PSYCHOTHERAPY: THEORY, RESEARCH AND PRACTICEVOLUME 19, #4, WINTER, 1982

DEPRESSION AS THE SEARCH FOR THE LOST SELF

MARCELLA BAKUR WEINER*Brooklyn College of the

City University of New York

MARJORIE TAGGART WHITEAmerican Institute for Psychotherapy

and Psychoanalysis

ABSTRACT: Depression is explored as a narcissisticdisturbance in which the self is unconsciously ex-pected to accomplish grandiose expectations andis regarded as a failure when it does not. Theseomnipotent fantasies include the prevention ofobject loss and triumph over death. In the lateryears difficulties in maintaining self-esteem, anessential component of a cohesive self, can pre-dispose one to depression since aging unavoidablyinvolves dwindling opportunities, failing healthand loss of loved ones, making it difficult to reachout for what life still has to offer.

A psychotherapeutic approach is outlined, fo-cusing on the treatment of depression as a searchfor the lost self in which the development of healthynarcissism in Kohut's sense, is seen as activatingarrested or inhibited ego functions. The devel-opment of a positive cathexis of the self is seen asa safeguard against the self destruction implicitin deep depression. This psychotherapeutic ap-proach is demonstrated in a clinical vignetteshowing how it opened up a new life for a suicidallydepressed woman in her sixties who was immo-bilized by a conviction that to be dependent in anyway was an unbearable humiliation leading tonarcissistic rage which could overwhelm her senseof self.

In helping a patient to search for her/his lostself, the therapist willl hopefully be absorbed asan empathic self-object to become the foundationfor the patient's self-soothing. In staying close tothe patients' self-needs, therapists can rediscoverneglected parts of their own selves.

We should like to discuss depression as aresponse to the painful experiences of theloss of the valued self. This is in contradis-tinction to the familiar assumption that

* Requests for reprints should be sent to MarcellaBakur Weiner, 383 Ocean Parkway, Brooklyn, NY11218.

depression comes about from object-loss(Freud, 1917).

The psychoanalytic concept of depressiontraditionally refers to the affects arising inconnection with object loss, however ambiv-alent the relationship. The affects held to beinvolved in the depressive state include:longing for the lost object (Freud, 1917); guiltover negative feelings toward the lost object,especially in the case of death (Freud, 1917,1923); guilt over surviving the deceased object(Lifton, 1968; Niederland, 1968); anxietyover the helplessness to restore the lost stateof well-being for which the object was es-sential (Sandier & Joffe, 1969), an identifi-cation with the lost object involving an af-fective change in self esteem, e.g., implacableself-reproaches if the object were ambiva-lently loved (Freud, 1917, 1923); and a per-vasive loss of interest in the external world(Freud, 1914-1917).

All of these aspects of depression reflect afocus on the object's value and the impactupon the bereft one of losing this valued ob-ject. Freud, however, in his pioneering ex-ploration of narcissism (1914) glimpsed thedestructive impact upon the valuation of theself in relation to the object loss, e.g., hetraced the possible consequent withdrawal intopathological narcissism, eved psychosis. Thiswithdrawal can imply that the self is respon-sible for the loss of the needed object. Suchan idea may lead to the affect of hopelessnessabout trying again to find need gratificationthrough another, since one can only rely ononeself and even that is risky. The nature ofthe self's responsibility for its irretrievableloss may be fantasized in at least two, notmutually exclusive ways: 1) I am all-powerfuland, therefore, in control of every occurrence

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in the universe so if I lose a needed object,my omnipotence does not exist (Kohut, 1971);2) I am so unworthy that no one can love mein a reliable way and nothing I can do willensure that I will be permanently loved sothere is no point in doing anything at all(Freud, 1917).

The difficulties encountered in analytic andpsychotherapeutic work in mobilizing egofunctions, when the possibility of a moregratifying life seems to have been closed off,are painfully familiar. The overwhelminghostility present in such cases is certainlyevident. But, too often, the therapeutic focusupon the aggression has seemed to lead to afurther collapse of self-esteem and sometimesto suicide.

