Advanced Psychopathology

Saturday, March 04, 2006

 

Gillian's response #4

Nancy McWilliams makes a distinction between the obsessive personality organization, and the compulsive one. Obsessional people rely on the defense of isolation, and sometimes more mature correllates of this such as rationalization, moralization, compartmentalization, intellectualization, reaction formation, and displacement. Particularly disturbed people with an obsessional organization may use isolation to the point of appearing schizoid. People with obsessional personality organization place excessive value on thinking, and find feelings in general to be childish, weak, and dirty, signifying a loss of control. Compulsive people, on the other hand, rely on the defense of undoing, and repeat a particular action over and over, with the hope that if they repeat a ritual they can take the fear and uncertainty out of their life. Compulsive behavior may be traced back to an unconscious fantasy of omnipotent control. People with this personality organization may believe on some level that they can control the uncontrollable with their compulsive actions. With both obsessive and compulsive personality structures, cleanliness, stubbornness, concerns with punctuality, and tendencies toward withholding are the norm. The basic affective conflict in obsessive and compulsive style is rage at being controlled versus fear of being condemned or punished if such rage surfaces. In therapy, affect will be dampened down, and rationalization and intellectualization may rule the day. In these types of personalities, words are used to hide and re-package feelings rather than to express them, and when asked about how they felt about something an obsessive or compulsive person will often respond with how they thought about something. Shame may be the only emotion that people with these personality styles may be comfortable discussing in therapy, and even here it will be a watered down form of chagrin, or mild regret. All in all, people with obsessive-compulsive personality styles need to be taught how to feel, and what to connect in feeling. They are detail oriented to the exclusion of affect and spontanaeity, and have trouble seeing the forest for the trees.

People with hysterical personality structure stand in nearly direct contrast to those with obsessive-compulsive personality structure. Repression is the major defense of this cognitive style, though sexualization and regression may also play a part. Hysterically organized people are most frequently women or gay men who may have been raised to believe that straight and masculine men hold drastically more power than females, or less masculine men. As a result, the hysterical personality structure may be organized around regaining power through seduction and over-sexualization, in an effort to posess the power of the masculine man. Cognitively, people who are hysterically organized tend to focus on overall impressions and emotional reactions. They perceive the cues in the environment that are vivid enough to sponteously strike them, rather than searching for information in the environment in a technical and detail-oriented way like someone obsessively or compulsively organized might do. This cognitive style facilitates repression, in the sense that memories may be vague and impressionistic, and may not connect in the mind of someone hysterically organized with any factual information such as time or place. This makes it easy for history to be rewritten, and for unwanted afftects to be repressed. Due to this repression, people with a hysterically organized personality may have emotional outbursts of the repressed emotion, often anger but sometimes with depressive tinges. Afterward the hysterically organized individual may feel that they were “taken over” by affects that are alien to them and that they “do not really feel.” Instead of needing in therapy to be taught to feel, people with a hysterically organized personality may need to learn how to think, and what to connect in thinking. They are highly emotional but disinterested in factual details, and unlike the obsessive-compulsive personality structure, the hysterical structure is characterized by an inability to see the trees for the forest of vague but intense emotionality.

Monday, February 27, 2006

 

Sheila's Reaction #3

McWilliams sums up Freud’s distinction between typical mourning and melancholia quite succinctly, where the former experience is a reaction to a loss in the external world, and the latter in which part of one’s inner world or self is lost or damaged. Indeed, Freud’s model of melancholia is described as a sequence of unconscious processes during which object loss, ambivalence toward and identification with that lost object all converge to generate an “anger turned inward”. Instead of being directed toward the lost object, negative affect is aimed at the self. These concepts of ambivalence and identification are absolutely fundamental components of Freud’s paradigm.
Bowlby challenges this Freudian conception head-on. No longer is identification seen as the primary process of mourning. Alternatively, Bowlby proposes that while the person strives to reclaim the lost object, identification is secondary. He also points out that empirical data does not support Freud’s supposition that ambivalence is characteristic only of pathological mourning. The ambivalence he describes can very often be found in healthy mourning. For Bowlby, it is simply matter of degree; it is the increased strength and persistence of this ambivalence that is of pathological significance. He also claims that while Freud did rightly acknowledge the importance of childhood loss, he did not quite connect this early mourning and its potential to take a pathological course and emerge in adult pathology. Similar to Klein, Bowlby asserts that, in fact, the course of childhood mourning describes not only how the individual reacted at the time of the loss, but also how that patient will handle similar losses into adulthood.
McWilliams echoes this emphasis on premature loss, the Freudian idea of the patient becoming the target of his or her own hatred, and the oral quality of the depressive’s behaviors. She has observed all of the above in her clinical work and provides examples to illustrate how they might manifest themselves in the context of therapy. It appears to me, however, that McWilliams’s major contribution to the discussion is her descriptions of the family dynamics influential in the etiology of depression. She acknowledges not only the genetic component but also the way in which a depressed parent’s interactions with the child can render that child more susceptible. Importantly, McWilliams points out causative factors that can exist in both healthy and dysfunctional families and that the internalized object need not necessarily be malevolent or hated. What is necessary, however, is both a perceived loss on the part of the child and the lack of opportunity for that child to emotionally work through and understand that loss.

