Psyche-zeitschrift fur psychoanalyse und ihre anwendungen vol:59 issue:9-10 pages:864-891
This paper presents a psychodynamic approach to depression based on theoretical formulations and empirical findings from diverse perspectives including developmental psychopathology, cognitive and developmental psychology, social and personality theory, and psychiatric genetics. This approach considers depression not as a disease but as distortions of the normal development of two fundamental psychological processes: the capacity for interpersonal relatedness and the establishment of self-definition or an identity. The first section of this paper discusses depression in terms of two broad types of early and later life experiences that create vulnerabilities that can lead to depression: an interpersonal or anaclitic vulnerability that includes experiences of loss and feelings of loneliness, and a self-definitional or introjective vulnerability that includes experiences of failure and loss of self-esteem and self-worth. Extensive research over the last 25 years, summarized in the second section of this paper, supports and extends these theoretical formulations about two primary nuclei in depression. The third section considers the clinical implications of these formulations, particularly the impact of patient characteristics on differential response to various types of treatments, resulting in different types of clinical outcome. These theoretically and clinically derived, and empirically supported formulations of depression have implications for the aetiology and treatment of depression and suggest the importance of focusing on the phenomenology rather than the symptoms of depression and of considering the complex interactions between genetic predispositions, personality development, and early and later life experiences in the pathogenesis and treatment of depression.