Older people are particularly prone to mel-ancholia in which the self is paralyzed andunable to perform the normal functions ofeveryday life, i.e., she is catastrophicallydepressed. In this process the self reacts tothe loss of the person by regressing to a"narcissistic identification with the object"(Freud, 1917) confirming the relationship(usually an ambivalent one) that the two per-sons engaged in originally. Thus, there is an"identification of the ego with the abandonedobject" upon the death of a loved one (Freud,1917). The person living judges oneself asthough s/he were the lost half-hated objectand behaves punitively toward it—or her/himself. Thus, the loss of what was once theambivalently loved object is now transformedinto self-loss, or, more accurately, loss ofself-esteem (White, 1980).

How do we explain this phenomenon in theolder person? One way of looking at depres-sion in the older person is to say that s/hehas been faced with a host of disappointments.The reality that s/he counted on in a "con-sensually validated, objectively defined"world no longer exists (Lichtenstein, 1977).This reality gave a sense of order to the uni-verse, a sense of permanence of the environ-ment as predictable and ordered. Both theinternal environment, i.e., the inner sense ofself reflecting the emptiness and struggles withdespair s/he now must face, are to be re-or-dered along with her/his outer attempts tobring order to chaos. The relationships ofself-to-self and self-to-other have undergonechange; the scheme of things has been dis-

rupted and one must now face a revolutionbipolar in nature, an inner and outer one. Forsome, despair may be the only outgrowth ofthis struggle if the perfectionistic striving forthat which was, i.e., the over-idealized lostrelation, remains fixed. Here it is the narcis-sistic rage which pushes other persons awayleaving the bereft one feeling isolated andempty; similarly, the rage is also directedagainst the self since the self cannot bringabout magical rescue fantasies, e.g., thoseof raising persons from the dead.

In order for this not to occur, a reorderingof thinking needs to come about, i.e., a re-conceptualization of the world of reality asmeaning that the average "expectable" en-vironment could be transformed into a not-so-average, and even a positively unpredict-able one. It means, in other words, a flexibilityof personal style and way of perceiving whichallows and encourages the self to chooseamong a group of objects and introduce intothe self a different quality of person. Thesenewer objects may not necessarily reflect thequalities of the old for it is these old objectswhich are ambivalently mourned. The new,somewhat different objects, more accuratelyreflect the continued search for the self whichcan be growing while retaining a sense ofcontinuity with the past. This forward flux,arising from the admission of new love ob-jects, with different qualities is not perceivedas a disintegration of the self, i.e., the ex-pected annihilation which sits alongsidedepression, but rather, the newer, reintegra-tion of self. The process is continuous.

Within this process is the capacity to un-derstand that the momentary pleasures of thefluid object/experience/time and space impactare acceptable and can be felt as pleasurable.It is the experience of the now as against thesometimes futile seeking of the later, for theobject constant-into-the-future which may,or may not, exist. Certainly, even where theexperience exists for a prolonged moment oftime, its termination is imminent in the ac-ceptance of death as natural to life.

Recognizing that some older people do havethis capacity to enjoy an expanding growthof the self, why is there such a high frequencyof depression with advanced age? While thestructural theory in psychoanalytic tenets hasnot been rigorously applied to the problems

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of aging, it has been suggested (Lichtenstein,1977) that id functions, especially sexuality,center around an urgent need to support asense of one's own reality as a person as wellas to discover in sexual experience the realityof another. It is thus the being with anotherperson in the sexual act which may affirmour own existence. Rather than the phenom-enon of "the other" understood merely asan abstract concept, it is the sense of selfwhich is reinforced by the mere act of beingtouched and stroked during intimacy with apartner, i.e., through physical loving, to benarcissistically appreciated. It is no accidentthat there is an inverse relationship betweendepression and sexuality in the older person(Blum & Weiner, 1979) for one is a loss ofself and the other, an affirmation of self. Fur-ther, it is suggested (Lichtenstein, 1977) that"one of the ego functions of orgasm is toascertain . . . truth." Orgasm here is seennot only primarily as an ecstatic pleasurableexperience but is "endowed with the powerto confirm, create and affirm convic-tion . . . of one's own reality." Thus, thefunction of a psychic structure such as the idmay also have an adaptive function in keepingwith our view of the ego as a mental apparatuswhich accurately perceives reality. That ourmental and emotional equipment can changefunctions implies that the sense of self, withall the related growth processes, throughoutlife, are not rigidified but fluid in nature. Thismay be a way of keeping in tune too with thefluidity of our changing times and values.

