Some subtypes of depression and their implications for psychoanalytic treatment

The author argues the case for the need to develop an integrative clinical psychoanalytic model of depression which takes into account various pathways leading to different subtypes of depression. Some factors intervening in the genesis and maintenance of depression (aggression, guilt, narcissistic disorders, persecutory anxieties, ego deficits, masochism, identification with depressive parents and fixation to traumatic events in which the subject felt helpless) are examined, as well as certain dynamic interrelations between them. The relationship between aggression and depression is analysed, with particular attention devoted to the steps through which aggression turns into depression. The origins of guilt are reviewed, including those conditions which are independent of aggression. Psychoanalytic interventions that could be pertinent for a given subtype of depression, but which could prove counterproductive when applied to another subtype are discussed. Clinical examples are given to provide support for the ideas presented, recognising that further studies are required to establish more specific correlations between the different depressive configurations and the types of psychoanalytic interventions best suited for changing them.