Melancholia, Mourning, Love: Transforming the Melancholic Response to Disability through Psychotherapy

The paper considers the unhappiness associated with disability and suggests that one strand of it can be understood in terms of narcissistic and melancholic states of mind. It refers to Freud's original distinction between mourning and melancholia, which highlights the self-reviling characteristic of melancholia when a harsh superego attacks the ego in response to loss. Clinical examples from psychotherapy with a disabled adult and work with the parents of a young disabled child illustrate the ego's narcissistic retreat from the harsh superego and the concomitant problem of love. The paper suggests that it is the lack of love which may constitute the greatest unhappiness where there is disability. Through psychotherapeutic work melancholic states of mind can be transformed: the emergence of Britton's ‘rueful humour’ and an acknowledgement of impermanence are two signs that transformation is under way. The author suggests, in line with Buddhist thinking, that melancholia rather than mourning is the natural response to loss; the capacity to mourn is an attainment, not a given, and is a likely outcome of successful psychotherapeutic work where disability is a factor.