First Year DEPRESSION
Teaching Notes - Judith Hamilton M.D.
Seminar 1: History
and Basic Concepts
The following notes are from Myer Mendelson (1974) Psychoanalytic Concepts of Depression. Spectrum Publications, Inc., Flushing, New York.
An on-going debate in the literature on sub-groups of depression:
19th century - idea of morbid taints and heredity
Late 19th century - Manic-Depressive Psychosis versus Dementia Praecox (Kraepelin) - depends on recoverability. Dementia Praecox became known as Schizophrenia (Bleuler).
20th century - included Involutional Melancholia - an agitated depression in post-menopausal women.
Then Neurotic Depression - not psychotic.
Then Endogenous versus Exogenous Depression according to absence or presence of apparent precipitating cause.
And Psychotic versus Neurotic Depression according to presence or absence of delusions.
Then Unipolar (only depressions) and Bipolar (alternating manic and depressive periods) Manic-Depressive Disorder
Then Primary and Secondary (to physical disease) Affective Disorder
Primary Affective disorder included Manic-Depressive, types 1 and 2 and Recurrent Depression
The following notes are from Edith
Jacobson – 1971 – Normal and pathological moods: their nature and functions, in Depression: Comparative Studies of Normal, Neurotic and Psychotic Conditions. I.U.P., New York, 66-106. Ego Psychology
A. Affect (affective state, feeling,
emotions) – early, Freud equated the affects with the energetic forces; later
(1915a) he defined affects as a subjective, conscious experience, one part of
the drive representation, the other part being the idea. In The Unconscious (1915b) Freud distinguished between
affects and feelings, affects referring to the whole set of psychophysiological
discharge phenomena, physiological insofar as they express themselves in body
changes and psychological insofar as they are perceived as feelings. Examples: love or hate and their derivatives. (American psychology favoured the term
“emotions” for the combined physiological and psychological manifestations.)
recommends that psychoanalysis use the term “emotion” synonymously with affects
to refer to the whole complex set of psychological and physiological
manifestations. (including affective motor, behaviour patterns, and affect
equivalents). Even in the most
“detached” ego states and ego functions we are never without emotions and feelings.
described affects as originating in the ego, but the energic tensions that
stimulated them may arise anywhere in the psyche. (e.g. guilt arising from conflict between the ego and the
superego). Affects develop
from specific though possibly complex tensions, and relate to definite
ideational representations; ie. object-directed emotional states.
B. Mood - examples: sad, hopeless,
depressed, angry, irritable, hostile, persecutory, expectant, elated, gay, triumphant. Think about the relation to attitudes.
· definition: temporary fixation of generalized
discharge modifications, induced by a significant experience whose discharge
pattern lends its quality to all simultaneous discharge patterns. (p. 71)
a cross-section through the entire state of the ego; particular qualities of
feelings, thoughts, performances during the whole day, no matter what their
by significant emotional
experiences expressive of one or more focal discharge processes; such an
experience may be stimulated from within, or from without, and need not come to
full awareness; it may be significant in terms of current reality, or because
it is associated with significant conscious or unconscious memories.
established, it affects
all patterns of responses to stimuli or objects; have generalized transference
· mechanisms involved: to produce a mood, the
provocative experience must be of a particular intensity and cause unusually
high energetic tensions which cannot be immediately and sufficiently relieved
by a focal discharge process only.
The memories of the provocative experience will remain strongly
hypercathected. The provocation
results in temporary, qualitative modifications of the concepts of the self
(representations) and of the entire object world. Certain concepts are hypercathected; contradictory inferences
derived from past experiences are hypocathected (relatively denied). Since our moods affect our attitudes
and behaviour patterns, the responses we get from others as a result of our
actions will commonly tend to confirm and promote the notions on which our mood
is based, until reality interferes sufficiently [eg. through interpretation, or lived experience] to bring about changes of these concepts and consequently of
function of moods; early mood dispositions and their development: If it is characteristic of all moods
that they allow a repetitive affective discharge on a great number and variety
of objects, such a prolonged discharge in small quantities, combined with
reality testing, must liberate psychic energy from fixated positions and reopen
the gate to new investments. This
process tends to protect the ego from the dangers of too explosive overwhelming
discharge; ie. a primitive economic function. The ultimate economic success will, however, depend largely
on the extent to which this prolonged discharge process permits true reality
inappropriate moods, conspicuous or prolonged swings of mood predominate in
persons whose ego operates frequently on a primary process level with high
quantities of deneutralized energy which threatens to be discharged
suddenly. Their ego lacks the
capacity for subtle, “secondary process” modes of economic functioning and
We can observe individual
predispositions to certain prevailing or recurring mood conditions already
in earliest childhood.
Reveals the child’s predilection for special affectomotor reactions,
and/or the influence of repetitive or prolonged exposure to the same type of
manic-depressive states, which show a severe pathology of the superego
functions - superego formation has a singular influence on the development
of affect and mood control and thus of mood predisposition. It has a modulating effect on emotional
expression in general; the rises and falls of self-esteem become indicators and
regulators of the self- and object-directed cathexes in the total ego, and of
the resulting discharge processes. Superego approval or disapproval may no longer relate to special,
unacceptable instinctual strivings, but rather refer to opposite notions
of the total self in terms of black and white, of “being good, expecting
reward” or “being bad, expecting punishment”. Consider also persecutory mood. These characteristics are narcissistic aspects of the self.
conspicuousness of early infantile affective and mood predispositions
shows the extent to which they are determined by such factors as the
child’s inherent drive intensity, the depth and intensity of his object
cathexes, his inherent tendency to respond to frustration, hurt or deprivation
with lesser or greater, rapidly passing or more enduring ambivalence.
normal and pathological mood
qualities or mood swings: In normal, find a much wider range, more subtle, more
intense, as well as tamed, controlled.
In pathological, find, narrow range, not well controlled.
Two Normal Types of
Mood Variations; The Nature of sadness and grief, of gaiety and cheerful
Sadness - an
emotional response of the ego to suffering
may arise from realistic external or from inner, conscious or unconscious,
may arise from identification with the suffering of others
suffering that promotes sadness always seems to be caused by experiences - or
fantasies - of loss or deprivation, such as by loss of gratification
either previously gained or
expected, by loss of love, by separation, or, in the case of mourning, by loss
of a love object.
may also arise as a result of physical sickness, by the concomitant loss of
instinctual and emotional gratifications.
the case of sadness and grief over loss, have:
of predominantly libidinal cathexes (unlike depression which involves an
by tensions within the ego; hypercathexis of the tragic event of the loss,
preoccupation with the happy experiences of the past, or the expected
gratification which could not be attained, combined with painful desires to
gain or regain them; alternating between hypercathexis of the happy past and
the sad events which induced the grief.
of the sad memories lead to innumerable painful but relieving discharge
processes (e.g. tears)
prolonged reality testing achieves a gradual renunciation of the wishful
fantasies and liberates libido for new pursuits.
libidinal cathexis of the self in its current situation (of loss and sadness)
is reduced, but not in favour of aggression. The libidinal object cathexes are likewise maintained,
though they may also be reduced.
as the stability of his self-esteem and his object relations is essentially
unshaken, a grieving person may be able to sustain his normal relationships,
interests, and activities. But the
gratifications which they may otherwise grant cannot be properly enjoyed, since
any pleasure, if permitted to develop at all, is tinged with pain because of
what is searched for and missed (eg. listening to music).
relations and ego activities acquire a subdued quality. They lack the recurring waves of
increasing narcissistic and object cathexes which result from full
gratifications and prepare for renewed pleasurable experiences and actions; reduced transference to reality.
and hopelessness are also found in sadness and states of grief without
is often mixed with self-pity - hypercathexis of the “poor, deprived self that
needs love and sympathy.”
