Kratak osvrt na melankoličnu depresiju – Drugi dio

Brief History

Melancholy is a concept that has been known since ancient times and has been thought about, studied, and sought to be defined. This concept, which has attracted people’s attention and interest, has been evaluated by different disciplines within their own subjectivities. I think the reason for this is that melancholy has a subjectivity of its own. This subjectivity has been objectified over time by different disciplines through the addition of connotations, and it has been handled in line with the characteristics of each era. For example, in Ancient Greece it was evaluated within the field of medicine and, under the influence of Hippocrates, was addressed within the framework of disease (Teber S., 2002). With the definitions of Theophrastus and Aristotle, it began to be used more in relation to literature and art; in the medieval period, efforts to conceptualize the term were set aside and it was said to be nothing more than laziness and idleness. In modern periods, melancholy was taken up again and efforts were made to understand it; it became a common topic of investigation for interconnected disciplines such as psychology, sociology, and literature. Aristotle’s question—“Whether he be a philosopher, statesman, poet, or artist, why are all men of outstanding ability clearly melancholic?”—opened a new door for investigating both that melancholy is a condition different from depression and that it is connected with creativity and intellectual activity, and ultimately for understanding melancholy in later periods. Although melancholy contains affects such as anxiety, fear, despondency, and grief, understanding melancholy is only possible within its own subjectivity.

The melancholic human character appears in written culture for the first time in Homer’s epics (Teber S., 2002). Although the word “melancholy” is not used in Homer’s epics, the temperament and melancholic behaviors of some heroes are presented in a highly vivid manner. Among these, Bellerophon and Ajax stand out most sharply; and, though not to the same extent, Agamemnon is also seen to exhibit mental behaviors characteristic of melancholy (Teber S., 2004). As narrated in the Iliad, Bellerophon is punished by the gods by being condemned to a completely lonely life. Although the reason for this punishment is unknown, the Iliad refers to the pains and sufferings Bellerophon endures (Homer, Iliad). “Bellerophon is the first melancholic personality identified by written secular history, the first archetype, and he served as a source for the famous physician Aretaeus of Cappadocia in Ancient times as he developed the manic–melancholic approach” (Teber S., 2002). Aretaeus proposed that feelings of sadness and fear lie behind angry and aggressive behaviors, and he defined melancholy as a kind of darkening of the soul and internal organs brought about by anger (Teber S., 2002).

In Homer’s period, melancholy was explained through a serious chain of definitions (Homer, Iliad), which indicates the importance attributed to it. The conceptualizations developed for various variations of melancholy reflect not only bodily or psychic sources, but also a kind of unity/relationship of body and soul. Some of the terms used include darkening, becoming angry, the chest region, and the body’s middle region (Teber, 2002).

The body’s middle region encompasses the chest and upper abdominal area. It is defined as the source of breath and the location of a “seventh sense,” and it is characterized as a region that includes organs such as the lungs, stomach, and heart. Although this may seem like a purely bodily explanation, the emphasis on this region actually points to the unity of body and soul. The reason is that the darkening of this region was believed to occur not as a bodily disorder but as a result of a psychologically driven effect. According to the same view, certain everyday experiences could also alter the state of this region and even lead to differences in the anatomy of the body. The term “darkening” also points, in parallel with views about the middle region of the body, to the darkening of internal organs. Accordingly, as a result of becoming angry, the invisible inner parts of the body darken and swell. This more often emerges as a result of the intensification of emotions that are not expressed outwardly. Fears, excitements, sorrow, and anxiety accumulate in the inner regions of the body and darken them. “Darkening” occurs both in the chest and upper abdominal regions with the accumulation of blood and bile, and also as a result of other emotional accumulations such as excitement and anger. This is an anatomical, physiological, and psychic darkening. The “darkening of the middle region” arises more from experienced events than from organ disorders (Teber S., 2002).

When we look at Homer’s epics, melancholy appears when heroes are overcome by anger or punished by the gods, and this leads to loneliness, distress, meaninglessness, and, in some places, suicidal behavior. In addition, the emphasis on the body in the epics and the idea that certain bodily changes are psychically interactive provided important clues for Hippocrates, Aristotle, and Theophrastus, who later described melancholy in considerable detail.

