The fragile self: narcissistic disturbance and the protective function of depression

The role of self-esteem in the aetiology of depressive disorders is not limited to negative self-evaluations. A broader concept, embracing the experience of the self, is necessary. A developmental model of self-esteem regulation is proposed, derived in part from Mahler's work on separation-individuation in infants and Kohut's work on narcissism. A concept of a 'fragile self' is formulated and developed; the depressive state is seen as protecting this fragile self. The model provides a coherent account of individual differences in proneness to depression (in interaction with environmental factors) which is useful to psychotherapists, yet open to empirical test and research use. The model is discussed in relation to psychological research on depression and implications for clinical practice are outlined.