Paper presented to CCPE, London - November, 2007.
© Dave Hiles 2001, 2002, 2003, 2004, 2005, 2006, 2007 

 

Envy, Jealousy, Greed: A Kleinian approach

Dave Hiles
(Psychology Department, De Montfort University, Leicester. LE1 9BH. UK.)
(Email:    drhiles@dmu.ac.uk  )

 

 "Certainly, then, envy is the worst sin there is. For truly, all other sins are sometime against only one special virtue; but truly, envy is against all virtues and against all goodnesses."
                                             
Geoffrey Chaucer - The Parson's Tale

 

1. Introduction
Geoffrey Chaucer's claim that envy is the worst sin of all is certainly worth taking seriously. Envy is one of the ugliest of experiences. It is the destructive attack on the source of life, on goodness itself. Envy is a common enough experience, but when it is experienced early in life, or when left unresolved, it can be overwhelming, and moreover it can be soul destroying (see the case example included in the Appendix).

There are many insightful portrayals and representations of envy in literature and popular culture. For example, in a small book by Joseph Epstein (2003), the characters of Iago in Othello, Claggart in Billy Budd, and Uriah Heep in David Copperfield are seen as insightful studies in envy. In the film Seven (1995, Dir. David Fincher), the serial killer chooses each of the seven deadly sins on which to base his crimes, leaving to last, the worst sin of all, envy. Curiously, another recent film, A.I. Artificial Intelligence (2001, Dir. Steven Spielberg) involves a story that examines the nature of love. However, although the issue of jealousy is explored, it is the omission of any serious treatment of envy that seriously undermines the film's impact. In the film, Amadeus (1984, Dir. Milos Forman), based on the original stage play by Peter Shaffer, the rivalry between Mozart and Salieri is explored. The story highlights Salieri's jealousy of Mozart's musical genius, but Salieri's conflict is really with God. Why has God granted Mozart such ability, and not him? In fact, it needs to be understood that Salieri is jealous of Mozart, but he is envious of God. At first, such an observation might seem rather odd, but it is precisely this issue that we will be concerned with in this lecture. 

Envy is closely linked to the human experience of love, and in examining this relationship we will need to make some important distinctions between envy, jealousy and greed. To do this we will need to draw on some psychoanalytical concepts taken from object-relations theory, in particular from the work of Melanie Klein. Eventually, my goal is to place this entire discussion within the context of a transpersonal approach to counselling and psychotherapy. Finally, I will relate these ideas, and Klein's concepts of gratitude and reparation, to a discussion of the dynamics of love and hate, which was first given serious attention in the pioneering work of the Scottish psychiatrist, Ian Suttie (1935).

2. Psychoanalytic Theory and Transpersonal Practice
As unlikely as it might seem to many counsellors and psychotherapists, there are important links to be made between psychoanalytic and transpersonal thinking. There have been important attempts to make such links in the work of Carl Jung and Roberto Assaglioli, and more recently by Michael Washburn (1994) and A.H. Almass (1988). This paper involves perhaps an even more unlikely attempt to build a bridge between some of the theoretical ideas of the radically post-Freudian psychoanalyst, Melanie Klein, and the transpersonal perspective, specifically in respect of her concept of unconscious envy.

One of the obstacles to such a project can be dealt with by simply considering an alternative to the deterministic, mechanistic model that Freudian psychoanalytic theory is often taken for. Instead, I prefer to view psychoanalysis as offering plausible narrative accounts of behaviour and experience. I also take the view that narrative is a primary mode of thought, and that the ego is a narrativizing device (for example, see Stern, 2004). From this point of view, psychoanalysis provides a hermeneutic model for both normal and pathological development, particularly identifying the crucial early experiences that have lasting meaning in people's lives. The emphasis in psychoanalytical technique is to focus on the unspoken core parts of the personality (nb. infant [Latin]= without speech). These "unspoken" parts of the personality can manifest as unconscious conflicts in client case material, and it was Freudís great insight that these are revealed in two distinct ways, (i) retrospective subjectivity (ie. phantasy, dreams, symptoms, observations, etc.), and (ii) present-centred inter-subjectivity (i.e. transference, therapeutic alliance, etc.). Thus, classical psychoanalysis offers a model of the psyche in terms of a conflict metaphor (i.e. a conflict narrative), for example, the conflicts between ego-id, good-bad, love-hate. Of course other narratives are possible, but the conflict narrative is a useful model for primitive, early processes.

