What is depression and how does psychoanalysis account for it?

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Depression, or ‘the depressive position’, in psychoanalysis was first proposed by Melanie Klein. Klein observed young children and noted how they experienced acute anxieties. Following these observations Klein proposed a theory of the paranoid-schizoid and depressive positions encountered by children during development. The two positions, although each is a model for all paranoid and all depressive behaviour throughout life, are seen as stages through which children progress even though there can also be regression from the depressive to the paranoid-schizoid position. The relationship between the two positions is a continuous and dynamic one likened by Bion (1963) to a chemical equilibrium. The depressive position is also a psychoanalytical model for adult functioning for a range of states from everyday grief to clinical depression. We will now consider the psychoanalytical basis of this position as accounted by Klein.

In order to understand the depressive position a little must also be said about the preceding paranoid-schizoid position as they have been said to exist in a state of equilibrium (Steiner, 1992). The paranoid-schizoid position describes a state of paranoia in which the child is a constant spiral of aggression and fear. Having not been able or not had the opportunity to establish a ‘good internal object’ (a sense of have a source of support inside oneself brought about having been supported in such a way) the individual does not have a basic sense of this goodness existing during its absence and has no internal resources to fall back on. In this state the individual feels persecuted and the primary anxiety is fear. Children in the paranoid-schizoid state often played games where they attacked a number of enemies and were then fearful of being attacked in return and this fear often lead to further hostility.

However, a marked change can be observed when the child enters the depressive position. Children in this state also act out scenes of violence but at the same time experience both remorse and guilt about the people who are hurt in their pretend games. This is they key difference between the paranoid-schizoid states. In the paranoid-schizoid position children are driven purely by an egocentric fear of retaliation against themselves in which they may be attacked in return.

In the depressive position children are also driven by fear but this fear is for others who may have been injured by their own actions and rather than fearing retaliation the child is truly concerned about the others’ well-being and feels guilt for having caused harm. In their play during the depressive position child often attempt to nurse better those that they have harmed in their imagination in order to restore them. The reason for the difference between the two positions is that children in the depressive position have, unlike those in the paranoid-schizoid position, internalised a good object. This allows them to cope well with difficulties and instead of simply hating enemies with impunity the child experiences sorrowful anxiety and the fear is turned into sadness and concern.

So what are the underlying processes which have moved development along from the paranoid-schizoid to the depressive position? The change which occurs is that instead of seeing the world as populated by purely ‘good’ and purely ‘bad’ objects, e.g. a loved mother who is gratifying and a hated mother who is frustrating, the child links these different experiences into a ‘whole object’, i.e. one mother who is both satisfying and frustrating.

This more realistic perception creates an anxiety situation which has not been felt previously, it is one of loss. The loss stems first from the fact that the child realises his own ambivalence and is shocked to find that the mother which he at times hates and attacks is the same one which he loves. The anxiety produced by the fear of hurting the mother he loves causes the child to feel true concern for her. Secondly, loss is also felt due to losing the concept of ideal objects.

A child growing up must come to realise that there is no such thing as an ideal object which will provide unlimited satisfaction and this realisation can be especially painful. The conflict produced by being disappointed in the mother for being imperfect and the concern about hurting or losing her causes the mixture of feelings which Klein described as depressive anxiety. This depressive anxiety is similar to the grief suffered by bereavement and is in essence a state of mourning (Klein, 1940). Klein believed that the child begins to move from the paranoid-schizoid and into the depressive state at around 3 to 6 months of age.

Klein believed that this depressive state was normal and that the depression experienced was appropriate when reacting to the loss of a loved object. As mentioned previously, Klein stated that the position could be used as a psychoanalytic model to describe all the various periods of depression in adult life as well. Adult depression can range from everyday grief for the loss of an object – which could be a valued idea as well as a person – to clinical depression, this will be considered later. The child’s progression into this position marks a more mature level of functioning and Klein suggested that this depressive state is an inevitable part of the human condition (Klein, 1935; 1940). Adult depressive anxiety is believed to be a mature state as it is an achievement to be able to experience appropriate sadness at the loss of an object instead of the paranoia of the paranoid-schizoid position.

However, sometimes the sadness associated with the loss of a loved object is too difficult and painful to bear and reparation (repairing the imagined damage) cannot occur. In these cases one of two defences is called upon. The first of these is to retreat to the paranoid-schizoid position as it is seems that in the face of acute depressive anxiety paranoia may be preferable. In the paranoid-schizoid position the individual can harbour the notion that an ideal object exists and the ambivalence (feeling both hatred and love for the same object) which marks the depressive position can be split and the cherished object can be divided into two: a purely loved and a purely hated one.

Klein likened her description of clinical depression to Freud’s ‘melancholia’ (Freud, 1917) which is in essence a paranoid state. On encountering depressive anxiety the melancholic will enter a state of loathing both himself and the lost object. The object has been split and only hatred is felt which does not allow for the concern and remorse felt for the still-loved object by the mourner who is working through their depressive anxiety. The paranoid state causes the loathing to turn into persecution and finally fear for the clinically depressed person and the cycle encountered in the paranoid-schizoid position can be seen to manifest again.

The second defence against the pain of depressive anxiety is the manic defence. In this state the person has attempted to negate the pain by convincing themselves that the lost object was actually of no significance to them and hence its loss has no effect. This is clearly a state of denial. Manic defence has three characteristics: the object is treated with contempt, the person feels they have triumphed over the object, and the person attempts to control the comings and goings of the object so that they are not made aware of their dependence on the object. However, when reality intrudes into the world of manic defence with the knowledge that the damage was not fixed and the object was in fact held dear, the individual crashes down into depression. The psychiatric state of manic-depression occurs when the person resorts to mania as a long-term strategy and becomes caught in the cycle between mania and depression as these two states are always in equilibrium.

In summary, Klein extended the work of Freud when she placed emphasis on the acute anxieties that children experienced and created her theories about the paranoid-schizoid and the depressive positions. The depressive position occurs later developmentally and also provides a psychoanalytic model for normal adult functioning. In the depressive state the individual has internalised a good object from which they can draw support and they have also realised their ambivalence towards objects.

The primary anxiety is for the welfare of the internal good object when in the depressive position. However, the depressive position is repeatedly lost and in need of re-establishing (Temperley, 2001). When it is lost the person regresses to the more primitive paranoid-schizoid state and the fluctuations between these states can take place over months or years. There is no state beyond that of the depressive position and hence to be truly adult requires an ability to live in the depressive position and to be able to handle the grief and sadness which are inevitable when loved objects are lost.

References:

Bion, R.W. (1963). Elements of Psychoanalysis. London: Heinemann.

Freud, S. (1917). Mourning and Melancholia. Pelican Freud Library, Vol. 11.

Klein, M. (1935). A contribution to the psychogenesis of manic-depressive states. In Love, Guilt and Reparation (1975). New York: Delta.

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