‘It’s a Shame I was Born in These Times’: Fear of Breakdown, Social Trauma, Traumatic Decompensation, and Hope-Against-Hope

Being a child nowadays means growing up in the shadow of a world pandemic and, for many children across the world, also in that of terrorism and war. It seems that for some children, with a background of multiple trauma and innate vulnerability, the accumulating effect of these extreme circumstances is simply too much. As Winnicott’s ‘fear of breakdown’ is realised externally by an actual collapse, as trauma is re-experienced both inside and out, by the child itself as well as by the people around them and society as a whole, the fragile psychic equilibrium, maintained by constant effort, may crumble and fall. The escalation of symptoms and suffering may be dramatic and overwhelming, up to traumatic decompensation. ‘Traumatic decompensation’ is clinically defined as decompensation following an exposure to a traumatic event. It seems that the defining element is not necessarily the extremity of the trauma but the intensity of the reaction to it. In reference to children, traumatic decompensation is commonly used by practitioners to describe children evidencing non-specific but extreme regression and symptoms, such as severe challenging behaviour, self-harm and suicidality following exposure to a traumatic event. Although clinically well-known and useful, traumatic decompensation is rarely referred to in the literature. This paper will attempt the following: a) establishing the relevance of traumatic decompensation in children; b) connecting it to Winnicott’s theory of ‘fear of breakdown’; c) presenting a case example, including successful interventions which are described in terms of mediopassivity and hope-against-hope, and d) drawing some general conclusions about working with traumatic decompensation in children, such as active invitation of reality into the therapeutic space, giving words to the unspeakable, creatively extending of the therapeutic holding network, and acknowledging the breakdown while adhering to faith and ‘hope-against-hope’ that may enable creativity, transformation, and the beginning of repair.