Report to Congress "Depression: psychological and psychodynamic ', Turin, October 16, 2004
We often do the questions that we will never find answers. C'immaginiamo a future that is not there. We try to predict what, how and when will change our lives. We can build a picture of the future. It is an act normal, spontaneous, characteristic of human beings. It is a simple gesture that helps us to live and dream. Who among us has not done? Yet, well look in our dream and imagine a possible future, performs important work out the small daily losses.
Inside of us we are fully aware of the slow changes imposed by life. S'incanutiscono hair and eyes see less. Change the way of interpreting life and every small event builds within us a new perception of itself. The hope, because everyone has one, is to live "better", so to speak. Next time ... change, change, change, and so ... lose, we lose, we lose.
is a paradox? No, absolutely not. Every time you conquer something new, a small part goes away. There remains the memory, as well as the sense of separation and loss. Is a common and indispensable for all human beings. But, if this is for everyone, because the person is sick when it is aware of the loss constant and continuous linked to life?
Maybe it's because we realize that none of us really loses something. There is always something in it, but something has changed. Within us keep the image of the relationship experienced what people call "memory." So the memory is the tiny space occupied by life events and placed in inaccessible places of the mind.
Some memories appear beautiful memory. Others less so, we are still suffering. Thus, the active memory a feeling which we give a color and emotion in which we live. Within us keep the image of the report, even when forgetting the events we lost.
Indeed, emotions and emotional experiences are never lost, but remain dormant waiting to express themselves.
Some people, however, are not able to leave the memories to oblivion: the event that triggered the feeling is still present in the consciousness and, in their daily activities, can not help but relive and express those feelings. And this, ironically, remains active even in the absence of the real thing. We are facing a state where the person continues to speak as if the event (and the "as if ..." is a "life motive" of many subjects), the time had stopped. Now, in the unconscious of men, time is a dimension that does not exist. Perceive either by past emotions, love and passion with the same vigor as when we were kids, but they are not constantly present to consciousness, they are only a few moments of life: in other words, the man has the ability to break away from some internal representations to devote to their vital activities.
Not all the memories, as we said before, you can set aside. Some of them are so loaded with affection spontaneously and completely unconscious, occur repeatedly in the consciousness of the subject. The strength of this action is, for some, so powerful that it has something to curse.
From a psychological point of view argue that the strength of these images is inherent in the trauma suffered by the subject. An intense emotion, when not expressed because the meta-object was not available, remains latent, always looking for a way forward. This is the real curse of psychic conflicts: they never stop for a lifetime. We find for them a form of expression acceptable to the ego, in mediation with the principle of reality or torture us for all existence.
This is the condemnation of the human race, forced to endure the frustration of not being able to satisfy in a simple and direct, their intimate needs.
This aspect, however, is common to all. The real difference is in the subject's ability to manage internal tensions.
For some people the loss is equivalent to internal disintegration. The ego, in its intimacy, fragmented and not sufficiently strong to recognize himself as a complete object, its integration in the search. The perception of the inner void is felt dramatically and the memory of an event already past, can not substitute for trauma. The individual continues to relate to the image of the situation. The remains unchanged over time of one's mind, in a desperate attempt to deny the trauma of separation and loss. Not always the losses related to real events, most often we are faced with people whose feelings of loss are the experiences that have no relation with the objective situation. I leave you to assume the bases on which we build an emotional relationship with each other.
Trauma is thus a state of mental imbalance generated by the internal structure and external situations that serve as activators of diseases.
A particular psychological imbalance is reflected in the experiences of depression in which the feeling of loss, of incompetence, denial and inadequacy are the basis of the relationship with the self.
The relationship with the image
It expresses the sensible form of the report with the object (be it a person, object or situation). It is the mental picture of a situation experienced, proven and therefore internalized. Through the image remains the relationship with each other and the free movement of energy: in practice we can express the feelings. It is thanks to it we can live in social relationships, establish relationships and move into the world. Not only that, thanks to the image we build our internal relationships.
is easy to think as we humans build relationships. In a dynamic sense whenever we experience a situation, we experience an inner experience: an experience that inevitably generates a feeling, an emotion. If things go well, we can circulate liberamente l'energia psichica nella relazione, ma se ciò non accade viviamo un'intensa situazione di disagio ed entriamo in conflitto con la realtà. Il trauma rappresenta appunto l'impossibilità di veicolare in modo diretto un'esigenza nata dalla parte profonda della mente, quella che sfugge all'attenzione della coscienza, poiché incompatibile con il principio di realtà.
