Approches psychodynamiques des troubles de l'humeur

Freud's works on melancholia highlight the relationship that exists between this disease and mourning, while pointing out that, contrarily to the person in mourning, the melancholic patient has lost a part of his ego, which relates to a narcissistic object relation. Abraham underlines the relationship between obsessive neurosis and melancholia and brings to light the ambivalence-induced conflict of melancholia: a fantasy of expulsion - incorporation of the object, associated to a deceiving conception of it (“primary deception”). On the basis of these ideas, Klein links up manic-depressive psychosis with the depressive position: a stage of total-object relations which, in these pathologies, corresponds to the introjection of an object that died because of the sadistic attacks of the subject. The works of contemporary authors underline several issues related to these problems: the role of identifications, the importance of ideal agencies, the exclusive attachment to external object, the negativity of the cyclothymic patients (denial of the internal reality, concept of “blank” object, pathology of the immobilized time and of the absence), and define the conditions of the psychotherapeutic approach of such diseases.