3. Melanie Klein and Object Relations Theory
Melanie Klein (1882 - 1960) has had a major impact on the development of psychoanalytic thought since Freud. She made highly original contributions to the development of object relations theory, but many of her theories remain controversial. Indeed, all psychoanalysts that have come after Klein must consider whether they align with her or against her. It has also been remarked that Melanie Klein was "more freudian than the Freudians." Amongst her original contributions to psychoanalysis were her theories of unconscious phantasy, introjection, splitting, the "paranoid-schizoid" and "depressive" positions, gratitude, reparation, the "play technique", and unconscious or primary envy.

Object relations is a system of psychological explanation based on the premise that the mind is comprised of elements taken in from outside, primarily aspects of the functioning of other persons. This occurs by means of the processes of internalization. This model of the mind explains mental functions in terms of relations between the various elements internalized. The British Object-relations School was pioneered in the work of Ian Suttie, Melanie Klein, Ronald Fairbairn, Harry Guntrip, Wilfred Bion, Donald Winnicott, and Michael Balint. The notion of object was first developed by Freud in relation to his instinct theory. The object designates the thing (usually a person or part-person) through which an instinctual drive is able to achieve its aim. Although Freud used the term imprecisely, it has come to occupy the cornerstone of modern psychoanalytic theory. Good accounts of object relations theory can be found in Greenberg & Mitchell (1983), Bacal & Newman (1990), St. Clair (1986) and Gomez (1997).

Object relations theory is the full realization of Freud's attempt to move "beyond the pleasure principle". The human psyche is recognized as not simply governed by a need to satisfy its basic drives. Objects that come to signify a particular drive reduction, become sought after merely for themselves. Therefore, in object relations theory, the psyche is seen to be object-seeking rather than pleasure seeking. 

For the infant, the first object is a part object, e.g. the mother's breast. The infant does not respond to the mother as a whole person, but simply as a "breast", a supplier of its needs. In turn, the breast becomes an object of desire in its own right. The ego is strengthened by the finding of "good" objects. Their internalization (introjection and identification) is important for the development of psychic structure and mental functioning. The infant's mind in effect results from the formation of an "internal world" populated by these objects. 

Central to the theory is the distinction between part/whole objects, good/bad objects, idealized objects, object constancy, transitional objects, etc., etc. The psyche through projection attributes or places unacceptable feelings onto objects, and through splitting, which is a primitive mental mechanism, can distinguish between the pleasurable and non-pleasurable aspects of the same object. These processes serve both an adaptive and defensive function.

4. Melanie Klein's Theory of Early Object Relations
In order to fully understand and appreciate Melanie Klein's theory of primary envy, it is necessary to consider the fundamental importance that she attributed to the infant's first object relation - the relation to the mother's breast. The "breast" is the archetypal good object. It is instinctively felt to be the source of nourishment, indeed of life itself. In normal infant development, the "breast" is introjected and securely rooted in the ego. This leads to the core of the ego being formed, and the basis for satisfactory growth and development is laid down.

However, the infant clearly invests the motherís "breast" with qualities that go far beyond the actual nourishment it affords. Inevitably the breast will fail to live up to these expectations - it is not perfect. The infant's early emotional life is characterized by a sense of losing and regaining the good object. The innate conflict between love and hate leads to the internalization of good objects and bad objects. Such conflict is essential for normal enrichment and growth of the personality and strengthening of the ego. Thus, conflict, and the need to overcome it, is seen as fundamental to human creativeness. With the mother's breast being experienced as both good and bad, the internal object splits along with the ego. This splitting results from the ego's early lack of cohesion, and acts as a defence against primordial anxiety, achieving a dispersal of the destructive and persecutory anxieties, and offering a mechanism for the ego to be preserved. An important distinction needs to be made between the good and idealized object. An extremely deep split usually occurs between an idealized object and an extremely bad object.