The younger generation perhaps receivingmore attention (good and bad) from the massmedia than ever before, are also perhaps moreaware of the relentlessness of their shiftingenvironment including the prospect of totalnuclear destruction. The songs of their gen-eration, the protest movements, pinpoint theunempathic "other" as the hope-deprivingsystem. The young, perhaps tragically, arealerted to the potential of alienation through-out one's life and are thus prepared. Con-versely, most older people have been andprobably still are "believers" in the good-of-all-for-all. The environment for themseems to have been fairly stable, with clearlydelineated roles and structures designed tofulfill those roles. Lacking preparation forthe feelings of powerlessness due to the on-

slaughts of aging, loss is unexpectedly andpainfully felt, depression covering the waste-land of despair.

Depression can then be viewed both as anarcissistic phenomenon reflecting inadequatedevelopment of internal structures especiallya cohesive sense of self and a distorted innersense of experienced time (Kohut, 1971).Depression may be time standing still, bestconceptualized as death. Freud in 1920 linkedthe death instinct to the theory of repetitioncompulsion. Thus, whereas the concept oftime may be conceptualized as time experi-enced, i.e., as passing through, repetition,by contrast, may be envisioned as a circlewhereby one comes to the same point againand again. The line as experienced time de-notes fluidity and constant flux more con-sistent with the early Greeks' (Heraclitus')version that nobody is capable of steppinginto the same river twice. Conversely, timestanding still or the actual negation of thepassing of time is better represented by thecircle. When one acknowledges the flow oftime, the experience of being is an awarenessof life and its transitory nature; the denial ofthis or the stopping of time would appear tobe an attempt to hold still, for eternity, i.e.,to prevent that passing of the movement oflife and, ultimately, the end of that life.

If narcissistic problems have been largelyinterpreted as the expressed feelings of emp-tiness within certain persons, or problems ofself/self-object relationships, lack of self-esteem, etc., then the holding still of time aseternity could be interpreted as an attempt tofill in the emptiness much as white space isperceived by the disturbed person as beingmore of figure than the ground it usually rep-resents . Involved too in this attempt to recreatean environment which, forever, holds somekey to the pain inherent in the flowing of life,is the grandiose notion that one is able to somanipulate time. Within this unconsciousstriving is the feeling and idea that I, alone,can do it, the contrasting omnipotent side ofthe utter despair and helplessness we see inthe symptoms of depression. It is thus sug-gested that the older adult manifesting signsof depression is responding to losses-over-time which she is attempting to deal with byexerting omnipotent power and control overher/his experienced enemy, the flowing of

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time. This behavioral manifestation can beseen as an adaptive function to slow downthe constant emptying of the self which leavesone devoid of all and any nurturing supplies.

Whereas the young can act upon the re-belliousness within them (not act out nec-essarily) in that our society affords them manyavenues of expression, refuge and escape, itsets rigid limitations to the elderly. Whereare the songs of rebellion for the older personanalogous to those of the former "Beatles"and other socially conscious groups? Whereare the issues around which to rally, e.g.,the new draft, the new sexuality, etc.? It isonly select groups such as the well knownone of the "Gray Panthers" which offers itsvoice as spokesperson for the elderly. Yet,how representative a group are they and howwidely supported by the older person and/orour media? Surely, the routes for the olderas compared to the younger rebel are narrowand confined. How understandable then is thephenomenon of depression in the older personas the only expected, if not reinforced means,of rebelling against that critical element—time. Symptoms then can get grudging at-tention and the narcissistic supplies so frant-ically sought, temporarily attained. The needto repeat—and to be able to repeat—i.e., therepetition compulsion, may then be viewedas an adaptive defense against the fear ofimpermanence.

