Depression in infants

DESCRIPTIVE ANALYSIS

General information:

We must first of all recall metapsychological evidence that the more young the baby is, the less it is differentiated, both intrapsychically and extra-psychically.

As a consequence, as soon as one speaks of the depression of the baby, the question of the maternal (or family) depression is ipso facto formed in a kind of reciprocity where cause and consequence reverberate each other within a etiopathogenic loop sometimes Very difficult to analyze and interrupt.

In fact, if maternal depression is one of the possible determinants of infant depression and even a very important factor, we will come back to it again, but it must be placed within the more general framework of the theme.

Depression in infantsDefinition of deficiency:

It is in fact very complex.

First, that said deficiency said frustration but this last term was so overused that it ended up losing its accuracy.

When one refers to the register of frustration, it is necessary to distinguish whether it relates to needs or desires.

Being frustrated at the level of desires leads to disappointment, but being frustrated at the level of needs results in harm, which in fact turns out to be very different.

This distinction raises at once the question of the theoretical model, explicit or implicit, to which reference is made.

Indeed, according to Freud’s view of the relation to the primary object as part of the instinctual, libidinal and aggressive dynamics, which is secondary to the drives of self-preservation, According to Bowlby’s view of this early relationship as based on the existence of a primary need for attachment, then in the first case one will consider the depression of the baby from the angle of An obstacle to desire, or in the second case it will be considered from the point of view of the deprivation of a need.

From the outset, the question involves the whole clinical approach and the therapeutic strategies that result from it.

Moreover, Ainsworth has a very judicious classification of the different clinical types of maternal deficiencies.

The quantitative deficiencies on the one hand, where the baby has to face a physical absence of its parenting reference (or better its main caregiver).

Qualitative deficiencies, on the other hand, where the mother is physically present but psychically absent or inaccessible because of her personal psychic state (anxiety, delirium or depression, for example).

To this central opposition must now be added the question of interactive discontinuities, the harmfulness of which is great through mixed effects, both quantitative and qualitative.

Theme of lack:

It is therefore crucial in the field of infant depression.

Again, in this thematic, maternal depressions represent only one of the possible links among others, even if it is an important and somewhat emblematic link.

Descriptive analysis of infant depressions

As always in the field of child psychopathology, two approaches are possible here – and in fact complementary – depending on whether one takes into account the observed child or the reconstructed child, a debate around which have taken place famous positions (Green, 1979) and more recently, Stern has made an interesting reflective contribution.

This polemic is, in fact, a filigree of all discussions on the relationship between development and structure.

Descriptive analysis of child psychiatry:

Classic descriptions:

We shall not repeat here the exposition of the classical descriptions which have centered the original works of Spitz like those of Bowlby and Robertson.

The tables of anaclitic depression and hospitalism are now well known, and we know how much their description has had a founding effect in the field of psychiatry of the first age, and this on three levels: clinical, theoretical and therapeutic.

These basic descriptions refer essentially to quantitative deficiencies in which actual separations in the field of external reality were effected, prolonged separations in the studies of Spitz, which were shorter in those of Bowlby, not to mention the names Anna Freud herself and Burlingham who also did an enormous job of observing and caring for children placed away from their parents at the Hampstead nursery during the London bombings.

It has become classic to say that in our countries fortunately the large tables of hospitalism would no longer be found in institutions but only at home (on the occasion of extremely unfavorable socio-family situations).

Let us hope that this institutional consolidation is everywhere effective, but here we must undoubtedly avoid too confident an optimism and remain vigilant. In fact, the care of young children induces – and direct observation of babies according to Bick’s methodology – a whole series of countertransferential attitudes aimed at protecting the adult from a revival of his own anxieties Archaic.

As a result, institutional arrangements are constantly running the risk of defensive developments, among which the more or less disguised abandonment of the child often threatens to resurface. Institutional reflection must therefore be permanent and carried out unabated to avoid such changes.

Moreover, if things get better under our climates, it is obvious that this is not the case everywhere and some recent documents, coming from Romania in particular, are there to testify.

In Romania, many children are still dying of typical hospitalism, to which the AIDS problem has undoubtedly played only as a reinforcement of abandonment behavior.

Fortunately, thanks to international mobilization, the situation seems to be somewhat more evolutionary than expected, but this slice of history confirms, if need be, that the depressive depression of the baby is always ready to arise or Reappear.

