THE PSYCHODYNAMIC MODEL OF DEPRESSION
Psychodynamic theorists have stressed three causes of depression: anger
turned against the self, excessive dependence on others for self-esteem, and helplessness at achieving one's goals.
On the surface, depressed individuals may
seem drained of anger, but their anger may be bound up inside them.
Anger Turned upon the 'Self'
The first contributions of the psychodynamic model to the understanding of
depression came from the early psychoanalysts. Karl Abraham (1911) and
Sigmund Freud (1917) in his classic paper, "Mourning and Melancholia,"
both stressed the importance of anger turned inward upon the self in producing depression.
On the surface, depressed individuals often seem drained of anger, and
this leads to the suspicion that their anger may be bound up inside them. For
Freud, the main clue to their inner state came from the difference between
normal bereavement (mourning) and depression (melancholia). The normal
individual and the depressive have two strikingly different reactions to
the loss of a person they love. For the mourner, the world now seems empty,
but his self-esteem is not threatened. The mourner will survive the loss. In
contrast, according to Freud, the depressive will begin to feel a powerful
sense of worthlessness and self-blame. He will feel rotten and guilty; he will
accuse himself of being a failure. This self-reproach is usually moral, grossly
unjustified, and most remarkable, publicly and shamelessly declared. It provides
the clue that anger turned against the self is actively motivated and
generates the low self-esteem of depression.
How could it come about that some individuals react to loss or rejection
by turning their fury against themselves? For Freud, such a motivation for
self-punishment follows from events in the depressive's childhood. During
childhood, the future depressive forms an intense love that is undermined
by disappointment with the other person. The depressive feels rage at having
been disappointed. The libidinal energy underlying love is freed, but it
does not become attached to any other person. Instead, the ego identifies
with or "incorporates" the lost person, and the released libido attaches to
this part of the ego. The rage originally felt for the person now is directed
against the self.
Subsequent losses and rejection reactivate the primal loss and cause the depressive's rage to be
turned again toward the original traitorous person,
who has now been fused with the depressive's own ego. Such turning of
anger in upon the self is the crucial step in producing the symptoms of low
self-esteem, public accusation, the need for punishment, and in the most
extreme cases" suicide. Depression ends either when the rage has spent itself
or when the new loss is devalued-ends, that is, until a new loss starts the
depressive sequence yet again.
The incorporation of a lost love object and anger turned inward upon the
self producing depression is well illustrated by the following case:
Debby was a nineteen-year-old who was hospitalized because of strong suicidal
impulses. During her hospitalization, she made a number of unsuccessful suicide
attempts, and in addition, she engaged in a bizarre form of self-mutilation: clawing
terribly at a particular spot on her left arm. These actions and impulses frightened her because
she experienced them as originating outside of herself. On the
other hand, however, she saw them as justified because she wanted to atone for her own
worthlessness and promiscuity.
Debby's depression seemed to be closely related to her feelings about her
mother, who had died a few years earlier under compromising circumstances; she had been
murdered by a soldier with whom she had been spending the night. The body was so badly
battered that it was identified only by a large distinctive birthmark on the left arm.
After her mother's death, Debby felt more warmth toward her mother than ever before.
She became her mother's staunchest defender. When her mother was accused of
ruining the family's reputation, Debby maintained that her mother
had been badly misunderstood and ill treated by the family, and that this had
caused her to carry on with other men. At the same time, however, Debby began
to drop her former friends and to take up new friendships with people who had
"bad reputations." She began to think of herself as a "bad person." As if to satisfy
her new self-image, she began for the first time to behave promiscuously.
Debby's promiscuity seemed to result from identification with her mother, for
this new part of herself provided the perfect target for the rage that her mother's
death provoked. Debby's genuine feelings were mixed: both love and anger. We
do not easily condemn the dead in our society, so instead Debby vented her anger by hating the
part of her self that had become her mother. This was expressed most concretely through her
self-mutilation. The specific part of her arm that she scratched so terribly was the exact
location of her mother's birthmark. By mutilating herself, she was simultaneously able to
identify with her mother by creating an ugly disfigurement on her left arm and to express her
anger toward her mother.