While lesser levels of depression may beviewed within the concept of repetition com-pulsion, the actual seeking of death, or thestate of inertia—time stopped—may be a ret-rogressive phenomenon, its goal being toreach that total surcease of motion, the endstate of no existence. This can be seen as adesperate effort to merge symbolically witha lost love object. Depression, even total in-ertia, may be seen as a more adaptive anddevelopmentally higher order of being thansuicide which is an outgrowth of early lacksand early despair. How strangely paradoxicalthat the very state of non-being, or the sur-render to total stoppage of life, seen in thevery process of aging and denied by thoseshrouded in depression in order to avoid thecertainty of change is succumbed to by othersin suicide whose rebellion or self-punishmentis the final surrender. Herein too lies the dif-ference between the feeling state of depression

and the act of suicide for in the former, theover-riding quality of that repetition com-pulsion is its life force as against the ret-rogression to the seeming no-existence or lackof fighting back in the suicide. What mayactually be occurring in the suicide is an actof narcissistic rage against oneself for havingfailed to realize infantile omnipotent fantasies,often including the saving of a parent fromdeath or the resurrection of the dead. In thesecases, the misery of an empty life only in-tensifies the hostility which is turned againstthe self for intolerable failure (White, 1978).

In focusing on the therapeutic overcomingof narcissistic rage against a positive cathexisof the sense of self, damaged by early loss,fantasized failures, or traumatic unattunementof the nurturing person, the therapist is con-ceivably activating inhibited ego functionsand also fostering the growth of psychicstructure which the depressed, immobilizedperson needs in order to be calm and to lookmore hopefully toward the future. We havefound it helpful to bear in mind that the personsuch a depressed patient desperately wantsis not the actual lost object from the past norits present-day equivalent nor the therapistas a transference displacement. As Kohutpoints out, it is "the missing segments of thepsychic structure," the internalized capacityto care for, value and plan for oneself—inshort, it is a state of mind that these patientspine for. From our years of clinical practicewith older persons, we have found that it isgenerally necessary to work through theregression to the early grandiose self-config-uration which perhaps the older patient, es-pecially, has used as an adaptive defense tocope with the traumas of early object loss ormassive disappointment in the nurturant fig-ures. The grandiose self-image requires thatthe patient be omnipotent, with completecontrol not only over her/his own body andmind but of others as well, including thetherapist. Fantasies either of having preventedthe early traumas or of undoing them are usu-ally interwoven in this defensive structureand it is seemingly necessary to empathicallyhelp the patient bring them to consciousnessbefore a more mature perspective on the lim-ited capacities of the self (particularly theself in later years) and others can be inter-nalized. Once this has been accomplished,

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the patient, having developed through ther-apy, a cohesive, positively cathected self, isin a much stronger position to deal with theearly traumas so that the wounds may heal,and s/he can seek a more satisfying life inthe context of stable self and object relations.

Another approach to depression where therepetition compulsion is used to preventchange can involve the interpretation oftransference as a.reenactment of early at-tachments, often disappointing to the parents,where hope of reliable caring was greatly un-dermined. In this way, one of the parts ofthe self is preserved and the process of slowand continuous depletion-of-self containedwithin that loosely defined movement called"cure."

Often it may seem pointless to explore thelong-distant past in the person, who, havingsuffered multiple losses, now 60 or 70, sitsbefore us, forlorn, lonely and depressed. Thedesire may be to help in the now situationfor that, indeed, seems the most critical. Yetwe have found, in our practice and years ofworking with the elderly, that explorationsinto the long-ago have proved most helpfuland rewarding for the now and for the future-still-to-be. This has come about through fo-cusing not on the contents of the verbal datapresented in treatment and which often con-centrates upon the interactions of the patientwith the others in the world but by listening,as sensitively as possible, to the thoughts,ideations, images and feelings of the selfwithin the person, to use the listening modeas a way of attempting to "recognize" theself-over-time rather than trying to teach orcure. We look for the early and later-devel-oped " I " containing the core roots of her/his identity, a sameness which despite allchanges in his life, paradoxically reflects thecontinuity-of-self. For it is the self which isthat repository whereby early ideas, thoughts,feelings and memories have been stored, tointeract in the experiences throughout life andwhich give us all a feeling of self-continuity.These early experiences come about throughthe interactions with the first significant personin our lives, the parent or parenting figures.Indeed, it has been dramatically shown thatthe way in which the mother talks to, holds,feeds the baby is crucial to this buildup ofwhat we shall loosely term the album of pic-

