Report on the Nurturing Autonomy: Recovery from Impaired Ego Function Caused by Early Life Traumatization

Few studies have examined patients with pathological personality traits in terms of their competency
to exercise autonomy, despite the increasing number of these individuals who visit psychiatric clinics
in Japan. The purpose of this study was to assess such patients’ competencies using medical record
data focusing not only on the therapeutic relationship but also on the patients’ social relationships
throughout their life histories. Two patients were evaluated: one with borderline personality disorder
and another with the “as if personality”, a concept of personality prototype proposed by Helene
Deutsch in 1942. Their clinical materials were analyzed from psychosocial viewpoints. I attempted to
identify the points in their lives at which any competency weaknesses originated. I further discuss their
competencies in decision-making and exercising autonomy using psychoanalytic theory, in particular
Winnicott’s contributions. Finally, I propose the role of contemporary psychiatry in nurturing patients’
autonomy, in order to help them live more comfortably in Japanese modern society.