The famous sequence: distress-despair-detachment, appears to be truly prototypical of depressive dynamics; The first phase is in fact a phase of anxiety, an active phase of calling and searching for the disappeared anaclitic object; The second truly depressive phase then seems to appear only when the anxiety-fighting mechanisms that were recruited in the previous phase are overwhelmed and exhausted; The last phase finally has the value of denial, more or less partial, of the problematic of lack.

We will find, mutatis mutandis, this sequence in the context of qualitative deficiencies and this is obviously a very interesting point of reflection.

In his 1951 World Health Organization (WHO) monograph (maternal care and mental health), Bowlby attempted to pinpoint the central depressive core of these phenomena by delineating a sort of hollow symptomatology that To evoke the essential depression described elsewhere in the adult (Marty).

The question of self-stereotypes also seems to require further study.

Exacerbated during the distress phase, on the contrary, they disappear and disappear completely during the phase of depressive despair.

Therefore, depending on the type of separation, the age of the child and the evolutionary level of its object relations, one must ask whether the autoerotisms observed during the anxious phase already have the value of substitution on a An internal object draft (a draft included in the autoerotic maneuver because it is mentally activated by it), or if it is a matter of self-aggres- sion pipes and then in a register closer to autosensuality.

Depending on the case of course, the narcissistic valence and the object valence of the observed auto-robotic behaviors will not have the same respective weight.

Of course, all experiments with quantitative deficiency do not have the same effect on all children.

It is in the interest of these historical works to have drawn the clinicians’ attention to the major role of the baby’s age at the time of the deficiency experience, the seriousness of the loss of the object during the second Semantics, on the prognostic weight of the duration of the separation and on the crucial role of substitutes offered or not by the environment and accepted or not by the child.

Let us add, finally, that the theoretical foundations which Spitz and Bowlby, each on their side, gave of these psychopathological pictures differ essentially by the place they devote themselves or not to the question of mental representations.

The whole of Spitz’s conception is based on his theory of the genesis of the object, the anaclitic depression being able to be understood schematically as a reversal of self-destructive aggressive impulses and also lacking external objects (because of the Separation) than of internal object (still insufficiently established). We are here in the register of the avatars of desire and let us recall that for S. Freud, the mechanism of reversal on oneself is, with the inversion in its opposite, one of the precursors precursors of repression.

The whole of Bowlby’s conception, on the other hand, is based on the ethological model of attachment, the anaclitic depression appearing at bottom as a consequence of a brutal disenchantment, a real deprivation at the level of a primary need, Ie unsupported.

Bowlby has thus been criticized for having somewhat shortened the question of mental representation, but recently, and especially since his death, these criticisms have been somewhat alleviated, for it has become clear that Bowlby did not, in fact, The importance of the psychic representation of the bond of attachment.

A recent article by Bretherton provided an update on this issue and will be discussed further below.

Depressive panels of a different type:

More recently – and in Paris in particular, in the Kreisler mobility – depressive pictures of a different type, often less spectacular, have been described in the baby.

It is here to speak, on the one hand, of depression called white or cold and, on the other hand, the empty behavior syndrome, both refer to an environmentally (and mainly maternal) rather qualitative deficiency.

White Depression:

This is a clinical picture that occurs in children suddenly confronted with a rupture or a bankruptcy of the maternal holding in the full sense of the term.

Until then, the dyad functioned normally, warmly, and brutally, for one reason or another, the mother is depressed and her interrelations with the child change, become devitalized.

The mother is there, there is no separation or quantitative deficiency, but if she continues to take care of the baby materially, in a way “the heart is no longer there.” His interactive style is transformed, the emotional tuning is altered and very quickly, the baby feels it deeply.

All the causes and all types of maternal depression can of course be at stake, but it goes without saying that the situation thus created is all the more dangerous because it risks going on unnoticed. In other words, if the great melancholic depressions are easily detected, the depressions that are not mentalised or camouflaged by defensive operation of the surgical type lead to an inadequate overinvestment of the material, factual and concrete relationship with the baby. Emptying progressively of all its lively and empathic thickness, without the mother or her entourage really becoming aware of the underlying depressive theme.

In addition, the possible difficulties of the psychic functioning of the mother related to its own type and prior personality, which until now, studies on the problem of maternal depressions seem to have insufficiently taken into account. The operative depressions occurring in previously borderline mothers appear to be particularly damaging.

In any case, faced with this radical and incomprehensible change for him of his interactive system, the baby will first try to fight against the maternal evasion and try to bring it back into a warm and affective interrelation.

