BookREVIEW: Catch Them Before They Fall
The Psychoanalysis of Breakdown
Reviewer Loray Daws
Dr. Christopher Bollas’s work has once more opened an important clinical vista within contemporary psychoanalytic praxis. Known for his evocative approach to the clinical process, that is his unique conceptualization of various experiences of self, Bollas provides us with another view into understanding the various vertices inherent in treating “breakdown” in “broken selves”. Adding to psychoanalytic pioneers’ work on regression, such as Bryce Boyer, Harold Searles, Peter Giovachinni, Michael Eigen, James Grotstein, Margaret Little, Melanie Klein and Thomas Ogden, Bollas serves as both clinical educator and background supporter in the creation of a therapeutic environment sufficient in holding and facilitating those clients experiencing, or in need of, “breakdown”. In an age wherein psychiatric medication and behavioural interventions seem the most prudent approach, as successful as they are, Bollas succeeds in illustrating the importance of an intra-psychic approach to such states of mind, as well as the various compelling reasons to think deeper about the value of providing an experience wherein unconscious eruption can facilitate a ‘new psychological beginning’. This book, given the fact that it is written by one of the most creative and thoughtful analysts of the independent tradition, is surprisingly easy to follow, although it begs re-reading, and by doing so, becomes increasingly evocative, and in itself, a transformative object. Again, the very way in which the book is written, with much respect for a client’s need for a different holding and intra-psychic support, as well as to the capacity of even younger psychotherapists to provide such holding, is to me a testament of the very process itself; that is, an environment seemingly easy to delve into, that is supportive with just the right amount of ‘demand’, and richly supportive throughout in its background complexity. On revisiting the text one continuously finds and re-finds thoughts that can be used in all models of psychoanalytic discourse, and one is left with a feeling of hope and competence in supporting those that must face unimaginable mental pain. This is a rare gift to the reader and practitioner.
Bollas starts his rich exploration with the phenomenology of “broken selves”- those that have suffered previous non-psychotic breakdowns – and describes the variations such broken selves can take, as well as the detrimental consequences when “breakdown” is met with anxiety, hospitalization and pharmacological intervention exclusively: “At this point the breakdown becomes structuralized. The personality reforms itself around the effects of the breakdown, reordering the self in order to function and survive under significantly reduced circumstances. This heralds a meagre future existence.” (Italics added p.15). The constricting inner discourse also includes the following haunting dictums (p.16);
- It’s best not to seek help from any other.
- If I am vulnerable, I must kill off feelings.
- Only a fall-back position can be safe.
- I must disinvest in the object world and abandon a relation to reality.
- I will give up on ambitions, plans, hopes and desires.
- I must find people who are in a similar situation and live within a new society of fellow broken selves.
Given the latter, the reliance on a concrete usage of the breakdown incident (as if it has no unconscious reason) may ensure an ‘autistic enclave’ characterised by muted affect, a preoccupation with reality, an inability to make use of the analyst’s thoughts, a neutral transference, and a hidden ghostlike self- representation vaguely attached to an ideal ‘self–before-breakdown’.
The chapter on ‘signs of breakdown’ is an evocative tour de force; a single review cannot do it justice and needs many readings; I will attempt only nodal thoughts on ‘signs of breakdown’, namely, that it is characterised by a transitional period wherein one observes (a) a slowing of speech patterns (not due to deferred action or frightening mental content), a spacey countenance and a rising anxiety in the therapist; or (b) a sudden onset found in highly vulnerable, but rigidly defended patients. Given the latter, Bollas serves as technical advisor in stating:
- Tolerate the fact that the patient may make use of the word ‘nothing’.
- Become inquisitive (a form of maternal tracking, if not symbolic reclamation) by asking “Just what have you done in the last few days”- a “what’s up?”; even if followed by “nothing”, this may, given the analyst’s gentle presence, give rise to various signifiers (parapraxal acts) of the breakdown.
Furthermore, in Bollas’s own psychoanalytic vision; “…in a moment like this it is vital that the psychoanalyst allow the analysand a great deal of time in which to recover thoughts that are attached to the event. This information gathering is crucial to what is to follow. We should note that at this stage it is not affect that is needed, but information. Asking a person how they feel is non-productive and will produce limp abstractions” and “… the analyst must wait until the analysand is in a position to talk, and if it seems that this may take longer than what remains of the session, then the appropriate measure is to provide more time. Time is the crucial variant in how well one can help a patient who is at the verge of breakdown” (italics added, p. 25). Bollas returns to this theme throughout his later chapters and positions the experience of breakdown within his concept of time and the affective realities brought about through ‘unconscious news’.
Another theme in Bollas’s thinking is the importance of interpretation, written or otherwise, that serves the analysand experiencing a breakdown with a lucid object, one that functions as a nodal point around which new psychic transformation can come about. “It is the analyst’s obligation to put, in lucid and memorable terms, the exact reasons why a person is having a breakdown, and why they are the way they are, in relation to their psychic history … in order for this to be transformative they need to know consciously how all the elements fit together into a gestalt; they need to comprehend how they are a composition of their lives. Provided it is clear, simply expressed and to the point, the written explanation constitutes a lucid object that will be read and digested again and again by the analysand….the frequent revisiting of the explanation immerses the self in the matrix of its psychic truth” (p. 87). The lucid object serves as psychic organizer supporting further reflection, working through, and hopefully, true and lasting psychic change. It is with this in mind that the book is brought to conclusion with a focussed and evocative dialogue between Sacha Bollas (Psychology Assistant, LA) and Christopher Bollas wherein many further questions and treatment concerns, such as malignant marriages, the therapeutic communities’ usual reserved reaction to extended sessions, to name a few, are thoughtfully and honestly addressed. Bollas’s book has made our future work more hopeful and as such serves as our lucid object.
Loray Daws PhD is a psychoanalytic psychotherapist in Comox Valley, Vancouver Island, British Columbia. He currently serves as faculty member at the International Masterson Institute and the Director for the BC Masterson chapter. He has published on the Rorschach Inkblot Method as well as pain, eating, personality and bipolar disorders. Loray also currently serves as assistant editor for the Global Journal of Health Science. Contact; [email protected]