Response to Commentaries

The Challenging Heterogeneity of Depression

Sydney Blatt and Patrick Luyten provide a useful overview of their insightful parsing of psychologically distinct forms of depression. Since our target article well exceeded recommended word limits, we could not mitigate our neglect of the psychological aspects of depression, in preference for the more bottom-up neuroscience views. Additionally, we felt that tackling the heterogeneity of depression (one of its most difficult and poorly understood dimensions from a neurobiological point of view) would have created an untenable project, and we fully anticipated being challenged around this neglect. We readily acknowledge that such heterogeneity is one of the most serious challenges not simply to our theory, but to any theory of depression—that is, how to accommodate the frustrating clinical heterogeneity of depression (indeed, it is an issue for virtually every category in DSM-IV, and perhaps for reasons that the authors nicely outline in their commentary: that DSM-IV strives to be totally atheoretical, to a fault.)

Rather than trying to squeeze insufficient psychological analyses into an already huge manuscript, we thought that it might be ideal to allow our psychoanalytically oriented commentators to share their psychodynamic perspectives without much hindrance from our own psychological coverage. Blatt & Luyten did that superbly, and we very much appreciate their largely top-down perspectives where one must address the “cognitive structural organization of meaning systems.” Although we largely agree with their analysis, an interesting question concerns the attachment history of individuals with the so-called introjective depressions. This typology of “introjective versus anaclitic” depression appears to clearly imply that separation distress in its various forms has nothing to do with the genesis of the introjective depressive style, and we wonder whether such an assu