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Much has been written about depression and its psychological and somatic characteristics. There is general acceptance that the feeling reactions of depression are not the same as the clinical syndromes of depression, although both may occur in response to a loss; that the process of mourning is different from that of depression; that the role of the superego in the turning of aggression in on the self precludes the occurrence of melancholia in childhood; and that some depressed patients also have episodes of mania. Frequently, however, it is difficult to distinguish whether an author is describing depression as an affect, a character style, or a disease syndrome. The following approach emphasizes the differentiating characteristics, as well as the importance of an underlying somatic adaptive mechanism of withdrawal for all depressive reactions.
The approach begins with what Engel has called the “conservation-withdrawal” reaction (Engel and Reichsman, 1956; Engel, 1962b); proceeds in developmental time to the differentiation of two affects of depression, called helplessness and hopelessness (Schmale, 1958, 1964), and their signal functions; then goes on to the depressive character defenses; and concludes with the syndromes of depression, which include symptom formations that defend against repressed infantile conflicts over deprivation.
The approach to depression to be presented not only parallels Freud's 1926 formulation about the affect of anxiety and how it may be related to a neurotic syndrome formation, but extends his ideas about separation and castration from the threat of loss to loss itself.