tures of ourself within ourself. These imagesof our selves being cared for, our self-rep-resentations can act as soothers at times ofeither needless loneliness, a common com-plaint in aging, or even preferred alonenessfor these images can be brought up at will,played with, toyed with and shuffled as onedoes cards in a deck, playfully or with a pre-determined goal. Where reliable nurturing hasbeen lacking and self-soothers deficient, agoal in treatment may be to reactivate healthyself-to-self relationships through the modeof analytic listening, i.e., the empathic, in-trospective mode (Kohut, 1977). We are sug-gesting that whereas mature object relationsmay be a consequence of the improvementof self-to-self relations, it has not been, formost of our patients, a major goal. The goalmost often is to promote "healthy narcis-sism." This approach could lead to reparationof the inadequate appreciation of the self asan integrated, valued and cohesive struc-ture, the lack of which is seen as "the ulti-mate predisposition leading to depression"(Gunther, 1980). This is unlike the tabooagainst narcissism as represented by Narcissusin the myth where self-love led to inevitableself-destruction. Here the need for the en-couragement of self-regard is paramount orthe continuous reinforcement of the libidinalcathexis of the self as energizing the forcesfor life. A brief vignette focusing on the im-provement of self-to-self relations is as fol-lows:

A very depressed woman in her early sixties, witha tragic background of psychotic parents, had almostcompletely submerged her self-feeling in her iden-tifications with those parents. When White, in hertreatment, finally discovered these self-destructiveidentifications she switched from focusing on the ef-fects of trauma and object loss in regard to the patient' sparents to a focus on what seemed to be a deep nar-cissistic problem. This involved conflicts over havingbecome a professional artist, surpassing her psychoticmother who failed as an artist and died when thepatient was five. Focus on the seemingly obviousoedipal competition had also led to a stalemate.However, when White began to deal more with thepatient's self-feelings, a seeming therapeutic impassebegan to open up. At one point, for instance, thepatient said that she was depressed after some unu-sually stimulating experiences the day before, in-cluding a session with the therapist. Rather thandwelling on the familiar territory of her loneliness,White decided to focus instead on Kohut's concept(1971) of "psycho-economic imbalance,"i.e., the

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problem of the unexpected upsurge of what he callednarcissistic libido but what we might also think of asa positive self-feeling. As Kohut described it, thisunfamiliar experience of self-feeling can seemthreatening because it feels out of control, and thegrandiose self needs to feel in complete control of allexperience, including the self-feelings. It was sug-gested to this patient that she needed to feel depressed,to remind herself of her loneliness in order to get afeeling of control over her unfamiliar "high," com-paring it to an intoxicated state where a person canfeel frightened at the inability to control one's move-ments or speech. The patient reacted to this by dis-cussing how she felt in an interchange with a deni-grating fellow artist where she had, for the first time,put herself forward, talking about an important grantshe had recently received. She said she was so involvedin her positive self-stance that she wasn't able to noticehis reactions. It was pointed out that unlike her pastencounters with him, she seemed to have had an impacton this artist since he had not tried to undermine heras he usually did. She was then able to think of thepossibility of playing a social game and not being soconcerned about what she was doing that she couldnot notice how the other person was reacting. Thesession ended as the therapist said she was entitledto her good self-feelings which evoked laughter inthe patient.

This vignette reveals a lot about the anxietylevel and the subtle feelings which occur ina patient where depression is deeply linkedwith narcissistic problems or perhaps whatcan be termed a pathology of self-feelings.This same patient had, only a few days before,been able to say that she thought she had hada disease which involved feelings of humil-iation and helplessness in asking for the mostbasic kind of help, e.g., if she had a fire orneeded to call the police, she got into a panicover fear of how she would look to them inher apartment. She spontaneously associatedto the time when her mother returned homefrom a mental hospital and she was embar-rassed at her mother's condition and what theneighbors had thought and connected this withher current fears of "street people"—pros-titutes, drug addicts, vagrants—as beingdangerously out of control just as her returningmother had seemed. The significance of thisearly memory of her mother's return had beenunclear for years. Now it was bursting forthin a context of recognizing her own narcis-sistic anxieties. White felt that an impetus tothis achievement of insight was given byasking her to associate a couple of weeksbefore to a fear of someone trying to breakin the door. Her association had been fire and

it was suggested that someone might be tryingto break in to help her. This gave her pause.She seemed to consider it, showing an ob-serving ego working and said she had neverthought of that possibility before. It came torepresent a turning point in moving away fromthe totally self-sufficient grandiose self andthe accepting of help as a caring rather thana denigrating experience. The now therapeuticfocus with this seemingly hopeless patientwas the fostering of the growth of psychicstructure by supporting the positive cathexisof the self at the particular points in devel-opment where there had been a traumaticfailure in such support. This focus finally waseffective in helping this patient to move froma seemingly hopeless view of her life, in herearly sixties, to an increasingly expandingattitude toward what life could still hold forher, despite her tragic losses and defeats. Thiscentering on the integration of the self seemedto be the only therapeutic approach whichbrought about forward-looking growth.

