Meetings of the New York Psychoanalytic Society

September 27, 1966. SUPEREGO AND DEPRESSION. David Beres, M.D.

The author considers the question of separating depression from other affective states, such as sadness, apathy, and grief, especially in terms of psychodynamic differences, and then considers the role of superego functions in depression. He discusses the importance of differentiating guilt from such allied affects as remorse and shame. Depression may not be complained of as such but may find expression in a need for punishment. An essential determinant of true depression is a sense of guilt that carries with it the assumption of a structured superego and an internalized conflict, but this does not imply that guilt is the sole cause of depression. Clinical examples are given to illustrate the differentiation among various painful affects and their causes, and to point up the special quality and special cause of the one state which Dr. Beres would diagnose as depression.

The author does not agree with those who have advanced as causative factors of depression what he believes to be its accompanying manifestations. Thus his view is at variance with Bibring who emphasizes the state of helplessness of the ego and with Jacobson who emphasizes narcissistic injury. In Civilization and Its Discontents, Freud says we should speak of a sense of guilt only after authority is internalized through the establishment of a superego, but later in the paper he seems to reverse himself, stating that the sense of guilt is in existence before the superego. In Dr. Beres' view, the crucial factor is internalization, which is the final step in a series beginning with identifications based on incorporation. In clinical instances of incomplete internalization, psychoanalysis may foster a delayed development of the superego. 'One may observe then the increasing expression of guilt and depressive reactions…'

Descriptions of alleged depressions in childhood, as presented by various authors, are unconvincing. Beres notes tha