In this study, we will examine the current psychoanalytic concept of depression, based on the observation of depressed patients. Depression presupposes an individual, psychic disposition and reveals itself through object relations. It is the blocking/stopping/slowing down of psychic functions, which most likely has organic foundations, and is triggered by a psychic conflict. This slowing down shows its effect by reducing psychic functions to a regressive level. Hospital observations show us that for each type of depression, there is a certain level of regressive function that allows psychic processes to continue with less inhibition and the pain of depression to be alleviated or completely eliminated. In depression, which is generally triggered by a relationship conflict, the depressed person is also deprived of narcissistic support. New theoretical developments in developmental psychology and attachment research continue to examine how we should understand this result.
Object Relations in Depression
Freud put two basic symptoms at the basis of depression: egocentric behavior patterns and self-complaint/self-devaluation. Depressives express their complaints in such a way that therapists feel helpless. In fact, they feel obliged to make suggestions to reduce the patient's suffering. As the depressed state continues, the depressive's response to all these suggestions is that nothing works. Self-devaluation is linked to the patient's devaluation of the Object. In this case, if we follow Freud, complaining and being self-complaining are interconnected.
Devaluing the object does not make the patient avoid this action; On the contrary, it provides opportunity for the continuation of its relationship with the outside world. Both being self-centered and complaining help the depressive stay in relationships with people. Through this mechanism, he seeks closeness with people who might be interested in him, tells them how bad he feels, and then asks what he should do next. Apparently, he has given up on making positive attributions to the object, and in extreme cases (severe depression) he has completely cut off his relationship with the outside world (which is good for him or that he values). Although it seems like this, it actually has a relationship with the outside world. It hasn't ended completely. So what does a depressive want from us?
Freud has provided an explanation to this question that will amaze us. That is, "Libido has regressed to the ego (I) and object libido has turned into narcissistic libido." This view explains us the egocentric behavior pattern. (Here) the trigger for depression is a threat of object loss. The regressive orientation in this context is the narcissistic identification with the object, which Freud illustrated with the metaphor of the shadow of the object of identification falling on the area that should be covered by the ego/ego (i.e. the self). Threatened or actual object loss is defended by transforming it into ego/self loss. The reproach against the object is replaced by the reproach against the ego/I. This is how Freud explains the depression that occurs with the attack/intervention of the Superego against the ego/ego, and does not continue to investigate the interactional dimension of depression by placing it within the framework of an internal process. Thus, it leaves open/incomplete the question of what a depressed person wants from his environment.
Many psychoanalysts interested in post-Freudian depression also approached depression like Freud (Rado, Fenichel, Cohen, Arieti, Blatt). Jacobson (1971) is one of the very few analysts who investigated the interactional dimension of depression. He took Freud's theory one step further. He suggested that in the worsening of depression, the depressive projects his own superego onto his relatives, thus keeping his psychological drama fresh as an object relationship drama. There are actually empirical observations to support this claim. DEPRESSION NEEDS A RELATIONSHIP PARTNER TO ENSURE ITS CONTINUITY. A depressed patient improves when he is temporarily separated from his relatives and friends (Matakas et al. 1999).
In the study, patients diagnosed as severely depressive (mono and bipolar with psychotic and non-psychotic symptoms) who were hospitalized in the psychiatric ward, They are divided into two groups (chosen randomly). The experimental group does not have any contact with their relatives for 1 to 4 weeks; The control group is left free in this regard. Likewise, both groups benefit from treatment opportunities. The experimental group gave more improvement feedback within 2 weeks compared to the control group. r (self-report). So, depression is not triggered only by a specific relationship; We can also accept that it continues to exist with a specific relationship. Thus, another dogma of depression research was shaken. That is, “it is a loss that triggers depression”.
Does Object Loss Make You Depressive?
Freud, “Trauer und Melancholie” In his work titled ", he explained that in both mourning and depression, the libidinous loading of the object is abandoned because the object is either lost or is threatened with loss. Later, most psychoanalyst writers also accepted this. The connection between the loss of important people and depression has always been discussed. Bowlby (1980) described in detail in Kasuistik that the loss of the mother at an early age facilitates the tendency to severe depression in later ages. Brown and Harris (1978) also have epidemiological studies on this subject.
