Kernberg's second personality dimension identifies the severity of mental illness, ranging from reasonably healthy to severely ill. Kernberg coined the term "personality organization," to label this dimension of severity. He marks three lines of demarcation along this continuum of severity to create three basic levels of personality organization. Following the traditional psychodynamic conventions for labeling mental illnesses, Kernberg uses three terms to identify these levels of severity ranging from reasonably healthy to seriously ill: 1) The term "neurotic" to refers to the most healthy personality organizations, 2) The term "borderline" to refer to less healthy personality organizations, and finally 3) The term "psychotic" is reserved for the most seriously ill and disordered personality organizations. These terms will be explained in greater detail in just a few moments.
According to Kernberg's model, well organized personalities function reasonably well and represent greater health while severely disorganized personalities function very poorly and represent severe illness. In order to assess the level of personality organization, Kernberg evaluates three factors: 1) Is the person's reality-testing intact? 2) Does the person have an integrated sense of self and others? and 3) What is the maturity level of the person's defenses?
1.) Is the person's reality testing is intact? This means, can the person distinguish between what is real from what is not. When someone's reality testing is not intact, they have difficulty separating subjective, perceptual representations originating in their own mind; from objective, real events occurring within their environment. A loss of reality-testing is indicated by the presence of hallucinations (for instance, hearing voices or seeing things that are not there), and delusions (being convinced of something that is not actually happening or that is impossible, such as a person who believes they possess the ability to fly).
2.) Does the person have a consistent sense of self and others? It is believed that a healthy, consistent sense of self-and-others develops during childhood through early interactions with caregivers. Ideally, these early interactions enable our mind to form an accurate, balanced understanding of ourselves; of other people; and of our relationships with those other people. In a sense, our minds build a model of what relationships look like, and how relationships are supposed to function. This relational model is very important because it subsequently forms the foundation upon which future relationships are understood and enacted.These concepts are derived from object relations theory and a more detailed explanation of this theory is reviewed in the theory section of this article.
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To possess an "integrated sense of self" means a person must be able to distinguish between themselves and others. They can accurately and separately perceive their own characteristics, and differentiate these characteristics from those of other people. As such, they recognize that their own thoughts, feelings, wants, needs, and perceptions are uniquely their own, and are not automatically known or shared by others. This clarity of self-knowledge develops from a clear and consistent sense of being the same person across time, and across situations. A stable and consistent self-concept enables people to identify the values and goals they aspire to achieve, and to acknowledge and accept their own thoughts, feelings, and perceptions as belonging to, and originating from, themselves. For a healthy person, these ideas might sound very strange: "Of course I'm the same person across time! Of course my thoughts, feelings, and ideas come from within me, where else would they come from?" In order to make greater sense of these confusing concepts, it is useful to compare an integrated sense of self to its opposite: a fragmented sense of self. In other words, what happens when people do not build an accurate model of relationships?
Unlike people with an integrated sense of self, people with a more "fragmented sense of self" are less clear about personal boundaries, values, and preferences. This occurs because their early interactions with others did not enable them to build an accurate model of relationships. According to object relations theory, this inaccurate model of relationships is a consequence of how self-and-other concepts are represented in the mind's relationship model. People who possess an integrated self-other concept are able to simultaneously experience opposite feelings about the same person (including themselves). This is because their relationship model permits both good and bad experiences to be represented as single representation of the same person. In contrast, people with a fragmented sense of self cannot easily do this. Instead, their minds end up storing good representations separately from bad representations resulting in two separated (split-off) representations of the same person, rather than a single cohesive whole. Therefore, instead of understanding that their experience of the same person has changed, they instead believe the person has changed. With this type of representational framework, it simply isn't possible to maintain a consistent sense of self and others across time and situations.
Lacking the ability to integrate both positive and negative elements of self and others (objects) into a cohesive whole, it becomes impossible for such a person to conceive of a single "object" as having both good and bad qualities. This polarized view of self and others leads to extremes of perception. These extremes are not intentional: it is part and parcel of how their mind's relational framework is set up to understand and organize relationships.
3.) Does the person use so-called "mature" defense mechanisms or do they rely on "primitive" defenses? Before we can describe mature and immature (primitive) defense mechanisms, we first have to define what is meant by the term "defense mechanism." Defense mechanism is a psychodynamic term used to describe the various strategies people use to manage internal conflicts between competing impulses, urges, and feelings. Conceptually, defense mechanisms are very similar to the more widely used term "coping strategies." Defense mechanisms should be understood to fulfill a similar purpose, namely to enable a person to manage stressful mental and emotional circumstances. An extremely simplified example of a stressful internal conflict might be: "I really want to eat that piece of chocolate cake," but "I am supposed to lose weight." A person confronted with both of these imperatives must figure out a way of reconciling them. Defense mechanisms serve this purpose. For instance, one so-called primitive defense is denial. A person could reconcile this eat-diet conflict by simply denying in that moment that they need to lose weight.
According to psychodynamic theory, defense mechanisms vary in terms of their maturity level. More mature defense mechanisms tend to be more sophisticated and flexible, and serve to optimize people's ability to function well in society. Less mature defense mechanisms tend to be simpler in nature, more rigid, and can interfere with someone's ability to function well. In general, mature defense mechanisms are considered flexible and more adaptive because they require a person make adjustments to accommodate reality and to acquiesce to social demands. Subsequently, they promote a person's functioning. Conversely, primitive defense mechanisms are considered rigid and maladaptive because they represent an effort to rearrange reality and/or to ignore the legitimacy of social demands. Such strategies typically undermine a person's ability to function well in society.
A good example of a mature defense is sublimation. Sublimation occurs when a person takes their upset and distress and channels this energy creatively into their work. As a result, their work tends to benefit, and they are less impacted by their distress than they would otherwise have been. Other mature defenses include the use of humor as a coping mechanism, and the use of anticipation (e.g., the ability to plan ahead) to reduce stress and conflict. These more mature defenses tend to use rational thought to buffer emotion. In contrast, the so-called "primitive" defense mechanisms are oriented around immediate action and represent an inability to delay gratification. Examples of immature defense mechanisms include denial, wherein a person simply ignores and denies any evidence of a conflict or distress. Splitting occurs when people think about themselves or others in absolute and extremely polarized terms as "all good" and "all bad", but not "both good and bad."