In antiquity, the dominant basic idea regarding melancholy was the doctrine of the four humors, “Quattuor Humores.” According to this, there are fundamentally four humors in the human body, and these determine a person’s constitution and character in different ways: blood, phlegm, yellow bile, and black bile (Dörthe Binkert). The humor that produces melancholy is identified as “black bile” (Pamuk O., 2003). These four humors also correspond to stages of life, elements, and seasons. They increase or decrease according to life stages or seasonal periods. The idea that black bile is the cause of melancholy and even madness is generally dominant until the medieval period. Rufus of Ephesus (2nd century AD) treated the subject in depth in “Bodily and Psychic Analyses,” which is an important source on the topic.

In Hippocratic writings, melancholy as black bile essentially refers to an “internal,” “embedded within the chest,” immanent, bodily impairment of health—a state of illness. Accordingly, the drying of the fluid secreted by the gallbladder causes the gallbladder to emit a kind of poison. The stomach, liver, intestines, and head are affected, and this results in clouding of consciousness. “In melancholics, insomnia, fear attacks, withdrawal from the environment, absent-mindedness, anger crises, and sorrow are seen. These people do not want to talk. When asked, they give short and reluctant answers. The chest region of melancholics is especially sensitive and painful. Vomiting occurs.” Although these seem largely like bodily analyses, for Hippocrates melancholy is not an affective disorder but rather a bodily-origin illness (as cited from Hippocrates by Serol Teber, 2004).

Aristotle and Theophrastus’s Problems XXX is the first known work written on melancholy. The most important emphasis in this book is the establishment of a relationship between melancholic temperament and art/creativity. At the same time, they argued that the prevailing “black bile”–dominant approach in antiquity was insufficient to explain melancholy.

Throughout the Middle Ages, melancholy was treated as a negative concept, shaped—as is known—by the influence of Christian culture. It was hardly possible in that period to speak of Aristotle’s affirmative view of melancholy from antiquity. Melancholy, which in antiquity was evaluated as a way of life, became, in the Middle Ages, a matter of unbelief, rebellion against divine order, and thus acedia—a mortal sin. In other words, melancholy moved away from an immanent domain toward a transcendent one (Teber S., 2002).

In antiquity, melancholic personalities generally attributed to extraordinary people were depicted in medieval artworks as sluggish, weary, lazy individuals of quite average intelligence. For centuries, the concept of melancholy continued to be perceived in this way (Demiralp O., 1999). By the Enlightenment, it is notable that the words acedia/melancholy were almost never used. Diderot and his colleagues’ Encyclopedia also does not include the word “acedia” (Teber S., 2002). In the Enlightenment, melancholy came to be associated with new forms of life. Qualifiers such as madness and insanity brought with them a negative view that also encompassed melancholy. When we recall that Michel Foucault’s History of Madness covers the period between the 15th and 18th centuries, this becomes even clearer (Foucault M., 1972). These are the periods in which the places vacated by lepers were allocated to the mad and the “great confinement” took place. “Erasmus wrote In Praise of Folly in 1509; then came Thomas More’s and Campanella’s works, Utopia and The City of the Sun, which can be defined as anti-mad society projects” (Teber S., 2002). These works are subjective responses to the rising humanist impulse to reshape society. According to the general view of humanist writers, “Where people are unhappy, poor, rebellious, barbaric, inclined to revolt; where the land is barren and swampy; where cities are filthy; where public works go badly—there the people are restless. Society is like a sick body; its humors are not in a good mixture; it has not been sufficiently cleansed. There the spirit is melancholic. Epidemics of madness are seen. There is a need for urgent reforms” (Teber S., 2004).

The above, in a way, reveals the approach of the movement called humanism to melancholy. Subjectivities and ways of life that were beginning to free themselves from religious authorities were now forced to conform to the rigid normative system of rationalism. Those who did not/could not conform were no longer defined as “sinful/impious,” but rather as “mindless/mad” or “wretched/insane.” The mindless mad were now excluded from “enlightened society.” The reason is that, against the work ethic highly exalted at the time, melancholics and the mad were not included in the production process. Therefore, as Foucault shows, psychiatry acquired the authority to confine and “treat” the “mad” in the name of society and the state, with labels such as “freeloaders” (Foucault M., 1972).