Perhaps our society's inability to take theself seriously is seen in our undue emphasison the interpersonal. Responses are often in-terpreted in terms of who one interacted with,how one felt being with this or that person.Little time is spent on the understanding orsoothing of the core self—by either therapistsor persons appearing before them. The en-joyment of aloneness never having been taughtor reinforced but seen most consistently asnon-normative behavior, wounding loneli-ness in later life is assuaged with ameliorativesuggestions of a "doing nature," e.g., "jointhe club, the center, the xyz group," and soon. This is not to suggest that activity is notto be encouraged but it is suggested that thelook into the self both by the therapist andthe person in treatment be undertaken.

What can this exploration reveal? Pushedby the therapist to explore this, one oftenhears tales of an early life whereby the en-vironment was, if not overly hostile, mostunsympathetic or out of tune with the realneeds and feelings of the person. Taught totrust only themselves in an uncaring atmos-phere, they were plunged into omnipotenceat an early age. So formed, this omnipotencecould then, they felt, deal with all aspects oflife and death. Indeed, it could control both,in themselves and others. So geared, the fan-

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tasies of control were such as to rule out allvulnerabilities of mankind, including illness,failure and the ultimate—death. Defendingagainst the underlying helplessness, theseunconscious expectations became internal-ized and were used throughout life as a meansof surviving the insults daily living can bring.Yet, the reality of the ultimate insult, agingand death, can intensify the unconscious ex-pectation of triumph over fate and rage at theself when this proves impossible. Power isnow lost and again, as in early childhood,the world cannot be trusted. But now the worldis the person her/himself and s/he can nolonger trust her/his own interior. Stripped ofone's magical powers s/he is nothing. De-feated, helpless, powerless over the separa-tions—in-death s/he can not reverse the lossesaccompanying the changes on the constantlymoving calendar, and s/he appears before uswith the symptoms of depression, the oldwound reopened and laid out before us withshame, guilt and inability to act. The powerwithin one felt to be so strong at one time isnow waning. No one has real power; every-thing crumbles and dies. And s/he, the patient,is ashamed that s/he can do nothing aboutthis.

Convinced early that one's omnipotenceand control over others would be lifelong innature rather than limited to the very earlystage of life, s/he is predisposed to depressionin the later years. The feeling and acknowl-edgment that s/he is neither so strong nor sobrave as s/he had believed, thus unable toretain heroic ideals, plunges her/him into selfrecrimination. Each of life's insults and dis-appointments are responded to as though lifecapriciously stole pieces of oneself to throwaway. For, where the child is not protectedenough, s/he needs to develop this sense ofpower as compensation for those who leaveher/him exposed and unprotected. S/he hasonly her/himself to rely upon. Yet this toovanishes. For, with the limitations to ourpowers that normal aging (as ambiguous andcontroversial as that term is) imposes, theself too may be questioned as it melts out ofits fixed frame. Like the "Snow Queen" inthe children's fairy tale, the vulnerability ofhumanness is not to be tolerated if it can allmelt away, piece by piece, until the final dis-solution— death. It is thus that this inability

to accept the realistic limitations imposedupon us by life dooms some of us to depres-sion. How contradictory it seems then to statethat the capacity to bear depression or lossthroughout life is a prerequisite for soundmental health (Zetzel, 1965). It is this abilityto think/feel myself as helpless and imperfectwhich allows for the "perfection" of optimalhealth! Thus, basic to the resolving of de-pression are the developmental tasks dealingfirst with the tolerance of the passive ex-perience or inability to modify a painful ex-isting reality and second the subsequent mo-bilization of those responses which achievefor us some means of gratification in the worldas it exists at the moment. This latter hasbeen referred to as that stage of existence weterm "happiness" but for which little em-pirical knowledge exists. How curious thatin conferences on aging for many years, muchdiscussion centers around depression and littleon joy! The closest we come is focusing onphrases like "coping" which, to us, suggestsa neutral routinized response to life. Whereis that conference or data on what makes forjoyful, zestful, involved living, at any age?

