Advanced Psychopathology

Sunday, February 26, 2006


Matt's Reaction: Freud, Bowlby, McWilliams

Bringing an evolutionary perspective to the study of clinical data, Bowlby presents an account of depression that is very impressive in its theoretical weight and consistency. He differs from Freud in several respects. For Bowlby, depression is not about ambivalence toward a lost object (which he points out is in any case is nearly always present); nor is it about identification with a lost object; nor about “hydraulic” dynamics of libido, which these days read as rather quaint and so 19th century. In Bowlby’s conception, it’s about loss in childhood and subsequent mourning, which he notes often goes awry and takes a pathological course. It’s also about the circumstances (environment) surrounding the loss, rather than the mostly intrapsychic factors Freud identifies. (On this last point Bowlby brings in Klein as an ally, while simultaneously rejecting most of the rest of her ideas.)
I am interested in the tone that Bowlby takes in his chapter. He’s pretty hard on old Freud, who after all captured the clinical picture of depression quite well and was among the first to explore its link with mourning, even if he missed the mark in the etiology department. Bowlby, with all the advantages of time on his side, seems a bit like a bully here—or perhaps like an Oedipal son slaying his elderly king of a father.
But I think Bowlby is missing something too. While his account of depression is certainly the tightest theoretically, this seems to be accomplished at the expense of etiological scope. Freud’s idea of a “lost object” seems quite expansive, including losses of “an ideal kind,” whereas Bowlby appears to be sticking to the more traditional loss of a parent. Since, as McWilliams points out, research has failed to find a link between depression and actual object loss in childhood, it is clear that we need a more inclusive understanding of depressive etiology. (Bowlby also takes no account of mania in this chapter, though perhaps he does so elsewhere). McWilliams steps in at this point, bringing together several schools of thought into a conception that includes multiple causal pathways to depression. She stakes out a squishy middle ground in some areas. For example, she confesses to an intuitive pull toward oral descriptions of depression (Freud) while admitting to the questionable generalizability of this observation (Bowlby). This leaves her with the theoretically softest and least internally cohesive of the three chapters, but it is also the most clinically useful and the best description of what we actually see in life. McWilliams elaborates Freud to embrace Bowlby. She plays the good mother in this family drama, healing the rift between father and son, rising above theoretical quibbling and rallying the family around the practicalities of everyday life.

This is beautiful Matt
Matt- excellent. so well done. -sheila
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