8

Personality and conduct disorders pointedly raise the question of how they should be defined and delimited. They are frequently associated with each other and are distributed along a psychopathological and clinical spectrum extending from normality to severe pathology. It is their noisiness and the unpleasantness they cause to the individual and, even more, to his entourage, that has led them to be characterized as disorders. The majority of them go unrecognized, not hindering, perhaps even helping, the success of those who have them. The pathological character of their manifestation thus depends largely upon social context, which often, insidiously and implicitly, becomes main nosiographical determinant. Anti-social conducts, narcissistic pathology, addictive conducts, borderline states, to name only the principle disorders, are based on individual vulnerabilities that most often will only be expressed and organized as pathological behaviors according to social context, events, and encounters. These are the pathologies of today, for they are in keeping with the social evolution of our times. Detecting the potential for them before the appearance of any disorder in the patient presupposes a theory of personality development not based on symptomatic and behavioral manifestations alone. In the same way, treating these disorders does not mean merely reducing them to their most patent manifestations, it is also means preventing both their organization into a stable behavior and the risks of future disorganization. It also means preventing damage to self-image and self-esteem in these subjects due to these disorders which marginalize them, sabotaging their potential and compromising their future. Psychoanalysis is, for the moment, the sole overall theory of personality development that allows for this approach. It emphasizes the importance of psychical functioning as an intermediary of the parents and an essential tool in the elaboration of conflicts, the containment of emotion and the protection of the subject and his potential. But this current psychopathology of conduct and personality disorders challenges psychoanalysis and causes it to evolve. The emphasis is shifted from a pathology of conflicts, fostered by a repressive society, to a pathology of connections, limits and dependence fostered by a permissive society. The drive-related issue of aggression and sexuality can no longer be considered as anything other than part of a dialectic with the issues of identity and limits and of the fear of being engulfed or abandoned by cathected persons. Defects in narcissism, such as the importance of insecure early relations in these subjects, are crucial to understanding these pathologies. The threat to narcissism generated by the cathexis of persons helps give belief phenomena and control mechanisms a decisive role in regulating interpersonal relations, self-esteem, and narcissistic equilibrium. This evolution also calls into question classical models for psychoanalytic treatment and even for psychoanalytical psychotherapy, and challenges psychoanalytical theory as to what constitutes the most fundamental data and the most effective means of bringing about change in these subjects. Beyond the psychoanalytical approach proper, what is taking shape is a theory of the psychical care of adolescents.