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307 Depression and Anxiety – 7 seminars

Seminar Leaders: M.A. Fitzpatrick Hanly and S. Mann

Course Description

Patients often come to a psychoanalyst reporting that they are depressed or anxious. This course will review the many faceted psychoanalytic theorizing on depression and anxiety as affects, states, and agents in various pathologies. The course will have an emphasis on conceptual review, clinical formulation, and psychoanalytic technique.

Course Objectives

  1. Candidates will review the literature from Freud to modern authors in order to compare and differentiate psychoanalytic theories on depression and anxiety and how these developed through time and across geographic regions in order to integrate knowledge of key concepts into psychoanalytic practice (1.3, 1.5).
  2. Participants will examine depression, depressive affect, and review the dynamics of mourning and melancholia after object loss in order to develop clinical formulations and capacity to analyze as well as to recognize where psychoanalysis is contraindicated (1.2).
  3. Participants will examine anxiety disorders, anxiety as an affect, and anxiety in relation to repression, splitting, and traumatic experience order to develop clinical formulations and capacity to begin and deepen a psychoanalytic process.
  4. Participants will explore, consider and discuss countertransference pressures in treating depression and anxiety as well as to identify different techniques to deal with such pressures (1.4, 1.5).
  5. Candidates will clarify and discuss, using case material, the difference between clinical depression, neurotic depression and the depressive position as well as the analysis of severe depressive anxieties, annihilation anxiety, castration anxiety, and the development of signal anxiety (1.3).

Seminar 1

Foundations Depression and Object Loss

Clinical depression is characterized by unremitting sadness lack of energy, anhedonia, (inability to enjoy ordinary pleasures), and disturbances in eating, sleeping and self-regulating. Freud (1917) compared and contrasted depressive (melancholic) conditions with normal mourning. Abraham (1911) underlined the depressive person’s “identification with the lost love object”, to indicate effective interpretive strategies.

Required Readings

Auchincloss, E. (2012). Depression (pp. 55-57). In Psychoanalytic Terms and Concepts. New Haven, CT: Yale University Press.

Freud, Sigmund. (1917). Mourning and melancholia (pp. 237-238).   The StandardEdition of the Complete Psychological Works of Sigmund Freud, Vol.14.

Abraham, K. (1911). Notes on the psychoanalytic investigation and treatment of manic-depressive insanity and allied conditions, (pp.137-156). In Selected Papers on Psychoanalysis. New York, NY: Basic Books (1953).

Rado, S. (1928). The problem of melancholia. International Journal of Psychoanalysis, 9, 420-438.

Seminar 2

Understanding the Psychodynamics of Depression

Analysts noted the incorporative processes in depression, the analysis of which added to therapeutic efficacy in the face of depressive misery. Asch brings three clinical examples of different kinds of depression. Brenner underlies that symptomatic depression and anxiety can be part of a conflict over drive derivatives of childhood origin, and that therapeutic change results in uncovering elements of those conflicts, and tracing them to their origins and development.

Required Readings

Bibring, E. (1953). The mechanism of depression, In Affective Disorders. Psychoanalytic Contributions to their Study (pp. 13-48). P. Greenacre (Ed.). New York, NY: International University Press.

Asch, S. (1966). Depression: Three clinical variations. Psychoanalytic Study Of the Child, 21, 150-170.

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

Seminar 3

Object Loss and Depression

The study of the psychoanalysis of childhood and adolescent loss (especially of a parent, sibling, important caregiver) can reveal regressions and the undoing of prior developmental and psychosexual gains. In cases of loss of a primary object, the psychoanalytic process reveals the threat of a sudden release of feelings of traumatic intensity and defenses against the threat, with the need to rework splitting of the loved and hated mother, as well as reworking Oedipal phase conflicts and narcissistic wounds. Renewed mourning, including analysis of anger, remorse, regret, guilt, and destabilized identity, is an important part of the psychoanalytic process and its therapeutic action.

