Depression is a mood disorder, understood from the psychoanalytical viewpoint as resulting from an intrapsychic conflict that stems from the ego's difficulties in integrating aggressive drives that are experienced as too dangerous for the preservation of libidinally cathected objects. These aggressive drives turn against the subject via the superego, which becomes too strict and demanding. Depressive manifestations are frequent in other clinical entities where the conflicts are essentially intrapsychic, such as the psychoneuroses.
Karl Abraham (1912/1989) was one of the first psychoanalytical authors to concern himself with depressed patients and to describe the extent of the ambivalence of their drives. Narcissism is another characteristic of the depressive personality, which that Freud emphasized in "Mourning and Melancholia" (1916-17g ). Subsequently, Abraham (1924/1927) described the pregenital underpinning of this ambivalence, given the importance of oral fixations in these patients.
Freud compared the psychological mechanisms of melancholia with those of mourning, which constitutes a depressive state in the normal person. The essential difference is the narcissism of the melancholic, whose intolerance of experiences of loss lead him to the oral incorporation of the lost object into the ego, where it is attacked by the superego. Conversely, the person in mourning finds himself faced with the painful difficulty of detaching the libido cathected onto the lost object so as to recathect it onto objects in the external world. However, the major problem raised by Freud's descriptions of the dynamics of melancholia is that he does not specify the variations in the psychological mechanisms corresponding to the different degrees of depressive states.
Melanie Klein (1940) developed the comparison with mourning in her description of the depressive position. For her, the capacity to work through one's mourning will depend on the possibility of resolving the reactivation of the conflict proper to the depressive position that the conflict causes, i.e., the feeling of losing good internal objects. Klein, like Freud, is imprecise when it comes to the different problematics of depression. However, clinical analysis shows a whole series of levels of severity in this problematic between the working through of the mourning process (or during the integration of the depressive position) and the peak of this process, which Klein described as "a melancholia in statu nascendi" (Palacio Espasa). These depressive forms of conflict can be defined by reference to the predominant form of the fantasies expressing the experiences of the loss of the object of libidinal cathexis, and by the quality of the types of anxiety experienced by the ego.
When fantasies of the catastrophic and irreparable destruction of the object predominate, given that the subject has very little confidence in his libidinal capacities, feelings of guilt become intolerable and feelings of sadness are massively denied. The ego can only resort to archaic mechanisms of defense: splitting, denial, projective identification, idealization, etc.—the mechanisms proper to schizo-paranoid functioning or to the dynamics of extreme melancholia, with confusion between the ego and the object attacked (the "parapsychotic" depressive conflict proper to borderline or psychotic structures).
When fantasies of severe and barely reparable damage or death of the objects take the upper hand, the ego will be confronted with intense feelings of guilt and sadness. The significant repression of the aggressive drives towards the object (an aggressiveness that reinforces the severity of the superego) will make it possible for the negative affects to be partially denied. The ego will succeed in keeping the conflict interiorized but at the cost of diverse inhibitions in the functions of the ego. Thus, the symbolic possibilities of the individual are limited, but are not qualitatively affected. This very narrow form of repression is often insufficient, and the ego also has to resort to maniacal defenses or to defenses of a melancholic type, which then determine the clinical manifestations of mood disturbances.
When feelings of abandonment and rejection prevail—i.e., when the experiences of loss are above all fantasies such as the loss of the object's love—depressive conflict will take a "paraneurotic form." The feelings of sadness are often conscious, for guilt is less intense and can equally easily become conscious. The ego's greater confidence in its libidinal capacities gives these subjects a profusion of fantasies of reparation that will counteract the damage done to the object, damage that is fantasized as resulting from their own aggressiveness. These fantasies underlie many of the neurotic mechanisms of defense, especially those of an obsessional kind, for example retroactive cancelling, reaction formation, etc. Under their influence, repression authorizes a greater possibility of symbolic expression, which distinguishes neurotic repression from the massive repression of the depressive type. Such a libidinal predominance changes the nature of what is repressed, for the counter-cathexis does not operate on aggressiveness alone, but also on the libidinal fantasies of an incestuous nature. This contributes to the sexual differentiation of parental objects, bringing into operation the conflict occasioned by triangulation and the Oedipus complex.
FRANCISCO PALACIO ESPASA
See also: Abandonment; Acute psychoses; Adolescent crisis; Anaclisis/anaclitic; Anxiety; Dead mother complex; Depressive position; Essential depression; Guilt, unconscious sense of; Identification; Internal object; Lost object; Manic defenses; Mania; Melancholia; Mourning; "Mourning and Melancholia"; Psychoanalytical nosography; Self-punishment; Suicide; Superego; Transference depression.