 

Freud, McWilliams, and Bowlby on Depression

In distinguishing mourning from melancholia (psychotic depression), Freud begins by discussing many of the features the two have in common. In both cases, the heart of the experience is a sense of loss (though in the melancholic state, this might be partially repressed) accompanied by symptoms such as a loss of interest in the outside world, in other love objects, and activity. The distinguishing factor for melancholia is the profound detriment in self-regard. The thrust of the paper, then, is the exploration of the causes for this "disturbance in self-regard." Freud concludes by saying that the specific feature distinguishing mourning from melancholia, is that in melancholia there is a regression of the ego into a narcissistic state through libidinal forces, whereas in mouring, there is the absence of this prolonged regression after the libidinal loss cathexis or discharge.

McWilliams, for the most part, picks up with where Freud departed but adds some theoretically expanding propositions, many of which she derives form Furman. The major contribution here is that the loss of the object or the object-love in early formative can be profound enough to create the depressive person, but, additionally, this feeling of loss, accompanied either by accute, pervasive feelings of guilt or rejection and abandonment, can be the internalized ambivalent reaction of the caregiver to the child's increased motility and dependence. The deep sense of loss is really endemic of that which is internalized through the identification with the caregiver.

It is here that Bowlby most dramtically departs, taking issue with Freud, and vicariously with McWilliams. Bowlby makes it very clear that he does not see the need whatsoever to incorporate the phenomenon of identification with the lost object to account for the depressive position. Bowbly seems to center his explanation on the gradual separation from the mother throughout the formative years, and the feelings of grief, loss, and aggression that mark the ambivalence of this period.

A final note is that Bowbly miunderstands Mourning and Melancholia, when he states that Freud argued that ambivalence was what distinguished one from the other. This is most certainly not the case, as Freud states in the conclusion that ambivalence is present in both instances.

 

Freud, McWilliams, and Bowlby on Depression (Dana)

Among the numerous psychoanalytic theories and derivatives of psychoanalysis, there are several descriptions involving the etiology of depression. Bowlby and Freud discuss specifically, the significance of loss in the development of depression.

McWilliams has quite a different view of the etiology of depression in which she seems to focus more on general stress and the way in which it is interpreted and how overwhelming the stress is perceived, given the coping resources available to an individual.

According to Freud, in his paper “Mourning and Melancholia”, depression develops from the loss of some form. The libido withdraws from the object with unconscious opposition as it is difficult to abandon something so integral to an individual. A person must be able to work through this loss during this process of mourning. The memories which the libido is bound to will become hypercathected as each are evoked. Eventually, this libido will become detached as the individual works through this mourning period to free the ego from this cathectic energy. However, if the individual does not have the opportunity to process loss in this way, the mourning can become melancholia, or what we would refer to severe, depression with psychotic features.

The Loss of a love object is also a central tenet in Bowlby’s view of depression. Bowlby’s discusses several views of depression including that of Freud and Klein, and includes data to support or discount aspects of these theories to add greater substance and justification for his view. His paper, “Loss and Mourning in Psychopathology” isolates certain aspects of these theories, and focuses on particular aspects of mourning and melancholia. Bowlby basically attributes depression to the distinct process of dealing with the loss of a love object. He discusses the pain and the yearning for the love objects return as well as anxiety that may result if the loss is not permanent, and there is a sense of some hope. This, however is not usually the case when the loss is permanent. Instead, the individual may unconsciously identify with the loss object as a way to gain an emotional tie with it as the unconscious yearns for the objects return. At the same time, the individual may feel anger for the departure of the love object and may therefore feel anger turned inward due to identification with the love object. This anger can take many forms, be targeted at others, expressed in several ways, and function in different ways. This anger is thought to be the central feature in the result of the resulting sorrow felt and yet this may come in several forms of pathological mourning and melancholia.

