The Experience of Breakdown

Winnicott (1974) tells us that fear of breakdown is a feature of significance in some of our patients, but not others. The term is vague, he says, but he means a “failure of a defence organization where there is a breakdown of the establishment of the unit self.” He adds a brief lesson on the early stages of emotional growth and points out that “the facilitating environment has a kind of growth of its own, being adapted to the changing needs of the growing individual” (Winnicott, 1974, p. 104). I think this latter point has many implications for our technique.

Winnicott contends that clinical fear of breakdown is “the fear of a breakdown that has already been experienced”. (p. 104) He asks, “Why does the patient go on being so worried by this that belongs to the past? (p. 105) “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 the transference.) [I prefer the word `potent` to `omnipotent` because it connotes a more progressive, rather than defensive or problematic process.]

Winnicott lists a variety of primitive agonies, and then adds, Fear of death and then Emptiness. “This 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 have happened. It is easier for a patient to remember trauma than to remember nothing happening when it might have happened. (see Music, 2009, on neglect)

I have frequently written about a turning point in my autistic patient Robbie’s treatment after a radical change in my technique, the reclamatory and vitalizing effect of which manifested itself in the session, and over the many years to come. I did,