Klein uses Freud's notion of the death instinct (thanatos) to explain the infant's instinctive response to anxiety. For Klein, complications of ego growth stem from idealization, persecutory anxiety, frustration caused by absences and loss, and fear of annihilation. Indeed, it is fear of annihilation which is primary - a fear of something that destroys from within, but it is experienced as being outside (i.e. something physical). The manic defences that can be mobilized to relieve the guilt aroused by the destructive fantasies of the depressed psyche are described in her classical paper:- "A contribution to the psychogenesis of manic-depressive states" (Klein, 1935). For good accounts of Klein's work see Grosskurth (1986), Hinshelwood (1991), Likierman (2001), Mitchell (1986), Sayers (1991, 2000), Segal (1964; 1979).

5. Jealousy
We will begin first with jealousy, because it is more conscious and easier to conceptualize. Jealousy is based on envy, but involves a relation to at least two other people. It pertains to a triangular (oedipal) relationship, i.e. it is whole-object oriented. It is commonly experienced with respect to love that a person feels is their due and has been taken away, or is in danger of being taken away, by a rival. Jealousy aims at the possession of the loved object and removal of the rival. It is usually the rival that is the target for aggression, which might suppress a more deeply felt envy towards the loved object. Also, in jealousy there may be a fear of losing what one has.

Jealousy implies envy of the actual or presumed advantage of a rival, especially in regard to the love of an object. Jealousy is often accompanied by suspicion that the loved person favours the other. Deriving from the oedipal conflict, jealousy is based on the wish for an exclusive relationship to the primary object. Unresolved jealousy can lead to the impossibility of forming meaningful relationships and lack of maturity of ego and Self. It raises issues of sharing, ownership, possessiveness. The qualities of the jealous client are included in Table 1.

6. Unconscious Envy
It is important to stress that we are discussing unconscious and not conscious envy here. Also, we need to acknowledge the controversial nature of this concept, which many psychoanalysts have found unacceptable (e.g. Donald Winnicott), although it is my belief that there is a widely held confusion concerning Kleinís basic ideas. During Melanie Klein's early professional work, there was an optimism that the psychoanalytic attitude of emotional understanding could improve our culture and human relationships. However, she gradually became acutely aware of the depth of her patient's resistances, and together with her observations of young children, she became convinced that there was a constitutional instinctive destructive factor at work - unconscious envy, which first manifests in early infancy as primary envy

Klein is often seen as claiming that the young infant has an innate destructive drive to destroy everything that is good. I will argue that this is simply a misunderstanding of the mechanism of envy. One view that is worth taking seriously is that proposed by Likierman (2001) who argues that Klein really offers two theories of envy. The first sees envy as involving a gratuitous aggression towards anything that is good, while the second sees envy as the fragile infant ego responding to a deprivation of some kind. This deprivation may even be minimal, or momentary. While I do not go along with this distinction fully, I do think it is a useful place to begin, with the second of these two theories being the focus here.

The best way to understand envy is to see it as the angry feeling that another (person) possesses, and is withholding, or keeping to itself, something one desires for oneself. The other person is, at the same time, to be seen as the reliable source for what one desires, and seen as possessing and withholding and keeping for itself something that "I want." Envy is the feeling of conflict that what one desires, and would normally be forthcoming, is being withheld. The envious impulse is to attach, or to spoil the very source that one originally relied upon. This impulse can become diabolically destructive and undermining, since it mobilizes such powerful defences -  devaluation of the good object, or rigid idealization. The infant's feeling of failed gratification is experienced as the breast withholding, or keeping for itself, the object of desire. Envy is therefore more basic than jealousy, and is one of the most primitive and fundamental of emotions.