Gaiety or normal, cheerful elation
pleasurable counterpart of sadness.
on libidinal processes, which lead to pleasurable discharges.
follow a happy event that follows a state of worry or sadness.
gain of pleasure is always a “regaining” which must inevitably conjure up
memories of previous loss or deprivation or suffering in general; all the more
so, the more intense and the more unexpected the wish fulfillment.
factor of unexpected is usually present in joyful and in sad moods. The occurrence of very good or very bad
events seems to be forever “unexpected”.
Normal, Neurotic and Psychotic Mood Deviations
with either normal or pathological qualities
are an economic modality of the ego, which partly reinstates a primary process
type of mental functioning.
themselves are not pathological, but rather their motivations distinguish
normal from pathological. Also,
the extent to which they permit of reality testing, and correction of
the prevailing self- and object-representations. The overemphasis of one set of representations involves
certain degrees of denial of contrary representations.
normal moods, denial does not extend to the provocative external event, or to
its immediate emotional impact which evokes the mood. This allows easier reality testing. If both are denied, reality testing is
interfered with and the psychic situation cannot be mastered and the mood
is not a distinguishing criterion
soon as unconscious conflicts participate in the development of the
mood, they preclude an ultimate economic success. Infantile fixations prevent a
reality testing sufficient to guarantee a true liberation of psychic energy
from its original fixated position.
well, hypercathexis of the pathogenic, repressed memories survives the mood and
tends to turn reality into a constant source of renewed provocations, thus
re-establishing the disturbed (anxious or hostile or depressed) affective
state. If the mood deviation
arises from a pathological narcissistic conflict, reality testing becomes even
less effective or, in psychotic mood conditions, impossible.
Moods induced by narcissistic conflicts
in general less reality testing than moods evoked by conflicts with the
mood disturbance arises from the discrepancy between the self-representations
and the ego ideal (superego) or
the wishful image of the self.
Hence it requires predominantly a testing of inner reality. External reality can be used only as a
medium on which the self can assert its value. The self-critical agents, which test our inner reality, are
deeply rooted in the unconscious and therefore highly arbitrary. Our self-representations are in general
even less realistic than our object-representations. Our chances for correct self evaluation are limited.
difficulties of reality testing manifest themselves even in moods evoked by a
narcissistic conflict that has a realistic basis.
contrast to other origins of moods, in moods caused by narcissistic conflicts,
not longings for objects but narcissistic desires are attached to the world or
are expected to be satisfied through the medium of the world. The higher and more illusory the
narcissistic expectations and the less realistic the object and self
representations are to begin with, the more pathological will be the conflict
and thus the resulting mood.
infantile origin and the power of the superego make moods evoked by unconscious
superego conflicts especially resistant to reality testing. This becomes impossible when the
superego has replaced the object world and, independent of its standards and
judgment, condemns and punishes the self or, the opposite, renounces its
Denial in moods
make a distinction not only between many types, but also between varying
degrees of denial and distortion which can be involved in mood
development. In general, denial
affects both the self and the object world, but it may lead to more conspicuous
distortions of one or the other.
traditional comparison between grief and depression (Freud, 1917) has been
misleading in implying that the former is normal while the latter is
depressed and elated states may develop within the range of normal mood
dangers of becoming pathological that are inherent in depressed and hostile
mood conditions are because of their involvement with aggression and conflict,
and the potential of including unconscious conflict, or, even worse, regressive
processes (which preclude reality testing and adequate discharge).
depressed moods or states of hostility,
of aggressive excitement, the world and the self appear inadequate,
faulty, bad, or injurious. They
are derogated, criticized with regard to their strength, ability,
superiority, or moral perfection, ie. in terms of ego or superego values. Thus the core of the narcissistic
disturbance in depression is always an experience of failure, though not
necessarily of moral failure. The
more the superego contributes to the conflict, the more will the self be
conceived of as morally bad, expecting punishment from without or within. Frequently, though, the conscious feelings and ideas of
inadequacy fend off hidden guilt conflicts.
hostile and depressed moods can gain intensity
through the calling away of aggression from the self or vice versa. Thus, angry moods may develop
from narcissistic conflicts, eg. from guilt conflicts or experiences of failure
or faults when the self-directed aggression is secondarily turned toward the
object world. Reversely, depressive states may be induced by a shift of aggression
from the objects to the self.
This prevents a devaluation of the object world, serves as an effective
defense against ambivalence conflicts, especially when the latter involve the
danger of loss of a significant love object.
in mood states, the self and the world tend to
assume complementary qualities. If
there is veering away of aggression to the self in depression accompanied by a
libidinal hypercathexis of the world, the self and object world acquire opposite coloring.
in persons who relate to the object world only
by way of narcissistic identifications, all conflicts, even those involving the
object world, are narcissistic in nature.
Since in this case the boundaries between self and object
representations are indistinct, any deflation of the world is cast back upon
the self. The self and the world
may be felt to have assumed identical qualities.
However, depressive states do not always develop
from attempts to resolve ambivalence conflicts by a turning away of aggression
from the love object (the object world) to the self. They may well be directly evoked by a primary, narcissistic
conflict. Such states of
depression induced by narcissistic conflicts may be intensified or influenced
by infantile narcissistic conflicts, but they may also be caused directly by
realistic experiences of failure, inadequacy, or moral transgression.
History and Summary of Freud’s Mourning and Melancholia
The following notes are from Freud, S. (1917) Mourning and melancholia. S.E. 14: 239-258.
Strachey (1957) - Freud wrote this paper in
1915. He conferred with Abraham
who suggested that there was a connection between melancholia and the oral
stage of libidinal development.
an extension of the paper on narcissism, seeing
the ‘critical agency’ in operation in melancholia.
in melancholia, because of regression, an
object-cathexis is replaced by an identification.
Freud limits himself to “a small number of cases whose
psychogenic nature was indisputable.”
Compare and contrast mourning and melancholia - Both
follow on similar environmental events, the loss of a loved person or
abstraction which takes the place of a person. Both are time-limited.
Melancholia: profoundly painful dejection
of interest in the outside world
the capacity to love
of all activity
of the self-regarding feelings to the point of self-reproaches and
culminates in delusional expectation of punishment.
It is a pathological state.
Mourning: if severe,
the same painful frame of mind
same loss of interest in the outside world, insofar as
it does not recall the
same loss of capacity to adopt any new object
same turning away from activity that is not connected with
the lost object
not the lowering of self-regard in mourning.
It is a normal state, not pathological.
