Reactive Depression: Lost in Translation!

The old classification of depression as reactive and endogenous, which are still observed in clinical practice, both cannot be accommodated under the current rubric of major depression. This is because psychiatric nosology under the Diagnostic and Statistical Manual of Mental Disorders (DSM) and its latest fifth edition (DSM-V) is still descriptive and not etiologic. The aim of this review was to revisit reactive and endogenous categories of depression from the perspective of today's understanding of etiological pathways. From an epigenetic perspective, the old dichotomy of reactive versus endogenous is interrelated through the impact of the environment (e.g., stress). This includes familial or prenatal depression, where the environmental impact is before birth, or childhood depression, where the early life stress is the precipitating factor to genetic susceptibility. In conclusion, searching for both environmental impact (e.g., stressors) and genetic predispositions in depression, even at a clinical level, could help clinicians with better therapeutic decisions.

Conceptos de eficacia terapéutica en psicoanálisis: una reseña histórica / Concepts of therapeutic effectiveness in psychoanalysis: a historical review

El autor parte de la base de que el conocimiento psicoanalítico del desarrollo y del proceso se ha expandido considerablemente durante las últimas décadas, y que durante este tiempo se ha desarrollado una competencia abierta de una variedad de teorías por el respaldo de la comunidad analítica. Desde esta perspectiva, el autor considera que es vital un mejor conocimiento de las fuentes de la acción terapéutica, como parte de la base científica de nuestro campo, de la cual dependen los avances futuros en la teoría y en la técnica. Este trabajo pone el énfasis en el cambio de visión desde los primeros días del análisis, cuando se buscaba un elemento terapéutico único para explicar sus efectos, hasta el presente, cuando vemos que el efecto terapéutico depende de múltiples procesos interactuantes, ninguno de los cuales puede asignarse una clara prioridad. Se postula que, en este estado científicamente deseable pero clínicamente problemático, existe la necesidad urgente de una mayor investigación por parte de los psicoanalistas, que requiere de cuidadosas descripciones del proceso analítico, especificaciones precisas de las hipótesis y sus predicciones clínicas, y de un buen diseño de investigación para poner a prueba estas predicciones (AU)

The author begins from the premise that psychoanalytic knowledge of development and process has broadened considerably over recent decades, and that during this time an open competition has flourished over a range of theories through the backing of the analytic community. From this standpoint, the author considers it vital to gain a greater understanding of the sources of therapeutic action, as part of the scientific basis of our field, upon which future advances in theory and technique depend. This paper highlights the change in perspective from the early days of analysis, where a unique therapeutic element was sought to explain its effects, up to the present, where we see that the therapeutic effect depends upon numerous interacting processes, none of which may be ascribed clear priority. The author postulates that in this scientifically desirable but clinically problematic state, there is an urgent need for greater investigation on the part of psychoanalysists, which calls for thorough descriptions of the analytic process, precise specifications of the hypotheses and their clinical predictions, and for a good research design to test these predictions (AU)

War neurosis, adjustment problems in veterans, and an ill nation: The disciplinary project of American psychiatry during and after World War II.

After World War II, the confidence of American psychiatrists was at an all-time high as a result of their successful participation in the war. When the incidence of mental breakdown in the American armed forces rose to unprecedented heights, new and effective psychotherapeutic methods were developed to treat the traumatic effects of the extraordinary stresses of warfare. At the same time, social scientists concluded that breakdown incidence was inversely related to morale, which led to the development of preventive measures aimed at specific groups. Both initiatives stimulated a number of psychiatrists to plan projects of social engineering after the war. They first focused on aiding the reintegration of returning veterans. Later, they addressed the poor mental health of the American population as a whole, which they considered to be the consequence of faulty child-rearing methods.

Between the laboratory, the school, and the community: the psychology of human development, Toronto, 1916-1956.

In the twentieth century, Canadian psychologists have been involved with the educational system and the community at several points in time. In this article, the psychology of human development as developed at the Department of Psychology at the University of Toronto from 1916 to 1956 is investigated. In a variety of projects, the mental health of children was investigated in educational settings while measures were designed and tested to prevent maladjustment and to promote mental health. Initially, research and intervention aimed at adjusting school children to the educational setting. Later, a critical perspective on social institutions and Canadian society was articulated.

Psychosocial stressors and adjustment disorder: van Gogh's life chart illustrates stress and disease.

The life of Vincent van Gogh is illustrative of the natural history of psychosocial stressors and their relationship to a person's states of health and disease. In the author's opinion, there is a lack of such understanding in the current, established criteria for psychosocial stressors in the diagnosis of adjustment disorder. By use of a life chart, which chronologically documents a person's major life events and concomitant health status over his or her life span, a fuller understanding can be reached regarding why an individual becomes ill at a particular time.

Adjustment disorder and psychiatric practice: cultural and historical aspects.

A universal concern of healers and health practitioners of all social groups is that of caring for individuals reacting to social and interpersonal hardships. One could view individuals experiencing such hardships as prototypical patients of a society's health profession, however this may be defined. In contemporary psychiatry, such individuals are diagnosed as showing an "adjustment disorder." In view of the time-honored legitimacy of caring for individuals meeting criteria for an adjustment disorder, it is ironic that the status of this "disorder" in the discipline's contemporary nosology is controversial and anomalous. In this paper, these and related issues are discussed. Emphasis is given to some of the cultural, historical and clinical-epidemiologic factors that render disturbances that can be diagnosed as adjustment disorder important in psychiatry and, indeed, worthy of inclusion in DSM-III. Theoretical and empirical problems that would render this entity a more legitimate one in contemporary biomedical psychiatry are reviewed.

Depression and loss: a theme in Robert Burton's "Anatomy of melancholy" (1621).

Robert Burton's Anatomy of Melancholy (1621) can hardly be thought of as a modern study in psychiatry, but it contains more elements of modern theory than have been recognized. Attempts to recommend the book to modern readers have missed the point that Burton, more clearly than other seventeenth century writers on melancholy, sees traumatic loss of attachment figures, status symbols and personal health as predisposing to mood disorders. In this he strongly anticipates such work as that of John Bowlby in Attachment and Loss (1969), 1973). Burton's theory is divided between the humoural physiological theory descending from Galen and the observation that loss is a frequent precursor of melancholy. He cannot reconcile the two, writing a book only poised on the verge of modernity. The Anatomy of Melancholy nevertheless very fully discusses etiological "hunches" which have found verification in recent studies of traumatic loss.