Symposium on 'Depressive Illness'—1. Introduction1

There are few problems more challenging than the subject of today's symposium. Depression, like anxiety, is a subjective experience integral to human development and the mastery of conflict, frustration, disappointment, and loss. At the same time, however, depression, again like anxiety, is not only to be regarded as an affective experience of general psychological significance. It is also the main presenting symptom of a regressive clinical syndrome, as severe, characteristic, and well defined as any to be found in the whole field of clinical psychiatry. This illness, moreover, because of its frequent occurrence in patients with a positive family history and its common association with specific periods of biological significance, poses crucial problems as to the relation between psychogenic, environmental, and constitutional factors in the development and structure of mental illness.

To most of you my point of departure must be familiar. Abraham, pioneer in this field, emphasized the role of constitutional factors in respect to depressive illness. He also indicated the general significance of depression as a symptom which might be compared and contrasted with anxiety. 'The affect of depression, ' he said in 1911, 'is as widely spread among all forms of neuroses as is that of anxiety. Anxiety and depression are related to each other in the same way as fear and grief. We fear a coming evil; we grieve over one that has occurred.' Certain aspects of recent psycho-analytic theory might be epitomized by comparing the following statement from Edward Bibring's 1953 paper, 'The Mechanism of Depression.' 'Anxiety and depression represent diametrically opposed basic ego responses. Anxiety as a reaction to danger indicates the ego's desire to survive. The ego challenged by the danger mobilizes the signal of anxiety and prepares for fight or flight. In depression, the opposite takes place; the ego is paralysed because it finds itself incapable to meet the danger.'

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