The work of
mourning - Reality-testing has shown that the loved object no longer
exists, and it proceeds to demand that all libido shall be withdrawn from its
attachments to that object.... Each single one of the memories and expectations
in which the libido is bound to the object is brought up and hypercathected,
and detachment of the libido is accomplished in respect of it.... When the work
of mourning is completed, the ego becomes free and uninhibited again.
The psychology of
melancholia - Melancholia is also a reaction to the loss of a loved object
or an ideal, or of the object’s love.
The patient may not know what has been lost. Or if he knows who has been lost he may not know what is lost. This is often unconscious in the patient.
the unknown loss results in similar internal
work as in mourning and will therefore be responsible for the melancholic
inhibition. But we cannot see what
is absorbing the patient so entirely.
the lowering of self-regard amounts to an
impoverishment of the ego. The
patient represents his ego as worthless, incapable of any achievement and
morally despicable. He reproaches
himself, vilifies himself and expects to be cast out and punished. He extends his self-criticism back over
the past, saying he was never any better.
This delusion of (mainly moral) inferiority is completed
by sleeplessness and refusal to take nourishment, and by an overcoming of the
instinct which compels every living thing to cling to life.
There is no correspondence between the degree of
self-abasement and its real justification. Also there is a lackof shame in the
melancholic; rather see an opposite trait of insistent communicativeness which
finds satisfaction in self-exposure.
. So, he has suffered a loss in regard to an object; what he tells us points to a
loss in regard to his ego.
involved - constitution of the human ego - one part of the ego sets itself
over against the other, judges it critically, and as it were, takes it as its
object. Distinguish this critical
agency from the rest of the ego.
The conscience. It
can become diseased on its own account.
In the melancholic, dissatisfaction with the ego is mostly on moral
The dynamics of
melancholia - The key to melancholia - the self-reproaches are really
against the love object who is lost, but have been shifted from the object to
the patient’s own ego.... An object-choice, an attachment of the libido to a
particular person, had at one time existed; then, owing to a real slight or
disappointment coming from this loved person, (a narcissistic injury) the
object-relationship was shattered.
The result was not the normal one of a withdrawal of the libido from
this object and a displacement of it on to a new one, but something different,
for whose coming about various conditions seem to be necessary. The object-cathexis seemed to have little
power of resistance and was brought to an end. (Regression to narcissism) Then
the free libido was not displaced on to another object; it was withdrawn into
the ego. There, it served to
establish an identification of the
ego with the abandoned object.
Thus the shadow of the object fell upon the ego, and the latter could
henceforth be judged by a special agency, as though it were an object, the
forsaken object. In this way, an
object-loss was transformed into an ego-loss and the conflict between the ego
and the loved person into a cleavage between the critical activity of the ego
and the ego as altered by identification.
melancholia - A strong fixation to the loved object must have been present
- On the other hand, the object-cathexis must have had little power of
implies that the object-choice has been
effected on a narcissistic basis, so that the object-cathexis, when
obstacles come its way, can regress to narcissism. The narcissistic
identification with the object then becomes a substitute for the erotic
cathexis, the result of which is that in spite of the conflict with the loved
person the love-relation need not be given up.
(Identification is the preliminary stage of
object-choice. The ego wants to
incorporate this object into itself, and, in accordance with the oral or
cannibalistic phase of libidinal development in which it is, it wants to do so
by devouring it.)
this object-choice is an ambivalent
one. The occasions which give rise
to melancholia extend beyond the clear case of a loss by death, and include all
those situations of being slighted, neglected or disappointed, which can import
opposed feelings of love and hate into the relationship or reinforce an
already existing ambivalence. This
conflict due to ambivalence, sometimes arises more from real experiences,
sometimes more from constitutional factors,...If the love for the object - a
love which cannot be given up though the object itself is given up - takes
refuge in narcissistic identification, then the hate comes into operation on
this substitutive object, abusing it, debasing it, making it suffer and
deriving sadistic satisfaction from its suffering....the trends of sadism and
hate which relate to an object, and which have been turned round upon the
subject’s own self...
(In both melancholia and obsessional neurosis, the
patients usually still succeed in taking revenge on the original object
and in tormenting their loved one through their illness, having resorted to it
in order to avoid the need to express their hostility to him openly. The object
is usually in the immediate environment.)
Course of the
illness - Melancholia passes off after a certain time has elapsed. Shares this feature with mourning. Perhaps analogous work has to be got
through. We have no insight into
the economics of the course.
The sleeplessness attests to the rigidity of the
condition. The complex of
melancholia behaves like an open wound, drawing to itself cathectic energies
from all directions, and emptying the ego until it is totally impoverished.
A somatic factor probably accounts for its
amelioration in the evenings.
Perhaps a loss in the ego irrespective of the object, a purely
narcissistic blow to the ego, may suffice to produce the picture of
melancholia, eg. an impoverishment of ego-libido directly due to toxins.
Tendency to change
round into mania - In both melancholia and mania, the content is the
same. In the former the ego has
succumbed to the complex, whereas in mania it has mastered it or pushed it
aside. Joy, exultation or triumph
seem to be the normal models for mania; all depend on the same economic
conditions. As a result of some
influence, a large expenditure of psychical energy, long maintained or habitually
occurring, has at last become unnecessary, so that it is available for numerous
applications and possibilities of discharge.
In mania, what the ego has surmounted and triumphed over is
hidden from the ego.
In mania, the ego must have got over the loss of the
object, and thereupon the whole quota of anticathexis which the painful
suffering of melancholia had drawn to itself from the ego and ‘bound’ will have
become available. The manic person
seeks ravenously for new objects.
This mania may not follow normal mourning because the work
of severance from the object is so slow and gradual that by the time it has
been finished the expenditure of energy necessary for it is also dissipated.
of view, psychical systems involved in the work of melancholia - In
melancholia, the relation to the object is not simple; it is complicated by ambivalence,
either constitutional (ie. is an element of every love-relation formed by this
particular ego), or else it proceeds precisely from those experiences that
involved the threat of losing the object.
For this reason, the exciting causes of melancholia have a much wider
range than those of mourning. In
melancholia, therefore, there are countless separate struggles carried on
over the object, in which hate and love contend with each other; the one
seeks to detach the libido from the object, the other to maintain this position
of the libido against the assault.
The location of these separate struggles - the Unconscious,
the region of the memory-traces of things
(as contrasted with word-cathexes). In mourning, too, the efforts to detach
the libido are made in this same system; but in it nothing hinders these
processes from proceeding along the normal path through the Precconscious to
consciousness. This path to
consciousness is blocked for the work of melancholia, owing perhaps to a
number of causes or a combination of them. Constitutional ambivalence belongs by its nature to
the (unconscious) repressed; traumatic experiences in connection with the object may
have activated other repressed material.
