Psychoanalytic observations on the pathology of depressive illness: selected spheres of ambiguity or disagreement

This paper has two general sources: my own clinical psychoanalytic work extending over about four and one half decades; and consideration of certain outstandingly influential ideas in our literature: first, those of the pioneer contributors, and then those of certain more recent writers, whose views have sometimes exhibited important differences from those widely held in the past. I try to evaluate the two groups--in their occasional overlapping and important divergences, in relation to my own clinical experience. A certain general position of my own emerges from such process inevitably; but it is far from "revolutionary." Indeed, the contrary is more largely true. In extreme anticipatory condensation--what I do propose, from my own reflections, is the preeminent importance of an archaic characterological core in depressive illness.     

A preliminary report on defenses and conflicts associated with borderline personality disorder

The authors present preliminary psychodynamic findings from a naturalistic study of borderline personality disorder compared to antisocial personality disorder and bipolar type II (depression with hypomania) affective disorder. An independent psychodynamic interview of each subject was videotaped from which ratings were made of the presence of 22 defense mechanisms and 11 psychodynamic conflicts. A factor analysis of ratings from 81 subjects supported the separation of borderline (splitting, projective identification) from narcissistic defenses (devaluation, omnipotence, idealization, mood-incongruent denial). While certain groups of defenses were associated with each diagnosis, defense ratings did not significantly discriminate the three diagnostic groups, suggesting a limit to their diagnostic value. Among 27 subjects rated, borderline personality was strongly associated with two conflicts: separation-abandonment, and a global conflict over the experience and expression of emotional needs and anger. Antisocial personality was psychodynamically distinct and more heterogeneous. Bipolar type II was associated with two hypothesized depressive conflicts: dominant other and dominant goal. Chronic depression, which was more common in both personality disorder groups than in bipolar type II, was associated with a third depressive conflict, overall gratification inhibition. Overall, conflicts were powerful discriminators of the three diagnostic groups. The heuristic value of these findings is discussed.