Guilt as a Source of Narcissistic Gratification

This article takes as its starting point a paper by Hugo Bleichmar presented at the 2003 Joseph Sandler Research Conference on Depression. The author argues in favour of viewing depression in a broad perspective. The Freudian prototype of “guilty depression” represents only one of many pathways leading to depressive states. Psychoanalytic understanding of depression should represent a multidimensional approach, characterised by interacting determinants, both internal and external. In clinical practice, this would imply an attitude of greater freedom and flexibility in the analyst. The paper compares the psychoanalytic account of depression with that given by the cognitive approach. It is argued that within a diverse research field, where depression is studied from different angles—as a disorder of the brain and in terms of cognitive deficits—the contribution of psychoanalysis is that depression is most usefully studied at the level of psychological causation. The psychoanalytic understanding of depressive states in terms of unconscious interpretation and meaning of experience represents a distinct contribution. Implications of viewing depression as an “illness” are discussed.