Siamo così in una situazione di frustrazione per altro assai comune al genere umano.
Da questo punto in poi, la regolazione della relazione avverrà attraverso i meccanismi difensivi di ognuno e dalle fissazioni energetiche, vale a dire la forma delle esperienze che hanno tessuto la trama relazionale dello psichismo soggettivo definendo, così, il contenuto e l'intonazione affettiva della relazione. Il soggetto inizierà a vivere secondo schemi funzionali al proprio inconscio, realizzando attività finalizzate alla riduzione delle tensioni interne.
Il meccanismo della coazione a ripetere si regge appunto sulla possibilità di elaborare l'immagine interna, a volte inconscia, del conflitto psichico, partecipando in modo dinamico alla costruzione della vita umana e sociale.
Per entrare nello specifico dello stato depressivo, l'osservatore esterno riconoscerà nella depressione un particolare modo di vivere la relazione con l'immagine.
Il senso comune è ormai sviluppato per tutti e, quindi, siamo in grado di riconoscere un soggetto depresso: osservandolo, ne riconosciamo the loss of interest in the things of life, seems burdened with a painful sense of emptiness and psychic exhaustion, difficulty in building relationships. Also, we can just argue that his ability to build relationships has been greatly reduced, it has lost something. Depressed people have lost their relationship with each other and no matter what the event is real or perceived: they miss it.
These people, however, has recognized the irony of fate often lack the conscious representation of the loss. They live an affection and a feeling without being able to give form to emotion. It is certainly a state of unconscious conflict expressed mostly by a painful feeling. A conflict claimed internal image that has lost its ability to be represented in a form, so they say unconscious, where, however, sentiment, affection, the conscience is often so devastating.
In the psychoanalytic sense, in the psyche of people is a complex operation: the ego of the person, not being able to hold the gap and thus the loss of relationship, carries out of adjustment. In order to maintain psychic integrity, the self maintains, so forced, the relationship with the representative image of the object relation and enriches the feelings inherent in the loss. With a mechanism for deflection of reality, the image is as real to dump on it their vital forces. Eventually it wants to treat himself as the other, getting all the sensations described above.
The internal conflict is, therefore, primarily tied to the instance of the ego and the superego, in relation to the situation generated by the image unconscious. It feeds the internal and instinctual drives co-defensive mechanisms AI and subjective morality of the superego, which govern the outcome.
Depression is, therefore, a disease that occurs when the result is a loss situation perceived as traumatic. In fact the person hallucinates the presence of the object by passing the internal anguish in psychosomatic manifestations of depression: what is made possible by the psychic terrain of the subject, in which the masochistic type of relational matrices are over-represented. The object relationship
The report expresses the object interaction that occurs between the subject and an external object, whether person or situation. In the innermost dimension expresses the bond economy, often unconscious, that the subject establishes with external objects. It defines, in its essence, the special relationship maintained by the person with the outside world and, based on processes of mutual influence, shapes and quality to the relationship itself.
is so important to human life that a small alteration of this ability to compromise psychological balance of the subject, as it is in the other and with each other that we build our lives. During
psychic development, the subject creates the object relationship in respect of two internal addresses. In describing these choices, Freud recognizes a management-type "anaclitic" and another called "narcissistic." The object choice "anaclitic" refers to the model of relationship experienced with people or situations in life, usually the parents and the child environment. Otherwise, when the subject organizes his life as a model object having only the relationship itself, the pattern of action is "narcissistic." Subjects
very oriented to object choices of narcissistic, often fall into a depressive state. The search for the other, having him as a reference, tells of an individual incapable of building a true object relationship and adult. The individual does not organize the report according to a reciprocal relationship, but other lives as an extension of himself, which then depends on and is highly conditional. The people are depressed
in which the link with the object is of absolute importance. Do not have a particular need for love, as confirmation of their general relationship with the objective world. Morbidly attach to people or situations in hopes of finding safety and protection. I'm really "glued" to their objects and have a crazy fear of losing them.
