Essential Depression

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ESSENTIAL DEPRESSION

The notion of essential depression was introduced by Pierre Marty in his 1966 article "La dépression essentielle," shortly after the notion of "operative thought," and it became a clinical construct in the treatment of psychosomatic disorders. The term essential depression emerged after "depression without an object" and is a more appropriate name than the latter because the phenomenon it describes constitutes the very essence of depression.

Essential depression involves a reduction in the level of both object-libido and narcissistic libido, without any positive economic counterpart, and thus without any libidinal connection at the relational level; this distinguishes it from other depressions of the neurotic or even psychotic type. This specificity of the relational mode with the investigator, an analogue for the overall relational mode, indicatesa diagnosis of this type of depression, which can be difficult to detect. Everything seems to take place without visible emotion, flattening any underlying drama or internal conflict. This absence of any nameable affect is comparable to the hypothesis of alexithymia: We find something like an erasure of the dynamic capacities of the basic mental functions across the entire spectrum—the absence of any vital link gives the impression of a functional breakdown. According to Marty, this abrasion of libidinal bonds and impression of fragmentation constitute the very definition of the death instinct (it should be recalled that Marty envisions the death instinct as a deficiency of individual movements of life without the opposing destructive charge carried by the death instinct as theorized by Sigmund Freud). However, adds Marty, "although essential depressives thus seem always to carry phenomena of death within themselves, the libido seems to be extinguished only when life is extinguished, except in certain rare cases." In such cases, he contends, the ego ceases to exist as an agency within the psychic apparatus.

Marty subsequently introduced this clinical construct into his work as a pivotal notion, along with "operative thought"—all within the framework of "disorganization" that is part of his model of the somatization process. His most extensive account is found in Les mouvements individuels de vie et de mort. Vol. 2: L'Ordre psychosomatique (Individual movements of life and death. Vol. 2: The psychosomatic order; 1980), where he emphasizes one of the main signs of essential depression: The disappearance of unconscious feelings of guilt in an ego that only poorly fulfills its roles of linking, distribution, and defense. He once again underscores the fragility of the preconscious at this stage. The deficit of this symptom is thus situated within the psyche, and somatic disturbances are the result within a system that is defensive and yet disorganizing in response to trauma. He theorizes that this phase is preceded by an automatic, diffuse anxiety that is related to anxiety neurosis, which for its part cannot be understood as an alarm signal that should trigger the mental defenses. In the first volume of Les mouvements individuels de vie et de mort, subtitled Essai d'économie psychosomatique (Essay on psychosomatic economy; 1976), Marty hypothesizes that the passage into essential depression occurs through depletion of the "anxiety apparatus" at the expense of psychic functioning.

Alain Fine

See also: Character neurosis; Depression; Disintegration, feelings of, (anxieties); Disorganization; Mentalization; Negative, work of the; Operational thinking; Psychosomatic.