McWilliams, discusses quite a different perspective of the development of depression. In fact, one might argue that this can be compared to many of the cognitive theories, except on an unconscious level. McWilliams argues that trauma during the preoedipal phase is more significant in the development of depression than that of the oedipal phase, which Freud stresses. She explains that when trauma occurs, this will eventually form a template in the child’s unconscious, so that when similar stress occurs, similar coping mechanisms are evoked. Unfortunately, the earlier this trauma occurs, the less mature resources the infant has to cope with the trauma due to an infants primitive and concrete cognition. This will form a template which will evoke more primitive interpretations of the stressful event and more primitive resources as a result. This early formation of a template with stress and primitive coping resources available forms a fixation and therefore determines how an individual will interpret stressful events in adulthood. Therefore, when an adult is confronted with a stressful event, they will unconsciously interpret the event with respect to the template that was formed and maintained throughout their life. They therefore will regress to that fixation point and the stress may seem much more overwhelming since the resources that adult has to cope with the stressor is rather fragile due to its emergence in the preoedipal stage. This inability to deal with stress at hand will be experienced as depression.


Sunday, February 26, 2006

 

James's Response #3

James Ellis
Response # 3

In his essay, “Mourning and Melancholia”, Freud expounds his position that psychotic depression is engendered by the loss of an object, be it real or imagined. He claims that, essentially, depression is healthy mourning gone awry. As opposed to healthy mourning, where the emotional investment of the lost object fades and readies itself for cathexis on to a new object, melancholia arises when the object loss is experienced as an ego loss. Guilt and self-loathing arise when the bereaved experiences the ambivalence felt towards the lost object and directs those feelings inward, attacking the ego.

Bowlby writes his essay “Attachment and Loss” in response to Freud’s position and through the lens of an evolutionary theorist who has been informed by the likes of Darwin and Shand. While Bowlby agrees with Freud’s basic contention that mourning and melancholia are intertwined, he adds to and subtracts from many of the specifics laid out by Freud. Quite generally, Bowlby feels that Freud places too much importance on the current experience of loss at the expense of overlooking how the inadequate resolution of developmental milestones can pave the way for pathological responses to loss. Bowlby encourages us to look at the way the child expresses yearning to regain the lost object and how the anxiety is handled. He disagrees that libidinal energy is turned inwards toward the ego and he tries to disabuse us of the notion that ambivalence in mourning is necessarily pathological.

Nancy McWilliams’s position on the etiology of depression is a synthesis somewhere between Freud and Bowlby, perhaps aligning herself closer towards the former. She seems to believe in the Freudian notion that depression is the result of anger towards external loss getting introjected. Yet, she appeals to the developmental aspects of Bowlby’s etiology when she describes how children who are raised by “unreliable or badly intentioned” caretakers will often attribute unhappiness to themselves over the adult objects. She assumes that early object loss will undoubtedly predispose (along with various genetic factors) a person to possible depression.McWilliams also describes the developmental phenomenon that children who are raised by ‘unreliable or badly intentioned’ caretakers will often attribute unhappiness to themselves over the adults.McWilliams also describes the developmental phenomenon that children who are raised by ‘unreliable or badly intentioned’ caretakers will often attribute unhappiness to themselves over the adults.

 

