Psychological theories provide evidence-based explanations for why people think, behave, and feel the way they do. Personality factors, history and early experiences; and interpersonal relationships are seen as important factors in causing depression. Unlike biology, psychology is not truly a unified field. There are still many disagreements within the field as to what subjects are important to focus on and what methods are best to use for studying them. Different schools of thought within psychology have developed their own theories as to why someone becomes depressed.
Psychodynamic theory was the leading school of thought within psychiatry and much of clinical psychology during the first part of the 1900s. It guided ideas about how therapy should be conducted. Early approaches focused on the interrelationship of the mind and mental, emotional, or motivational forces that interact to shape a personality. Dr. Sigmund Freud is credited with inventing psychodynamic theory and psychoanalysis. He suggested that the unconscious mind is divided into three parts. These parts include the:
- Id - this is the irrational and impulsive part that is a representation of primal animal desires
- Super-ego - which is the judgmental part that is a representation of the rules of society inside the mind
- Ego - the rational part which tries to bridge the other two parts.
According to Freud, the conscious and unconscious parts of the mind can come into conflict with one another. This produces repression. Repression is a state where you are unaware of having certain troubling motives, wishes or desires but they still influence you negatively. In general, psychodynamic theories suggest that a person must successfully resolve early developmental conflicts in order to overcome repression and achieve mental health. These conflicts might include gaining trust, affection, successful interpersonal relationships, and mastering body functions. Mental illness is a failure to resolve these conflicts.
There are multiple explanations that fall under the psychodynamic "umbrella" that explain why a person develops depressive symptoms. Psychoanalysts historically believed that depression was caused by anger converted into self-hatred ("anger turned inward"). A typical example regarding how this transformation was thought to play out may be helpful in further explaining this theory.
Neurotic parents who are inconsistent (both overindulgent and demanding), lacking in warmth, inconsiderate, angry, or driven by their own selfish needs create an unpredictable, hostile world for a child. As a result, the child feels alone, confused, helpless and angry. However, the child also knows that the powerful parents are his or her only means of survival. Out of fear, love, and guilt, the child repressed their anger toward the parents and turns it inwards so that it becomes an anger directed towards him or herself. A "despised" self-concept starts to form. The child finds it comfortable to think thoughts along the lines of "I am an unlovable and bad person." At the same time, the child also strives to present a perfect, idealized image to the parents as a means of dealing with for perceived weaknesses that make him or her "unacceptable". Caught between the belief that he or she is unacceptable, and the desire to act perfectly to get parental love, the child becomes "neurotic." This means they are likely to experience a great deal of anxious or depressed feelings. The child also feels a constant sense that he or she is not good enough, no matter how hard he or she tries.
This neurotic need to please and constant failure to do so can easily spread beyond the situation in which it first appears. The child might start to feel a neurotic need to be loved by everyone, including all friends, all family members, co-workers, etc. The goal of a traditional psychodynamic therapy might be to help the child, who is now an adult, to gain insight into the mistaken foundations of beliefs about badness and inadequacy so that the need to punish himself/herself and to be perfect decreases.
Psychodynamic theory has changed a fair amount over its long history. Many variations of the original theory are available today. One popular branch of modern psychodynamic theory is known as object relations theory. This theory is concerned with how people understand and mentally represent their relationships with others. The "objects" in object relations theory are representations of people. This is how other people are experienced, represented and remembered by each person. According to object relations theory, people's moods, emotions and many other aspects of their personalities can only be properly understood by the relationships those people have experienced. It is a basic assumption of the theory that early relationships tend to set the tone for later relationships.
According to this theory, depression is caused by problems people have in developing representations of healthy relationships. Depression is a consequence of an ongoing struggle that people with depression endure in order to try and maintain emotional contact with desired objects. There are two basic ways that this process can play out: the anaclitic pattern, and the introjective pattern. Even though these terms are not currently used in the DSM, some therapists may still use them to label different types of depression.
Anaclitic depression involves a person who feels dependent upon relationships with others. They grieve over the threatened or actual loss of those relationships. This type is caused by the disruption of a caregiving relationship with a primary object. It is characterized by feelings of helplessness and weakness. A person with anaclitic depression experiences intense fears of abandonment and desperately struggles to maintain direct physical contact with the need-gratifying object.
Introjective depression occurs when a person feels that they have failed to meet their own standards or the standards of important others and that they are failures. This type comes from a harsh, unrelenting, highly critical superego that creates feelings of worthlessness, guilt and a sense of having failure. A person with introjective depression experiences intense fears of losing approval, recognition, and love from a desired object.
Historically, psychodynamic theories were extensively criticized for their lack of interest in exposing their theories to scientific testing. This is known as a lack of empiricism. However, this has started to change recently. Another modern version of psychodynamic theory, Coyne's interpersonal theory of depression has been studied extensively. It forms the basis of a very effective treatment option known as Interpersonal Therapy or IPT. According to interpersonal theory, a person with depression has negative interpersonal behaviors that cause other people to reject them. In an escalating cycle, people with depression, who desperately want reassurance from others, start to make an increasing number of requests for reassurance. The other people to whom those requests are made start to negatively think about, avoid, and reject the people with depression or become depressed themselves. The symptoms of the people with depression then start to get worse as a result of other people's rejection and avoidance of them. Interpersonal Therapy has been designed to help people with depression break out of this negative spiral. We'll have more to say about IPT in the treatment sections of this center.