Mendelsohn, Myer PSYCHOANALYTIC CONCEPTS OF DEPRESSION New York: SP Books Division. Spectrum Publications. 1974. 352 pp.
Dr. Mendelsohn's new book is a masterful and scholarly work reviewing the psychoanalytic understanding of depression. Whether it is read as a whole or used as a reference book, it will prove invaluable to both students and practitioners of psychiatry alike in furthering a panoramic understanding of the development of the psychoanalytic concepts and the dilemmas that have been the basis for theoretical discussion for many years. The 23-page bibliography alone provides basis for further detailed study as well as a reflection of the author's dedication to his study of the subject.
After some initial discussion of the nosologic considerations, Dr. Mendelsohn begins his study in "the consulting rooms of the early psychoanalysts." He examines, chronologically, the work of such contributors as Abraham, Freud, Gero, Klein, and Cohen. He then reviews extensively the work of more recent authors and compares the theories of such people as Jacobson, Beck, and Sandler. He points out the differing emphases of each theory in what the author refers to as "the gradually evolving intrapsychic drama which was progressively elaborated to understand depression."
Dr. Mendelsohn has included in this second edition of the book a chapter evaluating the literature on mourning and depression in childhood. He opens the section by asking whether such states actually exist. He reviews the work of Bowlby and the criticisms resulting from his theoretical position. There is a review of observations on mourning in adults, children, and adolescents. He points out the discrepancy between theoretical positions and clinical observations and indicates the hope that more sophisticated studies, with adequate reporting, will begin to be published in the psychoanalytic literature.
The author follows through in more detail the analytic concepts to which he has previously referred in his chronologic account and discusses such factors as anxiety, the obsessional character structure, aggression, and orality. He follows this with what he refers to as the "macroscopic" presentation of depression and includes a useful section on depressive equivalents. In a metapsychologic chapter, he subjects the concepts of the ego, superego, ego ideal, instinctual drives, aggression, and psychic energy to a searching examination. This section in particular will prove valuable to students of psychoanalysis for its detailed review of modern contributions.
He finally moves to the treatment situation and very fairly ends with the general criticism that the literature on psychoanalytic treatment of depressive illness virtually ignores not only the astonishing effectiveness of the antidepressant medications and lithium carbonate but also the theoretical implications of these psychopharmacologic effects. He suggests in his conclusion that, as more effective medications become available, treatment will turn away from the purely psychoanalytic to a mainly pharmacologic approach to primary depressive illness. He believes that the psychoanalytic task of understanding depression has been largely completed, although it will undoubtedly continue to be revised and refined. He emphasizes, however, that although the primary depressive illnesses may be treated pharmacologically, there will be many a patient who is prone to depression who will still need and receive psychoanalytic or psychoanalytically oriented treatment. One would agree completely with this formulation, and it is on this basis that one cannot praise Dr. Mendelsohn's book too highly for its presentation of the psychoanalytic concepts of depression.
The book is well structured for reference purposes, delightfully written, and easily read. It deserves a place in the personal library of any practitioner, teacher, or student of psychiatry.