The Severe Superego and Guilt

Along with narcissistic vulnerability and related affects of shame, helplessness, or reactive anger, conscious or unconscious guilt often cripples depressed patients. Some patients reveal deep-seated feelings that they are bad or unworthy and are prone to attacking themselves through self-criticisms or punishments when they sense that they are behaving in an aggressive, competitive, or overly sexual manner. Examples of this are the cases of Ms. G in Chapters 4 (Getting Started With...

Defense Mechanisms in Depression

Psychoanalytic theorists have considered the possibility that certain defenses (i.e., internal or behavioral means of averting painful feelings or threatening unconscious fantasies) either may be specifically mobilized by depressive affects or may predispose individuals to the development of depressive syndromes (Brenner 1975 Jacobson 1971). Bloch et. al (1993) described three possibilities in this regard 1) defenses may become structured in response to a chronic mood disturbance 2) maladaptive...

Idealization and Devaluation

A s discussed in Chapter 8, depressed patients can have scrupulously held moral standards. Additionally, their personal expectations of themselves in other realms of endeavor can be unrealistic. These attitudes are rooted in an excessively perfectionistic ego ideal. The ego ideal, considered to be another dimension of the superego, establishes goals to be met and attributes to be held for the person to consider the self praiseworthy or deserving of respect. Failures to meet excessive...