Envy stems from an immature intolerance to frustration. In her work, Melanie Klein found that the first object to be envied was the breast. This is primary envy, and if tolerated, and worked through, will lead to normal development. But when the experience of envy is excessive this can lead to a weakened ego. The mechanism of envy involves attacking the good breast, so that introjection can no longer occur. In envy, there is an aim to possess the good object, but when this is felt to be impossible, the aim becomes a need to spoil the goodness of the object, in order to remove the source of envious feelings. Consequently, envy is the diabolical need to destroy the very source of goodness that maturation and growth requires. Moreover, this primitive envy can be experienced in later development as unconscious envy, and can be revived in the therapeutic alliance as a negative transference.

Unconscious envy always implies the subject's relation to only one other person, and relates back to the earliest exclusive relation with the mother, as good object. The subject envies the object for some possession or quality, initially in terms of part-objects, but this inevitably will persist into whole object relations.

Envy, therefore, is both a characteristic of early infancy and the personality in adulthood. An envious person may feel sickened at the sight of enjoyment, they may feel easy only in the misery of others. Envy often serves to stir up envy and jealousy in others. A consequence of excessive envy is an early onset of guilt - a guilt felt as persecution, and the object arousing the guilt as the persecutor. Indeed the deepest sources of guilt are always linked with the envy of the primary good object (the breast), and with feelings of having spoilt its goodness by envious attacks.

Defences against envy quickly lead to psychopathology, because they fail to prevent the destructive operation of envy. Unresolved primary envy can lead to psychotic symptoms in later life. Envy is commonly accompanied by self-pity, self-destructiveness, etc. Withdrawal of the good object, when not dealt with in rage and outward destructiveness, will turn inwards. The ego can implode and destroy itself. Suicide may be a later expression of the early need to self destroy which the infant cannot express for itself. The qualities that might manifest in the envious client are included in Table 1.

Table 1: Qualities to be observed

Envy:
persecution, frustration, guilt, self pity, idealization, acting out, ambition, disapproving, aggression, manic defences, intolerance, hatred, destructiveness, self-destructiveness, sabotaging, discounting, etc.

Jealousy:
rivalry, rejection, suspicion, exclusivity, possessiveness, tense relationships, immaturity, grievance, hostility, etc.

Greed:
craving, selfishness, insensitivity, poor discrimination, self-denial, dissatisfaction, demanding, insistent, (or, as a defence: emptiness, low self-confidence, over-adaptation, etc.)

Gratitude:
acceptance of limitation, generosity, sharing, healthy relationships, grace, tolerance, creativeness, repressed guilt, etc.

 



7. Greed
Greed is an impetuous and insatiable craving, exceeding what the subject needs and what the object is able and willing to give. Greed aims at possession of all of the goodness that can be extracted from the object, regardless of consequences, perhaps leading to destruction or spoiling of the goodness - but this is incidental, or innocent. Greed is mainly bound up with introjection, while envy is bound up with projection. Indiscriminate idealization can be fuelled by greed, since the need to get the best from everywhere interferes with the capacity for selection and discrimination.

It is my view that greediness is a primary state, a basic expression of Self and of desire. An intensity of greed, can lead to envy. Greediness can exhaust the good object, such that it seems to be withholding, setting up precisely the conditions for envy. The infant has no inkling of the limits of the world, limits of the mother, or the breast. It has no idea that the demands it will make cannot always be met instantly, and in full. A primary task in human development is to temper such demands, through a capacity for concern (Winnicott, 1963).

For the mature ego, greediness and neediness will be a continuing theme. Although, in my experience with clients who are not seriously disturbed, a common complication is a denial of greediness, sometimes experienced as emptiness. This stems from a conflict with the super-ego. It is not unusual in such cases to uncover damage or vulnerability in some early good object (n.b. Winnicott calls this the locus of concern). This may then be sufficient to result in the client's greediness being denied for fear of exhausting or completely destroying the good object.

