Object-related vs. narcissistic depression: a theoretical and clinical study.

This paper has focused on the sense of helplessness as an essential component of a depressive reaction. By inference, a sense of mastery and ability to achieve goals seems essential for a sense of well-being. Both patients presented here revealed infantile fantasies that hampered their exercising this mastery, and the path to well-being was the analysis of these fantasies. The treatment plans differed, though, in the locus of the fantasies. In an object-related depression such as Mr. Janson's, the fantasy involved the inhbition of functioning--that is, the inability to express aggression--and the treatment aimed at removing the inhibition. In a narcissistic depression such as Miss Gaynor's, the helplessness was not due to inhibited functioning per se. Rather, her goals were unrealistic, unattainable, and based on unconscious fantasies. Here the aim of treatment was the development of more reality-adapted and attainable objectives and the concommitant internalization of a more realistic sense of her own worth. Thus the common denominator in both depressive reactions was a sense of helplessness, and the path toward increased self-esteem was by way of the development of a sense of mastery and competence.