To summarize the historical and theoretical development of melancholy: it is possible to say that the connection established in antiquity between melancholy and creativity/intellectual ability gradually gave way to an identification with marginal characters who stood outside society. Perhaps it would not be wrong to think that, in this respect, melancholy has a problem with powers-that-be.

Melancholy from a Psychoanalytic Perspective

In texts produced within the classical psychoanalytic framework about melancholy, the first striking approach is the relationship established with narcissism. “Classical psychoanalytic-oriented researchers explain melancholy as a reaction to narcissistic injuries.”

When we first look at Abraham, we see that he lists five factors in the formation of melancholy as follows: excessive constitutional predisposition to oral erotism; fixation at the oral stage in psychosexual development; early and repeated disappointments in love in childhood; the first major developmental disappointment occurring before the resolution of Oedipal wishes; and the repetition of the primary disappointment in the person’s later life. According to Abraham, an individual who cannot express aggressive feelings outwardly because of a strong superego directs these feelings toward the self. In other words, there is a conflict among three systems known as id, superego, and ego. Thus self-esteem decreases and the person begins to accuse himself. Meanwhile, in order to regain the lost love object, the introjection (taking in) of that love object into the ego is also acknowledged (Abraham, 1924).

In 1895, in a letter to Fliess, Freud made an attempt to define melancholy—which he included among depressive states—purely neurologically. In a 1897 text in which he first announced the Oedipus complex, he stated that mourning and melancholy were different concepts, formed the outline of the work he would later write, and wrote: “Hostile impulses toward the parents (wishing them dead) are also an inseparable part of the neuroses. They emerge consciously in the form of obsessional thoughts. In periods when affection toward the parents is active—periods of their illness or death—this hatred is repressed. In such periods, blaming oneself for their deaths (what is known as melancholy) or (through the idea of punishment) punishing oneself in the same manner as theirs in a hysterical way is an expression of mourning. As we can see, the identification that occurs here is more than a way of thinking and does not free us from the necessity of seeking the drive.” Freud expressed the differences between mourning and melancholy superficially in this passage. On the other hand, Freud also touches on the role of conscience and identification. Freud wrote the draft of his article containing his first views on melancholy in 1915; in that article he argued that there is a relationship between melancholy and the oral phase of libidinal development (Freud, 1915). With the transition from a neurological approach to a psychological approach, Freud realized that melancholy was more than a “state of depression” and was a more complex picture. Thinking that the dynamics of melancholy could be grounded only with the clarification of the neurosis–psychosis framework, Freud, in Mourning and Melancholia, revealed how object choice in melancholy has a narcissistic basis, whereas mourning has a more neurotic underlying ground, and how libidinal investments differ in mourning and melancholy. He stated that the mechanism operating in melancholy becomes more complex under the influence of ambivalence and that the existing battle continues on many fronts (Freud, 1917).

According to Freud, in both mourning and melancholy one speaks of the loss of a loved person, an ideal, or an object. However, in melancholy, unlike mourning, there is a “disturbance in self-regard” caused by the feeling of loss. Freud’s finding here is one of the most distinctive aspects of melancholy. He describes the symptoms of melancholy as “a profoundly painful dejection; withdrawal of interest from the outside world; loss of the capacity to love; inhibition of all activity; and a lowering of self-regard that finds expression in self-reproaches and self-revilings and culminates in a delusional expectation of punishment” (Freud, 1915). In mourning, he states, the devaluation and lack of regard for the ego are not present; ego devaluation, weakening of the sense of self, and loss of self-confidence constitute the most important difference between mourning and melancholy. Freud notes that in mourning there is a real loss of an object; in melancholy, even when there is or is not a real loss, the person behaves as if he has lost a love object. He shows three preconditions of melancholy: object loss, ambivalence, and regression of the libido into the ego (Freud, 1917).