Thus everything to do with these struggles due to ambivalence remains
withdrawn from consciousness, until the outcome characteristic of melancholia
has set in. This consists in the
threatened libidinal cathexis at length abandoning the object, only, however,
to draw back to the place in the ego from which it had proceeded. So by taking flight into the ego love
regression of the libido the process can become conscious, and it is
represented to consciousness as a conflict between one part of the ego and the critical
What consciousness is aware of in the work of melancholia
is thus not the essential part of it, nor is it even the part which we may
credit with an influence in bringing the ailment to an end. We see that the ego debases itself and
rages against itself. We
understand as little as the patient what this can lead to and how it can
change. We attribute such a
function to the unconscious part of the work. Just as mourning impels the ego to give up the object by
declaring the object to be dead and offering the ego the inducement of
continuing to live, so does each single struggle of ambivalence loosen the
fixation of the libido to the object by disparaging it, denigrating it and even
as it were killing it. It is
possible for the process in the Unconscious to come to an end, either after the
fury has spent itself or after the object has been abandoned as valueless. The ego may enjoy in this the
satisfaction of knowing itself as the better of the two, as superior to the
ELEMENTS OF ABRAHAM’S FORMULATION OF MELANCHOLIA
The following notes are from Myer Mendelson, (1974) Psychoanalytic Concepts of Depression.
Spectrum Publications, Inc., Flushing, New York.
Freud (1909) - in the obsessional, hatred and love were always interfering with each other.
Abraham (1911) - neurotic depression is when the person has to give up his sexual aim without having attained gratification. He feels himself unloved and incapable of loving and therefore, he despairs of his life and his future.
Abraham (1911) - in psychotic depression, hatred was paralyzing the person's capacity to love; therefore, depression was associated with ambivalence and the projection of hostility; e.g. "People hate me because of my inborn defects"; "therefore, I am unhappy and depressed." Hostility reveals itself in dreams and symptomatic acts; there is a tendency to annoy other people; have violent desires for revenge. The more violent his unconscious destructive and vengeful fantasies, the more delusions of guilt, as though he thought he'd carried them out. This demonstrates "omnipotence of thought", as in the obsessional. Delusions of poverty spring from a repressed perception of his inability to love. there is hidden pleasure from suffering and from continually thinking about himself.
Freud (1915) wrote "Mourning and Melancholia"; published it in 1917.
Abraham (1916) corroborated clinically the idea of an oral pregenital stage of sexual life. Many patients whose method of achieving sexual pleasure had not achieved independence from the nutritive act, seen in, e.g. resistance to weaning; prefer to eat than have sex; eating relieves depression; medication is useful to depressives because of its oral satisfaction. In patients with psychotic depression, there are often two oral symptoms: refusal to take food, and fear of dying of starvation. Due to the regression to the oral stage the patient has a wish to incorporate his object, and fear that he might.
Abraham (1924) Like the obsessional, the manic-depressives person is ambivalent even between episodes. Both are similar in character structure: cleanliness, parsimony, obstinacy. Both experience sadistic impulses related to anal stage erotism (retention and expulsion) and sadism (destroy and control). In this stage, the object is experienced as being owned or possessed; it can be "done to" like feces.
A neurotic reaction to loss often includes constipation or diarrhea, thus symbolically denying and affirming the loss. The obsessional has a less primitive response: retention and control retains the object; the melancholic has a more primitive response: expulsion and destruction abandons the object. He was able to demonstrate that in the obsessional there was regression to the anal-sadistic stage, whereas in the melancholic, there was regression to the oral-sadistic stage.
Abaraham corroborated Freud's ideas about introjection - by fantasies of incorporation. This had the effect of overwhelming love with hate.
The following notes are from Karl Abraham (1924) A short study of the development of the libido, viewed in the light of mental disorders, in Selected Papers on Psycho-Analysis. 1927. Brunner/Mazel, Inc., New York. 422-433, 453-470.
Freud - Melancholia involves regression of the libido
to the oral stage, and the mechanism of introjection (cannibalistic fantasy of
of Melancholia and Obsessional Neurosis
and sadism - In illness-free intervals, patients with cycloid illnesses and
obsessional neurosis have the same character ie. anal-sadistic, sublimated. In
illness, when threatened with the loss of an object, the melancholic gives up
his object while the obsessional does not; ie. They regress to different
of two substages in the sadistic-anal stage.
Anal erotism has two, opposite pleasurable tendencies, and
anal sadism has two opposite pleasurable tendencies. At the anal stage, the person experiences his object as
something he possesses. Also, at
this stage, he is under the strongest influence of ambivalence.
(early erotic); and retentive (later erotic)
b. Destroy (early sadistic); and control or dominate (later sadistic)
When loosing an object, or under threat of losing an
object, the unconscious experience of the melancholic is that this is done by
expulsion of the object with destruction of the object, as the feces are expelled, whereas, the obsessional retains or
conserves the object by attempting, compulsively, to control or dominate the
The difference in these two attitudes towards objects is
crucial to one’s relations to the object world.
of the concept of object constancy:
p. 432 - “This differentiation of the anal-sadistic stage
into a primitive and a later phase seems to be of radical importance. For at the dividing line between those
two phases there takes place a decisive change in the attitude of the
individual to the external world.
Indeed, we may say that this dividing line is where ‘object-love’ in the
narrower sense begins, for it is at this point that the tendency to preserve
the object begins to predominate.”
(stable vs. earlier unstable ambivalence)
Once the dividing line has been crossed, the melancholic regresses to still earlier (oral) stages
of the libido. (Freud - “The object love has little
power of resistance.”)
for Freud’s idea of object loss in melancholia as an active abandonment of
the object - find a relationship between object loss, and a tendency to
lose (in the unconscious, expel - anal) and destroy (murder) things - followed
by the process of introjection(identification) which has the
character of a physical incorporation by the mouth (in the unconscious, eat
dirt, feces, eating the loved object whom he has killed - oral).
In normal mourning, introjection occurs, but is set in
motion by a real loss (death), which is consciously remembered; its main purpose
is to preserve the person’s relations to the dead object. Feelings of affection easily oust the
hostile ones in regard to an object he has (in reality) lost.
In melancholia, introjection is based on a radical
disturbance of his libidinal relations to his object. It rests on a severe conflict of ambivalent feelings, from
which he can only escape by turning against himself the hostility he originally
felt towards his object. In the
melancholic, there is so strong a conflict based on libidinal ambivalence that
every feeling of love is at once threatened by its opposite emotion. A ‘frustration’, a disappointment from
the side of the loved object, may at any time let loose a mighty wave of hatred
which will sweep away his all too weakly-rooted feelings of love. Such a removal of the positive
libidinal cathexes will have a most profound effect: it will lead to the giving
up of the object - a withdrawal of libido from the object, and all other
objects and interests, and redirecting it
toward the ego. After he
has thus “lost” his object, the melancholic attempts a restitution of it,
in Melancholia - The Oral Phase
of two stages in orality
a. Sucking - loving - earlier In this stage, devouring has the unconscious meaning of sucking in, possessing positively, taking the loved object inside as a result of libidinal desire. The melancholic has a longing to regress to this stage (warm, sucking, milk, soft, love, comfort) This is prior to self-object differentiation, pre-ambivalent.
- sadistic - later
In the melancholic, frequently see the tendency in
cravings to use the mouth in place of the genitals, and vivid cannibalistic
fantasies. They also, defensively,
or as punishment for their cannibalistic impulses, resist using their teeth
“chewing laziness” (eat hamburger meat only). This devouring of the object by biting results in the
destruction of the object. In
fact, “As soon as the child is attracted by an object, it is liable, indeed
bound, to attempt its destruction.”
