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On the basis of observations of depressive patients in a hospital setting, Matakas and Rohrbach critically review existing theories and offer a revised psychoanalytic understanding of depression, leading to some suggestions for treatment. Depression is characterized by self-devaluation, self-accusations, and a self-centered preoccupation, they note; the patient's complaints often lead the surrounding objects to offer help. Even though the help is rejected as useless, the relationship to the object is maintained. However, clinical studies show that, if patients are separated for some weeks from all family and friends, they get better. Thus, it seems that depression is not only caused, but also maintained, by a specific object relationship —contradicting the general assumption that depression is caused by the loss of an object.
Instead, the authors suggest that the trigger mechanism for depression is a conflict in the relationship, and that the depression defends against dealing with this conflict. However, the conflict need not be related to aggression, and depression cannot be understood generally as a defense against aggression or as an inward-directed aggression. To put it differently: depression is not a defense against aggression; rather, aggression is a defense against depression.
Matakas and Rohrbach state that a psychic conflict results in an organic inhibition (loss of vitality or libido, hormonal changes, vegetative symptoms) that expresses itself in depressive symptoms. They understand the depressive inhibition as a regression to a lower (earlier) functional level. Clinical work shows that allowing depressive patients to function on a regressive level (as the inpa-tient situation permits) usually leads to a relief of their depressive symptoms (one study showed that the rate of suicide dropped from 5% to 1% in a regression-permissive setting). The depressive inhibition can be seen as a protective measure that should not be questioned. Consequently, when treat