Freud, McWilliams, and Bowlby on Depression

Freud, McWilliams, and Bowlby on Depression
Joshua Scott

In healthy mourning, according to Freud, the libido attaches itself to some object. If the object is lost, the libido withdraws from that object and transfers to a new one. In the melancholic process, the libido is not redirected to another object. Instead, it is withdrawn into the ego. According to Freud, the initial object-choice was narcissistic. Therefore, the result of this inward cathexis is secondary narcissism as the ego is identified with the lost object.
The reduction in self-esteem of the melancholic, then, is associated with the reproaches against the abanodoned love object that have been transferred to the his or her own ego. For this reason, melancholics are publicly self-defeating. In reality, when they speak poorly of themselves, they are referring to the abandoned object.
According to McWilliams, depressive individuals view some part of the self as being damaged due to the internalization of some critical love object (similar to Freud’s object-cathexis model of depression). This introjection of a may occur through the traumatic or premature loss of the object, resulting in an idealization of the love object. All negative affectivity is then turned upon the self (“turning against the self”).
Additionally, a depressive personality can result from the separation-individuation process if the mother refuses to let go of her child, inducing feelings of guilt in her child, or when she distances herself from her child.
According to Bowlby, pathologized mourning (melancholia), is an exaggeration of the normal processes involved in mourning. Anxiety occurs when a person believes that her love-object is temporarily unavailable. When the object is understood to be permanently missing, the result is mourning and grief and pain. The person has an urge to recover the missing person long after the permanence of the absence is understood and may express anger and hatred towards the lost love-object (which Freud views as happening only in pathologized mourning). Unlike Freud, who eventually applied identification with the lost object to both normal mourning and melancholia, Bowlby reserves this aspect for pathologized mourning.
Bowlby rejects Klein’s belief that pathogenic mourning has its origin in the first year of life, revolving around feeding and weaning. Rather, Bowlby suggests that a child’s responses to loss are influenced by the support offered by her family at the time of and after the loss.

 

alex's response: conceptions of depression

Freud conceived of depression, termed melancholia in his time, as being related to mourning in that suffering comes from loss of a love object, the major difference being that the loss experienced in melancholia is unconscious. He described the melancholiac as being self-reproaching, yet observed that this loathing, often not truly applicable to the patient, is actually directed against an object which has been shifted onto the person’s ego. He wrote, “everything derogatory that they say of themselves at bottom relates to someone else” relating that the loss of the object somehow becomes transformed to a loss in the ego. While Freud compared aspects of melancholia to process of mourning, he also posited that the identification with the object, and fixation therewith, tends to resemble regression to the “still narcissistic oral phases of the libido.” Depression, for him, is characterized by conflicted feelings of extreme love and hate toward the object, resulting in ambivalence.
In his exploration of mourning and loss, Bowlby tends to disagree with Freud’s suggestion of identification and orality as the central processes at work. Instead, he looks at the evolutionary perspective, citing the work of Darwin and Shand as evidence of the survival value of mourning, as a means of gaining help for the perceived weakness that has come from the loss, particularly with respect to the emotional expressions of grief and the accompanying ideas of wanting to recover the lost person. Furthermore, he points out that Freud did not maintain a consistent stance about the role of anger and hatred, as it relates to mourning, first implying that ambivalence is present in all forms of mourning then writing that it is absent in normal mourning but persists in pathological mourning. Bowlby suggests that ambivalence toward the lost object is characteristic of all forms of mourning but increases in intensity in mourning which is more pathological. He also points out that while anger is expressed toward the object, it is generally directed at others, including the self, as well. Finally, Bowlby describes the central importance of childhood loss and mourning in later forms of depression, expressing the idea that early loss serves as a platform for vulnerability to later pathology because the significance of the child’s feelings of sadness are often failed to be recognized as such. Bowlby cites the work of Melanie Klein, writing that the modes of responding used by children during a time of loss and depression determine the way they will respond to loss later in life.
In her conceptualization, McWilliams first points to the tendency of depression to occur within families, likely through either genetics, the environment created by the behaviors of depressed parents which is then transmitted to the children, or a combination of the two. Like Bowlby, she discusses the impact of early childhood loss and the inability to adequately adapt to overwhelming feelings of loss and frustration, particularly when mourning is discouraged. Like Freud, she endorses the self-hating model of anger turned inward that characterizes people with depression, describing the inordinate guilt that they experience. McWilliams elaborates this concept, including the notion of introjection as the primary defense utilized by depressives and discussing the impact of the internalized object on their self-critical view. Turning against the self, she says, is a means of reducing separation anxiety and creating a sense of power. Furthermore, when reeling from a childhood history of unreliable caretaking and emotional instability, one would tend to choose overt suffering and self-hate over feelings of helplessness.

 

Bowlby, McWilliams & Freud on Depression: Lucy's Reaction

Freud’s view of psychotic depression was that, like mourning, it was directly brought about by the loss of an object (either a real loss or a metaphorical loss such as disillusionment). The depressed subject deals with this object loss in a way that leaves her enervated, unable to love, unable to feel pleasure in living, and self-reproach. Psychotic depression is vastly different (as it is subjectively experienced) from mourning because the pain of the object loss is experienced as an ego deficiency. This is manifested the depressive’s guilt and self-hate, which is lacking in the mourner. Freud argues that psychotically depressive guilt and pain stems from the subject’s ambivalence towards the lost object turned inward against her own ego.

