Picking Up the Pieces

Two Accounts of a Psychoanalytic Journey

Grace Jackson and Fayek Nakhla; Foreword by Joyce McDougall

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"The doctor says, You have to keep cutting yourself. Go on cutting yourself; you have to remain in touch with your body, with yourself, in whatever way you can."—Grace Jackson
When Grace Jackson began analytic therapy with Dr. Fayek Nakhla, she was struggling with the feeling that she did not exist. After many months of baffling silence in her therapy sessions, she experienced a psychotic regression characterized by violent behavior and self-mutilation. This engrossing and moving book is the story of the first few years of Grace's controversial analytic treatment, told in separate chapters by analyst and patient. This is the first time that a detailed account of the treatment process has been presented from both points of view.
Although Grace Jackson had a job and functioned relatively well in the outside world, the one activity that made her feel real—aside from cutting herself—was writing in a diary; her narrative is interspersed with excerpts from this journal, giving us a privileged insight into her private world, into her suffering and terror. Dr. Nakhla's account tells us of his misgivings as he attempted to understand Grace's extreme mental pain and conflict and to devise an effective treatment. Dr. Nakhla's approach, which eventually proved successful, was based on his understanding of the work of the British psychoanalyst D.W. Winnicott, and it followed the dangerous course of permitting Grace to experience her regression fully—even its violent aspects—in order to achieve the rebirth of her self. Together the two narratives provide an intimate picture of mental illness and of the therapeutic relationship that can help the patient regain sanity.

Fayek Nakhla, M.D., qualified as a psychoanalyst with the British Psycho-Analytic Society and is clinical associate professor of psychiatry at the State University of New York Health Science Center at Brooklyn. He is in private practice and on the faculty of the Object Relations Institute in New York City. Grace Jackson is the pseudonym of a writer and editor who lives in New York.

"Picking Up the Pieces is a unique, wonderful, and at times terrifying account  of the fragmentation of a self followed by gradual healing through psychoanalytic treatment. Nakhla and Jackson demonstrate extraordinary courage both in the treatment itself and in its exposure in this narrative. This book will be invaluable to those who treat patients with a psychotic core."—Arnold H. Modell, M.D.,  Harvard Medical School

"This unusual and deeply moving book documents a remarkable collaboration between a psychoanalyst and his patient as both reflect on the journey toward that conclusion which psychoanalysis recognizes as a cure: a process that involves both participants in deeply subjective engagements with self and other. Nakhla's courageous independence of thought and clinical intuition constitute a fine testimony to the best of contemporary psychoanalytical practice."—Christopher Bollas, British Psycho-Analytical Society

"This first-rate read and stranger-than-fiction account of a psychological journey tells of an intimate encounter between a patient and her doctor. The patient found herself—and her life—saved. At the same time, the doctor found lost parts of himself, personally and professionally. Therapists who would stay the course with the patients who need them most, and all of us who want to know what it is like to live on both sides of the razor's edge, will be enriched by this intimate book."—David E. Scharff, Director, The Washington School of Psychiatry

"In Picking Up the Pieces, analyst and patient together provide a fascinating account of a dramatic and unusual psychoanalytic treatment. Students and practitioners of psychoanalytic therapy will find much to learn and think about in this gripping therapeutic odyssey."—Robert D. Stolorow, Institute of Contemporary Psychoanalysis, Los Angeles

"This book will repay careful study by those who are charged with treating extremely disturbed patients. It will also have a broader appeal, because the heart of the book is the telling of a compelling story in nontechnical, existential terms."—F. Robert Rodman, M.D., editor of The Spontaneous Gesture: Selected Letters of D.W. Winnicott

"A unique book....Apart from its appeal to the general reader, this book has evident professional value. It not only provides an original addition to the growing body of research literature into the theoretical  understanding and treatment of patients in the grip of severely regressed and psychotic states but at the same time contributes to a deeper understanding of the unconscious fantasies and anxieties that underlie less extreme forms of pathology."—Joyce McDougall, from the Foreword

"Harrowing . . . A psychotherapy saga taken to its bloody limit: fascinating and disturbing."—Kirkus Reviews

"Blessedly free of the robotic prose that often accompanies clinical explanations of such intensive treatment, Picking up the Pieces moves between Grace's diary entries and Nakhla's progress notes with the pitch and intensity of a finely wrought novel."—Gail Caldwell, Boston Globe

"[Picking Up the Pieces] takes the reader on a journey that is both harrowing and unforgettable."—Chronicle of Higher Education

"Substantial essays. . . .A nice selection of color and black-and-white reproductions completes the volume."—Library Journal

"A remarkable account of a long and painful analysis of a very troubled woman. . . . Frank and deeply moving."—Susie Orbach, Guardian

ISBN: 9780300105674
Publication Date: September 1, 2001