The mechanism Freud sets forth actually shows that the melancholic’s self-denigration and devaluation are entirely directed at the object. On this point Freud says: “If one listens patiently to a melancholic’s many and varied self-accusations, one cannot in the end avoid the impression that the most severe of them are hardly at all applicable to the patient himself but that with insignificant modifications they do fit some other person, someone whom the patient loves or has loved or should love.” According to Freud, the hysterical wish for self-punishment in mourning is not present in melancholy. In other words, in mourning and melancholy, object choices and investments in the object, as well as the intention and quality of those investments, differ as Oedipal and pre-Oedipal levels. Abraham pointed to refusing food and drink as an indication of the wish for the object to be appropriated by the “I” and to be done so in an oral cannibalistic manner. He stated that in melancholy the only thing sought to be taken in is the object, and that taking the object in and trying to make it a part of the ego is related to the wish and effort to punish the object. This situation in melancholy is far more destructive than the simple mechanism in mourning (Abraham, 1908). Freud, too, discussed the predominant role of the oral phase in melancholy in his famous case history The Wolf Man (1914), noting that the ego’s wish to merge with the object is carried out, in line with the libidinal development stage, by devouring the object. Freud showed that in melancholy the object is wished to be swallowed in oral and cannibalistic fantasies, and that libidinal attachment to the object regresses back to narcissism so that the ego tries to appropriate the object (Freud, 1914).

When we look at Melanie Klein, we encounter not only fear of love loss, but also guilt related to desire toward the hated object and, accordingly, a major ambivalence period she calls the “depressive position” (Klein, 1946). Klein stated that failure to resolve this makes the child prone to later depression. In later writings, Klein notes that depressive suffering initially stems from an insufficiency in placing a good object within the ego, so that an intense sense of “badness” is part of the self. Klein thinks that being able to establish a secure relationship with a good internalized object is the key to a beneficial, productive, and creative life. Klein defined a major ambivalence period called the depressive position within the child’s developmental process and related depression to this period. According to her, when the child integrates the bad and good object images into a single object in the second to sixth month of life, he feels distressed that his sadistic, destructive fantasies toward his mother may have destroyed her. Klein calls this anxiety toward the mother—now a whole object—depressive anxiety and argues that it is followed by the depressive position. In this period, the child both intensely wants the love object and fears losing it, and also hates it and therefore feels guilty. The fundamental experience is, in contrast to the paranoid-schizoid position’s fear of being harmed by others, the fear of harming others. In this case guilt becomes the child’s basic affective experience. Klein accepts that depressive persons did not overcome this depressive phase in childhood and did not form “good” internal objects. According to her, depressive patients destroy their loved internal objects due to their own destructiveness and greed; as a result they are accused and tormented by the hated “bad” internal objects. While longing for the lost good objects, they suffer the oppression of the bad objects (Klein, 1957). According to Klein, manic defenses such as omnipotence, denial, idealization, and contempt are produced because of longing for lost love objects. These defenses may be used to rescue and repair lost love objects, to get rid of bad internal objects, or to deny excessive dependence on loved objects. Clinically, such persons deny anger and destructive feelings toward others, display a euphoria inconsistent with life conditions, idealize others, or adopt a contemptuous, demeaning stance toward others (aimed at denying the need for relationship). Another purpose of manic defenses is to gain victory over the parents and reverse the parent–child relationship; the wish for this victory leads to guilt and depression. Klein also attributes part of post-success depression to this mechanism. In this case, instead of anxiety and depression, a state of denial is observed as in mania. Hypomanic defenses are also activated against the threat of mourning or depressive affect. For some patients, success is a kind of loss of an ideal state; the pain felt due to this loss may end in depression (Klein, 1937).

Otto Fenichel stated that feelings of guilt accompanying the commission of a crime and feelings of satisfaction accompanying the realization of an ideal are normal models of melancholic and manic phenomena. He argued that the depressive person experienced a narcissistic injury in childhood, so that self-esteem and love became linked; when the person could not receive the positive responses expected from others, self-esteem declined. He relates suicidal thoughts to fantasies of satisfying the wish to merge with the lost love object (Otto F., 1974).