The object for the depressed person has a defined purpose. In moments of greatest difficulty is the role of protector and helper, and is used exclusively to satisfy the need of "addiction."
loss, should fear, is experienced in a dramatic way and not just because there is a risk of losing a relationship but because, in the separation, a part of him is missing.
The dependence on the object, thus generating a strong ambivalence. Driven by the desire for love, the loss remains an ever present danger. So, if one part identifying the object leads to regression to integrate fragmented self, the other the sense of loss conveys an intense aggressive behavior. The internal object, the result of identification, thus becomes the target object on which to act aggression, feeding the sense of guilt and the desire for death. The vulnerability
depressive
behind the behavior of the depressed person are often the subject of a reduced ability to tolerate change, experienced as negative and, more often, as dangerous.
The affection of the loss engendered by placing themselves in a new situation requires the ability to tolerate the frustration of having to let go of something which is very close and from which depends deeply. It matters little whether the event is real or fantasy-internal), l'affetto percepito è assolutamente identico.
La dipendenza dall'amore dell'altro vincola i sentimenti della persona e palesa le difficoltà d'integrazione di sé. Avvia il processo d'elaborazione del lutto, sviluppando inizialmente stupore, incredulità, risentimento, angoscia, per diventare in seguito atteggiamento depresso. L'elemento psichico dell'angoscia generato da questa situazione subisce una trasformazione, per diventare manifestazione somatica della perdita.
Quest'operazione si struttura in modo del tutto inconscio nella psiche del soggetto. Le determinanti costituzionali quali il terreno psichico soggettivo, gli aspetti filogenetico ereditati e le parti ontogenetiche manifeste nelle diverse situazioni di vita sociale, constitute the decisive element in the structure of elementary human defense mechanisms and the development of future pathologies. The living environment becomes more than the intrinsic characteristics of the subject, the fundamental condition in which aspects of depression will show.
The causes, if we can start talking, you may recognize the person in need of love and responsibility assigned to the other of psychic autonomy. Individuals with these characteristics based on the recognition of self-confidence, esteem, on the encouragement and the support received from the other. When I forgive him, failure is always around the corner. Unable to cope with their lives making load of "self", I experienced the strong feelings of guilt. The accusations and criticisms are directed so that the ego divetano target of personal failings. The meaning and the need for punishment becomes a dominant thought. Anxiety undergoes a transformation and becomes visibly behavior worthlessness, and limited autopunente the depressed person: it seems that even in this condition the person psychological integration build on their "lack of success."
Man becomes the child of his childhood, the other employee in the material and emotional sustenance. The regression is always at hand. Unable to bear the blame for the frustration to reward failure. This "paste" all'oggetto perduto diventandone il persecutore.
"Posso resistere a tutto fuorché alle tentazioni" recitava Oscar Wilde in un suo aforisma. La mancanza, quindi il "dover rinunciare", sembra essere uno dei compiti più ardui nello sviluppo psichico dell'individuo. Così la ferula dell'educazione ha imposto ferite profonde nella trama delle relazioni psichiche umane e, non sempre, il senso di fallimento e di rinuncia definitiva si sono compensati nei rapporti con gli oggetti vitali.
Così come la ferita sanguina ed il dolore travolge, la depressione compensa. È un circolo vizioso poiché la depressione accresce i bisogni narcisistici i quali, a loro volta, aggravano i sintomi.
In sintesi è l'incapacità del soggetto a superare in modo integrato le diverse fasi dello sviluppo psico-affettivo a favorire le manifestazioni depresse, anche se va ricordato che non tutti coloro che vivono un lutto diventano depressi.