Bowlby supports Freud’s notion that mourning and depression/melancholia represent two branches of the same tree, one pathological and the other a normal process. Bowlby also endorses Freud’s idea that ambivalence characterizes the experience of the depressed subject to the lost object, but feels that anxiety produced by ambivalence is also part of the pain of mourning (which Freud did not). Bowlby criticizes Freud’s overemphasis on the narcissistic characteristics of depression, by saying that identification with the lost object is not the primary mechanism of defense, and that anger and rage actually play a much greater role than Freud allowed in this particular paper. In terms of etiology, Bowlby seems to feel that very early oral fixations/developmental failures are what set the stage for a psychotically depressed reaction to object loss. The most important difference between Freud’s and Bowlby’s etiological theories seems to me to be Freud’s emphasis on current experience of loss (real or subjective) and Bowlby’s emphasis on early childhood experience.

McWilliams integrates many aspects of both theories, while incorporating the factor of genetic predisposition into her model. Her model borrows Bowlby’s idea that object loss in childhood predisposes one to possible depression and extends his position, saying that all types of parenting styles, pathology and family restrictions on emotion -- particularly dysphoric affect -- can lead to depressive symptomatology later in life. McWilliams follows Freud’s rich description of the subjective experience of the depressed person, but doesn’t seem to retain his notion that psychotic depression is the direct consequence of adult object loss.

 

Desiree-Rxn #3 Etiology of Depression-Freud, McWilliams & Bowlby

It appears that one of the main differences between Freud and Bowlby’s explanation for the etiology of depression concerns the arena of how experiences surrounding a lost love object predispose an individual to a depressive personality type. Freud’s description of the onset of melancholia seems to be a set of symptoms experienced directly after the loss of a love object in which an individual has unconsciously internalized the feelings of grief and anger towards the love object and in turn begins to see the ego as poor and empty, resulting in a melancholic disposition. In Bowlby’s argument, he saw significant validity in patients’ early childhood loss experiences and their relationship to childhood mourning as a more solid predictive factor for the development of depressive illness later in life. Bowlby directly credits Klein for conceptualizing the connection for identifying early childhood experiences with loss and mourning as a possible precursor for the development of adulthood depression. In direct contention with Freud’s theory, Bowlby contends that identification with the lost object is not the main process involved in mourning and that identification is independent of orality, but that it is possible for individuals to experience symptoms of depression related to oral fixations. Building upon the tradition of classic psychoanalytic theory, McWilliams stresses the importance of a genetic predisposition to depression as well as the influence of growing up in an environment with depressive parents and how the combination of nature and nurture appears to play a part in an individual’s tendency to experience depression in adulthood. McWillams appears to support Freud’s notion that depressive individuals tend to experience issues surrounding developmental oral disruptions (being weaned too soon) as evidenced by her treatment of depressive individuals who experience oral fixations. McWilliams appears to be in agreement with Bowlby concerning the importance of early loss of a love object and its connection to adulthood depression but McWilliams succeeds in identifying a new component concerning major loss in the separation-individuation phase as a critical element in the development of depressive dynamics previously unmentioned by either Freud or Bowlby. McWilliams speculates that if the child feels intense feelings of guilt or abandonment induced by the mother (primary love object) during this phase, the child eventually comes to internalize these feelings and reflect them back unto the self, resulting in experiencing part of the self as “bad” and thus setting the foundation for a depressive disposition in later life.

 

Freud, Bowlby, McWilliams: Etiology of Depression

Sara Petrasso
Essay #3

In his seminal essay, “Mourning and Melancholia” (1917), Freud argued that melancholia derives from unconscious loss, either literal or symbolic. This loss, he theorized, does not refer to conscious despair over an early, lost loved object (of whom one has unconscious, ambivalent feelings of both love and hate); rather, it refers to the experience of psychic loss over the internalized object. This occurs when the cathexis that is directed toward the love object is blocked, engendering a withdrawl into the ego. Consequently, the ego introjects the conflictual lost object, and experiences it as an unloved and unworthy part of the self.

