The term basic fault refers to the structural deficiency in the personality of subjects who during their early stages of development formed certain types of object relations—which later become compulsions—to cope with a considerable initial "lack of adjustment" between their psychobiological needs and the care provided by a "faulty" environment devoid of understanding. The effects of the basic fault on a person's character structure and "psychobiological dispositions" (which may predispose that person to certain illnesses) are only partially reversible.
Michael Balint developed this concept in The Doctor, the Patient, and the Illness (1957), as a result of his research with physicians in the area of psychosomatic disorders. Additionally, in "The Three Areas of the Mind" (1958), Balint developed the notion of the "basic fault zone" to situate therapeutic processes relating to states of regression in certain patients. This became the source for his metapsychological theorization, in The Basic Fault: Therapeutic Aspects of Regression (1968), of "zones of the psychic apparatus," which included a critique of Sigmund Freud's notion of "primary narcissism" and new considerations on the handling of regression.
Certain patients (those with schizoid personalities, narcissistic states, or addictions, for example) are unable to tolerate the frustrations of classical treatment and are largely inaccessible to interpretation. The therapeutic relationship thus requires modifications in technique to open up to analysis the interpersonal psychic processes inherent in the "basic fault zone."
This "zone" of the human psyche (which may be the ego) is unquestionably more primitive than both the "area of the Oedipus conflict" (Balint, 1968, p. 28) (prevalent in classical treatment) and the "area of creation" (p. 29). The processes that take place there are characterized by:
- An exclusively "two-person" relationship, where only the patient's needs count;
- A dynamic force other than conflict (proper to the oedipal zone): that of an anxiety that drives the patient to perpetuate old models of object relations that now indicate maladjustment, such as behaviors that are "ocnophilic" (desperately clinging to objects) or "philobatic" (attempts at self-sufficiency by keeping well away from supposedly dangerous objects); this dynamic also drives the patient to establish a harmonious relationship with his or her environment ("primary love");
- The prevalence of nonverbal processes or language usage that is nontypical of adults.
A kind of "psychological mothering" makes it possible to avoid reproducing the traumatic situation in treatment; object relations, rather than interpretation, provide the therapeutic leverage. Regression, which is in part linked to the analyst's responses, can be therapeutic ("benign") if it is aimed at producing recognition of previously unacknowledged needs rather than satisfying them. Certain soothing forms of satisfaction (libidinal and physical contact) help sustain the therapeutic relationship. Reestablishing the primary love relationship allows the basic fault, once it has been recognized, to heal. It is said to be "neutralized" when the patient can let go of his or her compulsive object relations.
This theoretical model is especially relevant to the treatment of borderline cases; it is used in the framework of focal therapies and in situations addressing combined psychological, medical, and social considerations (psychotherapeutic aspects of medical treatment, family planning consultations, and other such contexts). It sustains the fundamental metapsychological and clinical issues.
Inseparable from a conception of the psyche as a product of interpersonal relations—in particular, the ego as a "corporeal entity" (Freud)—and from a theory of treatment that makes use of regression, the "basic fault" has been subject to the criticisms that are usually made against any approach that aims at partial reparation: the risk of erotization, the risk of nondissolution of the transference, and so on. Balint viewed such criticisms as manifestations of anxiety on the part of analysts. Subsequent work has indicated that this conception of an early distortion in the ego should also take into account the pathogenic processes stemming from the patient's family and cultural contexts. Focus on the nonverbal should not allow the underestimation of the crucial role that language and signifiers (just as much as their deficiencies or dysfunctions) play in the constitution of the ego.
See also: Balint, Michael; Benign/malignant regression; Hungarian School; Libido; Primary love.
Balint, Michael. (1952). Primary love and psycho-analytic technique. London: Hogarth.
——. (1958). The three areas of the mind. Theoretical considerations. International Journal of Psychoanalysis, 9, 328-340.
——. (1959). Thrills and regressions. London: Hogarth.
——. (1964). The doctor, his patient, and the illness (2nd ed.). London: Pitman Medical Publishing. (1st edition published 1957)
——. (1968). The basic fault: therapeutic aspects of regression. London: Tavistock.