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(1962). International Journal of Psychoanalysis. XLI, 1960: Symposium on 'Depressive Illness'. Elizabeth Zetzel; Sacha Nacht; P. C. Recamier; W. Clifford Scott; Gustav Bychowski; Melanie Klein; Herbert Rosenfeld. Pp. 476-513.. Psychoanal Q., 31:121-122.
Psychoanalytic Electronic Publishing: International Journal of Psychoanalysis. XLI, 1960: Symposium on 'Depressive Illness'. Elizabeth Zetzel; Sacha Nacht; P. C. Recamier; W. Clifford Scott; Gustav Bychowski; Melanie Klein; Herbert Rosenfeld. Pp. 476-513.
Granted essential agreement as to the dynamic, structural, and economic significance of depressive illness, Zetzel raises the question as to whether adult maladaptation can occur without important infantile prototypes. The life cycle may be considered from birth to death as a developmental sequence with specific critical periods. Psychic development does not have to be viewed as completed with latency or even with maturity. Environmental stresses are seen as causative factors in mental illness, especially those pertaining to the later crises of life. Whereas Abraham regarded depressive illness primarily as the result of instinctual regression to a level of pregenitalfantasy and conflict, today the trend is to focus primarily on the regressive modifications of both ego and superego which facilitate the emergence of archaic states. These modifications may be induced by present maladaptation as well as by past.
Nacht and Recamier discuss the genesis and dynamics of depressive illnesses. The sense of loss of love is the fundamental depressive situation. The broken bond, once experienced as part of the primary relationship to the mother, is required by the depressive personality in order to be both very close and exclusively loved. Feeling constantly threatened by the massive irruption of his own aggressions, the depressive character needs the love of the object to maintain the equilibrium between love and hate which tend in him to defuse easily. He is unable to effect a true identification to replace the lost object since the need for love of the real object is too great. He does attempt an unneutralized introjection wherein the hatred can be discharged against a self which is now subject and object. The authors classify the clinical varieties of states of depression according to the degree of distintegration of the love relationship and according to the degree of internalization of object relations. They agree with the Kleinians that the fixation point of depression is at that stage of object differentiation
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at which it is topographically but not yet economically distinguished from the subject. It is also at this point that the fusion of opposing drives occurs. The authors disagree with the Kleinians in that they feel that one cannot speak of an ego or object at this stage in the true sense of the word, nor do they feel that the Kleinians grant sufficient importance to the influence of reality in the development of the predisposition to depression.
Scott reviews the literature pertaining to the relationship of the ego organization in pathological mourning to neighboring psychological states. He feels that more attention should be paid to the transition areas between 1, schizophrenia and depression; 2, mania, neurosis, and normal mourning; and 3, enthusiasm and depression. A patient is described who learned to tolerate the conflicts leading to depression and mania with the eventual emergence of normal mourning and enthusiasm.
Bychowski distinguishes between chronic and latent, and borderlinedepression. In the latter the depressive core is masked by a façade of character traits and neurotic symptomatology which only occasionally gives way and reveals the structure of the unconscious ego. New object relationships are built with insufficient cathexes since considerable amounts of libido remain invested in the introjects. Unsublimated primitive aggression, brought on by the unconscious goal of masochistic provocation, may break through in many ways. Addictions and eating problems may also complicate the picture. Changes in the intrapsychic equilibrium, brought on by inner or outer stress, lead to a weakening of defenses and the outbreak of manifest depressive illness.
Melanie Klein briefly reviews her concepts of the depressions experienced by the paranoid schizophrenic. The paranoid-schizoid position is bound to splittingprocesses and contains the fixation points for schizophrenia; the depressive position contains the fixation points for manic-depressive illness. The persecutory anxieties and splittingprocesses characteristic of the paranoid position continue, albeit diminished and altered, into the depressive position. The changes are due to the increase in fusion of the life and death instincts. The first phase marks the internalization of the mother in her good and bad aspects. In the second phase the preservation of the good object becomes more important since decrease in fragmentation leads to an increasing awareness of the differences between the good and bad objects. Depressive features in paranoid schizophrenics are not as easily recognized as in manic-depressive states. Owing to processes of fragmentation, and to the violence with which these take place in the schizophrenic, depressive anxiety and guilt are split off. The schizophrenic also easily projects depression and guilt.
Rosenfeld discusses the importance of the precipitating factor in the depressive illness. It is the analytic view that depressive illness is almost always precipitated by an object loss. The patient unconsciously believes that his aggressions have omnipotently caused this loss. All earlier experiences of object loss, leading to the earliest anxieties of the primal infant-mother relationship, are now reactivated. However, it is not only a disturbance in an object relationship which can cause a depression. Some patients become depressed when confronted with a situation which makes them aware that they or their lives are incomplete, that certain parts of their personalities have been split off and denied.
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(1962). International Journal of Psychoanalysis. XLI, 1960. Psychoanal. Q., 31:121-122