Il senso di colpa
In termini squisitamente psicodinamici, il senso di colpa rappresenta il motore stesso della depressione. È, in un certo qual modo, la risultante di un lavoro interno (processo di elaborazione) nel quale l'idea o la sensazione d'aver infranto, consciamente o no, delle regole portano a sperimentare questa sensazione penosa. Non è l'espressione di un dolore acuto, bensì l'eco di un disagio sottostante: un conflitto nel quale desideri contrapposti si sono scontrati nel campo di battaglia dell'inconscio.
From the desire of the object and the inability to own and control arises, therefore, the sense of guilt.
is always the expression of two opposing tensions: "the search for ..." and, "the impossibility a. .." When the subjective energies are missing and you can not repeat its attempts to satisfy unconscious, slowly takes over the sense of loss, inadequacy, inability. It literally depresses the system because it must maintain in their affection, but the result is deadlock, a situation where you do not go anywhere. Depressed does not mean reducing the quantum of internal energy, rather the opposite. The internal voltage increases feelings of hatred for the lost object is removed and turned into consciousness, thanks to the moral (superego) ego of the person who becomes, at this point, itself the target of his own unconscious aggression. In all this helps a good dose of masochism. The "I live the blame for that loss. Pour out upon him unconscious aggression - which once again reaffirms the need for and attachment to the external object - and is punished by becoming a martyr himself. After all, the victims often feel depressed. Who is the victim? Who is the murderer? Of course there is the persecutor. It is the internalized image of the relationship has become, itself, the replacement of the report object-relational or interrupted.
Today, and for reasons of intellectual honesty, we should recall Freud's statement by turning the image of the word guilt in that the "need for punishment." The basic idea and perhaps a little 'silly of our minds is that if expiated guilt, then the situation can be repaired. In fact this does not happen because, in meeting masochistically guilt, reactivate the suffering, as the sense of loss and powerlessness of the subject.
is painful but you have the sensation of seeing a man eat without ever satiate, where the hunger for love and vacuum formed contraltari ubiquitous lack of persecutory guilt.
We can say, a questo punto, quanto il persecutore aiuta il depresso a contenere l'angoscia interna. Vincolandola in un sintomo, la depressione appunto, l'energia psichica fluttuante si lega al persecutore e mantiene la relazione con l'oggetto. L'esito di questo lavoro si vede poi nei meccanismi di difesa utilizzati e dai quadri patologici evidenziati dalle persone.
Per ricordare, la depressione è uno stato psichico, qualificato da un abbassamento del tono affettivo ed emotivo. Causa un'importante caduta dell'autostima con sfiducia ed odio per il mancato soddisfacimento, si manifesta con la tendenza all'isolamento e con la mancanza d'incentivi e d'impegno per i compiti della vita, è convenzionalmente descritta all'interno di due quadri sintomatologici: endogenous depression and reactive depression.
The causes are rooted in the history of the first phylogenetic and onto the individual. It has a major impact because inevitably fluctuates in manic-depressive aspects. The enduring sadness, but also an altered state of excitement, accompanied by thoughts of misery, guilt, acting on the need for punishment and expiation. Fomenting the depersonalization and lack emotional, intimate feel of the subject.
For reactive depression, the situation is simpler. The person maintains a performance limits of a state sympathetic to the psychopathology. The melancholy mood, exacerbated by negative experiences and painful processes affect the elaboration of the subject, but limits in a moderate influence on the vital subject because the intrinsic possibility of mourning will lead to establishing new relationships and investment object.
Suicide
In promoting suicide melancholy boasts a great privilege. Affected by a mental disorder, suicide is recognized as an act strange, enigmatic, inexplicable and contrary to the natural and social. It is the reaction most relevant to conduct a self-destructive order essentially affective. In depression, suicidal behaviors are quite large. There is only the physical suicide, but also the mental, caused by the isolation, the denial of social contact, expression the difficulty in maintaining a relationship with oneself is not tormented by anxiety, the sense of pain and fear of the moment that will follow the current. All depressed
show, in clinical practice, ideas of suicide. Not all potential "suicide," however, have really taken this extreme action. The move represented the idea of \u200b\u200bsuicide when true, it requires a mental transformation is so important to change the relational structure of the subject with their own self-image.
The strength of such an act comes only at the end of a hard, exhausting and disheartening in which the perception of conflicting inner feelings, often experienced as negative and dangerous, leading to internal collapse of self-esteem.
