP founders Bandler and Grinder remark in their 'Structure of Magic', generalisations block growth. The challenge to remake a comment such as: 'If you trust a &*%#, they will let you down' and replace the 'you' with an 'I'. This is often therapeutically useful. 'Do you mean 'I once trusted a &*%# and they let me down?' Tell me about it.'

2c. Projection occurs when a person attributes to something outside the self, a quality that is truly inside the self. An example is ‘Pot calling kettle black’. Pronouns are the words used to denote the location of phenomena with respect to the ego-boundary, thus projection usually involves the misuse of the word ‘you’. The speaker says ‘you are/think/feel...’ when the truth is ‘I am/think/feel...’ Projection often features in blaming arguments and paranoia. Therapy groups in which 'You' statements are discouraged and 'I' statements encouraged feature far fewer raging projection storms.

4a. The ability to invest one's Self in a couple or group. To enter the 'We - space'. I mean this in a psychological sense rather than socially. I.e as an attribute of the individual, not whether the feeling is reciprocated by another. People who can't do this have difficulty in belonging or joining others.

4b. The capacity to disinvest from the 'We' after separation or death.

4d. Pathological confluence. Such people can’t distinguish between ‘I’ and ‘we’. The pattern is particularly clearly visible in groups, when the person claims to speak for everyone. ‘We’ really understand/care/disagree etc. The truth is ‘I really understand/care/disagree’. Such people are often ‘oceanic’ in their relationship to the world and tend to minimize differences. The line of plump bespectacled social workers: 'How are we today, deary?', and the comment of mothers of bedwetters 'We had a little accident' are examples.

Diana illustrates many of the pronoun confusions and other attitudes of a person with permeable ego boundaries. She was very vulnerable to the mass public projections of a fairy-tale princess.

Contrast her with Mick Jagger, who was asked by a reporter:

'Mick, what do you think of your image?'

Mick: 'I don't have an image......people have an image of me!'

I would appreciate feedback and debate on the list or backchannel about these ideas.

Cheers

Dave