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Depressions are among the most common of psychiatric symptoms and have been the subject of considerable attention in the literature. Recently, though, an appreciation has developed that, despite ostensibly similar symptomatology, depressions can arise out of different genetic histories and reflect different dynamics and structural conflicts. As an appreciation of these differences is essential to an understanding of the patient and to a formulation of the appropriate clinical intervention, this paper will focus on two forms of depression: those which reflect conflicts over object-related drives versus those which reflect conflicts over narcissistic ones.
Mourning and Melancholia4 introduced one of the first theories of depression. With later modification to accommodate the structural theory, the concepts first formulated in that paper have remained basic for the understanding of depressions and clinically viable to the present. The purpose of that paper was to explain the depressions and the decrease in self-esteem that result from the emotional loss of, and disappointment by, significant objects. The main point was that there is a withdrawal of libido from the object and a reinvestment in a regressive identification with it. Subsequently another part of the ego, later conceptualized as the superego, assumes the anger originally felt toward the disappointing object and displaces it against that part of the ego now identified with the ego. The feeling of worthlessness and loss of self-esteem so characteristic of depression is thought to be a secondary effect, a result of the anger turned inward to attack the internalized object.
Subsequent theorists have begun to question a number of these basic concepts and to conceptualize distinctions between depressive reactions which may have similar behavioral mainfestations but reflect