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April 26, 1982. PSYCHOANALYTIC OBSERVATIONS ON THE PATHOLOGY OF DEPRESSIVE ILLNESS: SOME SELECTED SPHERES OF AMBIGUITY OR DISAGREEMENT (The 17th Freud Anniversary Lecture). Leo Stone, M.D.
Dr. Stone limited himself to depressive manifestations which would qualify as "illness" in the everyday sense and excluded the demonstrably physiological or biochemical aspects of depressive pathology. He drew not only on published sources but also on his own clinical experience spanning more than four decades. His material included fourteen adults treated in classical psychoanalytic situations and nine in psychoanalytically oriented psychotherapy of varying intensiveness.
Abraham's classic papers on depression and Freud's "Mourning and Melancholia" effectively began the psychoanalytic study of depression. Rado's 1927 description of the metapsychology of introjected objects, loss, guilt, suffering, and propitiation, was followed by Gero's 1936 broadening of the concept of orality and emphasizing of the ultimate importance of phallic conflicts. Melanie Klein introduced the concept of the "depressive position" and stressed the role of good mothering. Freud's basic paradigm of 1917 distinguished between the intrapsychic processes of mourning and those of melancholia. Dr. Stone observed that none of his patients' marital partners corresponded with the usual description of a "narcissistic object choice," whereas several could have fulfilled the requirements of the so-called "anaclitic object choice." He suggested that Freud's use of the term really referred to the original archaic inclusion of the object in the patient's narcissistic structure. Dr. Stone mentioned the wide variety of phenomena in man's "symbolic universes" capable of precipitating depressive illness in the event of loss or narcissistic injury.
Freud distinguished mourning, which is normal and purely libidinal in its ideal form, from the fundamentally different condition of severe depression, based on a seriousl