This is the beginning of ambivalence.
The melancholic is fixated at the earlier
anal-sadistic stage of expulsion of his object, and at the later oral-sadistic
stage of biting, which is the stage where ambivalence begins and is therefore
at its most primitive, unmodified.
On this level, the individual threatens to destroy his libidinal object
by devouring it (the hostile part of the ambivalence). It is only gradually that the
ambivalence conflict assumes a milder aspect and that the libido consequently
adopts a less violent attitude towards its object. Nevertheless this ambivalent attitude remains inherent in
the tendencies of the libido during the subsequent phases of its development. For example, the next phase is also divided
into the earlier, phallic phase, and the later, genital phase. Through these there is further
modification of the ambivalence until, in the normal person, who is relatively
far removed from the infantile forms of sexuality, there is little ambivalence. The libido has reached a
On the way to complete object-love: Within the first - the oral- period,
the child exchanges its pre-ambivalent libidinal attitude, which is free from
conflict, for one which is ambivalent and preponderantly hostile towards its
object. Within the second - the
anal-sadistic - period, the transition from the earlier to the later stage
means that the individual has begun to spare his object from destruction. Finally, within the third - the
genital- period, he overcomes his ambivalent attitude and his libido attains to
its full capacity both from a sexual and a social point of view.
Pathogenesis of Melancholia
self-directed ambivalence of the melancholic - this is a libidinal conflict and
a narcissistic conflict (see Jacobson), self-love vs. self-hatred.
The melancholic, in his pre-illness, has an unusually high
degree of ambivalence in his emotional life - he may suddenly give up any of
his intensely pursued interests or objects (as a result of
disappointment). When the
libidinal cathexis has been withdrawn from the object, it is directed to the
ego, while at the same time the object is introjected into the ego. The ego is now mercilessly exposed to
the ambivalence of the libido. The
melancholic is filled with a tormenting self-contempt and a craving to belittle
himself. But also the opposite
tendency, a self-aggrandizement, a feeling of superiority, extreme sensitivity
to criticism, contempt for other people who apply the standards of reality to
his ideas. He feels he is the
“greatest sinner of all” and that his anger and feelings of hatred are
enormously powerful. So there is
an exaggeration of a positive and a negative narcissism.
precipitating narcissistic injury is an event experienced
as a repetition of a childhood trauma
It follows a disappointment of love, but the events that
usher in the loss of the object are more obscure. The event has a pathogenic effect because the patient is
able to regard it in his unconscious as a repetition of an original infantile
traumatic experience and to treat it as such - a strong compulsion to repeat in
manic-depressive illness (as many episodes).
heightened oral erotism - neuroses of all kinds in the families.
fixation - very exacting in their demands to have their special erotogenic zone
(and its derivative forms) gratified, and react with great displeasure to every
frustration in this connection.
For example, very jealous of seeing another child at the breast or of
seeing mother love the father.
infantile narcissistic injury - very frequently, “The child had felt that he
was his mother’s favourite and had been secure of her love. He had then suffered a disappointment
at her hands and had with difficulty recovered from its shattering effect. Later on, he had had fresh experiences
of the same sort which had made him feel that his loss was an irreparable one,
especially as there had been no suitable female person on to whom he could
carry over his libido.
Furthermore, his attempt to direct it towards his father had failed,
either straight away or after some time.
Thus as a child he had got the impression of being completely
deserted. And it was this feeling
that had given rise to his first attacks of depression. The constantly repeated attempts of the
melancholic to gain love from a person of the opposite sex are intimately bound
up with the early disappointment from both sides.”
the Oedipal resolution. The first
important disappointment comes before the child’s libido has overcome the
narcissistic stage, before the repressive forces have gained control over his
Oedipal impulses, just as he is making his first steps towards
object-love. Since his oral-sadistic
instincts are still in force, a permanent association will be established
between his Oedipus complex and the cannibalistic stage of his libido. This will facilitate a subsequent
introjection of both his love-objects.
repetition of the primary disappointment - This is the exciting cause of the
onset of a melancholic depression.
The whole sum of his anger in later disappointments is ultimately
directed towards one single person, the one whom he had been most fond of as a
child and who had then ceased to occupy this position in his life. Therefore, in melancholics, it is
the mother against whom the original hostile, cannibalistic impulses develop. Although it comes to include the father
through the Oedipal stage. Later
self-reproaches thus include reproaches against both parents.
introjection into conscience and ego
patient has introjected his original love-object upon which he had built his
ego ideal; so that that object has taken over the role of conscience for him,
although, it is true, a pathologically formed one. eg. The self-reproaching voice is based on mother’s voice.
content of the self-reproaches is ultimately a merciless criticism of the
introjected object. eg. of the one
and the other parent who have been introjected into the ego.
Starcke’s theory - that the withdrawal of the mother’s
breast is a ‘primal castration’.
The melancholic wants to revenge himself on his mother for this by
castrating her in his turn, either taking away her breasts or her imaginary
penis. In his imagination he
always chooses biting as the means of doing it. These phantasies are ambivalent, involving, on the one hand,
a total or partial incorporation of the mother, that is, an act of positive
desire; and, on the other, her castration or death, that is, a negative desire
tending to her destruction.
Review - “When melancholic persons suffer an
unbearable disappointment from their love-object, they tend to expel that
object as though it were feces and to destroy it. They thereupon accomplish the act of introjecting and
devouring it - an act which is a specifically melancholic form of narcissistic
identification. Their sadistic
thirst for vengeance now finds its satisfaction in tormenting the ego - an
activity which is in part pleasurable.
This period of self-torment lasts until lapse of time and the gradual
appeasement of sadistic desires have removed the love- object from the danger
of being destroyed. When this has
happened the object can, as it were, come out of its hiding-place in the
ego. The melancholic can restore
it to its place in the outer world.
In his unconscious, the melancholic regards this liberation from his
object as once more an act of evacuation.
Parathymia - the infantile prototype of melancholic depression
The melancholic depression is derived from disagreeable
experiences in the childhood of the patient. Consider the original emotional reactions of the child,
discovered through analysis, to traumatic experiences.
The patient illustrates in his memory “the intense longing
of the melancholic for the happy state when he was still at his mother’s
breast....Speak of a ‘primal parathymia’ ensuing from the boy’s Oedipus
complex. See with impressive clearness
how much the child longed to gain his mother as an ally in his struggle against
his father, and his disappointment at having his own advances repulsed combined
with the violent emotions aroused in him by what he had observed going on in
his parents’ bedroom. He nursed
terrible plans of revenge in his breast, and yet the ambivalence of his
feelings prevented his ever putting them into practice. Unable either to
achieve complete love or an unyielding hatred, he succumbed to a feeling of
hopelessness. In the years that
followed he made repeated attempts to attain a successful object-love; and
every failure to do so brought with it a state of mind that as an exact replica
of his primal parathymia. It is
this state of mind that we call melancholia.