8. Gratitude and Reparation
In Klein's theory, love and gratification are not enough - gratitude is needed too. Gratitude is closely linked with the trust in good figures. This includes the ability to accept and assimilate the loved primal object without greed and envy interfering too much. The wish to preserve and spare the good object then predominates. The healthy ego integrates the early conflicts, and if envy is not overwhelming, then gratitude overcomes and modifies the envy. A full gratification at the breast means the infant feels (s)he has received from the loved object a unique gift which (s)he wants to keep. This is the basis of gratitude. Enjoyment therefore is the basis of gratitude. Such enjoyment is the basis of all later happiness, and the feeling of unity with another person. Unity means being "fully" understood, which is essential for every happy loving relationship. Gratitude is closely bound up with generosity. Inner wealth derives from having assimilated the good object so that the individual becomes able to share its gifts with others. However, it must be recognized that expressions of gratitude in an individual can be prompted also by feelings of guilt, rather than the capacity for love.

Persistent gratification leads to more experiences of enjoyment and gratitude, and accordingly there is a wish to return pleasure. This recurrent experience makes possible gratitude at the deepest level and plays an important role in the capacity to make reparation. Klein emphasizes that gratitude is the goal of the psychoanalytic process.

9. A Transpersonal Perspective on Primary Envy
Although Melanie Klein would need considerable persuasion on the matter, I think it is not too strong a claim to make that in her concepts of gratitude and reparation, and the related potentially destructive impulses of envy and greed, etc., are the anticipations of a transpersonal theory of the processes of human unfoldment.

There have certainly been attempts to forge links between the work of Klein and that of Carl Jung (e.g. Fordham, 1995). Jungians have found obvious parallels between Klein's paranoid-schizoid and depressive positions and Jung's notion of archetypal processes expressing themselves in human unfoldment. However, I would like to explore these parallels a little further by taking them to a transpersonal level of understanding.

Recently, I became interested in Jung's treatment of the coincidentia oppositorium, the coincidence or conjunction of opposites. In this exploration I have been particularly helped by the work of William Blake (see Hiles, 2001).

The coincidentia oppositorium is an idea that occupies an important place in Jung's psychology. It is particularly important to realize that what is at stake in this conjunction is not the basic recognition of opposites, nor the simple interplay of opposites in our experience, nor even the union or marriage of opposites, but the shocking realization of their conjunction in the same object or situation.  The reason why the coincidentia oppositorium is so crucial is that it does not simply represent the opposition of hate and love, but represents hating and loving the same object. This, of course, is exactly the condition which can precipitate human envy, and is possibly a conflict that it is necessary for us to confront very early in our development, indeed throughout our lives. In this respect, it can be seen that envy is the central challenge to our psychic growth, i.e. resolving the "paradox" of loving and hating the same object. Jealousy is the outcome of the difficulties in sharing the loved object with someone else, and greed is merely asking, or demanding, too much from the loved object.

It is important to realize that hating one object, and loving another, is hardly a challenging experience. But hating and loving the same object, now that is a completely different matter!! And I want to argue that this is a theme, or what Jung would call a psychic truth, that must lie at the core of an existential-transpersonal model of human experience. It is almost certain that the fearful symmetry which William Blake refers to in his poem, The Tyger, is precisely this conjunction:

"Tyger, Tyger burning bright, In the forests of the night: What immortal hand or eye, Dare frame thy fearful symmetry?"
                                    
William Blake  (The Tyger)

In my own study of Jung and Blake, I have proposed that it is precisely this conjunction that constitutes the God archetype, which Jung equates with the archetype of the Self (Hiles, 2001). Confrontation with this archetype reveals the tragic contradictoriness of the Self, and also of God (as Jung points out), and is experienced as the dark night of the soul. The coincidentia oppositorium is the crucial archetype of the human psyche, it is the ultimate challenge to human growth, it is the unconscious conflict at the core of human existence. And, with respect to what we are discussing here, it is clear that it presents itself to us at critical stages throughout life, from the earliest stages of human growth as primary envy (Klein, 1957), through the inevitable experiences of loss across the lifespan, to the later stages in the prospect of death. Placed in this context, Klein's theory of unconscious envy takes on a new significance. Envy is the expression of an archetype that lies at the core of our being, and it would seem, it is an archetype that must find expression very early in our unfoldment. Envy takes on a transpersonal significance, as an in-built mechanism for dealing with life's inherent limitations. Indeed, if we take this claim seriously, then it does not take much effort to realize that the God archetype could not manifest itself in human consciousness in any other way. It is therefore my claim that envy is a necessary condition for human growth.