Once Debby began to acknowledge her feelings of anger toward her mother
consciously during therapy, her depression began to lift. The crisis and resolution
came violently, when Debby smashed every pane of glass in a door with her fist.
During this experience she believed she was hitting not a door but an image of her mother.
The conscious acknowledgment of this rage removed the need for indirect and symbolic
expression, and Debby's feelings of worthlessness and self hatred began to disappear.
(Adapted from Fancher, 1973.)
The Depressive Personality
Psychodynamic theorists since Freud have emphasized a personality style
that may make individuals especially vulnerable to depression: the depressive
depends excessively on others for his self-esteem. The depressive desperately
needs to be showered with love and admiration. He goes through the world in a state of
perpetual greediness for love, and when his need for
love is not satisfied, his self-esteem plummets. When he is disappointed he
has difficulty tolerating frustration, and even trivial losses upset his self-regard
and result in immediate and frantic efforts to relieve discomfort. So
depressives are seen as love addicts, who have become exquisitely skilled at
producing demonstrations of love from others and who insist on a constant
flow of love. Beyond receiving such love, however, the depressive cares little
for the actual personality of the person he loves.
(Rado, 1928; Fenichel, 1945; Arieti and Bemporad, 1978)
Helplessness at Achieving One's Goals
The third major strand in psychodynamic theorizing about depression
comes from the psychoanalyst Edward Bibring's (1953) claim that depression
results when the ego feels helpless before its aspirations. Perceived helplessness at achieving the
ego's high goals produces loss of self-esteem, the
central feature in depression. The depression-prone individual has extremely
high standards, and this increases his vulnerability to feeling helpless
in the face of his goals. The combination of strongly held goals to be
worthy, to be strong, and to be good, along with the ego's acute awareness of
its helplessness and incapacity to live up to these goals, is for Bibring the
mechanism of all depression.
Treating
Depression and Suicide
Post-Traumatic Stress Disorder (PTSD)
Social Anxiety
Generalized Anxiety
Panic Disorder
Major Depression Disorder
Agoraphobia
For the Therapy I recommend click here:
The Liberator Method
turned against the self, excessive dependence on others for self-esteem, and helplessness at achieving one's goals.
On the surface, depressed individuals may
seem drained of anger, but their anger may be bound up inside them.
Anger Turned upon the 'Self'
The first contributions of the psychodynamic model to the understanding of
depression came from the early psychoanalysts. Karl Abraham (1911) and
Sigmund Freud (1917) in his classic paper, "Mourning and Melancholia,"
both stressed the importance of anger turned inward upon the self in producing depression.
On the surface, depressed individuals often seem drained of anger, and
this leads to the suspicion that their anger may be bound up inside them. For
Freud, the main clue to their inner state came from the difference between
normal bereavement (mourning) and depression (melancholia). The normal
individual and the depressive have two strikingly different reactions to
the loss of a person they love. For the mourner, the world now seems empty,
but his self-esteem is not threatened. The mourner will survive the loss. In
contrast, according to Freud, the depressive will begin to feel a powerful
sense of worthlessness and self-blame. He will feel rotten and guilty; he will
accuse himself of being a failure. This self-reproach is usually moral, grossly
unjustified, and most remarkable, publicly and shamelessly declared. It provides
the clue that anger turned against the self is actively motivated and
generates the low self-esteem of depression.
How could it come about that some individuals react to loss or rejection
by turning their fury against themselves? For Freud, such a motivation for
self-punishment follows from events in the depressive's childhood. During
childhood, the future depressive forms an intense love that is undermined
by disappointment with the other person. The depressive feels rage at having
been disappointed. The libidinal energy underlying love is freed, but it
does not become attached to any other person. Instead, the ego identifies
with or "incorporates" the lost person, and the released libido attaches to
this part of the ego. The rage originally felt for the person now is directed
against the self.
Subsequent losses and rejection reactivate the primal loss and cause the depressive's rage to be
turned again toward the original traitorous person,
who has now been fused with the depressive's own ego. Such turning of
anger in upon the self is the crucial step in producing the symptoms of low
self-esteem, public accusation, the need for punishment, and in the most
extreme cases" suicide. Depression ends either when the rage has spent itself
or when the new loss is devalued-ends, that is, until a new loss starts the
depressive sequence yet again.
