Disorders and Treatment
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Despite the fact that depression is one of the most commonly experienced mental disorders in the world, the psychiatric community lacks a common understanding as to its cause or approach to treatment.
Mental illness, unlike physical illness, is not subject to external measurement. Because the field of psychology is not a unified one, there are many conflicting opinions as to the best approach for diagnosing or treating mental illness. While the defining characteristics of depression are commonly accepted, the source of the problem and the approach to treatment varies.
This article is a brief synopsis of what is arguably the earliest defined and best known of many theories, perhaps because it was advocated by the famous Dr. Sigmund Freud during the 19th century.
The psychoanalytic approach to understanding and treating depression predicates that the mind is composed of the Id and the Superego (together, the unconscious mind), and the Ego (the conscious mind), as first theorized by Dr. Freud. Freud believed that the Ego is the mediator between the conflicting Id and Superego, and that anxiety was rooted in that conflict. He believed that these unresolved conflicts of our childhood, including the incomplete separation of the inner self from our parents as we matured, were hidden deep within the unconscious mind. These conflicts negatively affected the development of the adult personality, causing depression.
Freud believed that the only cure for depression would be for the patient, guided by the psychoanalyst, to open themselves to recapturing memories - preferably bad ones - from childhood. The idea would be to root out the painful and unresolved issues that have caused the depression and address them. It was believed that only in this manner could the patient achieve a healthy, fully formed personality and become free from the pain of depression.
Psychoanalysis involved getting the patient to relax and then guiding them to the recall of their earliest memories. The psychoanalyst would have some tools available to facilitate this process, including Rorschach ink blots, which could give evidence of unconscious connections; the analysis of the meaning of Freudian slips, in which a patient will mistakenly utter a word that is purported to represent what is truly on the patient’s mind, because Freud believed that all behavior is determined; free association, wherein a patient responds spontaneously to a word spoken by the therapist, perhaps sparking some previously unstated thoughts or feelings; and dream analysis, where the actual remembered details of the dream were believed to be symbolic of unconscious feelings and memories.
Once problem areas were uncovered it was up to the psychoanalyst to guide the patient to a healthier understanding of the issues and, hopefully, an emotional healing.
Psychoanalysis could be extremely painful and time-consuming, and patients had to be prepared to devote much time and effort to the process, with the full knowledge that it isn’t always successful.
Psychoanalysis is what is known as a “global therapy.” Global therapies have the aim of rebuilding the patient’s sense of their relationship to the world by changing their entire outlook. This is in contrast to more frequently used modern therapies, like cognitive or behavioral therapy, which seek only to ameliorate symptoms.
Psychoanalysis is less often used today, partly for economic reasons – insurers might believe that medication is faster and cheaper – and partly because patients today might have less time available to spend “on the couch” and more interest in a quick resolution of their symptoms.
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