Primitive Agony

This concept, Winnicottian originally, may be likened with what Freud calls primary anxiety. The prototype of this traumatic anxiety is birth and refers to the state of Hilflosigkeit, of the primary helplessness of the infant overwhelmed by a wave of instinctual drive activity that it cannot deal with by itself over and above a certain intensity and a certain lapse of time if the environment does not come to its help.

It is in “The fear of breakdown” that D.W. Winnicott (1974) speaks of these primitive agonies. We may ask ourselves in passing if the French translation of the English term agony by “agonie” is really pertinent, as the French word indicates “atrocious anxiety, suffering” (Larousse). In its usual French sense agonie means death agony. The term “angoisses disséquantes primitives” (lit. “primitive dissecting anxieties”) is also used in French.

The fear that certain patients experience of having a mental breakdown exists in each one of us, but in very variable ways quantitatively speaking. According to Winnicott, this fear projected into the future concerns in reality something that has already happened, but which the subject was not in a position to experience and think about when it occurred. He links it to a failure of the primary environment and to a traumatic swamping by the instinctual drives that could not be contained. What we are faced with here is the

compulsion to repeat, traumatic experience, and the register of psychotic anxieties. “There are moments,” Winnicott writes, “when a patient needs to be told that the breakdown, a fear of which destroys his or her life, has already occurred” (p. 104, Winnicott's emphasis) and that it is a fact he carries in his unconscious, fearing to see it well up from the inside.

It is this “practical” side of things that came to the analyst's mind concerning a young patient, an anaesthetic nurse by profession, whose sessions are always crammed full with factual (but rich) material. Essentially it concerns emotion