Depression as the search for the lost self.

Abstract

Depression is explored as a narcissistic disturbance in which the self is unconsciously expected to accomplish grandiose expectations and is regarded as a failure when it does not. These omnipotent fantasies include the prevention of object loss and triumph over death. In the later years difficulties in maintaining self-esteem, an essential component of a cohesive self, can predispose one to depression since aging unavoidably involves dwindling opportunities, failing health and loss of loved ones, making it difficult to reach out for what life still has to offer. A psychotherapeutic approach is outlined, focusing on the treatment of depression as a search for the lost self in which the development of healthy narcissism in Kohut's sense, is seen as activating arrested or inhibited ego functions. The development of a positive cathexis of the self is seen as a safeguard against the self destruction implicit in deep depression. This psychotherapeutic approach is demonstrated in a clinical vignette showing how it opened up a new life for a suicidally depressed woman in her sixties who was immobilized by a conviction that to be dependent in any way was an unbearable humiliation leading to narcissistic rage which could overwhelm her sense of self. In helping a patient to search for her/his lost self, the therapist willl hopefully be absorbed as an empathic self-object to become the foundation for the patient's self-soothing. In staying close to the patients' self-needs, therapists can rediscover neglected parts of their own selves. We should like to discuss depression as a response to the painful experiences of the loss of the valued self. This is in contradistinction to the familiar assumption that * Requests for reprints should be sent to Marcella Bakur Weiner, 383 Ocean Parkway, Brooklyn, NY 11218. depression comes about from object-loss (Freud, 1917). The psychoanalytic concept of depression traditionally refers to the affects arising in connection with object loss, however ambivalent the relationship. The affects held to be involved in the depressive state include: longing for the lost object (Freud, 1917); guilt over negative feelings toward the lost object, especially in the case of death (Freud, 1917, 1923); guilt over surviving the deceased object (Lifton, 1968; Niederland, 1968); anxiety over the helplessness to restore the lost state of well-being for which the object was essential (Sandier & Joffe, 1969), an identification with the lost object involving an affective change in self esteem, e.g., implacable self-reproaches if the object were ambivalently loved (Freud, 1917, 1923); and a pervasive loss of interest in the external world (Freud, 1914-1917). All of these aspects of depression reflect a focus on the object's value and the impact upon the bereft one of losing this valued object. Freud, however, in his pioneering exploration of narcissism (1914) glimpsed the destructive impact upon the valuation of the self in relation to the object loss, e.g., he traced the possible consequent withdrawal into pathological narcissism, eved psychosis. This withdrawal can imply that the self is responsible for the loss of the needed object. Such an idea may lead to the affect of hopelessness about trying again to find need gratification through another, since one can only rely on oneself and even that is risky. The nature of the self's responsibility for its irretrievable loss may be fantasized in at least two, not mutually exclusive ways: 1) I am all-powerful and, therefore, in control of every occurrence