Emptiness to the Emptiness of Presence and Development
Introduction
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ccording to the World Health Organisation, 121 million people suffer from depression, which is the fourth greatest cause of death and disability worldwide. In psychiatry and the mental health disciplines, depression is an affective state or symptom characterised by sadness, a general sense of loss or failure, pessimism, low self-esteem, and a negative outlook on life.Depression affects the vegetative system in the form of an increase or decrease of appetite, and an increase or decrease of sleep. In addition, it also impacts the motor system in the form of a reduction of activity and vitality. The person has difficulty concentrating and loses the desire for life and for sexuality.
The Diagnostic and Statistical Manual of Mental Disorders (DSMIV) differentiates and classifies various forms of depression under affective disorders. However, depression, as a symptom, also appears under different diagnostic categories. In addition to bereavement, there is adjustment disorder with depressed mood, and depression also appears in anxiety disorders, personality disorders, and even psychosis.
Freud emphasised that there are different types of depression with varied aetiology. Depression is a heterogeneous group of conditions/
symptoms produced by different forms of causality. According to Freud, every psychiatric symptom is produced by a series of factors
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or a complemental series. There are somatic or genetic causes of depression, as there are psychical, or environmental, social and acci-dental causes. In the study of depression, Freud's thought contains three important distinctions: first, between grief and melancholia;
second, between somatic, psychical, and traumatic causes; and third, between earlier and later fixations to developmental phases.
In classical Freudian psychoanalysis, depressive symptoms were originally viewed as a blockage of libido caused by the loss of an object. In such instances, a subject is either/or and/or both, obliged to give up his/her sexual aim without being gratified, or he/she feels unloved and incapable of loving. As a result of a loss of love and satisfaction a person enters into despair about themselves and their future. The loss of an object produces negative effects within the subject by transforming evolving and dynamic emotions of love, pleasure and joy into devolving and stagnant feelings of sadness and hate.
In Mourning and Melancholia, Freud (1914) linked depression to the early oral incorporative phase of sexual development, as well as to a later phallic phase that involves more developed forms of the super ego and the ego ideal, the castration complex, and the Oedipus constellation. This later phase involves experiences of guilt, self-reproach, and self-punishment.
With his theory of different phases of development, Freud attempted to explain the existence of different types of depression.
But in true dialectical spirit, Freud wrote the song of difference and sameness, the heterogeneity of depression, and the unity of different forms of loss and grief that take place in different phases of development.
In addition, Freud observed that depressed patients have the same kind of ambivalence he had earlier found in obsessional neurotic patients, in which hostility interferes with the capacity to love. The depressed person both loves and hates the lost object. Freud applied a model of regression to depression: unresolved conflicts at the oral phase were considered directly related to excessive desire (Lacanian puissance), to a search for oral gratification as well as to an uncon-scious wish to destroy (devour) the desired but frustrating sexual object. In addition to sharing certain characteristics with mourning, melancholy involves a regression to the oral phase of the libido, when identification with the lost object occurs.
Abraham (1911) formulated five factors in the pathogenesis of melancholia: a constitutional overemphasis on oral eroticism; fixation at the oral stage; early and repeated childhood disappointments in love; occurrence of first major developmental disappointment before Oedipal wishes are resolved; and repetition of primary disappoint-ment in later life. The death of or separation from a parent early in the patient's life is a common feature in the history of the depressed subject. The child also had to live with the grief, of the remaining parent and sometimes may become the bearer of more than the usual amount of parental hopes and fantasies.
More recently, in the United States, Blatt (1997), following Freud, and post-Freudian and ego psychological thought, has dif-ferentiated between two forms of depression: an anaclitic depression related to feelings of loss and abandonment; and an introjective depression related to a cruel superego, and focused on issues of self-esteem and self-criticism. These two forms of depression are based on Freud's ideas regarding the psychogenesis of depression in two different phases of development. Blatt and collaborators sever the.
link that Freud established between these two forms of depression and between the oral and phallic phases of development.
From a structural notion of interdependency, to establish difference and distinction is the other side of establishing relationship between different terms. An example of this would be the relation-ship between object libido and narcissistic libido, anaclisis and introjection. The ego is first an object, narcissistic libido is first object libido, and once the ego and narcissistic libido are established, object libido always implies narcissistic libido, and the ego is always included in the object. Thus, I link these two forms of depression to the ideal ego and the ego ideal respectively. Both are intersubjective structures, and constitute differentiations within narcissism and relationships to the object, but one is linked to the early relationship to the mother and the second to a later relationship to the father.
In this respect, Lacanian theory allows for a precise differentiation between the ideal ego and the ego ideal. The ego ideal and the super ego are closely related but not exactly the same. In depression, the ego ideal plays a role in the individual sense of a loss of ideals, or of falling short of ideals, whereas the super ego represents the self-punitive faculty. Vergote (2003) wrote about the role of the ego ideal in the generation of a depressive neurosis, but did not examine the
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role of the ideal ego in depression, or more specifically in the case of depression in the borderline condition. In the ideal ego, the ideal refers to the objet k and the body image, not to societal values and ideals.
