Psychological Etiology of Mood Disorders

Psychodynamic Perspective
I. Depression
A. Sigmund Freud and Karl Abraham
 Disturbances in the infant-mother relationship during the oral phase (the first 10 to 18 months of life) predispose to subsequent vulnerability to depression
 Depression can be linked to real or imagined object loss
 Introjection of the departed objects is a defense mechanism invoked to deal with the distress connected with the object’s loss
 Because the lost object is regarded with a mixture of love and hate, feelings of anger are directed inward at the self.
B. Melanie Klein
Understood depression as involving the expression of aggression toward loved ones, much as Freud did.
C. Edward Bibring
Regarded depression as a phenomenon that sets in when a person becomes aware of the discrepancy between extraordinarily high ideals and the inability to meet those goals.
D. Edith Jacobson
Viewed the state of depression as similar to a powerless, helpless child victimized by a tormenting parent.
E. Silvano Arieti
 Observed that many depressed people have lived their lives for someone else rather than for themselves. He referred to the person for whom depressed patients live as the dominant other, which may be a principle, an ideal, or an institution, as well as an individual.
 Depression sets in when patients realize that the person or ideal for which they have been living is never going to respond in a manner that will meet their expectations.
F. Heinz Kohut
His conceptualization of depression, derived from his self-psychological theory, rests on the assumption that the developing self has specific needs that must be met by parents to give the child a positive sense of self-esteem and self-cohesion. When others do not meet these needs, there is a massive loss of self-esteem that presents as depression.
G. John Bowlby
He believed that damaged early attachments and traumatic separation in childhood predispose to depression. Adult losses are said to revive the traumatic childhood loss and so precipitate adult depressive episodes.
II. Mania
 Most theories of mania view manic episodes as a defense against underlying depression.
 The manic state may also result from a tyrannical superego, which produces intolerable self-criticism that is then replaced by euphoric self-satisfaction.
 Bertram Lewin regarded the manic patient’s ego as overwhelmed by pleasurable impulses, such as sex, or by feared impulses, such as aggression.
 Melanie Klein viewed mania as a defensive reaction to depression, using manic defenses such as omnipotence, in which the person develops delusions of grandeur.

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