In 1991 I had 20 therapy sessions with William D. Brown, Ph.D., a psychologist in private practice. In 1998 I wrote a letter analyzing his work.

At the time of the 1998 article I knew nothing of the work of Sidney Blatt, a psychoanalyst. It was only weeks ago, in 2017, that I read about Blatt’s work that identified so-called anaclitic depression in which persons have a focus on social concerns and whose depression, intrapsychically, centers on orality and pre-Oedipal issues. He distinguished anaclitic depression from so-called introjective depression in which persons have a concern for identity and self definition and whose depression, intrapsychically, centers on guilt and Oedipal concerns.

My 1998 letter about Dr. Brown strikingly anticipates these issues. I intuitively grasped the reciprocal relationship between internal object functioning and external object functioning. I talked about a type of person who had minimal social interests (external objects) but had hyperdeveloped concerns centering on guilt and identity or self definition (internal objects) (introjective personalities) (namely, I) . I also talked about a type of person whose concerns centered on social issues (external objects) who had an impoverished internal development (internal objects) (anaclitic concerns). I even had an intuitive grasp that Oedipal issues played a role in the matter!

What say you now, Lisa Osborne?  Did Dr. Taub (St. Elizabeths Hospital faculty member) even know what I was talking about?  And why didn’t Dr. Taub see that I was talking about issues raised by Sidney Blatt?

Here is a summary of Blatt’s work:

A greater amount of emphasis on either self-definition or relatedness during one’s personality development may increase the individual’s vulnerability for specific types of depression. In fact, there is a great amount of empirical research that suggests that high levels of self-criticism or dependency are vulnerability dimensions for depression. Individuals with a dependent personality style may experience depressive states in response to disruptive interpersonal events and their experience an “anaclitic” form of depression, centered on feelings of loneliness, abandonment, and being unloved.

[Strikingly, I talk in the 1998 letter about Dr. Brown’s possible fear of abandonment.]

Blatt & Shichman (1983) comprehensively articulate that those with anaclitic disorders are plagued by feelings of helplessness and weakness; they have fears of being abandoned, and they have strong wishes to be cared for, protected, and loved. Within the anaclitic configuration, neurotic-level pathology ranges from the infantile personality, in which pre-oedipal, dyadic issues predominate (e.g., anaclitic depression), to hysteria, in which more oedipal, triadic issues are found. Borderline-level pathology is of an anaclitic, or hysteroid type. Psychotic-level pathology includes nonparanoid schizophrenia, characterized by more diffuse—and less rigid—qualities (Ibid). If we are mapping anaclitic personality pathology onto a DSM-III-R nosology, we find the Dependent, Histrionic, and Borderline personality disorders(Ouimette, Klein, Anderson, Riso, & Lizardi, 1994). Blatt & Shichman (1983) go on to explain that what is common among anaclitic pathologies is the preoccupation with libidinal themes of closeness, intimacy, giving and receiving care, love, and sexuality. In the pathologically anaclitic, the development of a sense of self is neglected as these individuals are inordinately preoccupied with establishing and maintaining satisfying interpersonal relationships (Ibid). Indeed, as the authors note, the pathologically anaclitic individual’s symptoms “are expressions of exaggerated attempts to compensate for disruptions in interpersonal relations. These disturbances are manifested in conflicts around establishing satisfactory intimate relationships and around feeling loved and being able to love. The basic wish is wanting to be loved” (1983, p. 200) (italics added). They go on to suggest that this preoccupation stems, in part, from a past in which important others have been depriving, rejecting, overindulging, inconsistent, or unpredictable—thus creating an environment in which closeness was precarious
(Ibid). Regarding defensive maneuvers, the anaclitic tends to use avoidant ones, such as denial, repression, and displacement (Blatt & Shichman, 1983). The cognitive processes of the anaclitic tend to be more figurative, focusing on images and affects.

They tend to think less critically, and more simultaneously as opposed to sequentially.

On the other side of the personality dialectic, individuals with a self-critical personality style may be more vulnerable to depressive states in response to disruptions in self-definition and personal achievement. These individuals may experience “introjective” depressive states around feelings of failure and guilt centered on self-worth. In “Levels of Object Representation in Anaclitic and Introjective Depression,” Sidney Blatt reviews Fenichel and Bibring’s theories of development and extrapolates that introjective depression is considered more developmentally advanced than anaclitic depression. This conclusion is supported by both Bibring and Fenichel’s discussions that one source of depression (anaclitic) is primarily oral in nature, originating from unmet needs from an omnipotent caretaker; while another source is related to the (more developmentally advanced) formation of the superego and involves the more developmentally advanced phenomena of guilt and loss of self-esteem during the oedipal stage.

Patients with introjective disorders are plagued by feelings of guilt, self-criticism, inferiority, and worthlessness. They tend to be more perfectionistic, duty-bound, and competitive individuals, who often feel like they have to compensate for failing to live up to the perceived expectations of others. Within the introjective configuration, neurotic-level pathology ranges from paranoia, at the more primitive end of this spectrum, to obsessive compulsive disorders in the middle of the spectrum, to phallic narcissism and guilt-laden depression (i.e., introjective depression) at the higher end. Borderline level pathology is of an introjective, or over-ideational type. Psychotic-level pathology includes paranoid schizophrenia, characterized by more rigid and fragmented-functioning compared with their more amorphous anaclitic counterparts (Ibid). If we are mapping introjective personality pathology onto DSM-III-R nosology, we find the Paranoid, Schizoid, Schizotypic, Antisocial, Narcissistic, Avoidant, Obsessive-Compulsive, and Self-Defeating personality disorders.

What is common among introjective pathologies is the preoccupation with more aggressive themes (as opposed to libidinal) of identity, self-definition, self-worth, and self-control. In the pathologically-introjective, development of satisfying interpersonal relationships is neglected as these individuals are inordinately preoccupied with establishing an acceptable identity (Ibid). As the authors note well, “The focus . . . is not on sharing affection—of loving and being loved—but rather on defining the self as an entity separate from and different than another, with a sense of autonomy and control of one’s mind and body, and with feelings of self-worth and integrity . . . The basic wish is to be acknowledged, respected, and admired.” It is suggested this preoccupation stems, in part, from a past in which important others have been controlling, overly-critical, punitive, judgmental, and intrusive—thus creating an environment in which independence and separation was made difficult.

The introjective tends to use counteractive defenses (as a means of controlling the conflict or impulse, as opposed to avoiding it), such as projection, doing and undoing, reaction formation, intellectualization, rationalization, isolation, identification-with the-aggressor, and overcompensation. The cognitive processes of the introjective tend to be more literal, focusing on thoughts, rationality, and things, as opposed to relationships. They tend to think more critically, and more linearly as opposed to simultaneously.