Meeting of the Psychoanalytic Association of New York

May 16, 1988. A PSYCHOANALYTIC PERSPECTIVE ON DEPRESSION. (23rd Freud Anniversary Lecture.) Charles Brenner, M.D.

Dr. Brenner's purpose was to re-examine the understanding of depression in mental illness from the psychological point of view, which he feels has been relatively neglected in the current emphasis on neurobiological approaches. In Dr. Brenner's opinion, the prevalent conceptualization of depressive illness is misguided and thus impedes optimal treatment. Relying on data acquired through the clinical psychoanalytic method, Dr. Brenner has arrived at two conclusions. The first concerns the psychodynamic and psychogenetic role depression plays in mental illness: it is an error to equate depression as an affect with depression as an illness. The second, a corollary of the first, is that mental illnesses exhibiting depression as a prominent feature cannot be assumed to be similar on that basis. Therefore, an adequate nosology of mental illness cannot be based on the presence of depression.

Dr. Brenner reviewed the nature of affects and their role in psychic conflict. Affects can be most parsimoniously described as a combination of two elements, "a sensation or experience of pleasure or unpleasure, and an idea or ideas." Either of these elements may be unconscious, but both must be present by definition in any affect, whether repressed or not. The unpleasurable affects, those responsible for initiating psychic conflict, can be differentiated into two types: anxiety, and what Dr. Brenner termed misery. The only significant distinction between the two is in the tense of the ideational content (unconscious or conscious) as it relates to the four basic calamities defined by Freud. Whereas in anxiety there is anticipation of a future calamity (real or imagined), in misery, the calamity is believed to have already occurred. Dr. Brenner employs the term depressive affect to refer to the basic affect of misery in order to better clarify its relation to s