Beyond Depression—The Depleted State

Abstract

This paper has attempted to differentiate the stages of adaptive and regressive reactions to loss in the aged. Central to this study is the hypothesis that depletion is a distinct and separate entity in a chain of psychological responses—that is beyond depression. A study of the general reactions to loss reveal three basic patterns of behaviour: mourning (and its somatic equivalent), neurotic depression, and melancholia, in order of severity. The ability to cope with loss is seen to be determined, in part, by the individual's capacity to resolve ambivalences, to tolerate depression and the ability to relate to whole objects. If reparation by projective identification is not possible, depression merges into melancholia. The pattern of reaction to loss begins early in life, largely determined by the child's separation and reunion experiences with his mother, and continues as a ‘defensive style’ throughout life. The problems of object loss and depression are intensified in old age when the individual is simultaneously coping with real losses of self (body ego) and decreasing stimulation from external objects. Even in the best of circumstances, the reality reinforcement of the ageing process may exacerbate exhaustion of the positive forces in the nuclear self and, if some restitutive action or substitute object relationships for emotional refuelling are not possible, regression will occur. Individuals of melancholic disposition are particularly vulnerable because they are relatively incapable of neutralizing aggression. Ageing offers an ideal opportunity to study the breakdown of defences and defusion of instincts as the lines of growth are reversed. Depletion reactions which have generally been subsumed under the diagnosis of depression and/or senility are seen as distinctly differentiated and observable precursors to the ego's fragmentation, disintegration and abandonment of an ‘objectless’ world.