How ready the melancholic is even during his free
intervals to be disappointed, betrayed, or abandoned by his love-object....In
each symptom of his various depressive periods he faithfully repeated all those
feelings of hatred, rage, and resignation, of being abandoned without hope,
which had gone to colour the primal parathymia of his early childhood. (p.
A. Based on Edith Jacobson (1971), "Normal and pathological moods: their nature and
contrast to affects, which are always focused on an object, moods are diffused
over the whole object world.
allows for the gradual discharge of drive elements that would otherwise be
experienced as overwhelming; thus, those predisposed to strong moods are often
people with weak affect-tolerance.
D. The theme
of any mood is one pole of a contrasting pair: eg. happy/sad, elated/depressed,
angry/affectionate. It is part of
the psychology of moods that the accentuation of one pole goes along with the
denial of the other. This denial
is seen, to a greater or lesser degree in all moods, more prominently in the
more pathological mood states.
"Mostly, in normal moods the denial does not extend to the
provocative external event or to its immediate emotional impact which evokes
E. Moods are
complex phenomena, involving every aspect of the ego and, in particular a
complementary configuration of the self and object representations, eg. in
mania the self is wonderful and the world is adoring.
cannot be distinguished from affects or graded as to normality and
pathology by their duration alone.
Important indicators of pathology are: fixity as opposed to
modifiability of the mood, disproportion or inappropriateness to the
precipitating event, and inability to test reality. Thus moods are within the normal range
and appropriate in quality as long as they are compatible with the momentary
external and internal reality and can be recognized as temporary ego states due
to conscious reactions to realistic events. They will yield to reality testing and consequently be
controllable and of limited duration.
The less conscious a person is of the sources from which his moods
arise, the less easily can the psychic situation be mastered and the more
inappropriate are the mood qualities. (p. 88)
AS MOOD STATE FOLLOWING ON NARCISSISTIC INJURY
Edith Jacobson 1971
Precipitated by a blow to the self-esteem (a 'narcissistic injury') that
interferes with an important source of self-esteem: rejection, criticism,
humiliation, illness, failure, etc.
B. The mood
state is reversible if the narcissistic injury is reversed.
C. There is
no significant regression in the level of object relations and corresponding
mode of narcissistic regulation (eg. to object-splitting or decathexis of the
object world). It is important to
distinguish between withdrawal of interest due to preoccupation with the hurt,
and the more ominous decathexis of the entire object world seen in depressive
D. The state
of narcissistic injury is always the recurrence of an earlier compensated or
defensively warded-off narcissistic injury - usually in childhood. (Abraham
E. The state
2. ended by compensatory adjustment to the
injury (eg. accepting substitutes, changing ideas of what is valuable)
3. ended by defensive warding off of the injury
(eg. denial and reversal, disavowal of the significance, reaction formation)
4. a precursor to a depressive illness
content of the mood state may be extremely varied - helplessness, hurt,
self-blame, blame of others, shame, rage, rebellion, etc. Ego functions,
especially those reflecting capacity for focused attention, may be affected.
EDITH JACOBSON (1953)
(simple, psychotic, endogenous (psychosomatic) features, in cyclothymics)
consists of a triad of symptoms: periods of depressed mood, inhibition
of thinking, and psychomotor retardation.
The central psychological problem in depression - narcissistic
breakdown: loss of self-esteem, feelings of impoverishment, helplessness,
weakness, and inferiority; or, in the melancholic type, of moral worthlessness
and even sinfulness.
Premorbid manic-depressive personality -
richness of their sublimations, delightful companions, full genital response,
emotional warmth and unusual affectionate clinging to people they like.
Remarkable intolerance toward frustration, hurt, and disappointment. Simultaneously thetendency to
too strong fixations to their love-object and to a quick withdrawal of object
cathexis. The object choice
of these persons must have been, to begin with, on a narcissistic basis,
which permits them to regress easily to the narcissistic identification with
They require a constant supply of love and moral support
from a highly valued love-object (whom they idealize). The patient's self-representations
retain the infantile conception of a helpless self, drawing its strength from a
powerful, ideal love-object, which he has to constantly hypercathect with libidinous
BIBRING’S MECHANISM OF DEPRESSION (1953)
(An ego state in response to narcissistic injury.)
A. Depression is an ego-psychological phenomenon, a 'state
of the ego', an affective state (p. 21) Depression is the emotional
expression of a state of helplessness and powerlessness of the ego (e.g.
the individuals described either felt helplessly exposed to superior powers,
fatal organic disease, or recurrent neurosis, or to the seemingly inescapable
fate of being lonely, isolated, or unloved, or unavoidably confronted with the
apparent evidence of being weak, inferior, or a failure. (p. 23) In all cases,
there is a blow to the person’s self esteem. (p. 24) It results from the
tension between highly charged narcissistic aspirations (of the ego ideal) and
the ego's awareness of its helplessness and incapacity to live up to these
B. Three sources of self-esteem:
1. The wish to be
worthy, to be loved, to be appreciated; that is, to be loved by the ego ideal.
The wish to be strong, superior, great, secure; that is, to satisfy
remnants of the ideal ego (infantile narcissism).
3. The wish to be
good, loving, not aggressive, hateful nor destructive; that is, to love the ego
Depression sets in when one or more of these conditions
fail and the ego feels helpless to resurrect them. It is a state of the ego whose main characteristics are a
decrease of self-esteem, a more or less intense state of helplessness, a more
or less intensive and extensive inhibition of functions, and a more or less
intensely felt particular emotion.
It often includes fatigue and anxiety.
C. Narcissistic aspirations of each
psychosexual level which can be frustrated and lead to depression:
1. Oral – the need to get affection, to be
loved, to be taken care, of to get
“supplies,” or by the opposite defensive need: to be independent,
Anal – the wish to have mastery and control over the body, the impulses
(drives) and persons (objects).
Not to feel guilt or remorse over excessive aggression, nor to
Phallic – the wish to be admired, to be centre of attention, to be
strong and victorious, not to be defeated.
Traumatic narcissistic injuries early in childhood
predispose a person to later neurotic and probably also psychotic
But not all
depressions occur in “orally-oriented” persons.
Also, aggression against the self is not always
present. It is the ego’s awareness
of its helplessness, which, in certain cases, forces it to turn the aggression
from the object against the self, thus aggravating and complicating the
structure of depression.
D. Jacobson's 1971 critique
of Bibring, in "On depressive states: nosological and theoretical
problems" (p. 175-182):
1. He downplays the role of aggression. In part, he limits himself to the
depressions reflecting a tension within the ego (between the ego and the ego
ideal, and in which he leaves out the occasion of "hostile deflation of
self-image), and he leaves out, or considers it only "complicating",
the depressions in which there is tension between the ego and the superego
(guilt). Also, in concentrating on
the ego and narcissistic feelings of frustration, he downplays the role of
ambivalence (the instinctual point of view).
In describing depression as a "basic ego state" and limiting
this to feelings indicative of the state of narcissistic balance, Bibring ignores the theory that
suggests that even "basic ego states" can be understood in terms of
the underlying cathectic and discharge processes which involve self- and
object-directed, sexual and aggressive or neutralized drives.
3. The issue of
'simple' depression’: he treats it as less severe but she maintains it belongs
with the more severe depressions.
