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- Category: A Study Of Psychopathology
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Depressive reactions among female patients have largely to do with separation experiences. The few female patients who developed depression following promotion had psychotic illnesses. Among the male patients in this study with reactive depressions, experiences which have to do with success and failure are the most frequent precipitating event for the illness. In addition, there were many chronic anxiety reactions generated by ambivalence towards success and failure. In a few instances, there might have been a contributory traumatic experience in the background, e.g., a heart attack or death of mother.
In a young man and in a man who was past middle age and well into his fifties, depression after the experience of failure or what was interpreted as failure was easy to understand. In the younger patient, it was akin to a rude awakening, a realization of one’s limits with the initial attempt to achieve; in the older person, it was the symbolic realization of one’s declining powers and the meaninglessness of lifelong struggle. In a sense, the older patient found himself exactly where he was thirty years or so before, except that now, with age, there was limited time and hardly any desire to start all over again.
In the male patient, in his thirties and forties, the conscious pursuit of success was impeded by an unconscious courtship of failure. The varying degrees of success and failure were correlated with varying amounts of this ambivalence. The typical history was that of a person who forced himself, or was forced by circumstances, to assume autonomy at an early age. Even before adolescence, he showed many signs of self-sufficiency. He then drove himself in pursuit of achievement and success, consciously motivated by pride and unconsciously avoiding a return to the psychological bondage to his parents.
In American culture, parents force autonomy upon their offspring at an early age with early severance of dependency ties. It is not unusual, for example, to see young people with moneyed parents working in order to have money of their own. In the Philippines, if a boy has parents with money, it hardly occurs to him to work. Sons are expected to grow up loyal to their parents, look after them, help younger siblings and generally be unselfish. The male patients in this study tended to be exceptions in the general culture. In their pursuit of success, they broke off ties with their parents. At least seven ran away from home in their early teens. The rest accomplished an early “artificial” separation by reaction-formation.
The depressed patient expressed guilt about not being a good son and for wanting too much. Before his parents and the public, opprobrium brought by failing one’s parents cannot be redeemed by material success. The latter only aggravates the guilt.
Points of difference between the depressed Filipino patient and his Western (American) counterpart may be speculated upon. Aside from differences in philosophies of child rearing, one encouraging dependence and the other autonomy, the unconscious fantasies behind ambition-driven behavior may also differ. The Filipino patient is in search of self-esteem, prestige, and values pertaining to enhancement of self. The Western patient fantasizes that with success he may regain happiness through a symbolic recapturing of the love of the people he left behind. He finds that success brings nothing of this and in fact can actually be an even lonelier position. The feeling of emptiness recapitulates the original feeling of rejection and leads to vicious self-hate. American culture places a premium on accomplishment and success. Filipino culture does not give unequivocal support to this goal. He must, first and foremost, be a good son; then and only then, may he also be successful.
These familial and cultural experiences lead to somewhat different psychological formulations. In the Filipino patient, internalization of parental figures does not occur as completely and thoroughly as in Western patients. He has not broken off ties with them to the same extent; they continue to be very much a part of his present reality. Moreover, he sees other people close to him—spouse, uncle, employer—as part parent or part superego, which affords him ease to split off externally some of his original ambivalence towards parents. A Western patient who regresses in depression is giving up the internalized love object, liberating self-destructive instincts and, if severe clinically, results in a psychotic depression. In the Filipino patient, since internalization of parental figures is incomplete, the regression seeks to re-establish the libidinal ties by coercing the superego representatives (wife, family) to be loving and thereby save one’s ego from further invasion of sadistic, destructive elements from the superego.
The Filipino patient in this study drove himself in the interest of self and, in his mind, over his parents’ entreaties. His drive and ambition were fueled by a symbolic rejection of his parents enabling him to get away from them and establishing a separate identity. Success was therefore achieved, symbolically as it were, over his mother’s dead body. The theory of “pathognomonic introjection” as Fenichel labelled it is not quite applicable to these Filipino patients. The formulations of ego psychologists, who see depression as an ego experience, may be more apropos of these patients.
Of this group, Myer Mendelson (1960) in his review cites Edward Bibring as the principal proponent. Bibring sees depression, not as “an inter-systemic conflict, i.e., by a conflict between ego and superego,” but as “stemming from conflict or tension within the ego itself.” Bibring, as reviewed by Mendelson, defines depression as “the emotional expression (indication) of a state of helplessness and powerlessness of the ego, introspective of what may have caused the breakdown of the mechanisms which established (the) self- esteem.”
Describing Bibring’s work, Mendelson (1960) says:
While acknowledging the great frequency of oral fixations in the predisposition to depression and of the orally dependent type among those so predisposed, he appealed to clinical experience to substantiate his thesis that self-esteem may be decreased in other ways than by the frustration of the need for affection and love. He outlined how self-esteem can be lowered and depression brought about by the frustration of other narcissistic aspirations, e.g., of “the wish to be good, not to be resentful, hostile, defiant, but to be loving, not to be dirty, but to be clean, etc.” which he associated not with the oral but with the anal phase. Depression over the lack of fulfillment of these aspirations will be colored by feelings of lack of control and weakness, i.e., by feelings of being too weak to control the libidinal and aggressive impulses or of guilt at this lack of control.
He described still another set of narcissistic aspirations which he believed were associated with the phallic phase. He characterized these as “the wish to be strong, superior, great, secure, not to be weak and insecure.” The depression and the loss of self-esteem resulting from the frustration of these wishes will be colored by feelings of inadequacy and inferiority.
The second paragraph would appear to apply to those patients who developed depressive reactions after failure experiences.
Ultimately, then, the depression following success or failure comes from a feeling that one has rendered himself unworthy of being loved. The love relationship which he has turned his back on, but which he never felt to have completely lost, is now perceived as having been totally cut off. In this respect, a similarity exists with a Western patient, who drives himself toward achievement and success with the fantasy that these things will bring him love. “Love me for what I can do” is the Western ethic. The depression comes when after having done everything, love does not come. The Filipino patient says “Love me for myself, in spite of my greed, ambitiousness and disobedience.” And it is in the hope of being forgiven and, hence, loved again, that the Filipino depressed patient saves himself from total annihilation. To the Western patient who develops depression after success, the painful realization that the expectation of love is a neurotic fantasy, brings him back to his feet. To the Filipino patient, repeated affirmation from still living and available sources of love around him, even if they are now second editions of the original love objects, suffice to preserve intact his ego.
The anal-sadistic components are not given the great emphasis they receive in Western depressions. These are what make the latter notorious for vicious self-hate. Their presence crystallizes the need for punishment in the form of mutilation or castration. Western patients display prominently obsessive-compulsive character organization. Filipino patients are more apt to belong to the “hysterical character” category. In the obsessional neuroses, “the genital organization has been replaced by the anal-sadistic one,” the self-destructive need for punishment predominates. In hysteria, “the feeling of guilt apparently predominates as remorse, longing, and fear of the loss of love.” (Nunberg 1955) Every psychiatrist who has dealt with such depressions knows that one gets a mixture of both elements; it is only the predominance of one over the other which makes the difference.