10. Ian Suttie - The Dynamics of Love and Hate
I think that it is worth mentioning here that this notion of envy as playing a crucial role in human growth is not really a new idea, and indeed, it is echoed in the work of a neglected pioneer of object relations theory. I am thinking here, of Ian Suttie, a Scottish psychotherapist and member of the Tavistock Clinic, and his publication: "The Origins of Love and Hate" (1935). In his work, Suttie anticipates many of the ideas of object relations theory, as well as many of the ideas of Melanie Klein. However, Ian Suttie was a severe critic of Freud's instinct theory, and in this respect, it was relatively easy for the early developers of object relations theory to discount and ignore his work, while still using his ideas. It should be noted that Suttie generally accepts Freud's principles of therapeutic practice, but he was an uncompromising critic of Freud's theoretical ideas of early development.

Suttie does not refer explicitly to envy in his work, but it is clearly implied in his discussion of hate. In the preface to the the 1960 edition of Suttie's book, J.A. Hadfield writes:

" . . [Suttie . ]  rejected the idea that the infant is born a bundle of instincts. He held that the infant was born with a simple attachment to the mother, who is the sole source of food and protection. [ . . ] Basing the origin of love in this primal attachment of the child to the mother, he finds both fear and hatred to be due to the deprivation of that attachment. We can only hate a person whose love we desire, seems to be his theme" (Suttie, 1935/1960, p. 16).

Suttie writes:

"Hatred, I consider, is just a standing reproach to the hated person, and owes all its meaning to a demand for love" (Suttie, 1935/1960, p. 37).

Suttie anticipates by more than twenty years the ideas of Melanie Klein, and he also clearly anticipates the particular distinction between two theories of envy made by Likierman more than 60 years later. The neglect of Suttie's work is a rather poor reflection on the field of psychotherapy. However, as a bridge between object relations and transpersonal theory, his work may finally receive the recognition it deserves. The point is that the process of envy and jealousy and greed are all expressions of the complex dynamics of love and hate, involving the crucial archetypes that will steer the ego from its omnipotent origins to its eventual position of maturity. I would like to sum up my own belief as follows:-

"Envy is a necessary condition for human growth. We are born with the capacity to love and to hate, but only by being loved can love overcome hate." 

This, of course, echoes the words of the Buddha:

           "In this world hate has never yet dispelled hate. 
            Only love dispels hate."
                                                           
Dhammapada.

 

References

Almass, A.H. (1988) The Pearl Beyond Price: Integration of personality into being - an object relations approach. Diamond Books.

Bacal, H.A. & Newman, K.M. (1990) Theories of Object Relations: Bridges to Self Psychology. Columbia University Press.

Epstein, J. (2003) Envy. Oxford University Press.

Fordham, M. (1995) Freud, Jung, Klein: The fenceless field. Routledge.

Gomez, L. (1997) An Introduction to Object Relations. Free Association Books.

Greenberg, J.R. & Mitchell, S.A. (1983) Object Relations in Psychoanalytic Theory. Harvard University Press.

Grosskurth, P. (1986) Melanie Klein: Her world and her work. Aronson.

Hiles, D.R. (2001) Jung, William Blake and Our Answer to Job. Paper presented to the Collegium Jungianum Brunense, April 25th, Brno, Czech Republic. Available at:           http://psychematters.com/index.htm  (Unfortunately this site has been "taken over", but I will try to make it available in another way, soon. However, if you need this I can email a copy to you).

Hinshelwood, R.D. (1991) A Dictionary of Kleinian Thought. (2nd Ed.) Free Association Bks.

Klein, M. (1935) A contribution to the psychogenesis of manic-depressive states. Int. J. Psychoanalysis, 16, 145-74.

Klein, M. (1957) Envy and Gratitude. Tavistock. (Reprinted in the volume entitled "Envy and Gratitude" in Klein's Collected Works published by Virago)

Klein, M. (1963) Our Adult World and its Roots in Infancy. Heinemann.