Bowlby disagrees with Freud’s conceptualization of melancholia, and believes that Freud overlooked the critical role that pathological mourning plays in its development. Bowlby believes that it is the way, and extent, to which the child mourns the loss of the object (e.g., how yearning for the object is expressed, how anxiety is handled, how persistent the mourner is in regaining the lost object) that are of central importance to future pathology. He departs from the Freudian conceptualization in the following ways: object loss does not automatically precipitate internal loss and absorption of the lost object; libidinal energy is not turned inward; and feelings of ambivalence in mourning are not pathological, except in excessive forms.

Nancy McWilliams holds a somewhat closer outlook to that of Freud in conceptualizing the etiology of depression, though she incorporates aspects of Bowlby’s position as well. Similar to Freud, she believes that external loss and anger get introjected and become one with the self. She elucidates the functional role of this self-defeating process by noting that it allows one to deny the reality of painful abandonment by the love object, and provides the self with a false sense of comfort by placing ‘badness’ within one’s locus of control. Perhaps most importantly, and closer to Bowlby’s approach, she examines the relational factors that moderate the relationship between loss and depression. For instance, she cites the ways that parents may encourage or discourage the expression of grief, and whether parents themselves are depressed, as being other causative factors in depression.

 

Jenni's Rxn Paper: Freud, Bowlby, McWilliams

Both Bowlby and Freud believed that the yearning involved with object loss is highly significant and may or may not be intensified by guilty feelings or a fear of retaliation. Both men also maintained that anxiety is related to a belief that the loved figure is temporarily absent, while mourning parallels a belief that the loved one is permanently absent.

Bowlby, however, differentiated his concept of mourning from traditional psychoanalytic theory with two main observations. First, he pointed to evidence suggesting that identification is not the only, nor even the primary method involved in mourning. In fact, Bowlby believed that identification with the lost object occurs only sporadically in mourning and, when present, denotes pathology. Second, he separated identification as a separate process from orality.

Bowlby also disagreed with Freud’s view that ambivalence is not present in normal morning. Instead, he maintained that ambivalence can be a part of healthy mourning and more intense and persistent in pathological cases. Furthermore, Bowlby disagreed with Freud in his belief that hatred for the lost object occurs in unhealthy mourning and not in healthy mourning. Bowlby believed that hatred for the lost loved one can occur in both types of mourning.

Finally, Bowlby summarized the psychoanalytic literature on object loss by highlighting the fact that little attention has been given to the processes of mourning that take place in infancy and childhood. He emphasized the importance (and lack) of understanding for: (1) the type of loss, (2) age at which the loss occurred, (3) nature and source of anxiety and anger, and (4) current and subsequent environmental factors, contributing to the way a child deals with loss.

Similar to Bowlby, McWilliams believes that depression stems from unmourned losses of varying types. She also writes that depressed persons suffer from a self-belief that they “drove away” their loved one. Through projection and suppression, feelings of abandonment are transformed into an unconscious belief that the frustration was provoked, deserved, and likely to be repeated by anyone who gets close to the depressed individual.

Also similar to Bowlby, McWilliams acknowledges a child’s capacity to mourn and grieve. In fact, she states that families who: model denial of grief; encourage the child to believe that he/she is better off without the lost object; or require the child to reassure his/her caregiver(s) that he/she is not suffering, suppress the normal mourning process. The smothering of normal grief reactions in a child can eventually lead to a belief that there is something wrong in the self. Additionally, the child is given the message that grief is dangerous and normal needs for reassurance are destructive.

In describing types of loss, McWilliams draws attention to the separation-individuation process that occurs between a parent and child, highlighting the idea that loss during this phase almost guarantees depressive dynamics. Mothers who cling to their children and provoke guilt with separation leave their offspring believing that normal desires to be aggressive or independent are hurtful. In contrast, mothers who push their children away in reaction to their own fear of abandonment leave their children with hatred for normal dependency needs. In both cases, children are left experiencing an important part of themselves as bad.


 

Kelly's Reaction: Freud, Bowlby McWilliams

Freud juxtaposed mourning and melancholia to draw a distinction between what he views as two separate and divergent processes – a view not shared by Bowlby. Melancholia is distinct from mourning in that the loss of the object is essentially denied and an intricate psychic process is engendered to bypass the pain and reality of the object loss. Freud’s conceptualization of this process is briefly outlined below:
a) Object is lost due to either external causes or psychic trauma (rejection of ideal object, disappointment, disillusionment)
b) Object loss is denied and libido withdraws into ego establishing a narcissistic identification with the lost object (substitutive object)
c) Substitutive object takes revenge on the original object by sadistic torments and criticisms. In this way the person avoids openly expressing their rage which would in essence acknowledge the reality of the original loss (akin to normal mourning process).

