That characteristic of loss of energy and interest of sadness, surely we have experienced most of the human beings. We are emotional beings, and therefore, when a situation of displeasure or frustration comes into our lives, it hurts, hurts us and makes us feel empty or without purpose and hope; that state of meditation and introspection that sadness allows us leads many people to rejection because it causes pain and discomfort.
Many of us flee from that period of introspection for fear of all those thoughts that arise, and so we go looking for distractors for years without paying attention to what really moves our conduct. Neurotic depression is recognized by a chronic state of affective disturbance, that is, an emotional disturbance for more than two years. In Psychology-Online we explain more about what is neurotic depression, its symptoms, causes and treatment.
An analysis with a psychoanalytic approach refers to this type of depression an etiology like the other neuroses by a intrapsychic conflict, that is to say, by an internal struggle in the same person.
In the text "mourning and melancholy" by Sigmund Freud (1917), reference is made to this type of depression, referred to as melancholy. Freud describes the following similar symptoms between grief and melancholy:
- Loss of interest in the world.
- Loss of capacity for love.
- Inhibition of all productivity.
The negative self-concept
But Freud also mentions that there is a symptomatic element in melancholy that is not going to be observed in mourning and is a series of self-reproaches and denigrations of oneself:
- I am useless
- I don't know why I exist
- I don't know why my wife got married and she's still with me
- I'm rubbish
Loss
Below we quote Freud verbatim to explain what the work of mourning consists of:
The examination of reality has shown that the loved object no longer exists and from it now emanates the exhortation to remove all libido with the links of that object. An understandable renunciation is opposed to this; that renunciation can reach such intensity that it produces a estrangement from reality and a retention of the object by way of a hallucinatory psychosis of desire.
So reality shows us that the object is gone, either because it has died or because the situation that gives us comfort can no longer continue (work, partner, freedom, ideals). One becomes very reluctant to accept loss (tolerance for frustration) and we begin to deny and reject it, one tries to choose the estrangement from reality, that is, stop seeing reality and satisfy the need for the object to be in a way hallucinatory.
The unresolved duel
The normal thing for Freud is that once the work of mourning is completed, the ego becomes free again, that is, the libido that had been deposited in the object (for example, the energy is withdrawn from the lost job, the old partner loving). So the grieving process involves realizing that the object is gone, all the libido placed on the object, you put your own self and thus later release that libido again in another object.
This is the explanation that Freud offers, and it is at this point that the difference between mourning and melancholy is observed, since the problem with melancholy is that it is an extended duel.
Freud said that the neurotic subject knows who he lost but does not know what he lost in him, so it is understood then that melancholy is an unconscious loss.
What happens in melancholy is that all that libido (energy) that was floating when the object is lost, it returns to the self and it absorbs it, thus begins the narcissism that is also part of the theory of Freud. On the other hand, in the duel, when it is resolved, the libido returns once more to the objects. (For example, where others see that a person is going through a grieving process and has no interest in things or events that would normally attract your attention: going out with friends, working, doing sport. Other people may observe it as something abnormal or atypical but how they finally relate it with the recent loss and they come to consider it normal "it is normal that he is like this because of the loss of ...").
For this reason, there is almost a temporal issue at stake that should not be lost sight of in the clinic. Although we are aware that it is naive to believe that a normal grief lasts between five and seven months and a pathological grief extends. You cannot structure a schedule or manual for the duration of the duel but it is important to take this point into account (for example, a patient who refers being very sad about the breakup with a couple for ten years than another who refers that for a month).
Narcissism
When we mention narcissism we must discard that erroneous idea that it is someone who believes a lot or superior, but rather narcissism implies that the center of the problem is always in them. In melancholy, all the libidinal energy is placed in oneself. There is something in libidinal energy that even when in a negative sense generates a feeling of specialty - being the worst in the world - the speeches of being people with depressive neurosis always end up relapsing to themselves (for example, it is that I am always so garbage, I am worth very little, I am not I serve). So we see that things always go towards a narcissistic system.
A key point in melancholy (depressive neurosis) is that these people are not ashamed in the presence of others - they do not hide their self-reproach, they are not ashamed that others know how "bad" they are - they even give the impression that if there are more people listening how bad are better.
Self-criticism
Freud described that in melancholy (depressive neurosis) there is an extraordinary reduction of the ego feeling - it is felt very little - and this characteristic will not manifest itself in the duel. We know then that in grief there is sadness, regret, pain, but it is not related to blaming all this on oneself.
In mourning, the world has become poor and empty, in melancholy that happens to myself. The patient describes his ego as unworthy, sterile and morally despicable, reproaches himself, denigrates himself and expects repulsion and punishment. Freud (1917)
So in mourning, it is the world that is poor and empty (for example, I am not interested in what happens outside, no I am interested in what the others are going to do, I am not interested if they get together to eat, I am not going to go because I matter). In melancholy what happens to the world happens to the self, so patients they begin to think unworthy and despicable in a moral sense - what you expect from others is revulsion. Thus, in the clinical development of melancholia, we can analyze that the patient thinks that no kind of alteration, but he extends that self-criticism to the past, that is, he was always a garbage and was never worth nothing.
As we develop throughout the article there is a marked but at the same time subtle difference between depression neuroticism and grief, so we must know how to distinguish them in order to diagnose it and thus intervene in her. A grieving process leads to acceptance, so the goal is to help the suffering subject to identify these unconscious losses and guide you so that you can afford to start a process of healing, the grieving process.
For psychoanalysis it is important to take into account the following points in its treatment:
- Know how to differentiate between grief and melancholy (normal and pathological manifestation).
- Help the subject to recognize what it is he lost it with the loved object.
- Take into account the temporal indicator.
- Understand the narcissistic system that manages the subject with neurotic depression, the pleasure that he finds in his suffering.
- Avoid iatrogenesis in psychoanalytic treatment that can initiate a manic episode.
In the following articles you will find more information about the psychological treatment of depression and the behavioral techniques used to treat depression.
