1. Freud, S. (1915/1950): Mourning and Melancholia. Collected Papers, Vol I. London, Hogarth Press and the Institute of Psychoanalysis. 2. Klein, M. (1960): Our Adult World and Its Roots in Infancy. Tavistock Publications, London. 3. Rado, S. (1951): Psychodynamics of depression from the etiological point of view. Psychosom. Med., 13. (more…)

Institute of Clinical Psychiatry, Sc hool of Medicine, University of Milan, 20122 Milan, Italy
A positive global evaluation is certainly possible at the end of a thorough discussion on anxiety and depression in the four fields in which the workshops have been articulated, that is, family, biology, psychopathology, and treatment. What seems difficult if not impossible is to reach definite conclusions in a field that is almost exactly characterized by the continuous overlapping of con­trasting theoretical and pragmatical proposals and models. The word "anxiety" derives from the Latin "angere" (to constrain), that is probably the somatic implication of the affective state that the word describes. In common language, it is synonymous with preoccupation (pre-occupy) —to occupy oneself before any event, to be waiting for it, and it describes in other words an alerting signal, a feeling of danger, a danger almost impossible to face. On the contrary, the word "depression" originates from the Latin "deprimere," that is, to crush down, to diminish, to fall dynamically. It is finked to the antinomy "value/without value," implying the conception of loss of values, that is, contempt for oneself in the Latin sense of "without value" (pretium). This is, in the clinical sense, the condition of the depressed person —a person pervaded by feelings of unworthiness, unable to find his own values (dispretium), and who can reach the extreme condition of melancholy, the complete lack of any will to live. This is a condition in which the individual no longer has true values because he does not belong to the world of meanings of existence. In fact, we cannot have any real knowledge of this "death," but can only reach a hy­pothetical meaning that can be symbolized but not understood. As we have seen, common language already describes two affective ways of perceiving the life to which psychodynamics (primarily psychoanalysis) has given a scientific organization. In this field, we find the description of anxiety as an expression of the failure of the defense mechanisms against the unconscious drives; anxiety also points out the individual successive evolutional steps: fear of losing objects, castration, ego-superego conflicts, and then the feeling that indicates the exhaustion of the homeostatic mechanisms brought against a stimulus that one is unable to face. In all the conditions mentioned, both symbolic and real, anxiety is a danger signal that testifies to the activation of the mechanism (to face stimuli or conflicts) to maintain individual integrity (3). As we have already stated, depression points out the loss of values or depre­ciation of self. This inability to establish one’s own value is deeply rooted in primordial relationship in the personal evolution (2). In the mother-son relationship, when the difference between subject/object has been established, the individual/subject is unable to build his own indepen­dent value. The extreme condition of this is melancholy (1). Through a wide range of conditions, anxiety and depression trace a path from normality to pathology with continuous overlappings. Anxiety is experienced as an unbearable present linked to a future suffered completely in imperative and unknown terms, whereas depression is experienced as a guilty past, condi­tioning everything and transforming the present time only into expiation and punishment. Therefore, in anxiety, the time parameter is experienced as extremely accel­erated; in depression, we can observe the complete time collapse. This is revealed by the total psychomotorial slowing down of the depressed patient who only seems to react when facing the burden of guilt that has not received adequate punishment. This is when anxiety appears in depression as a signal of the above mentioned event. This increasingly complicates the problem of distinguishing between anxiety and depression. Psychopathology and treatment do not give any satisfactory answer to all the problems involved. However, we cannot consider this fact negatively; the active opposition of themes must continue to promote progress in the knowledge of two ubiquitous conditions of human experience. (more…)