The higher they climb, the lower they fall. A contribution to the psychodynamics of depression

The opinion that depression is a reaction to a loss is supported. It is suggested that the loss is that of an inflated idealized version of the self which is a necessary aspect of living to the neurotic in order to derive pride, satisfaction and self-esteem. Self-idealization is a process which begins early in childhood in response to basic anxiety and develops on the level of magical, fantasied, wishful thinking. When events of life pierce the armour of self-glorification, the individual falls like a deflated balloon into the depth of despair and self-hate, the clinical expression of which is depression. Depression, through its slowing down of living processes, helps to isolate the individual from his environment and therefore permits the psychic apparatus to devote its energies to reinflate the balloon and restore the premorbid idealized image. Certain therapeutic implications inherent in this point of view are discussed. No claim is made that the suggested dynamic point of view is the exclusive dynamics of depression or that it obtains in all types of depressions.

Aggression

Aggression as a basic drive was considered by Freud to arise from the Death Instinct i.e. it was viewed as a counter-drive to libido. Objectors to this theory view aggression as normal if it tends to preserve the individual and the species, and pathological if it does not. They regard aggression, not as a basic drive, but as an outgrowth of frustration in goal-attainment. Elements of pathological aggression include deprivation, inadequacy, and conditioned hostility. The overt, antisocial act may be precipitated by anything which, symbolically or actually, seems to intensify the above factors. Aggression is most intense toward individuals who can either gratify or frustrate basic needs, i.e. family and friends. Elements of aggression may be seen in a great many situations; a few of these are examined.

SHORT PSYCHOTHERAPY WITH PASSIVE PATIENTS. AN EXPERIMENT IN GENERAL PRACTICE

The most pressing problem in general practice today is the provision of adequate psychotherapy for psychogenic illness, which is responsible for 30 per cent. of all consultations (College of General Practitioners, 1958) and only a small proportion of which can be treated by trained psychiatrists. This paper describes a form of brief psychotherapy directed towards modifying neurotic character traits and securing freer expression of personality assets in the passive compliant type of personality which was found in 71 per cent. of all patients specially interviewed in late 1959 and 1960 in a working-class Belfast practice.