Psychodynamic Depression
Definitions
Grief - the affective state precipitated by loss; felt with the loss of a loved person
- initial response to grief is shock or denial
- may cause major depression once the initial response wears off Þ lack of energy, interest, feeling of hopelessness
- common to have self approaches Þ i.e. I could of done this or this
- DSM-IV
calls it adjustment disorder with depressed mood
- Duration
: - 1 year or so; can have residual aspects for many years - time heals
- Treatment
: is time unless sleeping is greatly impacted, then may turn to hypnosis
Mourning - the process by which grief is resolved; requires a lot of intensive work
Bereavement - another word for the grieving process
Psychodynamics of Grief
Major Concepts (syllabus): the psychodynamics of reactive depression (depressive neurosis) are as follows:
The ego experiences the loss of an important object. The loss may be real or unconsciously fantasized, and the object may be another person, an inanimate object, or an abstraction
The feelings toward the "lost" love-object have been highly ambivalent (both loved and hated). The anger is largely unconscious (repressed)
The ego unconsciously refuses to give up the object and takes its psychic representation within itself, together with the highly ambivalent feelings attached to it. (A utilization of the mechanisms of "introjection" or "incorporation")
Part of the ego in this process may take on attributes of the lost object (if it is a person), thus maintaining an unrelinquishable tie. (This is called "identification" with the lost object)
The aggressive feelings toward the object, which is now psychically incorporated into the ego, are thus in effect directed toward the self. (The internalization of aggression)
The negative affects in depression (the self-reproach, feelings of worthlessness, etc.) then are thought to be those which were actually meant for the lost love-object.
The superego (or conscience) participates in this process in several important ways. It is often at the behest of a strict and punitive superego that the ego represses the aggression felt toward the object in the first place and thus facilitates the introjection. After the introjection has taken place, the harsh superego facilitates the turning of aggression upon the self
In his theory it is felt that the whole process is set in motion by some contemporary psychic event which unconsciously recapitulates a childhood experience or loss, rejection, separation, etc.
Mourning and melancholy - Freud 1918 Þ The model for Reactive Depression (lecture)
(sexual desires, aggression), Ego (mediator), Superego (conscience)
Ego forms relationships with objects (i.e. another individual) Þ forms a cathexis or emotional connection with another person; forms a mental representation of the person (may be unrealistic representation) Þ the more accurate the representation of the person we choose to love, the better off we are
Id is involved in any love relationship and there is always ambivalence (positives and negatives) i.e. a sense of frustration or anger even in the most loving relationship
When grief occurs (i.e. loss of the object) Þ develop a sense of angry cathexis Þ the object in which cathexis is attached to is now lost Þ need to develop relationships with other objects and deal with the positive and negative aspects of the Id
The positive aspects of Id are much more apparent during the mourning process
Most cultures have a set of rituals dealing with the process of mourning (i.e. what is expected)
process of dealing with the positive feelings are not a problem Þ think about fond memories, look at old photos, etc
process of dealing with the negative feelings is more of a problem Þ suffer some degree of pain or discomfort (i.e. the black armband or wearing black clothes)
Black armband symbolizes anger at the departed
Example of a woman who could not resolve this process - she did not want to live ("nothing left for me")
- Depression is aggression turned inward
Þ she was furious with herself thus wanted to die
Couldn’t resolve the negative aspects of Id
She was angry at her husband for having many love affairs
She internalized the anger which should have been targeted toward her deceased husband
She began showing the positive aspects with thanks and gratitude toward her psychiatrist for helping her
She began showing the negative aspects with anger during an appointment about the doctor being 10 minutes late Þ transference of negative aspects
Unresolved grief is our understanding of depression