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The term "dependence" is part of contemporary [[language]]; it is frequently used in the field of [[psycho]]-[[pathology ]] but more for descriptive convenience than to specify a precise relational modality concerning the subjection of a [[subject ]] to an [[object]]. Sigmund [[Freud ]] used the term infrequently but made reference to it in his [[discussion ]] of the [[pleasure ]] [[principle]]: "It will be rightly objected that an organization which was a [[slave ]] to the [[pleasure principle ]] and neglected the [[reality ]] of the [[external ]] [[world ]] could not maintain itself alive for the shortest [[time]], so that it could not have come into [[existence ]] at all. The employment of a [[fiction ]] like this is, however, justified when one considers that the infant—provided one includes with it the care it receives from its mother—does almost realize a [[psychical ]] [[system ]] of this kind" (1911b). Serge Lebovici (1991) remarked that the [[human ]] [[being]]'s original [[state ]] of dependence is a fundamental postulate of [[Freudian ]] [[theory]]; it is the [[baby]]'s [[Hilflosigkeit]], or [[helplessness ]] (détresse or désaide in [[French]]).

As Michael [[Balint ]] ([[1968]]) remarked, the [[notion ]] of "[[oral ]] dependence" appeared in the [[work ]] of Otto Fenichel in 1945. Fenichel describes oral [[character ]] traits, especially a disguised dependent [[need]], created by reaction-[[formation]], [[manifest ]] in attitudes and behaviors of independence and rebellion. Franz Alexander used this [[idea ]] to describe ulcerous [[subjects ]] who indicate their condition by the [[conflict ]] between the [[desire ]] to maintain a state of [[infantile ]] dependence and the [[affirmation ]] of independence of the [[adult ]] ego.

Melanie [[Klein ]] showed no interest in the [[concept]], but her students Paula Heimann and Joan Riviere, in Developments in [[Psychoanalysis]], refer to the [[infant]]'s [[total ]] dependence on the [[mother ]] at the beginning of [[life]]. The concept becomes central in the [[thought ]] of Donald [[Winnicott ]] (1963), who emphasizes that the baby, who is dependent on the care of those around him, is subject to a "[[dual ]] dependency," which will become simple dependency as soon as he or she becomes aware of it.

This is part of a normal [[process ]] for every human being, so that not every state of dependence later found to [[exist ]] can be reduced to it. Yet this inaugural kernel, which is characterized by a [[sense ]] of powerlessness (as well as the [[narcissistic ]] omnipotence associated with it), is the basis of subsequently-observed states of [[mental ]] dependence and defects in the [[separation]]-individuation process. Adolescence especially is a period of reactualization and the heightened revival of [[feelings ]] of dependence and infantile helplessness. Philippe Jeammet (1989), who considers dependence to be characteristic of this period, has developed the concept within a metapsychological perspective that cannot be easily summarized. According to this conception, the adolescent shows himself to be clinically dependent whenever he feels that his object [[needs ]] threaten his [[autonomy ]] and narcissistic equilibrium.

Some authors have examined dependence in the [[treatment ]] of borderline states, following Winnicott, who emphasized the [[danger ]] of underestimating the [[transference ]] dependence in this type of [[case ]] as part of the [[counter-transference ]] risks of his [[interpretation]]. He, like Balint, cautions against an overly systematic interpretation of transference dependence, introducing the risk of reinforcing the dependence—especially oral dependence—of the [[patient ]] on the [[analyst]], and the latter's omnipotence. Otto Kernberg, [[working ]] with narcissistic [[patients]], describes their inability to depend on the analyst from the beginning of [[therapy]], which can be compared to the [[fear ]] of "giving in to dependence" described by Masud Khan.

In contemporary [[psychiatric ]] clinics there has been a recategorization and [[clinical ]] reassessment of dependence. The term is no longer only applied to drug [[addiction]], alcohol or tobacco dependence, and so on, but tends to define a [[biological]]-[[psychological]]-behavioral syndrome that is very broad and includes those states as well as pharmacodependence. The concept of "addiction," which is very similar to that of dependence, is an indication of this broadening. Thus the pathological behaviors in which an act of [[incorporation ]] (often but not exclusively through use of a toxic object) allows the subject to relieve the [[internal ]] tension by short-circuiting a threatening mental condition are grouped under the term "addiction." These include alcoholic and drug-related [[behavior]], [[bulimia ]] (and [[anorexia]]), as well as addictions that do not involve the ingestion of a product ([[games ]] of [[chance]], shopping sprees, [[sexual ]] addiction), and even relational dependence.

[[Bibliography]]

* [[Freud, Sigmund]]. (1911b). Formulations on the two principles of mental functioning. SE, 12, 218-226.