In reviewing depression, it may be thoughtof as a narcissistic disturbance which expe-riences the self as a failure. While some au-thors such as Jacobson (1954) talk to the guiltfactor inherent in depression, others (Bibring,1953) omit this, emphasizing, rather, the re-lationship between depression and fluctuatingself-esteem. Most writers on the subjectholding a dynamic point of view agree thatdepression relates to discrepancies in one'sown narcissistic expectations. That is, both"elated and depressive responses can be foundat an early age as a result of experiences ofnarcissistic gratification or frustration"(Mahler, 1975). For some theorists (Mahler,1975) normal narcissism is felt as the height-ened self-esteem which is prerequisite to ex-periences of separation and the ability to say"no." Relating this to the approach whichsuggests that a lack of integration and valuingof the self throughout life predisposes one todepression, it is this response to the experienceof failing parts of the self which producesthe observed phenomenon of depression.

If narcissism, in its healthy aspects, maybe conceived of as the counterpart of depres-sion, where the former sustains sufficient self-

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esteem and the latter makes for depletion, wewould need to encourage the positive cathexisof the self, i.e., healthy narcissism in ourpatients. Goldberg (1980) in endorsing thisconcept states: "Narcissism, in its positivesense, is the unwillingness to be dissuaded,discouraged, or ridiculed against giving birthto the most audacious and grandiose projects.It is a commitment to passion." Unlike thedepressed person, where grandiosity and itsfailure is equated with a sense of loss, offailure of the self, passion for an idea, how-ever grandiose, may be viewed as the heightof healthy narcissism. Here the pursuit itselfis rewarding, offering a constant refuelingand re-energizing of the self, despite its ul-timate failure or success. It is the ability ofthe self to take risks, to stay committed to aset of values no matter how pejoratively it isviewed by others.

How then do we imbue our patients whoappear before us apathetic, withdrawn, un-inspired, helpless and despondent, with pas-sion? How, in particular, when the severelydepressed patient often renders the therapisthelpless with accusations of: "You are nothelping me. I still feel rotten. What's thepoint of it all?" The therapist may retaliateout of her/his own countertransference bypointing out to the patient the need to feeldeprived and/or her/his inability to use help.Since most therapists wish to feel appreciatedby the narcissistic strokes their patients givethem (Miller, 1979), the patient who seemsimpervious to the brilliant interpretations of-fered renders the therapist's own self-esteemvulnerable, a difficult position to be in. De-spite this, we are faced with the task of givingto our patients not merely clinical insights inour joint search for their lost selves, but thecourage to do and with it, the courage to be.This courage in the therapist may have comeabout (Miller, 1979) through resolution ofher/his own narcissistic problems wherein,from her/his own early experience, s/he isable to understand and feel what it means to"have killed oneself," (Miller, 1979). It isjust this struggle of the therapist which makesher/him most effective. This effectivenessmay be translated in the approach to the pa-tient. It is indicative of caring. A simple"What did you eat?" may be as convincingto the older person that you care as a detailed

and necessary history of one's life. A respectfor what the patient's depression means tothe therapist communicated through the em-pathic attunement arising out of the thera-peutic process is also crucial. This is revealedin the observance and sensitive response bythe therapist to the patient's every nuancewhile accomplishments, however minor, areapplauded.

In thus helping the patient search for a lostself, we stay close to ours. It is perhaps thiswhich can be viewed as courage and whichthe patient can use to search for a meaningto life. It is hoped that this reparative expe-rience, leading to the reactivation of struc-tures, i.e., parts of one's self can be her/hisnew self-soothers. Thus, when disappoint-ments, insults, traumas occur, these self-soothing devices can be applied to injuriesin not merely a coping but also a sustainingway, so that s/he can feel whole again andlife's experiences both reacted to and actedupon, with joy, with passion. If we truly joinin this search for one's lost self, we may, notaccidentally, rediscover parts of our own.

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