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Just as physical pain is the most common somatic symptom propelling people to seek medical care, so are depressive symptoms or depressive character dispositions (allied often enough with anxiety and dissatisfaction with work performance and relationship patterns) the most common complaint of those coming into the mental health care system: reason enough to welcome this magisterial study by Sidney Blatt and his gifted colleagues into the psychopathology and psychotherapy of the depressive experience. Blatt, a psychoanalyst and empirical psychological researcher, is properly praised, in Peter Fonagy's foreword to the book, as “one of the giants in our field.” This volume is the culmination of an extremely productive life's work, one joining clinical study to empirical research into the nature of the depressive experience. This should not be read, of course, as noting the end of this life's work; I trust it will long continue, on the same wideningly generative path.
What is the essence of Blatt's impressive exposition here? It is simply this: that clinical depression and/or the depressive character formation are not unitary clinical entities; rather, Blatt, based on his clinical psychoanalytic experience and thirty years of empirical research, has distinguished two fundamentally different depressive diatheses, designated anaclitic and introjective, differing in symptomatology and character attributes, and differing as well in the formative childhood experiences that create a predisposition to the one or the other, and in implications for prognosis and psychotherapeutic outcome.
Anaclitic (or dependent) depression is marked by interpersonal issues of care, connectedness, and relatedness. A central fear is of abandonment, loss, and helplessness, to use the Engel-Schmale idiom (Engel and Reichsman 1956; Schmale 1972). Here we see a desperate need to maintain supporting and nurturant links, and to ward off feelings of being unwanted and unloved. At its life-threatening extre