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Benedek, T.F. (1956). Toward the Biology of the Depressive Constellation. J. Amer. Psychoanal. Assn., 4:389-427.

(1956). Journal of the American Psychoanalytic Association, 4:389-427

Toward the Biology of the Depressive Constellation

Therese F. Benedek, M.D.

SUMMARY

The aim of this paper is to demonstrate the universal nature of a depressive constellation. The term, depressive constellation, designates a core organization of opposing instinctual tendencies and their primary object representations. The origin of this nuclear psychic organization is in the bipolarity of the processes connected with alimentation. Since alimentation as a psychic organizer functions through mother-child-mother relationships, "depressive constellation" constitutes a psychodynamic link in the chain of generations.

These generalizations are based upon study of the psychobiology of the female procreative functions and upon the analysis of the transactional processes between mother and infant (symbiosis).

Studies of the female sexual cycle indicate that the estrogen phase is associated with active, object-directed heterosexuality; the lutein phase is accompanied by passive, receptive, retentive tendencies which represent preparations for pregnancy and motherhood. These tendencies repeat the developmental processes through which the passive-receptive relationship of the infant girl with her mother becomes the mature woman's active, giving attitude toward her child.

In each phase of woman's procreative growth—the lutein phase of the sexual cycle, pregnancy and lactation—the two levels of motivation and action can be differentiated: receptive-retentive tendencies on one hand and active-giving attitudes on the other. This

biopsychological conflict and duality of function is inherent in the normal procreative processes of women; at the same time, it is the basis for the potential pathogenic hazards of motherhood. Psychoanalysis established that the psychopathology of depression is associated with regression to the oral phase of development. To this we add: each phase of procreative growth necessarily brings about such regression. While this is a source of well-being and maturation for healthy women, it is dangerous for those mothers whose past experiences do not prepare them to participate in the gratifications or to endure the dangers of motherhood.

Birth is a traumatic separation for both mother and child. Their relationship is re-established through the processes of alimentation. Through the rhythmic repetition of hunger and satiation, the biologic unity is replaced by psychologic communications through introjections and projections. The newborn eventually learns that the source of need is inside and the object of gratification is outside. At the same time, the infant is the object of the mother's receptive needs. She feels "whole" with him and "empty" without him. This attitude plus the exaggerated charge of the mother's incorporating fantasies during lactation indicate that the mother during the postpartum period as well as during pregnancy responds to the increased demands on her with an increased wish to receive. These emotions originate in the biological regression of motherhood; they indicate that the postpartum symbiosis is oral—alimentary—for both infant and mother.

Through memory traces of alimentary experiences, the infant introjects the "good-feeding mother = good-satiated-self"; and the "bad, frustrating mother" = "bad, frustrated (hungry, painful self." Introjection of memory images of "good mother" produces confidence, hope and increasing capacity for tolerance to frustration. At the same time, the mother develops confidence in her own motherliness; her gratification is projected onto the child. These are repetitive, reciprocal transactional processes of identifications and projections through which primary object relationship and primary self-representation are established.

Failures in gratifications in the child result in crying fits, i.e., in sudden total regression to the undifferentiated phase in which mother as object did not exist. In the process of calming down,

the infant projects part of the aggressive motor excitement onto the mother, and by this the infant develops hatred for the object he needs to establish his "self" again. As the calming-down process continues, the aggressive impulses disappear via introjection, and the equation "bad mother = bad self" becomes established within the psychic organization. This introject constitutes the ambivalent core of the personality and represents the fundamental, alimentary origin of the depressive constellation.

From the standpoint of the mother, the frustrated infant causes a corresponding frustration of her receptive needs, inducing a regression which activates the ambivalent core from the alimentary phase of her own development. This intensifies her aggressive behavior toward the infant and revives the preverbal memories of her own aggression and dependency on her own mother. She thus becomes not only "bad mother" but also "bad child" again. Just as she could regain emotional equilibrium as a child only by satiation through her mother, her emotional balance can now be re-established only through her (satiated) child, who in this respect becomes the powerful "good or bad mother." The transaction between mother and child may lead clinically to depression in the mother; simultaneously, this reaction in the mother intensifies the ambivalent charge of the "depressive constellation" in the child, which predisposes to depressive reactions. Individual variations in the organization of this nuclear conflict are explained by differences in the innate anlage of the child, transacting with individual differences in the behavior of the mother. (Furthermore, the ambivalent core is necessarily in continual transaction with all intrapsychic processes, and therefore influences the organization of the personality as a whole.)

Normally, the libidinal aspects of mothering, satisfied by an increase of receptive tendencies, maintain a positive, psycho-economic balance in favor of the satisfactions from motherliness. Pathologic variations of maternal behavior originate in the alimentary-derived ambivalent core, which might interfere with both the receptive and the giving aspects of procreative functions. The culture of our time, emphasizing masculine ideals, may obstruct the passive trends and lead to emotional infertility, or a strict superego may demand such perfection in giving that anxiety

and guilt activate the ambivalent core and give rise to depressive reactions.

The normal, cyclic frustration of the propagative instinct leads to sublimation. But if the woman's attitudes toward procreation are strongly ambivalent due to hostile identification with the mother, the hormonal stimulation of the procreative instinct mobilizes the ambivalent core (of the hated, bad self and hated, bad mother image), leading to clinical depression. If developmental conflicts have affected the hormonal cycle by lessening the available energy, the woman may feel empty, arid and suffer from angry humiliation. The same process may occur with lessened libidinal energy during climacterium.

Pregnancy is biologically and psychologically opposed to the state of arid depression, but with parturition the mother's receptive needs require restoration. This occurs through the normal course of the alimentary-symbiotic relationship between mother and infant. The mother's giving, i.e., her object relationship with her child, does not diminish but rather replenishes her libido reservoir. The real significance of this "feed-back" is most evident when frustration and anxiety make emotional support from other sources necessary. The husband-father's giving is effective only in so far as it helps to sustain the mother until such time when she becomes able again to receive security from her motherliness, through her child. This is clinical evidence that mother and child are one psychoeconomic, transactional unit during the alimentary phase of development.

The transactional processes of the alimentary phase of development are basic processes of human development. They represent the model of communication of each meaningful interpersonal relationship. Such relationships affect, through reciprocal introjection and identification, both participants commensurate to their personality and their particular function in the relationship.

According to the stress which the continuation or the interruption of such relationship exerts upon the individual, the core organization participates with all other factors of the personality in maintaining the equilibrium of the psychic economy. Since this occurs through the intensification of the receptive tendencies and implies regression to the oral-alimentary phase, the term,

depressive constellation, appears justified. Since this term refers to a universal psychodynamic construct, its significance is broader than the pathogenesis of clinical entities of depressions. However, reactivated by specific stress situations, the universal core organization may become depressogenic.

The study of clinical depressions, psychosomatic disturbances, and, last but not least, personality structure and its evolution during the whole course of life (parenthood, aging) can be advanced by the concept of the "depressive constellation."

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