Key points
- “Introjective” or “melancholic” depression is characterized by self-criticism, self-punitiveness, and guilt.
- "Anaclitic" depression is characterized by sensitivity to rejection, emptiness, inadequacy, and shame.
- Progress in therapy with depressive people may involve making evident and reducing the grip of guilt or shame.
Generally, depression is a state accompanied by unremitting sadness, lack of energy, anhedonia (inability to enjoy simple things), as well as problems in eating, sleeping, and keeping normal levels of energy. Yet, depression cannot be defined as a singular condition.
Blatt and his colleagues (1993, 2008) distinguished between two kinds of depressive disorders: “introjective” (called “melancholic” by early psychoanalysts), which is characterized by self-criticism, self-punitiveness, and is dominated by guilt; and “anaclitic,” which is characterized by sensitivity to rejection, as well as feelings of emptiness and inadequacy, and is dominated by shame.
In both types, we are talking about the experience of loss, in one way or another. Already at the beginning of the 20th century, it was noted by such prominent clinicians of the time as Freud and Abraham that people in depressed states direct negative feelings (such as anger or envy) away from others to protect them from negative outbursts and toward themselves, for some reason hating themselves out of all proportion to their actual flaws. It was later elaborated that a precursor to a depressive state is the experience of premature loss, usually in childhood.
Adult individuals who came to psychoanalytic treatment connected their depressive episodes in their adult life to early childhood experiences, often forgotten or repressed. Among such experiences were the passing away of important family members, imprisonment of a father, a depressive primary caregiver, emotional detachment and coldness emanating from parents, or when the child had been used as a family mediator between the parents, to name a few.
So, what are the differences between these two types of depression?
Introjective Depression
It is called that because of introjection—the way a child learns to react to the world. The main introjective feeling here is guilt. This guilt is directed inward—the person tends to blame themselves. This readiness to blame themselves may be a residue of their belief that the source of their unhappiness lies within themselves, thereby preserving hope that only self-improvement (note the “only” and the “self” here) can alter their circumstances.
People with introjective depression tend to idealize other people and remember them fondly, as well as criticize themselves and ascribe negative attributes to themselves only. It is very difficult for them to accept that the opposite can also be possible—others can be objectively guilty of something, and the person is totally in the right. Introjective depression was shown to appear in families where caregivers are negligent, abusive, distant, or very fragile, while also denying responsibility for such behaviors.
The family also withholds the right of mourning for the young person, through which they could understand and process why a person divorced or died. Nancy McWilliams gives the example of a father who prohibited his daughter from grieving over her deceased mother because it worsened his ulcer.
Thus, introjectively inclined depressive people see themselves as the only source of their misfortunes and generalize themselves as selfish or destructive, in comparison to other people whom they idealize, even if they are negligent or abusive.
Introjectively depressed individuals work hard to be “good,” but rarely succeed to their satisfaction, because the issue is, of course, not in their badness, but in how they perceive themselves as morally inferior to others.
Anaclitic Depression
Anaclitic means relating to a strong emotional dependence on others. We know that children are existentially dependent, and if those on whom they must depend have proven themselves unreliable, the child might experience the loss of the relationship and the shame of feeling diminished or nonexistent in this relationship. The children of grandiose narcissists, who manipulate children and try to use them, are prone to the anaclitic type of depression.
The anaclitically depressed person’s distress lies in the perception that life is empty, meaningless, and uninfluenceable, and they are left with a chronic sense of incompleteness, emptiness, futility, and despair. Since their early relationships weren’t full enough, they see life as meaningless and feel loneliness in this big world. Their psychologies are therefore organized around themes of relationship, affection, trust, intimacy, and warmth—or their absence.
Whereas introjective depression is full of blaming internalizations of internalized adult figures (“the voice of my mother is speaking in me”), the anaclitic is too empty of any internalizations that could give a person any direction. It is a depleted state of mind in which the person is struggling relationally.
With anaclictic depression, treatments are not to be limited to a certain number of sessions, because though they may provide relief, the person might perceive the relationship with the therapist as another relationship that was cut short traumatically. Working in open-ended therapy and addressing the feeling of emptiness and shame for as long as needed teaches the person that long-term meaningful relationships can be maintained and brought out from therapy into everyday life.
Shedler and Westen et al. empirically identified depressive conditions in which both introjective and anaclitic features may be present.
Conclusion
Depressive people are often pleasant to communicate with because they try to please other people, be helpful, and prove their worth. They are naturally appreciative of relationships and seem nonaggressive, as they aim hatred and criticism inward rather than outward. They are also usually generous, sensitive, and very compassionate.
However, people living with depressive individuals find it difficult to be around them 24/7, as it takes a psychological toll.
Good progress in therapy with depressive people involves making evident and reducing the grip of either guilt or shame, depending on the type of depression. Providing them with tools to express disappointment, anger, envy, and criticism in constructive ways, as well as establishing and retaining the balance between idealization of others and deidealization of themselves to a more objective version of reality—where it’s OK to be disappointed in people who behave inappropriately and to be proud of themselves and happy without any particular reason.
For more information on depression and anger and the guilt-versus-shame dynamic, read my previous posts.
Via PT