Silvano Arieti, on the other hand, defines in severely depressive patients a clearly present ideology before the illness. According to this, those prone to depression live not for themselves but for what Arieti calls a “dominant other.” Often the dominant other is the spouse, but an ideal or an institution may also take its place (a dominant goal or dominant ideology). Similar to Bibring’s views, Arieti emphasizes the patient’s helplessness when he realizes this is not possible. Such patients often cannot accept or imagine an alternative that would end living for another. They realize that living for someone else is not working, yet they also feel they cannot change. If they do not receive the response they want from the dominant other or cannot reach their impossible goals, they perceive life as worthless, because they are tightly bound to an unrealistic life plan that they cannot give up (Arieti S., 1977). Rado believes melancholy is due to the patient’s punitive superego. According to him, the patient is punished by the superego because of unconscious hostile feelings toward a loved one who has died. The depressive person’s self-worth depends on narcissistic nurturers outside the self. Rado emphasizes the depressive person’s narcissistic needs and self-confidence. Defining depression essentially as a sense of helplessness, Rado argues that anhedonia (inability to take pleasure) or insufficiency in enjoying pleasurable experiences is a key phenomenon for depression (Rado S., 1928).

The melancholic’s narcissistic regressions—internalizing the object and working it through within the self—cause a splitting of the self and make the object a part of the self. One part of the ego becomes conscience, and another part becomes the object. Thus, in melancholy, the problem that appears to be outside or within external reality actually takes place entirely within the self. Yet in this process the internal separates from the external—in other words, the doors to external reality close. These complex events developing within the self can sometimes lead to the devaluation of the object and to the ego’s enjoyment of the pleasure of triumph over the object, and sometimes to manic reactions that include grandiose attitudes. Another way mania emerges is when conscience (a part of the self) interrogates the other parts of the self and ultimately prevails, arriving at the thought “I am not guilty.” In melancholy, conscience—one part of the self—sometimes criticizes the sadistic attitude of the other split part of the ego toward the object; sometimes, while the ego enjoys the pleasure of victory over the object that has become part of the self, guilt feelings become dominant under the influence of conscience, and a part of the ego is subjected to narcissistic regression. As can be seen, melancholy is more than a simple expression like mourning; it is a complex struggle with many fronts, a confusional state. Note that the melancholic person sometimes resorts to manic defenses, often lives depression, and sometimes experiences mania and depression together (Rank, O., 1923).

For the melancholic, the fact that object choice occurs on a narcissistic basis has vital value. On one end of this ground stands the “I” and on the other end the object. Thanks to this ground that makes both transitions possible, in a danger or an ideational loss, libido shifts to the ego, protecting the melancholic against the loss of the object and/or a characteristic of the object. As is seen, rather than a mourning reaction, melancholy involves—at least at the ideational level—a danger of loss and a self-protective reaction against the fear and anxiety created by this danger. What is lost cannot be clearly understood. In melancholy, a wholeness forms along with the object that is identified with and taken in. In fact, carrying out the hatred felt toward the lost love object and applying that hatred sadistically becomes possible in melancholy. This shows the sadomasochistic aspect of melancholy. On this, Gabbard says: “The object relations of such patients are sadomasochistic; they either feel wretched and worthless or, identifying with the persecutor, make those around them suffer. Suicide is the culmination of this” (Gabbard, 1994). The sadistic feelings partially felt and enacted toward the introjected object are actually an indirect satisfaction of the melancholic’s masochistic wishes. The melancholic’s speaking of the self as wholly worthless and morally degraded, and the apparent self-humiliation, in fact express feelings toward the love object with which the person is ambivalent. We may call this a seemingly masochistic attitude but a realistic sadistic wish. In melancholy, to the derivatives of masochism we can add withdrawal from external reality and narcissistic closure, alongside the introjection of the object. The melancholic’s efforts to belittle and devalue the self in ways that do not accord with reality may correspond to a negative narcissistic attitude. When we look at how this mechanism operates, we can speak of both the intertwining of many concepts and many psychosexual development periods in melancholy and how archaic and regressive the psychic conflicts belonging to those periods are. We can attribute the weakening and impoverishment of the ego—not the impoverishment of the external environment—to the multi-front struggle within and to the expenditure of libidinal investment in that struggle (Freud, 1917). As can be seen, in melancholy there is an invisible but intense internal struggle requiring great energy.

