The author's theory of a depressive constellation is based upon her psycho-analytic experience with mothers and children and her research into the female sexual cycle. She suggests that each phase of the menstrual cycle is accompanied by a regression to orality. the mother of the newborn child reacts to the demands made upon her by an increase in her receptive wishes. A complex interrelationship is established between mother and child. The satisfied infant promotes a feeling of confidence in the mother and increases her motherliness. When the child fails to be satisfied this can result in self-directed hostility, leading to the equation 'bad' mother = 'bad' self. The failure to meet the child's needs results in the frustration of the mother's receptive wishes. This may activate the hatred which was once associated with her own oral deprivation. She thus becomes the 'bad' mother in identification with her own mother as well as the 'bad' child. Well-being can only be regained by the infant's satisfaction which would represent her own gratification at her mother's breast.
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The core of the depressive constellation consists of the introjected hated, frustrating mother now identified with the self which is consequently 'bad' also. The depressive core can be stimulated by regression to the oral phase which occurs during the female procreative cycle. In those women who are ambivalent owing to identification with the 'bad' mother, hormonal stimulation of the reproductive drives can mobilize the depressive constellation and lead to depression.
George L. Engel and Franz Reichsman. 'Spontaneous and Experimentally Induced Depression in an Infant with a Gastric Fistula: A Contribution to the Problem of Depression.'
This is a case report followed by discussion of an infant girl who was found at birth to be suffering from congenital atresia of the oesophagus. Cervical and gastric fistulae were established and the child discharged to her home. She was to return for a further operation later which would allow the child to swallow normally. Owing to a number of circumstances the child was neglected at home, and she had to be readmitted to hospital at the age of one year and three months. She there remained for nine months and was successfully operated upon. It was noted that a depressive withdrawal reaction appeared when the infant was confronted with a stranger. During the depression-withdrawal reaction there was a profound reduction in the secretion of hydrochloric acid and pepsin by the stomach. A number of factors are listed as being the cause of the reaction. Amongst these are: (i) the interference with the normal feeding pattern as a result of the anatomical defect; (ii) the mother's uneasiness with the abnormal child; (iii) the mother's subsequent pregnancy; (iv) the move from the grandparent's home to an isolated house in the hills.
The latter half of the paper is taken up with an examination of the relationship between depressive phenomena in infancy and those of adult life. The authors have found Benedek's formulation (see above) very helpful in understanding the child's depressive reaction. They suggest that after a period of activity which ends in exhaustion the depressive reaction supervenes. This occurs only when there is no longer any hope of resuscitation of the mother-childsymbiosis. The child's failure to show anxiety instead of depression when confronted with a stranger can be attributed to the repeated past failure of the anxiety response.
The authors propose that two basic processes predispose to the nuclear psychodynamic constellation which is potentially depressogenic. The more primitive is a tendency towards biological withdrawal in the face of threatened exhaustion. The second factor is what Benedek has called the 'ambivalent core'. In depression there is not only an oral process of introjection of the object but also an inactive pre-oral, pre-object primordial process. The active phase has the aim of restoring the lost object. The child's reaction of depression-withdrawal represented the reaction of the inactive, pre-oral phase.
Judith S. Kestenberg. 'Vicissitudes of Female Sexuality.'
This paper takes up the problem of the rôle of the vagina in early development. It begins with a discussion of the activity-passivity problem as it relates to femininity. It is suggested that, prior to the period when the vagina is recognized as a bodily organ, tension arising within the vagina is expressed as a yearning for a passive experience. The girl in pre-puberty reacts to sexual tension without being aware of its source. The influence which each libidinal phase has upon the final psychical representations of the vagina is described at length—separate sections of the paper being given over to the oral, anal, and phallic phases. At one stage according to the author vaginal sensations are projected on to the baby. This projection of vaginal sensations transforms the idea of the vagina as a devouring mouth or bad-smelling hole into that of a precious organ. In this early maternal stage of development play with dolls represents the child's mother relationship and the externalized vagina. In the conclusion Kestenberg suggests that the long period of vaginal frustration imposed upon the girl biologically facilitates the development of maternal feelings. This is accomplished by the transformation of vaginal tensions into maternal urges.
Sandor S. Feldman. 'Crying at the Happy Ending.'
'There are no tears of joy, only tears of sorrow'; Feldman ends his short paper with these words. He shows by means of numerous examples that crying at the happy ending arises from a number of causes. It may be due to delayed effect; to sad events the memory of which is awakened by a happy ending; or to guilt. A further explanation is offered, the essence of which is that in adult life the individual can no longer experience the happiness and the parental protection of childhood. Feldman points out that we cry not only over past unhappy events, but also because the happy childhood with its illusions is gone, and we cry for the sad end which is sure to come—the separation from the beloved ones.
Leon Saul and Edith Sheppard. 'An Attempt to Quantify Emotional Forces using Manifest Dreams; A Preliminary Study.'
The observation that there was a striking difference between the manifest dream content of normal subjects and hypertensive patients led the authors to undertake a systematic study of 500 dreams obtained
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from 200 subjects. A hundred of these were normal and the other hundred suffered from hypertension. A survey revealed that the dreams of the hypertensive patients showed a higher frequency and intensity of hostility associated with anxiety than did those of the normal subjects. A scale was devised to 'measure' hostility as expressed in the manifest dream. The results obtained from the use of this scale indicated that it could discriminate between the dreams of normal subjects and hypertensive patients, i.e. from the judges' scoring there was both a greater intensity and frequency of hostility in the dreams of the hypertensives than in those of the normally tensive.
The authors emphasize that the use of the scale is of no help in arriving at the latent dream thoughts, nor can it take the place of a full understanding of the predominant unconscious conflicts present in the individual case. Nevertheless as a method of measuring emotional forces it may be a useful adjunct to more comprehensive investigation.
Philip Weissman. 'On Pregenital Compulsive Phenomena and the Repetition Compulsion.'
In this paper the question is raised whether or not all forms of play in the pre-genital period which 'discharge unpleasure' are inevitably an expression of the repetition compulsion. The author points out that the observer must decide whether or not the play is an autonomous ego activity. Viewed in this light repetitive normal play is to be distinguished from compulsive play, which is also to be seen in very young children. This latter type of play is not conflict-free. The fact that such play is conflict-ridden indicates that it also has the function of discharge of unpleasure. The example of a young child's play given by Freud in Beyond the Pleasure Principle is re-examined. The author comes to the conclusion that the child's activity was not due to the repetition compulsion but was a manifestation of conflict. Pre-genital compulsive behaviour and compulsive symptoms are nonautonomous ego-activities, and are similar to the later post-latency obsessional compulsive phenomena. The presence of compulsively patterned behaviour and of compulsive symptoms in pregenital life gives rise to a number of important clinical problems; e.g. what is the final outcome of these pre-genital compulsions in later life, and do such phenomena continue into the obsessional neurosis of the adult.
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Freeman, T. (1957). Journal of the American Psycho-Analytic Association 4, 1956, No. 3. Int. J. Psycho-Anal., 38:298-300