The fact/determination that an early loss increases susceptibility to depression does not necessitate the conclusion that a current loss will trigger depression, because depression only exists within a relationship. and object loss is a less primary condition than “relationship”. However, Brown and Harris determined that early maternal loss has priority over other biographical experiences in triggering depression that may occur in later ages. However, it should be mentioned here that giving birth to a child and then postpartum depression is not an object loss (O'Hara, 1995). Married women are more likely to be chronically depressed than women who live alone and do not have a current relationship (Keller et al., 1981, 1984). Depression often reveals itself in a partner relationship (Keitner et al., 1990; Goldstein et al., 1996). Finally, depression is more common in adolescents who spend adolescence unable to become autonomous from their parents (Bemporad, 1978).
Defense Mechanism of Depression and Aggression
The depressed person seeks closeness with the interaction partner that will ensure the continuity of depression. Based on this, the analyst is inclined to interpret depression as a defense. The rule is this: on the one hand, the patient wants to get rid of his neurotic symptoms; On the other hand, symbol toms continue to exist. The trigger for non-severe depression is usually a relationship conflict, and the conflict is warded off through depression. For example, a housewife becomes depressed in order not to face the fact that her husband humiliates her; Postpartum depression occurs to cover up the mother's jealousy of her child, or some people become depressed when they fall in love because they are worried about attachment and that this attachment will make them dependent.
These few examples can show us that depression can be triggered by various life events. Triggering conflicts caused by devaluation, jealousy/envy, or fear of commitment need to be defended. With depression, one partner may want to provoke the other partner into feeling sorry for themselves; A postpartum woman may want to influence her mother to become a mother to her, or a lover may push the love object away from himself to overcome his fear of commitment. The rule is this: WHEN CONFLICT ELIMINATES, DEPRESSION ALSO ELIMINATES. Freud was of the opinion that defending/resisting aggressive impulses towards the object was a priority when depressed. An ambivalent relationship with the object and a perceptual threat of losing it triggers the aggressive drive; However, in order not to lose the object, this impulse is turned/directed against the self. Milrod (1988) calls this "the ego's commitment to aggression". The extent to which the ego is burdened by aggressive impulses also determines the severity of depression (Hayhurst et al., 1997).
However, Cohen et al. (1954), in their research examining the biographies of 12 severely depressed people, did not find any conscious or unconscious high-level aggressive impulses. Moreover, if depression is the defense of aggressive impulses against the object, then appropriate interpretations of this (given to the patient) should tend to reduce depression. In reality, this is not the case, though. Bemporad (1978) states: “For decades, therapists have tried unsuccessfully to get their depressed patients to express their anger or to separate it from their internalized picture” (p. 44). Mentzos (1995, p. 63), “depression "When you try to talk to the patient about the depth of depression and the aggressive impulse layer of his depression, the patient's depression deepens," he warned. It is often true that, yes, there is a link between the drive for aggression and depression. This can also be observed directly. The urge to anger and aggression can protect us from depression, as far as we know from clinical experience. But this does not automatically lead us to the understanding of defense of depression and aggressive drive. Instead, we can look at it this way: anger and aggression are healthy reactions (to life) that make us depressed and that we want to change.
It is also very difficult to determine at what level depression is a defensive function of the ego. When we temporarily separate patients from their relatives, they recover; We have seen from our experience that when they come together again, they get worse again. If we accept that depression is a defense and holding on to this defense is also a resistance, then we have to ask how this resistance, which has already been overcome, can affect the future. The impasse here is to view depression as a defense (e.g. regarding a relationship conflict). Ultimately, we can say this: Depression is generally not a defense of the aggressive drive.
PSYCHIC INHIBITION IN DEPRESSION
(vital) Decreased motivation, reluctance, decrease in fantasies, falling libido and aggression. Depression, described by vegetative symptoms such as aggressivitaet, physical weakness (weakness), changes in hormone levels, sweating/changes in weight, corresponds to the subjective perceptions of the depressive and objective bodily function deficiencies. The feeling of helplessness alone cannot define depression. If psychological experiences accompanied by feelings of worthlessness and (self-)complaining are not accompanied by symptoms such as deterioration/decrease in bodily functions, then we cannot call it depression on its own. However, the anaclitic depression of babies is a real depression, because it is related to the decrease in vitality in them.
What we call depressive inhibition is actually regression. Abandonment of mature Ego (I) functions. The concept of depressive inhibition describes a mental state that wants to do something but cannot do it. regress
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