Winnicott - The Interaction of Past and Present in the Fear of Breakdown

"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.

This idea may or may not prove immediately useful to the clinician. We cannot hurry up our patients. Nevertheless, we can hold up their progress because of genuinely not knowing; any little piece of our understanding may help us to keep up with a patient's needs.

There are moments, according to my experience, when a patient needs to be told that the breakdown, a fear of which destroys his or her life, has already been. It is a fact that is carried round hidden away in the unconscious. The unconscious here is not exactly the repressed unconscious of psychoneurosis, nor is it the unconscious of Freud's formulation of the part o the psyche that is very close to neurophysiological functioning. Nor is it the unconscious of Jung's which I would call: all those things that go on in underground caves, or (in other words) the world's mythology, in which there is collusion between the individual and the maternal inner psychic realities. In this special context the unconscious means that the ego integration is not able to encompass something. The ego is too immature to gather all the phenomena into the area of personal omnipotence. It must be asked here: why does the patient go on being worried by this that belongs to the past? 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 other words, the patient must go on looking for the past detail which is not yet experienced. This search takes the form of a looking for this detail in the future.

Unless the therapist can work successfully on the basis that this detail is already a fact, the patient must go on fearing to find what is being compulsively looked for in the future.

On the other hand, if the patient is ready for some kind of acceptance of this queer kind of truth, that what is not yet experienced did nevertheless happen in the past, then the way is open for the agony to be experienced in the transference, in reaction to the analyst's failures and mistakes. These latter can be dealt with by the patient in doses that are not excessive, and the patient can account for each technical failure of the analyst as countertransference. In other words, gradually the patient gathers the original failure of the facilitating environment into the area of his or her omnipotence and the experience of omnipotence which belongs to the state of dependence (transference fact).

All this is very difficult, time-consuming and painful, but it at any rate is not futile. What is futile is the alternative, and it is this that must now be examined." (pp. 104-105)
　

　

Donald Winnicott (1974). Fear of Breakdown. International Review of Psycho-Analysis, Vol. 1, pp. 103-107.