Madness: Terror and necessity – thoughts on Winnicott

Abstract

This paper addresses the notion of irrationality and madness, as they are understood within the psychoanalytic framework. By highlighting their similarities and differences, as well as by emphasizing the crucial defensive position that manifest psychosis holds in the midst of all this, an attempt is being made to delineate the links between the conjectured earliest interaction that the infant has with its environment and the burgeoning conscious rational mind. Winnicott's conceptualizations around fear of breakdown, disintegration, the environment-mother, and therapeutic regression are utilized to form a bridge between the theoretical understanding of madness and the clinical applications of this understanding, as illustrated by a clinical vignette.

Keywords:

• madness
• irrationality
• disintegration
• containment

Notes

¹Protagoras, 345e.

²Persons for whom this excess of excitation, linked as it is to states of deep turmoil and despair that have remained uncontainable and therefore lead to deficiencies in symbolization and an incapacity for psychic integration have been given the name “slaves of quantity” by de M'Uzan (1984), and have been included among those which manifest non-neurotic morbid entities such as massive passages à l'acte devoid of meaning, somatoses, or psychoses. Bion (1962), on the other hand, would refer to these conditions as the undreamable experiences of the psychotic.

³ Phaedrus, 245b.

⁴Shakespeare, A Midsummer's Night Dream.