You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Therapy with psychotic patients is an investigation of the «original source of life and the ruptures of this source, as it is of ruptures in the dialogue that I conduct with myself and with others», in the words of an analysand on the day she started looking back at his episode of psychotic depression. It calls on us to address the most ungraspable traces of those unconscious inscriptions, along with those early breaches in the mother-child relationship that can disrupt or block the primary processes of subjectivation and differentiation. Or, as Winnicott (1945) put it [he wrote the paper Primitive Emotional Development using his own experience with psychotic patients and children as its starting point], it calls on us to confront the breaches of the primitive processes of integration, personalisation, and construction of the Self in relation to the other, with the most severe forms of fear of the breakdown which has already happened, the unthinkable anxieties which he called primitive agonies (Winnicott, 1971).
According to Ogden (2014) in his recent «rewriting» of Winnicott's study, the breakdown which has already happened dates back to the primary relationship and is recorded as an event which has happened but not been experienced.
I would add-and I am thinking of the clinical evidence and theorisations about the non-repressed unconscious inscriptions and about unconscious transmissions between generations-that this may be a question of events occurring even before the subject's biological birth, when he has to accommodate within himself, for example, an unresolved breakdown belonging to previous generations.
The fear of breakdown also concerns the analyst in the transference-countertransference relationship, which can entail stubborn impasses, or-when we succeed in making use of it-permit the transformation «from breakdown to breakthrough» (Bergstein, 2014).
I shall present two clinical illustrations: the first deals with some episodes from a therapy held at the pub