Psychotherapy based on identity problems of depressives

I present here what I call my identity-theoretical concept of depression, discussing both bipolar disorders and major depressive disorders. The method is phenomenological in that through interviews with depressives we become aware of their being-in-the-world, their social roles and the various identities they form through identification and under the pressure of their environment. In contrast to the normal individual, whose identity is autonomous, flexible, and continuously changes throughout the life cycle, depressives have what I call an "overidentifying" identity formation. That is to say, they cannot stand back and be autonomous, they must overidentify or throw themselves excessively into whatever particular social expectations they encounter. This leads to an "overadjustment" to the norms of society, a rigidity, and an excessive dependence on others. Patients in the manic phase may show the opposite extreme in their effort to avoid the overidentification tendency. Furthermore, depressives cannot tolerate ambiguity, they cannot deal with the positive and negative characteristics in one or the same object or person. Depressive or manic episodes are precipitated by situations where ambiguity cannot be avoided, or where conflicting identities are demanded at the same time, for example when a high quantity of high quality work is demanded in too short a time for this to be possible. Any sort of changes or role losses that demand flexibility of one's identity or the capacity to step back a bit and suspend one's characteristic habits or identity manifestations will precipitate manic or depressive episodes in such predisposed melancholics. On the basis of my identity-theoretical concept certain guidelines for psychotherapy suggest themselves, and these are presented. I call this "identity therapy," and I distinguish it from cognitive therapy because it is not the cognitive schemes that are disturbed in these patients but rather their identity structure. I discuss separately the guidelines for treatment in the acute and in the rehabilitation phase of the illness. In the former I suggest helping the depressive accept the role of patient in order to relieve the pressure of sociologic conflicting expectations on the patient's brittle identity concept. It is important for the patient to be able to resume social roles and routine activities, beginning in an anxiety-free setting where ego-satisfying achievements are encouraged. In the rehabilitation phase self-reflection is more encouraged, with the patient achieving an understanding of what has precipitated the episode of the illness in terms of the overwhelming of the patient's identity concept.(ABSTRACT TRUNCATED AT 400 WORDS)