A Lacanian perspective on depression: necessary symbolic losses and the significance of grief
Although Lacan never dedicated a seminar to depression (like he did with anxiety), Lacanian theory has many relevant concepts with which to frame and organise a fundamental psychoanalytic under-standing of depression. For Lacanians, depression is a symptom of a mostly neurotic structure that reflects conflicts beyond the oral phase of development. In addition, depression can also be precipi-tated by the absence of separation rather than simply by a forced loss of the object and separation from the other (Hassoun, 1997).
Depression can be related to instances when necessary and symbolic losses did not take place, and the subject becomes destined to experi-ence a pervasive sense of loss not from having experiexperi-enced loss but from not having experienced a necessary structural loss that they then spend the rest of their lives trying to internalise and incorporate.
Grief did not take place, but not because a forced separation took place and the grief was denied, but because a necessary separation itself was compromised.
Early psychoanalytic theory was impressed by the accidental, environmental, and traumatic series leading to the production of psychopathology. Freud developed the complemental series to account for the interaction between genetic, environmental, and psychical factors. Psychical factors refer to unavoidable traumas and pains that are necessary for development, and are, therefore, struc-tural and not accidental and/or environmental. In life there always are "major developmental disappointment before Oedipal wishes are resolved-7 and repeated "primary disappointments" are an integral part of development. The oral, anal, and phallic phases of develop-ment all have major disappointdevelop-ments built into them.
In this chapter I want to trace the various normal and necessary losses, of object and ego that the subject needs to endure throughout the course of development, and relate them to the various manifesta-tions of depression. In contrast to the contribumanifesta-tions of authors that
have developed Freud's ideas about the existence of two categorically distinct forms of depression, I want to continue his attempt to unify the various forms of depression by locating a similar problem and symptom in different phases of development.
The loss of the maternal breast in weaning is one of those struc-tural developmental/environmental problems, pains, and disappoint-ments that all infants experience as part of the developmental process and that, give the human subject the marks of a divided subjec-tivity. The assumption here is that an accidental/environmental cause/factor (the mother's absence from the child's life, for example) could come to quantitatively, as it were, aggravate and intensify the injury/loss occurring during normal development. The injury produces a fixation whereby the emotional life and desire of the subject remains marked by the characteristics of the oral phase of development. But from a Lacanian perspective, a loss produces fixation not only because of the loss of love but because the actual loss prevents normal separation and mourning from taking place. The structural and accidental series taken together, plus the contribution of a later precipitating factor, would account for the development of melancholia or severe depression later in life.
Without a structural or psychical perspective, there is a twofold problem with a one-dimensional traumatic disappointment model.
First, most major depressive disorders occur mostly within neurotic and not psychotic structures. In addition, a major depressive episode could also be precipitated by the action of the genetic and psychical series alone. An accidental loss or death of the mother is not required for the onset of major depression.
Disappointments in life are not only inevitable but also necessary.
The same is true of grief. If a loss and grief are denied, the person then spends their life trying to grieve a denied and unconscious loss, and therefore the suppressed grief turns into a stagnant depression.
Lack of separation from the mother prevents the emergence of grief. In addition, oral problems related to the fusion and separation from the mother can be related to both psychosis and depression. But in the case of anaclitic depression, the oral problems of separation are a defensive regression for problems that originate elsewhere.
The losses conditioning the depression are rooted in later phases of development. Depression per se is rooted in a neurotic structure.
However, in contrast to Vergote (2003), I do not mean to say that there
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is such a thing as a separate depressive neurosis. Rather the symptom of depression takes place in different structures and responds to different although structurally related forms of developmental losses.
Vergote noted that a loss of ego ideals can lead to a regressive
"longing for a fusive attachment to the lost mother". However, he does not consider the fixation to the fusive attachment to the mother (the jouissance of the Other) not due to loss but due to the absence of loss or the absence of the absence of the maternal objet a that I will theorise as a conditioning factor for depression in the borderline character.
In psychosis the lack of separation from the mother, or from the jouissance of the Other, as Lacan puts it, are directly related to the psychotic structure. This view is consistent with the commonly held psychoanalytic assumption that the earliest forms of traumas and failures in development lead to psychotic and not neurotic structures.
Although neurotic structures can have psychotic symptoms and psychotic structures can have neurotic symptoms, neurotic and psychotic structures are qualitatively and developmentally different.
From this perspective, a depressive disorder could not merely represent a failure /fixation to the oral phase of development. The regression to the oral phase is a defence against problems occurring at later and properly Oedipal phases of development. This is what Freud called retroactivity. What comes later redefines what came before. When listening to a depressed patient, one perceives Oedipal problems revealed/concealed through oral dependency needs. Both the client and the therapist feel more comfortable discussing the client's problems in terms of oral dependency needs and problems of love and attachment. Sexuality is usually conveniently excluded from the cognitive equation.