JACOBSON'S VIEWS ABOUT DEPRESSION (1971)
A.Ego psychology view - feelings of security, depression, and
elation are characteristic states of normal or disturbed narcissistic
equilibrium. (Agreeing with
Mahler), Elated and depressive responses can be found at an early age as a
result of experiences of narcissistic gratification or frustration.
B. A clear distinction
between neurotic, borderline, psychotic, and between the different types of
C. Drives must be included to
understand - The basic conflict in all depressed states: "Frustration arouses rage and
leads to hostile attempts to gain the desirable gratification. When the ego is unable (for external or
internal reasons) to achieve this goal, aggression is turned to the
self-image. The ensuing loss of
self-esteem is expressive of the narcissistic conflict, ie. a conflict between
the wishful self-image and the image of the deflated, failing self. The nature of the mood condition that
then develops depends on the intensity of the hostility and the severity and
duration of frustration and disappointment." (p. 183)
To distinguish among the various groups of
depression: Freud differentiated
the mechanisms operative in the depressive states of compulsive neurotics and
With respect to psychotic depressions, their
special qualities may be determined by the underlying neurophysiological
A psychoanalytic theory of depression presupposes
a "multiple factor" genetic approach, taking into account: the drives
involved in the conflict, and in the instinctual constitution; the ego, the
super-ego and ego ideal; developmental psychogenetic aspects, including the
factors of sequence and timing.
SANDLER (1967) (from "On disorders of narcissism" in From
Safety to Superego, 1989)
(Depression as a response to narcissistic injury
without using the concept of drives.)
The basic form of unpleasure in disturbances of
narcissism is an affective experience of mental pain. Mental pain reflects a substantial
discrepancy between the mental representation of the actual self of the moment
and an ideal shape of the self.
Lack of self-esteem, feelings of inferiority and unworthiness, shame and
guilt, all represent particular higher-order derivatives of the basic affect of
pain. These are determined and
influenced by the manifold and complex elements that enter into the formation
of the ideal self.
A narcissistic disorder: its central
feature is the existence of an overt or latent state of pain that has
constantly to be dealt with by the ego; and the defensive and adaptive
maneuvers that are responses to it can assume pathological proportions. These include the so-called seeking of
narcissistic supplies, overcompensation in fantasy, identification with
idealized and omnipotent figures, pathologically exaggerated forms of
narcissistic object choice, compulsive pseudosexuality, many aspects of
homosexual activity and other perversions. Various forms of self-punishment may be seen, particularly
when superego factors predominate in causing pain. Self-damaging and self-denigrating activities may be
sexualized and reinforced by masochistic trends.
Depression: If the individual's adaptive
and defensive maneuvers fail, and he is left helpless and hopeless in the face
of the (conscious or unconscious) state of pain, he may then develop a
depressive reaction. This view
places the depressions in the wide realm of narcissistic disorders.
(1976) From "Melancholia: a reconsideration"
(An ego psychological point of view using the
metapsychological tradition of separating the ego-ideal and the superego into
two equivalent sets of functions – the first being loving and rewarding and the
second being critical and punishing.)
The basic mechanism of all simple depression
- the abandonment by the ego ideal of the ego as a loved object resulting in
the fall of self-esteem (Bibring, 1953);
a sense of inferiority; loss of the ego ideal's love.
The distinguishing mark of melancholia -
the heightening of the criticisms of conscience; increased attacks by the
superego on the ego; sense of guilt or moral inferiority; expression of the
superego's hatred (Schafer, 1960)
(1923) Melancholia - involves regression from object cathexis to
narcissistic cathexis (1917)
Later Freudians (Ego psychology) – conceptualized
melancholia as a profound instinctual defusion in which the loosened
sadistic-component came to hold "sway in the super-ego; as it were, a pure
culture of the death instinct...” The regression was to the preambivalent stage
of object relationships.
A. Regression to
(Preambivalence - in which the separated "good" and
"bad" objects, with their instinctual cathexes of libido and
aggression respectively, are not yet integrated in a state of fusion. This stage, emerging from the preceding
one of primary narcissistic fusion of self- and object-representations, is
characterized by the attempt to maintain a “purified pleasure” self through the
aim "to introject into itself everything that is good and to eject from
itself everything that is bad" (Freud, 1925) Thus arise the separated "good"
and "bad" objects, the former introjected into the self, initiating
the establishment of the differentiating grade of the self-ideal, the
"substitute for the lost narcissism of...childhood" (Freud, 1914),
and the latter projected into the outer world, the forerunner of denial.
Although the premelancholic has reached the next,
ambivalent, anal-sadistic stage in development, under the threat of object
loss, he reverts to the previous state of preambivalent object relations. In this reversion, the "bad"
(disappointing) object is introjected into the superego.
B. Double introjection
Sandor Rado (1928)
formulated the process in melancholia as a doubleintrojection of
the lost object. The twin
introjects are the "good" and "bad" objects arising out of
the instinctual and ego regression to the preambivalent object stage. The "bad" object is
introjected into the ego, the "good" into the superego.
(1953) confirmed the idea of a double introjection. However, she proposed that the
inflated, good or bad, punishing, powerful parents are introjected into the
superego, while the deflated, bad, worthless, weak parents are introjected into
(1976) The premelancholic has reached the ambivalent stage of object
relations. He seeks in his love
object those characteristics of the self's own internal ideal that lie beyond
its grasp. The object is loved,
that is, for its potential to restore the state in which the self was its own
ideal. (the narcissistic object relation). The object is loved as a longed-for extension of the self
and is treated in accordance with the desire to bring it into the realm and
under the control of the self - that is, to restore the narcissistic fusion.
When the narcissistically loved object
disappoints, it loses its function to the patient as the projection of his
own ideal and as the haven of the "good" aspect of his ambivalently
loved and hated object. Narcissistically,
it is a "lost" object.
In the ensuing reintrojection of the lost
perfection into the patient’s ego-ideal, the patient is thrown back once
more upon his own internal self-ideal, which lies outside his attainment. He feels depleted and helpless, and it
is in this helpless loss of self-esteem that depression is manifested.
When what is sought in the love object is some
form of perfection pertaining to the later preoedipal stages of development,
simple depression develops on disappointment and loss.
When what is at stake is the recovery of earlier
and more archaic forms of grandeur through the establishment of the loved
object as the externalization of more primitive forms of the self-ideal, the
loss of the loved object may precipitate, not only a fall in self-esteem, but
also a re-emergence of the "bad" object as a separate
component under the impact of the regression to the preambivalent stage and
the accompanying instinctual and object defusion.
The object is not only lost in its
"good" aspect, but also must be dealt with in its separation as a
"bad" object, one which has hatingly frustrated the wishes of the
patient. As such, it not only
becomes the target of reactive rage, but is fantasied as a raging, punishing,
and depriving aggressive object in itself. As an external inhibitor of wish-fulfillment and prohibitor
of need-satisfaction, it is introjected by incorporation within the
context of the series of hating introjects that constitute the precursors of
If the object separation is particularly marked
and the defused instinct of aggression particularly strong,...severe feelings
of guilt and self-reproach become manifest.
