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116 Core Concepts: Depression – 2 Seminars

Seminar Leaders: C. Levitt and M. Vallabhaneni

Course Description

These two seminars examine Freud’s concepts of object loss, mourning and melancholia and psychoanalytic thinking on depression after Freud. Clinical depression has some of the same characteristics as mourning, but Freud suggested some of the significant differences between normal mourning and depression. Freud puts it in the following way: “The melancholic displays something else besides which is lacking in mourning—an extraordinary diminution in his self-regard, an impoverishment of his ego on a grand scale. In mourning it is the world which has become poor and empty; in melancholia it is the ego itself. The patient represents his ego to us as worthless, incapable of any achievement and morally despicable; he reproaches himself, vilifies himself and expects to be cast out and punished. He abases himself before everyone and commiserates with his own relatives for being connected with anyone so unworthy. He is not of the opinion that a change has taken place in him, but extends his self-criticism back over the past; he declares that he was never any better. This picture of a delusion of (mainly moral) inferiority is completed by sleeplessness and refusal to take nourishment, and—what is psychologically very remarkable—by an overcoming of the instinct which compels every living thing to cling to life.” (p. 245)

Bowlby looks at the literature on the effects of object loss in childhood and refuses to draw a hard and fast distinction between mourning and depression arguing that pathological development depends on the nature and type of mourning in childhood. Volkan looks at complications in the mourning process and their consequences for psychic development. Paul Denis, in his brilliant paper, links depression with fixation in general and fetishism in particular, with the hypercathexis of the shadow of the object, the direction of all ego energy to the maintenance of the absent object and thus the impossibility of libidinal satisfaction. In Bowlby’s first listed essay in the readings, he attempts to integrate the findings of neuroscience with psychoanalytic insights regarding depression from Freud through Melanie Klein, Edith Jacobson and Ronald Fairbairn, without reducing the latter to the former. Kernberg, in his last paper cited below, develops a theory of protracted mourning in which the identification with the lost object engenders deep characterological changes in mental structures especially in relation to the superego.

Course Objectives

Candidates will learn how to:

  1. Use the major diagnostic category (1.3) (Depressive Personality, McWilliams, 2011) to recognize depression, pathological mourning, related to suicidal ideation as linked to specific (1.3) knowledge of psychopathology, that is, recognition of symptoms characterized by guilt, self-criticism and perfectionism (melancholic or introjective) or by shame, embarrassment, high reactivity to loss and rejection, and vague feelings of inadequacy and emptiness (anaclitic);
  2. Formulate an assessment, using key concepts of psychoanalysis (4.5) to identify both introjective and anaclitic dynamics and to interpret the typical defenses of depressive character: narcissism, self-blame and masochistic reaction formation to unconscious sadism directed at the lost or rejecting object, and introjection and projection;
  3. Consider the relationship between depression and object loss in relation to pathological mourning;
  4. Consider the masochistic elements of depression in terms of the identification of the patient with the lost object and the redirection of the rage toward the object to the introjected element within the ego;
  5. Follow the implications for psychoanalysis of the recent findings of neuroscience in relation to understanding the physiological processes which subtend the psychic experience of depression;
  6. Understand the impact of prolonged mourning on character development and change;
  7. Maintain professional psychoanalytic boundaries (4.2) under the pressure of a patient’s provocative masochistic behaviors and attitudes, by interpreting the associative process and the transference;
  8. Facilitate change (1.2) through containing and interpreting, in part through employing effective skills in observation of self.

Seminar 1

Object Loss: Mourning and Melancholia

Required Reading

Freud, S. (1917). Mourning and melancholia. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 14, 237-258.

Freud, S. (1921). Group psychology and the analysis of the ego, Section VII “Identification” (pp. 104-109); Chapter XI “A differentiating grade in the ego (pp. 128-133). The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 18.

Freud, S. (1923). The ego and the ID. Chapter III, The ego and the superego (pp. 27-39). In The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 19.

Seminar 2

Depression in Psychoanalytic Thinking After Freud

Recommended Readings

Bowlby, J. (1961) Processes of mourning. International Journal of Psychoanalysis, 42, 317-340.

Volkan, V. (1984). Complicated mourning. The Annual of Psychoanalysis, 12, 323-348.

Brenner, C. (1991). A psychoanalytic perspective on depression. Journal of American Psychoanalytic Association, 39, 25-43.

Denis, P. (1992). Depression and fixations. International Journal of Psychoanalysis, 73, 87-94.

Kernberg, O. F. (2009). An integrated theory of depression. Neuropsychoanalysis, 11, 76-80.

Kernberg, O. F. (2009). Some observations on the process of mourning. International Journal of Psychoanalysis, 91, 601-619.

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