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ARTICLE HISTORY Received 12 September 2023; Accepted 25 September 2023
In this ambitious, worthy, and admirable project, Watt (2023) not only reviews and updates a wide spectrum of multidisciplinary contributions supportive of the separation-distress hypothesis of depression, but also leaps forward to extend and lay ground for a matrix foundation concept of depression – multiple promoting and opposing biological, psychosocial, environmental and societal determinants in a recursive interaction around an evolutionarily linked and conserved “shutdown for survival” related to hibernation and sickness behavior.
Here we are given no less than an extraordinary opportunity to explore how we may facilitate and integrate new data to create dialogue of emerging study results, insights and innovation between neuroscience, psychiatry, psychoanalysis, and related disciplines. In particular, psychiatry and its related disciplines may benefit from mutually informed and interconnected research and the translational application of potentially novel findings.
Watt emphasizes the altricial anaclitic stages of early development (Parens & Saul, 2014), a need for continuity and an essential contingent dyadic reciprocity, not only for nurturance and protection of the newborn but significantly for the establishment and regulation of a foundational and maintaining central nervous system (CNS) and immune system structure and interconnecting process that fosters social and biophysical thriving into the future. Moreover, separation distress experience is later cognized from a deeper affective anlage to the elaboration of loss – hopelessness, despair, shame, guilt, sadness – variations relating absence of presence, detachment rejection, humiliation, or interruption of dependence (Spitz & Wolf, 1946).
This framework is the foundation for Watt’s urging that psychiatry has to finally liberate itself from the search for monofactor etiologies (viz monoamine deficit etiology of depression) and magic bulle