Depression, Anxiety and Affect Theory

'Depression' as a diagnostic entity is characterized by an alteration of affect. It is, indeed, often referred to as an affective disorder. The most common and most obvious symptoms of depression, the symptoms which have given it its name, are what are commonly called depressive affects: grief, despair and guilt, in varying degrees and combinations. Not only are these affects painful in themselves; they are also often associated with an inability to function normally and with self-injurious or even with self-destructive tendencies. It is doubtless this fact—that the emotions of depression are both painful and associated with serious behavioural abnormalities—that has resulted in their being used as a basis for diagnostic classification.

Similar considerations account for the place of anxiety in currently accepted diagnostic schemas. Anxiety as an affect is also painful—at times, intolerably so—and associated with an incapacity to function normally. Like 'depression', 'anxiety state', 'anxiety hysteria' and 'anxiety neurosis' are diagnostic entities in current usage. Depressive affects and anxiety are also often present in the same patient, as witness the diagnostic category of agitated, i.e. anxious depression.

It may be recalled in this connexion that Freud (1926, app. C) paid some attention to the fact that grief and anxiety may both originate in, or at least make their first appearance in connexion with, the same infantile experience, an experience which he proposed to call a traumatic state. We shall return to this suggestion later. First, however, we shall devote our attention to some other aspects of depression.

We shall begin with nosology. The consensus among analysts at present is that 'depression' or 'depressive illness' is a valid diagnostic category. If not an illness, it is at least 'a specific psychiatric syndrome' (Zetzel, 1960) that can be readily recognized in the majority of cases by an experienced clinician. Many analysts support the vie