The incorporation of a lost love object and anger turned inward upon the
self producing depression is well illustrated by the following case:
Debby was a nineteen-year-old who was hospitalized because of strong suicidal
impulses. During her hospitalization, she made a number of unsuccessful suicide
attempts, and in addition, she engaged in a bizarre form of self-mutilation: clawing
terribly at a particular spot on her left arm. These actions and impulses frightened her because
she experienced them as originating outside of herself. On the
other hand, however, she saw them as justified because she wanted to atone for her own
worthlessness and promiscuity.
Debby's depression seemed to be closely related to her feelings about her
mother, who had died a few years earlier under compromising circumstances; she had been
murdered by a soldier with whom she had been spending the night. The body was so badly
battered that it was identified only by a large distinctive birthmark on the left arm.
After her mother's death, Debby felt more warmth toward her mother than ever before.
She became her mother's staunchest defender. When her mother was accused of
ruining the family's reputation, Debby maintained that her mother
had been badly misunderstood and ill treated by the family, and that this had
caused her to carry on with other men. At the same time, however, Debby began
to drop her former friends and to take up new friendships with people who had
"bad reputations." She began to think of herself as a "bad person." As if to satisfy
her new self-image, she began for the first time to behave promiscuously.
Debby's promiscuity seemed to result from identification with her mother, for
this new part of herself provided the perfect target for the rage that her mother's
death provoked. Debby's genuine feelings were mixed: both love and anger. We
do not easily condemn the dead in our society, so instead Debby vented her anger by hating the
part of her self that had become her mother. This was expressed most concretely through her
self-mutilation. The specific part of her arm that she scratched so terribly was the exact
location of her mother's birthmark. By mutilating herself, she was simultaneously able to
identify with her mother by creating an ugly disfigurement on her left arm and to express her
anger toward her mother.
Once Debby began to acknowledge her feelings of anger toward her mother
consciously during therapy, her depression began to lift. The crisis and resolution
came violently, when Debby smashed every pane of glass in a door with her fist.
During this experience she believed she was hitting not a door but an image of her mother.
The conscious acknowledgment of this rage removed the need for indirect and symbolic
expression, and Debby's feelings of worthlessness and self hatred began to disappear.
(Adapted from Fancher, 1973.)
The Depressive Personality
Psychodynamic theorists since Freud have emphasized a personality style
that may make individuals especially vulnerable to depression: the depressive
depends excessively on others for his self-esteem. The depressive desperately
needs to be showered with love and admiration. He goes through the world in a state of
perpetual greediness for love, and when his need for
love is not satisfied, his self-esteem plummets. When he is disappointed he
has difficulty tolerating frustration, and even trivial losses upset his self-regard
and result in immediate and frantic efforts to relieve discomfort. So
depressives are seen as love addicts, who have become exquisitely skilled at
producing demonstrations of love from others and who insist on a constant
flow of love. Beyond receiving such love, however, the depressive cares little
for the actual personality of the person he loves.
(Rado, 1928; Fenichel, 1945; Arieti and Bemporad, 1978)
Helplessness at Achieving One's Goals
The third major strand in psychodynamic theorizing about depression
comes from the psychoanalyst Edward Bibring's (1953) claim that depression
results when the ego feels helpless before its aspirations. Perceived helplessness at achieving the
ego's high goals produces loss of self-esteem, the
central feature in depression. The depression-prone individual has extremely
high standards, and this increases his vulnerability to feeling helpless
in the face of his goals. The combination of strongly held goals to be
worthy, to be strong, and to be good, along with the ego's acute awareness of
its helplessness and incapacity to live up to these goals, is for Bibring the
mechanism of all depression.
Treating
Depression and Suicide
Post-Traumatic Stress Disorder (PTSD)
Social Anxiety
Generalized Anxiety
Panic Disorder
Major Depression Disorder
Agoraphobia
For the Therapy I recommend click here:
The Liberator Method