Likierman, M. (2001) Melanie Klein: Her work in context. Continuum.

Mitchell, J. (Ed.) (1986) The Selected Melanie Klein. Penguin.

Sayers, J. (1991) Mothering Psychoanalysis. Penguin.

Sayers, J. (2000) Kleinians: Psychoanalysis inside out. Polity.

Segal, H. (1964) Introduction to the Work of Melanie Klein. Heinmann.

Segal, H. (1979) Klein. Fontana Modern Masters.

St. Clair, M. (1986) Object Relations Theory and Self Theory. Brooks/Cole.

Stern, D. (2004) The Present Moment in Psychotherapy and Everyday Life. Norton.

Suttie, I. (1935/1960) The Origins of Love and Hate. Penguin.

Washburn, M. (1994) Transpersonal Psychology in Psychoanalytic Perspective. SUNY Press.

Winnicott, D.W. (1963) The Development of the matter of concern. In: The Maturational Process and the Facilitating Environment: Studies in the theory of emotional development. Hogarth Press.

 

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APPENDIX: Case example taken from a published source (*)


Patient: Male, 72 yrs., highly creative in his public life. He is tired looking, frail, lacking spontaneity, his speech is slow and halting, monotonous in tone. He is a sensitive man, a perfectionist, easily hurt and moved to anger and tears. He can be unforgiving, pessimistic and demanding. His physical health is good; he sleeps poorly without medication; his appetite is poor. He is preoccupied with the past, constantly thinking of his past life with his parents and with his own children.

Presenting problem: He has a long-standing history of recurrent mood swings, from age 34 when first hospitalized and treated for manic-depressive illness, with numerous relapses since. When depressed he becomes socially withdrawn, uncreative, expresses marked feelings of futility, worthlessness, and at times is suicidal. He has difficulty concentrating and relaxing, is hypersensitive to noise, and has profound feelings of guilt about his being a burden to his family, and doubts that he will ever recover.

Personal history: His early family life can be described as unsettled, and stressed. Father: often "absent", temperamental, dramatic, prone to rages. Mother: domineering, possessive, protective. One younger brother. Shortly after he was born, his mother became ill/depressed, hospitalized for 2-3 months, he was looked after by an aunt. Bedwetting until age 10. Left school at 15, wounded in action during the war, which deeply affected him. At age 34, he married his first wife, and with a new-born daughter, career pressures, a year later he suffered his first breakdown when he was seriously manic. The marriage broke up 7 yrs later, and he took an overdose. He has married twice since, and has five children in total. Describing how he feels when he is depressed, he says,

"There is this terrible emptiness. I just want to go away, disappear, cover myself up until it goes away [ . . ] It is like every fibre in your body is screaming for relief yet there is no relief. [ . . ] It is like a light switch. I feel suddenly turned off. There is a tiredness, a feeling of complete lethargy."

Something unexpected may simply unsettle him, e.g. a family matter:

"It doesn't so much develop. It just goes bang like that, and I find I am in the grip of it again and I can't shrug it off."

He describes himself as tempestuous, possessive, often intolerant of others, and in his early years, he was an exceedingly jealous and insecure man. "I am a jealous person, certainly, insanely jealous - when it comes to females. I had my first sweetheart and she was given a lift in a car full of people, sitting on a chap's lap. And I saw her and I stopped the car and I dragged her out and I beat this bloke up - just for the fact that she sat on his lap. I was 17 at the time. Raging jealousy. I have remained very possessive. I was then. Less so now." And, when he was age 6, at a picnic, he remembers his mother: "She was so beautiful and I remember one of the chaps was pulling her hair right back and it upset me so much I ran inside the house and cried. I don't know why. Did I love her? Was she my girlfriend deep down? I was jealous."

Treatment: The history of his treatment has progressed through hospitalization, drugs and bedrest; then hypnotherapy for insomnia; and more recently antidepressants, ECT, lithium. Psychotherapy does not seem to have been considered.

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                    * - I have abstracted this material from a case study that is in the public domain. It is taken from:

                             Milligan, S. & Clare, A. (1993) Depression and How to Survive It. Ebury Press.