Depression - Psychodynamic Theory
I have been interested in the mechanics of depression since childhood, when my mother ‘suffered with her nerves’ - her explanation of what I now recognise as a very severe melancholia defined by Burton in 1621 as "a kind of dotage without a fever, having for his ordinary companions fear and sadness, without any apparent occasion" (p739). My interest was further compounded by my clients, Valerie and Jo, when it become apparent to me that depression is one of the most common and debilitating phenomenon that I will probably have to encounter in my role as a Counsellor.
Before beginning, it may be useful to briefly consider Freud’s warning that depression is not a homogenous group of conditions and that it probably involves more than one aetiology (Freud 1917). It can reflect underlying cultural and environmental trends in addition to physiological factors. (Desjerlais et al. 1995)
A review of the literature reveals that research relating to the nature and origins of the psychodynamic theory of depression is rich in contributions to the theme, thus this essay of necessity represents a high-altitude skim over a massive topic. I will concentrate on authors who have made some of the most seminal contributions to the development of the theory, namely Abraham, Freud, Jacobson, Klein and Mahler. (There are, in actuality, numerous other pioneers in the cultivation of this theory, such as Malan, Sandler, Spiz, Bibring, Rado, Blatt, Benedek, Lindemann, Kohut, some of which, due to word limit, I have not included). Bowlby‘s theory of attachment, although not psychodynamic per se, is also considered, because the way in which people relate to loss of attachment appears relevant to our understanding of depression. Schore, who describes the neuroscience of attachment and how the brain of the parent and infant interact, has also been included
The first thing we need to do is to be clear about four quite different ways that we may talk about depression. Jacobson referred to them as normal, neurotic, psychotic and grief reactions (1971 p19).
What Jacobson (1971) referred to as normal depression, appears to be akin to what Klein referred to as the depressive position (Segal 1973). She, who it appears from my literature search (Klein 1940, Meltzer 1989, Spillius 1983, Money Kyle 1964), more than any other psychoanalytic pioneer viewed the infant as a miniature adult, found evidence of a "depressive position" from birth (Klein 1932 in Meltzer 1989 p37). This is essentially a state of health, a capacity to bear guilt, stay in touch with mental pain and emotional problems and bring thinking to bear on situations (Meltzer 1998). According to Klein we oscillate between our ability to stay with painful situations or seek temporary relief through splitting and projection (defence mechanisms), returning to the paranoid-schizoid position - the state of mind existing in babies ; one that is constantly returned to throughout life to greater or lesser degrees (Klein 1932 in Money Kyle 1964). Defence mechanisms are defined as tactics which the Ego develops to help deal with the ID and the Super Ego (Freud 1923). Freud introduced the term 'ego' in "The Ego and The Id" (1923). He holds that only a portion of the mind is conscious and the rest lies hidden deep within the subconscious, ruled by conflicting forces of a super-strong libido (id) and super-controlling morality (superego) all translated through the ego, which attempts to balance the two through rationality (1923). Libido is described as the ‘energy of the sexual instincts‘ (Frued 1925).
Neurotic depression or reactive depression can be understood as an exaggerated response to stress due to a weak state of ego strength combined with a failure of the external support system. Neurotic depression consists of a fall in self esteem after the ego has been abandoned by its ideal (Sandler 1965)).
In modern day terminology, Jacobson's...
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