Required Readings

Bowlby, J. (1963). Pathological mourning and childhood mourning. Journal of The American Psychoanalytic Association, 11, 500-541.

Laufer, M. (1966). Object loss and mourning during adolescence. Psychoanalytic Study of The Child, 21, 269-293.

Bleichmar, H.B. (1996). Some subtypes of depression and their implications for psychoanalytic treatment. International Journal of Psycho-Analysis, 77, 935-961.

Seminar 4

Mourning and Depression

This seminar takes up Klein idea that whenever the loss of a loved person is experienced, the early depressive position, and its anxieties, guilt, and feelings of loss and grief (derived from oral and Oedipal situations) are reactivated. We see that in her long term “Depression Study”, Leuzinger-Bohleber found that chronic depression was linked to traumatic experience.

Required Readings

Klein. M. (1940). Mourning and its relation to manic depressive states (pp. 311-338). In Love Guilt and Reparation and Other Works (1921-1935). New York, NY: Free Press.

Stone, L. (1986). Psychoanalytic observations on the pathology of depressive illness: Selected spheres of ambiguity or disagreement. Journal of The American Psychoanalytic Association, 34, 329-362.

Leuzinger-Bohleber M. and Ellman C. (2017). Case of chronic depression presented and discussed (TPS Annual Day in Psychoanalysis).

Seminar 5

Anxiety: Review of theory and clinical approaches

This seminar will present a review of the concept of anxiety, in various theoretical contexts, with a clinical illustration by Sharpe.

Required Readings

Auchincloss, E. and Samberg, E. (2012). Anxiety (pp.18-20). In Psychoanalytic Terms and Concepts. New Haven, CT: Yale University Press.

Freud, S. (1933). New introductory lectures on psychoanalysis lecture XXXII (first part). The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 22, 81-85.

Sharpe, E. (1931). Chapter 5: Anxiety outbreak and resolution – the technique of psycho-analysis. International Journal of Psycho-Analysis, 12, 24-36.

Rangell, L. (1968). A further attempt to resolve “the problem of anxiety”. Journal of American Psychoanalysis Association,16, 371-404.

Seminar 6

Treating Anxiety (American Freudians)

This seminar takes up Arlow’s review of Freud’s danger situations (from Inhibitions, Symptoms and Anxiety) and presents a clinical example of treating a patient whose symptoms are linked to anxiety. Brenner clarifies the effects of anxiety and depression in initiating repression and in compromise formations.

Required Readings

Arlow, J.A. (1963). Conflict, regression and symptom formation. International Journal of Psychoanalysis, 44, 12-22.

Brenner, C. (1982). Anxiety and depressive affect in pathological compromise formations, (pp.162-179). In The mind in conflict. New York, NY: International University Press.

Seminar 7

Treating Anxiety (Kleinian and Comparative Approaches)

This seminar presents Joseph’s ideas as she tracks the shifts in the session between defenses belonging primarily to the paranoid-schizoid position and the experiences of ambivalence and guilt characteristic of the depressive position. Joseph focuses on what leads to the avoidance of anxiety rather than to understanding it, presenting four clinical examples. We read Britton’s review of Bion’s ideas on “unspecified dangers” and “fear of fragmentation” and his account of Bion’s theory of container contained in clinical approaches to anxiety. Britton illustrates these concepts with two extended clinical examples. We study how Blass compares the nature of internal objects in Freud’s thought and Klein’s to show interesting overlaps and differences in their views on the fear of death (annihilation anxiety).

Required Readings

Joseph, B. (1978). Different types of anxiety and their handling in the analytic situation. In Psychic Equilibrium and Psychic Change. London: Routledge (1989).

Britton, R. (1992). Keeping things in mind. In Clinical Lectures on Klein and Bion. London: Routledge.

Blass, R.B. (2014). On ‘the fear of death’ as the primary anxiety: How and why Klein differs from Freud. International Journal of Psycho-Analysis, 95(4), 613-627.

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