ABSTRACT
Before embarking on a detailed analysis of major depression in children and adolescents, it will be useful to briefly review the historical debate on whether or not the syndrome exists in these populations. Freud's theories (1917/1950) stated that the mechanism of depression involves the introjection of a lost object and the turning against the self of aggressive impulses originally directed against the ambivalently loved lost object. The diathesis to depression in adults was created by interpersonal loss during early stages of development. From that time to the present, many psychoanalytically oriented authors have postulated that children could not experience mourning or depression. Many of these psychoanalytic theories of depression required a specific symptom or developmental condition to be present for the diagnosis to be established. This symptom or condition was necessary, but not sufficient, for diagnosis. For example, Rochlin (1959) noted that only ego-versus-superego conflicts were properly called depression. These depressions were characterized by guilt. Rie (1966) regarded the discrepancy between the person's self-representation and the wished-for concept of the self as the central conflict in depression. He viewed patients’ verbal descriptions of their own mood as the most important symptom in depression. This type of reasoning led clinicians to infer that depression could not exist in children. Generally, the arguments stated that because young children did not have a sufficiently developed superego, or because children did not form stable self-concepts, then these children could not be truly depressed. Mendelson (1974) summarized the various arguments doubting the existence of mourning in children. These assertions follow a line of reasoning, not founded on clinical observation, used to argue against the existence of depression in children. These include that children: (a) do not have sufficiently developed egos, (b) lack object constancy, (c) have insufficiently developed reality testing, (d) feel sad only for short periods of time, (e) lack the capacity for sustained mourning, and (f) use regressive defenses too extensively. Both Mendelson (1974) and Garfinkel (1986) found that the empirical evidence from a large number of investigators refutes these positions.
