A case of intractable depression
The case illustrates well what Brandchaft, following Kohut (1977), believed to be perhaps the most common source of chronic depression especially in later midlife-an inability to claim and sustain a life of one’s own. Brandchaft saw his formulation of the genesis of Mr. N’s psychological problems as a clinical explication of the quintessential human struggle Kohut (1982) described: to preserve and unfold an innermost self while “battling against external and internal obstacles to its unfolding” (p. 403). For Brandchaft, “external obstacles” refers to misattunements between parent and child that contextualize the child’s repudiation of his own uniqueness. And “internal obstacles” refers to the psychological conflict that becomes structuralized when a child cannot harmonize the need for intimate ties with the need to preserve a distinctive perspective of his own. In Mr. N’s case, that conflict is the soil from which the organizing principles underlying his depression grew. Organizing principles (Atwood & Stolorow, 1984, p. 36) reflect the unconscious structuring of personal experience; in the
absence of sufficient self-awareness, the individual is blind to his role in structuring his own reality. The world in which he lives is experienced as though it were something independently and objectively real rather than as something partly constituted by his own organizing principles.