Bleichmar H B
Int J Psychoanal. 1996 Oct;77 ( Pt 5):935-61.
The author argues the case for the need to develop an integrative clinical psychoanalytic model of depression which takes into account various pathways leading to different subtypes of depression. Some factors intervening in the genesis and maintenance of depression (aggression, guilt, narcissistic disorders, persecutory anxieties, ego deficits, masochism, identification with depressive parents and fixation to traumatic events in which the subject felt helpless) are examined, as well as certain dynamic interrelations between them. The relationship between aggression and depression is analysed, with particular attention devoted to the steps through which aggression turns into depression. The origins of guilt are reviewed, including those conditions which are independent of aggression. Psychoanalytic interventions that could be pertinent for a given subtype of depression, but which could prove counterproductive when applied to another subtype are discussed. Clinical examples are given to provide support for the ideas presented, recognising that further studies are required to establish more specific correlations between the different depressive configurations and the types of psychoanalytic interventions best suited for changing them.
作者论证了开发一种综合性临床精神分析抑郁症模型的必要性，该模型需考虑导致不同亚型抑郁症的各种途径。文中考察了一些影响抑郁症发生和维持的因素（攻击性、内疚感、自恋障碍、迫害性焦虑、自我缺陷、受虐狂、对抑郁父母的认同以及对主体感到无助的创伤事件的固着），以及它们之间的某些动态相互关系。分析了攻击性与抑郁症之间的关系，尤其关注攻击性转化为抑郁症的具体过程。回顾了内疚感的起源，包括那些与攻击性无关的情况。讨论了对特定抑郁症亚型可能适用，但应用于另一种亚型时可能适得其反的精神分析干预措施。文中给出了临床实例以支持所提出的观点，同时认识到需要进一步研究，以确定不同抑郁构型与最适合改变它们的精神分析干预类型之间更具体的关联。