The clinical picture of melancholia is thus
established in a combination of a fall in self-esteem through the loss to the
self of the externalized self-ideal (the "good" object), which is
reintrojected and assimilated to the unattainable internal self-ideal, and of a
heightening of self-criticism through the introjection of the frustrating
prohibitor (the "bad" object), which is taken into the superego. To both is added the ingredient of the
masochistic helplessness of the self.
CONCEPT OF 'THE NARCISSISTIC DEPRESSION' IN THE ANALYSIS OF CHARACTER NEUROSIS (1989)
(Shift in focus from symptoms to depressive
Pathological character traits develop in a child
in response to various extreme parental demands and responses, or following
object loss or physical or psychological abuse. The child has a narcissistic investment in the
functioning of these traits, in their adaptive, gratifying and reactive
capacities. When these traits
are analyzed (becoming ego-dystonic), the patient suffers a narcissistic
injury to his self-image, which leads to a depression.
"He becomes aware
of real and/or imaginary helplessness, and of an incapacity to live up to both
conscious and unconscious goals.
This is exacerbated further by his recognition of the discrepancy
between his goals, aspirations, and the realization of the unacceptable nature
of the underlying unconscious motives.
Whereas the patient previously may have felt good and righteous, he now
feels bad and considers himself unlovable."
He "may experience intense feelings of
forlornness, abandonment, and helplessness. His goals may not have changed, but he now sees them as so
exalted he no longer hopes ever to attain them. The loss of a sense of mastery evokes feelings of
humiliation and shame. Conversely,
the goals may now be changed and the patient, when middle-aged, may despair
about wasted years and misdirected energy." (p.88)
Seminar 3: Controversial Issues and the Treatment of Depressed Patients
view of the predisposition to melancholia, precipitant and dynamic processes.
view of the typical disposing sequence.
view of the ego’s response – helplessness and hopelessness (Dorpat 1977)
Blake Cohen’s group- histories of people with manic-depressive depression as
to those with depression in narcissistic character.
– self- and object-representations; importance of the operation of the
Parkin's elaboration of the double introject.
Charles Brenner (1991) – a
good example of the evolution of Freudian theory.
is an affect, not an illness.
Anxiety is the unpleasurable affect that signals the advent of something
bad, of calamity; depressive affect – when the calamity has already
happened. Either may develop
around any of the danger situations – loss of the object, loss of love,
castration, and punishment. When
either occurs in connection with a wish for gratification of a drive
derivative, what ensues is psychic conflict.
Conflict has four components: drive derivatives, unpleasure
in the form of anxiety and/or depressive affect, defense, and superego
manifestations. These interact,
resulting in a compromise formation in such a way as to achieve the greatest
pleasure and the least unpleasurable affect. Conflicts that are intense enough to be clinically
significant originate in childhood.
Libidinal and aggressive (less so) drives are associated with the
erogenous zones. Every effort made
to reduce unpleasure is part of a defense; in general, defenses oppose the
gratification of instinctual wishes that would cause unpleasure.
every conflict, depressive affect plays its part in initiating defense, just as
anxiety does. What varies among
patients is the role of depressive affect in the resulting pathological
Freud’s explanation, the analogy with mourning gives a model for why depression
is self-limited in time.
Identification occurs in normal mental life, not always associated with
object loss; it is a defense against object loss. When identification occurs in a context of intense ambivalence, loss
results in depression.
levels of loss - oral, anal, phallic (p.35) - can result in depression. In some instances, a patient’s symptom of depression is
related to object loss and to inadequate mothering, but not in all. Similarly, oral wishes my predominate,
but they do not always do so;
phallic and anal conflicts are often more important than oral ones. Identification may play a crucial role,
but there are many patients in whom that is not so. Finally, aggression turned against oneself is not the cause
of depression. It is a consequence
alternative word for depressive affect would be “misery”. Misery is part of the
human condition. Depressive affect
is part of every pathological conflict.
Similarly, all the calamities of childhood are present in each patient
to some degree. However, in many
patients, castration conflict has played the major role. Substitute for “castrated” – injured,
Leo Stone (1986) - “narcissistic object” choice indicates
an “…original failure of
separation… from the mother. (p. 333)
reports from his experience of “the preeminent importance of an archaic
characterological core in depressive illness.”
Robert Lupi (1998) Panel at
the Fall Meeting of the APA, 1995.
Nersessian – anxiety is always a
feature in both mourning and melancholia.
Ambivalence is also always a feature of both, and the pain of mourning
is more intense and longer in duration when there are more hostile and hateful
feelings than affectionate ones in the relationship.
Leon Hoffman – supported Freud’s
theorizing against those who criticize it. “Freud’s discovery of
transference, as well as his attempts to integrate Adler’s and Jung’s
criticisms into a comprehensive theory, led him to consider the theoretical
importance of relations between the individual and objects and the mentalization of these relations, and
to eventually develop the structural theory.”
Stephen Mitchell – “As one reads this paper (“Mourning and
melancholia”) one can almost see the mind
fracturing before Freud’s eyes into separate agencies and internalized
objects. The boundaries between
inside and outside become permeable.”
described Freud as here describing how internalization happens, but the theory
is entirely drive-based. In
discussing identification, Freud comes close to articulating the idea that
became important to object relations and relational theory,” that identifications have an emotional
primacy in their own right and are not simply a compensation for lost objects;
instead, primary object relatedness might be a basic motivating factor.”
quotes Fairbairn’s phrase, it is “when the
tie to the object…has been
exclusive, adhesive, and addictive that loss is more likely to precipitate and
be omnipotently preserved through pathological depression.”.
Otto Kernberg – Proposed that “identification is regarded as the
internalization of a significant object relationship, a representation of the
object interacting with a representation of the self under the impact of a
dominant affective state. The more
significant the relationship, the more intense the affect…” He proposed a “genetic disposition to pathological activation of affects that will be
integrated into the aggressive drive and, in particular, a tendency to
excessive rage, anxiety, and despair under conditions of early frustration and
object loss.” These lead to "a “hypertrophic” superego and a
predisposition to depressive reactions.” His view of drives are that “they are built up from the underlying affects incorporated into self-
and object representations.”
Rothstein – “...the loss of fantasied
aspects of the self are central in narcissistic and masochistic pathology. Similarly, he said, the self-directed
rage in melancholia is not simply the displaced object-directed rage now aimed
at the internalized identification; it is also a critical, self-punitive
response for not being able to omnipotently prevent the calamity.”
Pierre-Gilles Guéguen (2009) – Depression is “part of an ideology that propagates the ideal of happiness for
consumption…its residue which has to respond to the Master’s will by erasing
itself through more consumption of the objects ‘medication’.”
Lacan suggests that depression “isn’t
a state of the soul, it is simply a moral failing…which is ultimately only
situated in relation to thought, that is, to the duty of well-saying or to find
oneself again in the unconscious, in structure.” It indicates that the subject does not find a voice in
which to express its state of being, which includes the body. Treatment involves offering to the
patient the opportunity to establish a social bond through speech, supporting the
transference, and making maximum use of “the transforming
action of speech and the dialectization whereby symptoms change.”