Lacanian theory postulates what tentatively could be called a paradoxical factor in the generation of depression. For normal development the infant is not only to attach and find emotional and biological satisfaction in the maternal breast, but is also to separate from the breast in the process of weaning. When weaning does not take place this also produces a fixation to a primitive form of pain/satisfaction that Lacan calls jouissance. Either too much or too little produces the same result in this regard. Excessive attachment to the breast leads to a form of repetition where the ego continues to search for a loss that did not take place.
Depression and self-esteem: letting go of ego and object In Mourning and Melancholia, Freud compares for the first time normal grief with pathological depression. The former is regarded as a reaction to the loss of an external object (i.e. actual death), whereas in the melancholic patient the object has not perhaps actually died but has been lost as an object of love. The major intra-psychic consequence is an impoverished ego in so far as it becomes identified with the lost object. Due to the narcissistic charge with which the object has been invested, the loss of the object implies a loss at the level of the ego. The ego identifies with the object and thus the object cathexes are situated within the ego. Because the object cathexis is replaced by identification, the loss of the object is experienced as a wound or hole in the ego. This wound or hole in the ego renders the ego more vulnerable to the attacks against the lost object that now through identification are re-directed towards the ego. These attacks also take the form of self-recriminations. The super-ego takes up the hatred of the object and turns it against the ego. The ego now is blamed for the loss of the object. The ego succumbs to the judgment of the critical agency. Freud observes that in mourning, this perturba-tion of the self-esteem is absent.
For Freud, melancholia is a malady of the ego. Loss of self-esteem is due to loss of love. Freud also said that in mourning it is the world that becomes worthless and empty; in melancholy it is the ego. The loss at the level of the ego points to a connection between the ego and the object. In The Ego and the Id, Freud (1923) recognised that psychopathology could teach us many psychical facts about normal development that remain otherwise inaccessible to the naive empir-ical eye. Suffering teaches the human subject something about the nature of life, desire, and psychic structure. Identification, far from being the pathological sign of depression, is the normal develop-mental process by which the ego separates from the object.
In development, the ego, as an agency or psychic structure, is first categorically separated/differentiated from the object during the Lacanian mirror phase. At six months, as the infant allegedly enters the Kleinian depressive position, the subject incorporates the loss of the object and acquires a whole body image of both the mother and the bodily ego. Prior to that the ego represents identification with the felt sense of the partial object, or the breast. The ego is the thought,
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idea, and feeling of the object. Identification is an idea and a felt sense of the object that will come to define not only the ego but also the object.
Melanie Klein's depressive position argues that when the child discovers that the real total mother has two breasts that correspond to the phantasised good and bad breast, the child realises that h e / she hated and loved the same breast/person. He/she then feels remorse, grief, gratitude, and the wish to make reparations for the phantasised attacks on the object. However, it is difficult to consider how the depressive position could be more important than the process of weaning and the experience of grief associated with it.
To be fair to Klein, she would argue that the depressive position is precisely how weaning is won. The emotional ambivalence towards the mother is indeed a very powerful factor in the psyche and from this reality the Kleinian model derives its cogency and power.
In Totem and Taboo, Freud gave a very detailed account of primal and primitive ambivalence towards the father. However, this was the Oedipal father, and not the mother of the early or first phase of Oedipus, as Lacan calls it.
Elsewhere I have written that good-enough mothering (to use Winnicott's term) is a complex function composed of imaginary and symbolic representations and registrations of the mother. For Lacan (1957), the mother and father exist in different registers of experience.
Both the imaginary and symbolic mother and father are inter-dependent and necessary for development and yet by themselves can be-problematic. They can also be severed or split off from one another. The presence of the breast represents the imaginary mother or the image of the mother. The symbolic mother represents the also necessary absence and separation from the mother /breast.
In Lacanian theory the concept of the symbolic father is related to the Freudian concept of a dead father, but the concept of the sym-bolic mother is quite different from Green's concept of a dead mother. Lacan has a positive and constructive notion of a symbolic death linked to the separating function of the father that links the subject to the symbolic order of language and culture. Green's dead mother is a bad mother who is psychically dead/depressed and that therefore does not attach to the child as an objet a of her desire. The dead mother becomes a bad nothing inside the child. In contrast to this, Lacan's symbolic mother is the mother that is turned towards
the father and society, but also loves the child as a subject in his/her own right. The symbolic mother represents a necessary Oedipal rejection on the part of the mother. She is absent, but this absence is an empty presence that helps inscribe the subject into the symbolic order.
The notion of the symbolic killing of the mother is also found in Kristeva's (1989) work. This is not surprising given that she was an acknowledged or unacknowledged reader/follower of Lacanian
The notion of the symbolic killing of the mother is also found in Kristeva's (1989) work. This is not surprising given that she was an acknowledged or unacknowledged reader/follower of Lacanian