Internal/External Problematic in Melancholy

Although the experience of “feeling abandoned” by one’s internal objects is universal, under sufficient internal or external pressure anyone may experience this abandonment and it may resolve without lasting long. Yet some, faced with this terrifying inner threat, feel themselves in the position of a victim and build psychological structures designed to deny the existence of this mental state. Melancholy is one such construction. Freud says that the self needs to feel loved by its internal objects in order to survive and continues: “For the ego, living means being loved by the superego.” The melancholic’s terror is related to losing the feeling of being loved by anything inside (Freud, 1915).

In melancholy, the object is not actually dead as in mourning, yet there is a behaving as if it were dead and a denial that it is not dead. In other words, the fact that the object is not dead but lost is equally traumatic for the melancholic. The melancholic’s personal world, thoughts, and subjectivity are so real that this world is almost equivalent to reality and is so active. The object internalized by the melancholic is incorporated into the melancholic’s ego, and the object, objectified, finds life within another self and becomes a part of it. The melancholic’s swallowing and incorporating the object in this cannibalistic manner is something that works against the pleasure/unpleasure principle (Freud, 1920). As is known, the satisfaction of desire depends on external reality. In melancholy, satisfaction is achieved delusionally. In a sense, the melancholic’s discourse is: “The object is inside me and I do not need the external world.” With the incorporation of the object into the ego, the need for external reality disappears. Yet external and internal reality always move together, and one foot of internal reality continues to stand in external reality. Therefore, it can be said that this is the most important difference separating mourning from melancholy. In mourning and sadness, there is an interaction between external reality and internal/psychic reality. Sadness is due to the loss of an object in external reality. The loss of the object is not denied, nor is external reality denied. Also, there is not an internal/psychic impoverishment; rather, a deprivation is experienced in external reality. The object is external, and the memories of the object are internalized and experienced. In mourning, libidinal investment continues to be transferred to external reality. Narcissistic regression is not required. The melancholic object, because it is incorporated into the ego, makes external reality unnecessary, and libidinal investment continues narcissistically (the satisfaction experienced is a false satisfaction). This false satisfaction—separating internal/psychic reality from external reality—and the pleasure experienced as a result are never a true experience of pleasure. Therefore, the ego that cannot experience real pleasure becomes impoverished, weakened, and powerless. Because drives exist to be satisfied. Drives that are not satisfied, or drives that have reached only a false satisfaction, eventually lose their vitality and their capacity to be worked through (to be satisfied, to find gratification). Thus, the drying up of the drive world also weakens and dries up the ego. Behind doors closed to external reality, the ego enters a barren, impoverishing world together with the internalized object it believes will bring satisfaction. By internalizing the object, the melancholic forms a splitting mechanism between internal and external reality as well. What makes melancholy complex is this splitting mechanism that operates in two directions—within and between internal/external. With the entry of this mechanism, external reality is suspended and the self is attempted to be made independent of external reality; subjective reality becomes objective reality. Objective reality becomes the only reality for the melancholic. When the pleasure/unpleasure principle comes into play, an autoerotic and delusional false satisfaction mechanism is activated. As is known, the reality principle is the true satisfaction of desire through the pleasure principle; it is what provides the satisfaction of unsatisfied drives (Freud, 1920). Because the hatred that is actually toward the object is experienced not openly at its true source but indirectly and as if it were toward the self, the relationship always proceeds on a narcissistic basis. Here it is necessary to mention hatred, an important affect. According to Freud, the object is born with hatred. Hatred is an affect that both enables separation from the object and individuation (Freud, 1897). The child cries “Mother, where are you, feed me” and shows hatred. The melancholic’s hatred is experienced so indirectly and complexly that satisfaction remains at an autoerotic level; drive satisfaction cannot occur; it moves away from the reality principle; object relations are lived only inside, through a symbiotic introjection. The “I” becomes “we” within the self. But drives cannot remain unsatisfied. With autoerotic satisfaction, it only seems satisfied—like a hungry or thirsty person imagining that he drank water or thinking he is full—which corresponds to a dangerous, even deadly outcome. It reaches the same endpoint by operating in an opposite way to the Nirvana principle suggested by Barbara Low (Low B., 1923). If maximum satisfaction ultimately leads to death, lack of pleasure leads to the same outcome. In other words, one could say that in melancholy there is a problem in “unpleasure.” The melancholic’s narcissistic object choice disrupts the functioning of the pleasure principle. Because drive gratification does not occur, the continuity of the psychic apparatus is endangered. In contrast, in mourning, the continuity of pleasure is interrupted; but this interruption is nothing other than the postponement of pleasure. In mourning, abstaining from food and drink and other negative signs serve to preserve internal and external reality, because these negative signs occur toward separation from the object and investment in external reality.