The subject, when it is in the vital relationships to have to deal with the perception of not having an inner base in a position to give assurances, no longer able to give a color to life: it is absolutely achromatic or black, as most people often say in analysis. In this condition soon the sense of apathy and take possession of invalidity of the person to become despair. Living
this dismay fully committed person's life as reflected in the notes of the unconscious, power failure and present of all existence. Think of "get out", to use a metaphor, it becomes much more of a thought. Become an idea, sometimes nagging, one solution. No longer holds the contrast with the internal object, death takes the color of peace, inner peace from the demon: the pervasive sense of guilt and anguish.
Life employment with emotional others often leaves no solution. Suicide becomes the ultimate gesture in which the subject reconstructs his psychic integrity, if only for a moment, and finally breaks the relationship with the persecutory object. The depressed this search: desperately wants to regain the power of life and death and leave a tangible sign. Needless to say, the act is very aggressive, because there is the idea of \u200b\u200bhitting the other through violence directed at their person.
To simplify, one could argue the veracity of a statement that often hovers in the feelings of people who are depressed during the long monologues of the analysis. "Suicide proves your inability to look after so if you can not look after me as a person overall, to look after the memory of me". One known exception is the "damage" suffered by the families of people killed by suicide. Note
more pathological then the situation is not so much suicide as such, it is often thought of as an extreme act that created, because the attachment to depressive symptoms.
In many cases of work I was told, "Doctor get back to my symptoms, the ones I know them and people are socially integrated, but the singularity of the depressed person to keep the relationship at this point libido, with the symptom is amazing.
"I'm the doctor who did not want to get well." "I allowed my husband to get me all this. For I have not done anything?". "I have a feeling of being I do not want to feel good." "I lost the desire for everything. I just want to stay in my corner, as the chair of asylum."
The allegations, reported by the books of the sitting, are not encouraging. They taste of renunciation. But people do not stop groped, even if the direction is not consistent with the survival instinct.
The primary impulse is to flee. There is a need to move away from guilt, unconscious from the claim of being responsible for the suffering of others, the weight of this aggression is not accepted and acted against themselves. The feel is imminent disaster caused by the inner sense of guilt from which there is no way out.
The complex of guilt-expiation comes to suicide when sentiment becomes unmanageable and remorse feed relentlessly intrapsychic conflict.
In fact the act does not occur with a linearity of this type. The final self-destructive act is carried out only when the subject, as a result of suffering, often far from consciousness, but not always, can not maintain the minimum basic relationship to the preservation of its structure psychic. The narcissistic investment on the ego is impoverished to the point of itself become an object among objects, so potersene leave, just as you would with broken plate of the pantry. Conclusions
Depression is today called the evil of the century. Many of the roots belonging to the inner world of the subject and have little to do with the current living conditions. People seem afflicted by life. Burdened by the newspaper can no longer find the courage to stop to listen, to talk about, to see themselves and that world unknown to the sphere of infinite consciousness.
care are possible. Are not simple. Above all, do not respond to a request for linear solution. The matrices unconscious depression are supported by an experience as old as the subject and have been built by successive small lesions psychic. The girl in the chair alone kindergarten is only a static picture of a life much larger. Today, the etiology of depression does not contribute in the search for the event, with the capital E. I note simply a constellation of events characterized by large and small losses.
People were full of energy but were not able to handle an influx so large in the psyche, have been forced to implement the most basic defense mechanisms. The denial, the systematization of the event in its opposite are just one example of unconscious defenses activated by the mind.
Today we tend to rationalize everything. We would like an explanation for everything but how can you explain a love if we do not live? And then the solution is to stop and analyze the affects. Then you must break up the puzzle in emotional relationships because, just passing through abreaction of his psychic conflicts we can rebuild.
The goal is not to become happy, you live in accord with the environment, supported by an inner serenity that can withstand the daily attacks. Sometimes the actions in this path are combined. The medicine helps. Psychology helps. But the only thing they can not do science is the path: this domain is only dell'uomo. E, se esiste il libero arbitrio, in questo l'uomo lo può esprimere.
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