Fear of breakdown: a clinical example

This paper describes work with a patient whose unconscious fear of breakdown was increasingly undermining her capacity to function. The effective false-self defence which the patient had organized to deal with early trauma was breaking down into psychosomatic anxieties and disorders from which she had no will to recover. It was this feature that led her doctor to recommend psychoanalysis. As the transference became established the patient was able to reveal to the analyst in a concrete way the nature of the early trauma which had caused the original breakdown at a time when the patient's immature ego was not strong enough to encompass the experience. The traumatized child part of herself therefore became split off and defended against. The work of the analysis has been concerned with the gradual experiencing for the first time, with the support of the analyst, the pain and terror of the early breakdown. Over a period of years this has led to re-discovery and re-integration of the lost child into the patient's present ago organization. In the course of this work the patient remembered, and felt the need for, her transitional object. The original object was found and brought to the analysis, and eventually the patient established the link to the early good enough mother before the breakdown. There have been marked changes in the patient's health, and capacity for functioning. She is now able to contemplate the future, and the termination of her analysis in a realistic way. As already stated, work with this patient relied heavily on the theoretical formulations in Winnicott's paper noted below.