Donald Winnicott: Fear of Breakdown

Eric De Kolb, Nervous Breakdown

On the whole the word can be taken in this context to mean a failure of a defence or organization. But immediately we ask: a defence against what? And this leads us to the deeper meaning of the term, since we need to use the word “breakdown” to describe the unthinkable state of affairs that underlies the defence organization […]

In the more psychotic phenomena that we are examining it is a breakdown of the establishment of the unit self that is indicated. The ego organizes defences against breakdown of the ego-organisation and it is the ego organization that is threatened.[…] in other words we are examining a reversal of the individual’s maturational process. 

 

[…] I content that the clinical fear of breakdown is the fear of a breakdown that has already been experienced. It is a fear of the original agony which caused the defence organisation which the patient displays as an illness syndrome.

[…]There are moments, according to my experience, when a patient needs to be told that the breakdown, a fear of which destroys his or her life has already been. It is a fact that is carried round hidden away in the unconscious[…] In this special context the unconscious means that the ego integration is not able to encompass something. 

[…]It must be asked here: why does the patient go on being worried by this that belongs to the past? The answer must be that the original experience of primitive agony cannot get into the past tense unless the ego can first gather it into its own present time experience and into omnipotent control now assuming the auxiliary ego-supporting function of the mother [analyst] In other words the patient must go on looking for the past detail which is not yet experienced. This search takes the form of a looking for this detail in the future. 

[…] the breakdown has already happened, near the beginning of the individual’s life. The patient needs to “remember” this but it is not possible to remember something that has not yet happened, and this thing of the past has not happened yet because the patient was not there for it to happen to. The only way to “remember” in this case is for the patient to experience this past thing for the first time in the present, that is to say, in the transference. This past and future thing then becomes a matter of the here and now, and becomes experienced by the patient for the first time. This is the equivalent of remembering, and this outcome is the equivalent of the lifting of repression that occurs in the analysis of the psycho-neurotic patient.  

 Winnicott, D. W. (1974). Fear of breakdown. International Review of Psychoanalysis, 1, 103-107.

Fear of Breakdown, Fear of Death & Suicide

Egon Schieles, Agony the Death Struggle

I content that the clinical fear of breakdown is the fear of a breakdown that has already been experienced. It is a fear of the original agony which caused the defence organisation which the patient displays as an illness syndrome

[...] the breakdown has already happend, near the beginning of the individual's life. The patient needs to "remember" this but it is not possible to remember something that has not yet happened, and this thing of the past has not happened yet because the patient was not there for it to happen.  The only way to "remember" in this case is for the patient to experience this past thing for the first time in the present, that is to say, in the transference. 

[…] Many men and women spend their lives wondering whether to find a solution by suicide, that is sending the body to death which has already happened to the psyche.[…] Death, looked at this way as something that happened to the patient but which the patient was not mature enough to experience has the meaning of annihilation

I now understand for the first time what my schizophrenic patient (who did kill herself) meant when she said : "All I ask you to do is to help me to commit suicide for the right reason, instead of for the wrong reason." I did not succeed, and she killed herself in despair of finding the solution. Hear aim (as I now see) was to get it stated by me that she died in early infancy. On this basis I think she and I could have enabled her to put off body death till old age took it toll.   

Winnicott, D. W. (1974). Fear of breakdown. International Review of Psychoanalysis, 1, 103-107.

Fear of Breakdown & Feeling of Emptiness

Martin Barre, Misplaced Objects

Ι content that the clinical fear of breakdown is the fear of a breakdown that has already been experienced. It is a fear of the original agony which caused the defence organisation which the patient displays as an illness syndrome. 

[...] the breakdown has already happend, near the beginning of the individual's life. The patient need to "remember" this but it is not possible to remember something that has not yet happened, and this thing of the past has not happened yet because the patient was not there for it to happen.  The only way to "remember" in this case is for the patient to experience this past thing for the first time in the present, that is to say, in the transference.

In some patients emptiness needs to be experienced, and this emptiness belongs to the past, to the time before the degree of maturity had made it possible for emptiness to be experienced.

To understand this it is necessary to think not of trauma but of nothing happening when something might profitably have happened. It is easier for a patient to remember trauma than to remember nothing happening when it might have happened. At the time the patient did not know what might have happened, and so could not experience anything except to note that something might have been. 

[…] Now, emptiness is a prerequisite for eagerness to gather in. Primary emptiness simply means: before starting to fill up. A considerable maturity is needed for this stat to be meaningful. Emptiness occurring in the treatment is a state that the patient is trying to experience, a past state that cannot be remembered except by being experienced for the first time now. 
 

In practice the difficulty is that the patient fears the awfulness of emptiness and in defence will organize a controlled emptiness by not eating or learning or else will ruthlessly fill up by a greediness which is compulsive and which feel mad. When the patient can reach to emptiness itself and tolerate this state because of dependence on the auxiliary ego of the analyst, then, taking in can start up as pleasurable function; here can begin eating that is not a function dissociated (or split off) as part of the personality; also it is in this way that some of our patients who cannot learn can begin to learn pleasurably. 
 

The basis of all learning (as well as of eating) is emptiness. But if emptiness was not experienced as such at the beginning, then it turns up as a state that is feared, yet compulsively sought after. 

 Winnicott, D. W. (1974). Fear of breakdown. International Review of Psychoanalysis, 1, 103-107.