By Julie Le Franc, Psychotherapist and Psychologist
Sigmund Freud, father of psychoanalysis, discovered through his pioneering self-analysis that he had unconscious neurotic mechanisms that made him experience symptoms of anxiety and depression. In his seminal work Mourning and Melancholia (1915), Freud described all of the symptoms of a severe and debilitating major depressive disorder amongst patient’s mourning the loss of a loved one.
His description of the symptoms of melancholia satisfied most of the diagnostic criteria today in DSM-IV for “Major Depressive Disorder, severe, with Melancholia”. Freud demonstrated that psychological mechanisms could lead to a severe and life-threatening medical illness.
Sigmund Freud not only developed a theory of the mind (e.g. conscious and unconscious mind, the id, ego and superego), but also a treatment modality using his psychoanalytical theory.
The experience of clinicians over the years since Freud wrote Mourning and Melancholia and the findings of extensive research into the treatment of major depressive disorders has demonstrated that when patients are medically ill with a major depressive disorder, psychoanalysis alone is not enough.
Indeed, medical treatment with psychotropic drugs that act on serotonin and noradrenaline neurotransmitter systems are essential to restore patients to a level of health and functioning that then enables psychoanalysis to work for those with Major Depressive Disorder with Melancholia. This is because major depressive disorders cause impairment in cognition as well as energy and motivation. For clinically depressed patients, it can be a huge struggle to get out of bed in the morning, yet alone attend diligently for weekly sessions of psychoanalysis.
Sigmund Freud demonstrated how the process of loss and mourning could lead to an illness called melancholia. Other psychological traumas, apart from loss can also literally make your patients ill. Frequently, the psychological trauma required to make someone ill can be so painful that your patient may not want to know about it i.e. it is pushed into the unconscious mind.
The patient may need to be treated with antidepressant drugs, and will benefit from psychoanalysis to look into the unconscious and face the pain and anxiety in a safe and structured therapeutic space.
We have witnessed many times, patients developing a deep insight and understanding into what was previously unconscious. This has enabled them to deal effectively to heal their unconscious wounds. This active process of becoming conscious and ‘sorting out’ previously unconscious issues is called ‘working through’ in psychoanalysis.
Patients achieve this through developing understanding, acceptance, forgiveness and making reparation with the most important people in their lives (e.g. parents, siblings, partners and children).
Research has shown that brief psychoanalytical psychotherapy (45 – 50 min. once a week with the duration of being less than one year) is highly effective (Howard, 1998).
A good outcome from antidepressant medication and psychoanalysis includes a significantly reduced risk of relapse of major depressive disorder into the future.
So what does depression have to do with Sigmund Freud?
If he had access to SSRI antidepressants, Freud would have prescribed them, thereby helping people with his psychoanalytic treatment.
Howard, E. (1998). Mourning and Melancholia. The standard edition of the complete psychological works of Sigmund Freud. Translated from the German under the General Editorship of James Strachey. In Collaboration with Anna Freud. Vol XIV. The Hogarth Press, London.
Supported with Educational Grant from Solvay Pharmaceutical.
The Medical Link August/September 2006 – issue number 048