In melancholia, the object loss becomes ego loss because the individual is unable to fathom existence not in relation to the original object. It is this narcissistic requirement that Freud believes disposes the individual to a pathological response to loss.

Bowlby’s conceptualization differs from Freud on many aspects. First, he conceptualizes pathological mourning (melancholia) as an exaggerated form or extreme variant of normal mourning – thus on the same continuum rather than a divergent process. Second, Bowlby views hatred and animosity inherent in normal and pathological mourning. Freud, on the other hand, views hatred for the lost object as indicative of an ambivalent relationship and a sign of pathological mourning. Third, Bowlby questions Freud’s assertion of identification with the lost object as a regressive attempt to substitute the libidinal tie. Rather, he views the identifactory process as secondary to a persistent striving to recover the lost tie – a response which he views as a normal part of the loss process.

McWilliam’s contribution to the topic at hand is her emphasis on the genetic and environmental factors that may predispose one to a pathological response to loss. Namely, she highlights circumstances that may engender depression: a) lack of space to mourn loss, i.e. poor role modeling from significant others and/or outright discouragement of mourning, b) the developmental influence of rejection from primary object along the lines of overindulgence or underindulgence, especially in breastfeeding (Erna Furman), c) family biology / genetics.

In closing, one question that stood out from Freud’s conceptualization: I wondered how Freud distinguished between the superego and its formation from the critical internalized lost love object part of the ego?


 

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.

 

Nirit's response: Depression by Freud, Bowlby and McWilliams

Freud, Bowlby and McWilliams formulate different approaches to the etiology of depression, each of which emphasizes different players as determinants of depression. Freud explains the disposition of depression as a series of internal psychic measures that prevent the self from accusing the love object by turning the hatred against part of the self. Bowlby explains adult depression as childhood depression caused by actual attachment disruptions that are carried over to adulthood. McWilliams emphasizes how childhood abnormal circumstances translate into inner psychological formulation of self guilt and self “badness” which then promote the adaptation of different defenses to maintain the existing inner distorted beliefs.
According to Freud, the etiology of depression is rooted in the unconscious ambivalence inherent in significant relationships. Each significant relationship with a love object is bound to be ambivalent – between love and hate, between a wish to love and be loved and a fear to be abandoned or to abandon. Injury and/or disappointment occur in situations of loss of the love object (separation from boy-/girl-friend), which strengthen the hatred (part of the ambivalence) towards the love object. Since experiences of hatred towards the love object induce intolerable anxiety, the psychic in a series of steps would transfer the accusing/hatred cathexis to part of the ego. Thus the libidinal cathexis now withdraws into the ego in a way that one part of the ego is identified with the abandoned object. The self, this way, openly and consciously avoids the hate to the real significant object (which is anxiety inducing) and turns the hatred against the self - the substitute object within the self.
Bowlby conceptualized that the origin of adult depression is a re-activation of an earlier response to separation or loss of the object’s love. Child response mechanisms to unexpected actual early experiences of separation from parents (especially the mother) or the loss of the object’s love as experienced by the child, will maintain their grave intensity and would automatically repeat themselves in a future adult separation. According to Bowlby the actual experiences of loss in childhood may be prolonged separations from parental figures or shifts in the love of the mother such as when a new baby arrives. Those experiences and the child’s unresolved responses to them would create a persistent tendency to develop psychological depression as adults whenever experiences of loss occur.
McWilliams explains depression as unprocessed childhood circumstances and parental attitudes that result in an inner belief of “badness” (“I am a bad person”) and guilt (“I deserve everything bad that happens to me”). In order to deal with that negative self-perception the individual would adopt several defense mechanisms to maintain the negative self perception. The actual circumstances may be both actual-loss-oriented such as divorce or grief and psychological-loss-oriented such as premature push to achieve individuation or parental criticism of the wish for proximity or severe guilt-inducing communications. Successful processing of a child’s inner feelings within the family context, may reduce the risk of developing distorted perceptions, and therefore decrease the probability of later depression.

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