References

• ABRAHAM K (1953) Notes on the psychoanalytical investigation and treatment of manic-depressive insanity and allied conditions. Selected Papers. New York, Basic Books, pp. 69-75.
• ARİETİ Silviano (1977) Psychotherapy of severe depression. Am J Psychiatry, 13: 864-868.
• DEMİRALP, Oğuz (1999), Tanrı Bakışlı Çocuk, Yapı Kredi Yayınları, İstanbul.
• DÖRTHE Binkert (n.d.), Melankoli Kadındır, trans. İlknur İgan, Ayrıntı Yayınları, İstanbul.
• FENİCHEL Otto. Nevrozların Psikanalitik Teorisi. Ege Üniversitesi Matbaası. İzmir, 1974.
• FAUCAULT Michel (1972) Akıl ve Akıl Bozukluğu: Klasik Çağda Deliliğin Tarihi. İmge Yayınları, İstanbul.
• FREUD Sigmund. Metapsikoloji. Payel Yayınları, İstanbul, March 2002.
• FREUD Sigmund (1963) Mourning and melancholia. The standard edition of the complete psychological works of Sigmund Freud. London (Ed), Vol. 14, pp. 237-260.
• GABBARD GO (1994) Psychodynamic Psychiatry in clinical practice. Washington, American Psychiatric Press, pp. 219-248.
• HOMEROS (1993), İlyada, trans. Azra Erhat - A. Kadir, 7th ed., Can Yayınları, İstanbul.
• KLEIN Melanie (1937), ‘Love, Guilt and Reparation’, in Love, Hate and Reparation (with Riviere). London: Hogarth.
• KLEIN Melanie (1946), ‘Notes on some Schizoid Mechanisms’ Int. J. Psycho-Anal., 27 (III).
• KLEIN Melanie (1975) Mourning and its relation to manic depressive states. Love, guilt and reparation and other works 1921-1945. New York, Free Press, pp. 344-369.
• KRİSTEVA Julia. Kara Güneş: Depresyon ve Melankoli. Bağlam Yayıncılık, İstanbul, October 2009.
• LAPLANCHE J./Pontalis J.B. Temel Düşlem/Kökenlerin Düşlemleri/Düşlemin Kökenleri. Bağlam Yayınları, October 2002.
• ÖZMEN Mine. Depresyonda Dinamik Nedenler. Duygudurum Dizisi 2001;6:283-287.
• ÖZGEN B. Ahmet. Karanlığın Aydınlığı: Melankolinin Tarihsel Psikanalitik, Sosyolojik ve Felsefi Boyutları Üzerine Bir Araştırma. Mimar Sinan Güzel Sanatlar Üniversitesi Genel Sosyoloji ve Metodoloji Programı. Yüksek Lisans Tezi, İstanbul, 2006.
• PAMUK Orhan (2003), İstanbul: Hatıralar ve Şehir, YKY, İstanbul.
• TEBER Serol (2002), Aşiyandaki Kahin, Okuyan Us Yayınları, İstanbul.
• TEBER Serol (2004), Melankoli, 3rd ed., Say Yayınları, İstanbul.

Abstract

In this study, melancholic depression is evaluated from a psychoanalytic perspective. The study consists of three parts. The first chapter consists of a review of researchers’ definitions and conceptualization efforts regarding melancholy from past periods to the present. In the second chapter, evaluations of melancholy by psychoanalysts—especially Sigmund Freud—are presented. In these evaluations, the differences and similarities between mourning and melancholy are discussed comparatively. In the last chapter, which may be considered a brief summary of the study, it is shown how melancholic subjects use external and internal reality.