In psychosis, the original "unthinkable state of affairs that underlies the defense organization" (Winnicott, 1974).
In Winnicott's developmental schema, the innate "maturational tendency" (of the baby to become integrated as a whole ongoing being) is effective insofar as there exists "a facilitating environment" (which both is and is not provided by an emotionally attuned mother) adapting and developing alongside the developing infant. The infant can then integrate, and eventually object-relate, proceeding from "absolute dependence" to "relative independence." Winnicott describes "the fear of breakdown" as the fear of re-experiencing the conditions previously feared during failure of the environment, which are described as various degrees and types of "primitive agony," associated with different defense systems, "disintegration" for example being a defense against unthinkable dread of a return to an "unintegrated state." These unthinkable fears will be reached in analysis in the transference, and it is during analysis that the feared but not yet experienced (because the subject was not yet integrated enough to experience it) disaster can be known and understood.
Winnicott approached this formulation earlier (Winnicott, 1962) as "unthinkable anxiety," and on different occasions, and while describing his concept of development used this earlier term. His purpose in using this term was to emphasize that psychotic illness, even "infantile autism" (Winnicott, 1967), is always a defense organization, and to describe the conditions underlying the establishment of such organizations.
See also: Good-enough mother; Negative therapeutic reaction.
Winnicott Donald. (1945). Primitive emotional development. In Collected papers, through paediatrics to psychoanalysis. (p. 145-156). London: Tavistock Publications, 1958.
——. (1974). Fear of breakdown. International Review of Psycho-Analysis, 1, 103-107. Also in Psychoanalytic explorations. (p. 87-95). Winnicott, Clare, Shepherd, Ray, and Davis, Madeleine (Eds.). London: Karnac, 1989.
——. (1962). Ego-integration in child development. In The maturational processes and the facilitating environment. (p. 56-63). London: Hogarth Press and the Institute of Psycho-Analysis, 1965.
——. (1967). The aetiology of infantile schizophrenia, in terms of adaptive failure. In Thinking about children. (p. 218-223). Shepherd, Ray, Johns, Jennifer, and Taylor Robinson, Helen (Eds.). London: Karnac, 1995.
"Primitive Agony." International Dictionary of Psychoanalysis. . Encyclopedia.com. (February 19, 2019). https://www.encyclopedia.com/psychology/dictionaries-thesauruses-pictures-and-press-releases/primitive-agony
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