Typus melancholicus et mélancolie : synthèse théorique à partir d’un cas clinique

Abstract

ObjectiveThe aim of this paper is to propose, starting from the description of a clinical emblematic case, a theoretical synthesis of the work of phenomenological psychopathology dedicated to melancholia and typus melancholicus (TM), a clinical concept that describes the premorbid personality vulnerable to major depression (“melancholia” for the psychopathological tradition). MethodThis is a phenomenological analysis of a case study of melancholia, of its premorbid personality and pathogenic triggering situation. We adopt two main phenomenological keys to understand the development of melancholia: a role-identity theory and desynchronization theory. The former understands melancholia as a disorder of identity triggered by the loss of the social role with which one has previously over-identified. The latter sees melancholia as the effect of the desynchronization from the social environment that further develops into an inhibition of the cognative–affective dynamics of life. We present the case of Jonas (64years old), whose mother (94years old) recently died. Before his mother's death, Jonas’ life was entirely orchestrated by the caring for his mother and synchronized in time with this (e.g., he used to go to her house every 4hours, had all his meals with her, etc.). Jonas, in addition to being hyper-synchronized and hyper-syntonic, fulfills all diagnostic criteria for TM, including “orderliness”, “conscientiousness”, “hyper/heteronomia” and “intolerance of ambiguity”. TMs attach a disproportioned importance to their social roles (or external representations of identity) at the expense of their own ego-identity. ResultsThe passage from premorbid personality to melancholia is triggered by the death of Jonas’ mother that entails a profound depersonalization. Desynchronization and role loss cause Jonas’ fall into this severe depersonalization, the core feature of which is the feeling of the loss of feeling. ConclusionsThis original contribution demonstrates that a clinical case can contribute to the construction and refinement of theoretical and conceptual frameworks (like princeps Tellenbach's studies). Over-synchronized tempo and over-identification with social role are emblematically in this case the two sides of the same coin. A parallelism can be established between synchronization (with the mother) and respect for the role at the expense of own identity. The clinical case of Jonas highlights a conceptual bridge between the model of melancholia as loss of social role and the model of melancholia as desynchronization.