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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The depressive character is characterized by perpetual and unsuccessful efforts to maintain self-esteem and to avoid a sense of helplessness. Such individuals suffer from chronic depression which may or may not be masked, but which permeates their character. Although the condition is among the commonest seen in many of our clinics and practices, it remains without a generally accepted diagnostic form. It is suggested that the essential, clinical, dynamic, and structural features of the depressive character are: (1) consistently low self-esteem and a sense of helplessness, dependent object relations and chronic guilt; (2) self-directed aggression and masochism are frequent but not invariable; (3) extensive use of the mechanism of denial is as common as the previously described obsessional defenses seen in patients subject to psychotic depression; (4) often the depressive character suffers from intense oral envy; (5) depressive character traits may help to ward off any of the basic anxieties, namely, object loss, loss of love, castration anxiety, and superego anxiety (guilt) (6) the depressive character may be similar to a number of related disorders, namely, the obsessional character, hysterical characters with a large oral component, and depressive borderline states; (7) sensitivity to loss, sadness, and fragility of self-esteem makes the depressive character especially vulnerable to regression into overt depression; (8) the persistence of oral incorporative mechanisms, ambivalent, dependent object relations, ego versus superego tension with depressive affect, and sensitivity to loss are characteristic of the ego of the depressive character.
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PMID:The depressive character. 123 40

This article considers the relationship between depression and characterological masochism from a contemporary psychoanalytic perspective. Nosology is discussed historically from Krafft-Ebing to the DSM-III-R category, self-defeating personality disorder. Masochistic character traits are conceptualized as attempts to cope with depressed helpless and hostile feelings that have become part of the core self-concept. Psychotherapeutic strategy for treatment of masochistic patients at different levels of characterological integration is discussed. Many questions about self-defeating personality disorder remain open at present. The need for psychoanalytically informed clinical research on characterological masochism and particularly the relationship between masochism and depression is stressed.
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PMID:The depressed masochistic patient: diagnostic and management considerations--a contemporary psychoanalytic perspective. 206 Nov 39

In examining the conditions of depression and masochism, my intention has been to expand our area of study beyond psychodynamics alone. My first aim was to present what I believe are the intimately intertwined dynamics of each condition, a metaphorical double helix of depression and masochism in a matrix of narcissism. It may make clearer how either depression or masochism may present clinically in combination, at times in tandem, or manifestly as either state alone. My second, but major, aim is ecumenical: to interweave contributions from outside psychoanalysis. The neurophysiological bases and genetic determinants for most depressions are by now well-recognized. Masochism, much like depression, with which it is closely allied, may not necessarily arise out of conflict alone. I have presented brief excerpts of material, much of it still speculative, from areas of genetics, biochemistry, and ethology, to support the concept of a biological anlage for masochism. This would help explain the enormous difficulties therapists find in the path of its successful treatment. I believe Lorenz's theories on animal "bonding" suggest precursors to our concepts of masochism. I further believe our field of study has reached the point at which these and probably additional scientific disciplines can be helpful or even necessary for the further understanding of character, and for the solution of the persistent riddle of masochism, whose full understanding has continued to elude us.
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PMID:Depression, masochism, and biology. 299 Nov 2

Depression and moral masochism are inseparable, and originate in a particular climate of lived experience in which one or both parents suffer from a masochistic-depressive disposition. Developmentally, there has been a deficit in the child's experience of shared pleasure, and of being a source of enjoyment to the parent. Instead, the child experiences himself or herself as a source of pain and feels responsible for the parent's dysphoric, anhedonic state. This is not simply a fantasy construction of the child, as parental reproachfulness is characteristically encountered. The child makes reparative efforts, but they generally do not succeed. Central psychological capacities are compromised under these conditions, particularly a sense of personal efficacy and of natural entitlement. The evolution of initiative, autonomy, and individuation are also significantly affected. The aggression, both conscious and unconscious, which is generated by these early conditions creates intrapsychic conflict which further inhibits the development of these essential psychological functions. Some therapeutic recommendations are proposed based on these considerations.
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PMID:Depression and moral masochism. 830

The author argues the case for the need to develop an integrative clinical psychoanalytic model of depression which takes into account various pathways leading to different subtypes of depression. Some factors intervening in the genesis and maintenance of depression (aggression, guilt, narcissistic disorders, persecutory anxieties, ego deficits, masochism, identification with depressive parents and fixation to traumatic events in which the subject felt helpless) are examined, as well as certain dynamic interrelations between them. The relationship between aggression and depression is analysed, with particular attention devoted to the steps through which aggression turns into depression. The origins of guilt are reviewed, including those conditions which are independent of aggression. Psychoanalytic interventions that could be pertinent for a given subtype of depression, but which could prove counterproductive when applied to another subtype are discussed. Clinical examples are given to provide support for the ideas presented, recognising that further studies are required to establish more specific correlations between the different depressive configurations and the types of psychoanalytic interventions best suited for changing them.
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PMID:Some subtypes of depression and their implications for psychoanalytic treatment. 893 19

This paper describes the evaluation, initial psychotherapy and subsequent psychoanalysis of an adolescent who presented with a severe psychosomatic process involving total body pain and profound fatigue. The author details the complex and multifaceted nature of the psychosomatic process as it unfolded in the treatment. The psychosomatic problem was not a single entity, but rather was comprised of diverse interwoven elements such as somatization, conversion on pre-oedipal and oedipal levels, conflicts over aggression, sexuality, identity, masochism, secondary gain, anaclitic depression, internalized self-other interactions with a depressed mother and transgenerational transmission of trauma. The author uses the case material to discuss technical approaches to problems that often arise in the analytic treatment of patients with complicated chronic pain and fatigue as the primary complaints. Such approaches include respecting the mind-body split as a primary defense, speaking the language of the body along with the language of the mind and developing the verbal sphere around the non-verbal symptoms. The author emphasizes that complicated chronic pain problems are common and can be helped by psychoanalysis as long as the unique and complex features are understood and reflected in the technical approach.
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PMID:Building bridges between body and mind: The analysis of an adolescent with paralyzing chronic pain. 1287 60

The author attempts to understand the underpinnings of a ruminative depression that occurred in a patient after a troubled first analysis. Negative therapeutic reaction is often assumed to be the result of a patient's unconscious guilt or masochism and thus an intrapsychic phenomenon, but the author asserts that iatrogenic phenomena in the form of persistent misunderstandings and enactments that remain unanalyzed contribute to a destructive treatment experience. The analysand may relive the failed treatment again and again in his or her mind in an attempt to resolve it. The author asserts that a traumatic treatment experience can foster depressive rumination.
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PMID:Depressive rumination in an analysand after a traumatic treatment. 2162 7