1974 Fear of Breakdown. Int. R. Psycho-Anal., 1:103-107 (IRP)
Fear of Breakdown 崩溃的恐惧
D. W. Winnicott
SUMMARY
I have attempted to show that fear of breakdown can be a fear of a past event that has not yet been experienced. The need to experience it is equivalent to a need to remember in terms of the analysis of psychoneurotics.
This idea can be applied to other allied fears, and I have mentioned the fear of death and the search for emptiness.
PRELIMINARY STATEMENT
My clinical experiences have brought me recently to a new understanding, as I believe, of the meaning of a fear of breakdown.
It is my purpose here to state as simply as possible this understanding, which is new for me and which perhaps is new for others who work in psychotherapy. Naturally, if what I say has truth in it, this will already have been dealt with by the world's poets, but the flashes of insight that come in poetry cannot absolve us from our painful task of getting step by step away from ignorance towards our goal. It is my opinion that a study of this limited area leads to a restatement of several other problems that puzzle us as we fail to do as well clinically as we would wish to do, and I shall indicate at the end what extensions of the theory I propose for discussion.
INDIVIDUAL VARIATIONS
Fear of breakdown is a feature of significance in some of our patients, but not in others. From this observation, if it be a correct one, the conclusion can be drawn that fear of breakdown is related to the individual's past experience, and to environmental vagaries. At the same time there must be expected a common denominator of the same fear, indicating the existence of universal phenomena; these indeed make it possible for everyone to know empathetically what it feels like when one of our patients shows this fear in a big way. (The same can be said, indeed, of every detail of the insane person's insanity. We all know about it, although this particular detail may not be bothering us.)
EMERGENCE OF THE SYMPTOM
Not all our patients who have this fear complain of it at the outset of a treatment. Some do; but others have their defences so well organized that it is only after a treatment has made considerable progress that the fear of breakdown comes to the fore as a dominating factor.
For instance, a patient may have various phobias and a complex organization for dealing with these phobias, so that dependence does not come quickly into the transference. At length, dependence becomes a main feature, and then the analyst's mistakes and failures become direct causes of localized phobias and so of the outbreak of fear of breakdown.
MEANING OF 'BREAKDOWN'
I have purposely used the term 'breakdown' because it is rather vague and because it could mean various things. On the whole, the word can be taken in this context to mean a failure of a defence 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.
It will be noted that whereas there is value in thinking that in the area of psychoneurosis it is castration anxiety that lies behind the defences, 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 organization, and it is the ego organization that is threatened. But the ego cannot organize against environmental failure in so far as dependence is a living fact.
In other words, we are examining a reversal of the individual's maturational process. This makes it necessary for me briefly to reformulate the early stages of emotional growth.
EMOTIONAL GROWTH, EARLY STAGES
The individual inherits a maturational process. This carries the individual along in so far as there exists a facilitating environment, and printed above, as follows:
This particular paper was offered for posthumous publication because it was written shortly before Donald Winnicott's death and it contains a first condensed statement based on current clinical work. The formulation of these clinical findings around the central idea contained in the paper was a significant experience. Something surfaced from the depths of clinical involvement into conscious grasp and produced a new orientation to a whole area of clinical practice. It was the intention to study further some of the specific topics in the paper, and to write about them in greater detail, but time did not allow this work to be done.
Because my husband would have wished to be associated with the publication of this new Journal, I am very glad that the Editor was willing to include one of his papers in this first issue of the International Review of Psycho-Analysis.
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only in so far as this exists. The facilitating environment is itself a complex phenomenon and needs special study in its own right; the essential feature is that it has a kind of growth of its own, being adapted to the changing needs of the growing individual.
The individual proceeds from absolute dependence to relative independence and towards independence. In health the development takes place at a pace that does not outstrip the development of complexity in the mental mechanisms, this being linked to neurophysiological development.
The facilitating environment can be described as holding, developing into handling, to which is added object-presenting.
In such a facilitating environment the individual undergoes development which can be classified as integrating, to which is added indwelling (or psychosomatic collusion) and then object-relating.
This is a gross over-simplification but it must suffice in this context.
It will be observed that in such a description forward movement in development corresponds closely with the threat of retrograde movement (and defences against this threat) in schizophrenic illness.
ABSOLUTE DEPENDENCE
At the time of absolute dependence, with the mother supplying an auxiliary ego-function, it has to be remembered that the infant has not yet separated out the 'not-me' from the 'me' – this cannot happen apart from the establishment of 'me'.
PRIMITIVE AGONIES
From this chart it is possible to make a list of primitive agonies (anxiety is not a strong enough word here).
Here are a few:
1. A return to an unintegrated state. (Defence: disintegration.)
2. Falling for ever. (Defence: self-holding.)
3. Loss of psychosomatic collusion, failure of indwelling. (Defence: depersonalization.)
4. Loss of sense of real. (Defence: exploitation of primary narcissism, etc.)
5. Loss of capacity to relate to objects. (Defence: autistic states, relating only to self-phenomena.)
And so on.
PSYCHOTIC ILLNESS AS A DEFENCE
It is my intention to show here that what we see clinically is always a defence organization, even in the autism of childhood schizophrenia. The underlying agony is unthinkable.
It is wrong to think of psychotic illness as a breakdown, it is a defence organization relative to a primitive agony, and it is usually successful (except when the facilitating environment has been not deficient but tantalizing, perhaps the worst thing that can happen to a human baby).
STATEMENT OF MAIN THEME
I can now state my main contention, and it turns out to be very simple. I contend that 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 organization which the patient displays as an illness syndrome.