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Lewin, B.D. (1961). Reflections on Depression. Psychoanal. St. Child, 16:321-331.

(1961). Psychoanalytic Study of the Child, 16:321-331

Reflections on Depression

Bertram D. Lewin, M.D.

In previous centuries, psychiatry did not use freely the term depression, as it does now, to indicate a pathological complex of symptoms. The old literature was apt to speak of melancholia instead, and the history of the melancholia concept from Hippocrates to Kraepelin constitutes a large part of the history of psychiatry. That the word depression has replaced it so extensively may be due to the authority of Kraepelin and his use of its cognate adjective in the diagnostic label, manic-depressive. In one application, involution melancholia, the older word survives, and it was current at the time of Freud's early writings. We find Freud and Abraham writing of melancholische Depression, implying thereby that they meant one form of depression—a structured complex of symptoms.

Present-day psychiatry has not completely rejected the concepts which Kraepelin used in regard to manic-depressive psychoses, but it has let them lie fallow. Not much, for example, is done operationally with Kraepelin's organic assumptions, and indeed the idea of symptom, in its nineteenth-century meaning of sign of a disease process, has fallen into desuetude. The word symptom remains, but it has a new meaning. In manic-depressive psychoses, in other psychoses and in the neuroses, symptom has come to mean a psychological structure, as Freud defines it in The Problem of Anxiety(1926). Psychiatrists are gradually getting away from the word's original denotative implication.

Certainly, in psychoanalytically pervaded thinking, there has been an inevitable, insidious change of meaning not only in the concept of symptom, but also in the concept of depression.

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