Everything happens a little then as if it beckoned to him that it still existed and that it could not let him falling into isolation in his internal work of depressive elaboration.

This is what an author like Lanouziere has called the child’s “therapeutic solicitude” to his mother, a child-therapist function that would be the origin of many care-seeking vocations -that of S.

Freud himself, who had to face the depression of his mother at the death of his brother Julius).

This phase of rescuing the mother by the baby is an active phase, more anxious than depressive in the strict sense and corresponding to the phase of distress that we mentioned above in the context of quantitative deficiencies.

During this first phase, the baby uses all the means of the board, that is to say all those which are at his disposal and which are essentially corporeal, given his level of development since, before the language, c ‘Is the body that represents the main relational factor between the infans and his entourage.

One can thus observe anorexic phenomena, disturbances of sleep, cries or hyperexcitability … all signs having a call value in the perspective of a maternal recovery as we have evoked. From there, there are two things: either the baby succeeds, or else it fails.

If he succeeds in getting his mother out of his movement of depressive isolation, things resume their previous course and the psychopathological dynamics are disarmed.

If he fails, he will somehow exhaust himself in his therapeutic effort and enter himself into a depressive phase whose kernel has been meticulously by Kreisler.

From its description, we can retain four main components: thymic atony, motor inertia, interactive withdrawal, psychosomatic disorganization.

Thymic atony:

“The baby’s depression is a global athymy, closer to indifference than sadness.”

It is a dismal indifference, without complaint or tears, the characteristic of the depressive semiology of the young child being to be a semiotics in negative, hollow, reducing and reversing all the vital skills of the child in good Health: not only the appetite to nourish oneself, but also to look, to listen, to feel, to move, to know, to function, to progress … and perhaps even to think, we will come back to it.

It is the pleasure to be desired which is altered as a whole.

Motor inertia:

It is a slowness and a monotony of gestures and attitudes that may have evoked the depressive slowdown described in the adult by Widlöcher and his team.

“Mimicry is poor, body mobility as stuck, with the notation that the trunk is more affected by the trunk and the roots of the limbs than the relatively more mobile manual and digital ends.”

This very fine Kreisler notation is sometimes very useful to differentiate a depressive picture of certain preautistic hypotonies for example.

This motor inertia is marked by passivity and marked by a repetitive tendency, sometimes very impressive, which infiltrates the rare playful activities in fact devoid of imaginary and fantastical density.

In terms of differential diagnosis, this tendency to repetition is very easily distinguishable from psychotic stereotypes.

On the other hand, depressive atony is sometimes more difficult to distinguish from asthenia, especially since there are real depressive asthenias, at this age as at other periods of life.

It is this fund of inertia which is evident in certain depressive anorexia, as well as in the more or less complete collapse of the various autoertisms.

Interactive Retreat:

Marked by the progressive impoverishment of communication, the interactive withdrawal is revealed by a decrease in initiatives and responses to solicitations.

At the most, there is sometimes an impressive fixity of the gaze without blinking of the eyelids, the fugitive diversion when approaching or taking in the arms, alternating finally between moments of frozen vigilance and periods of gloomy vacuity, strange and Worrying.

Psychosomatic disorganization:

As with any age, but perhaps even more clearly in the infant, depression appears as an essential element of psychosomatic disorganization.

The forms of somatization are very varied, ranging from the most banal (nasopharyngitis, bronchitis, diarrhea) to the most severe that it is not useful to detail here but which can affect all devices (sleep and diet disorders mostly).

We shall return later to the question of psychosomatic disorders and the eventual eventual organization of a true personality of psychosomatic type marked by the failure of preconscious functioning.

Finally, we must insist: on the spectacular reversibility of the disorders under the effect of therapeutic measures (as distinct from the rapid encyclopedia of psychotic symptomatology); On the disappearance of the anguish of the foreigner with maintaining a relative interest for inanimate objects at the expense of contact with people; On the semiological value, especially in the crude forms, of the sudden modification of the behavior of the child which stands out from its previous habitus.

Moreover, on a metapsychological level, the child’s entry into this type of cold depression seems to be echoed by the maternal depressive rupture, and to refer to a complex defensive dynamics within which an author like Green considers the (A very dangerous mechanism aimed at protecting the child from primary maternal disinvestment), an identification with the depressive functioning of the “dead mother” itself, and an identification Unconscious to the object lost by the mother.

These different mechanisms engage contradictorily but cooperatively certain levels of primary identification and may in the aftermath, by a putting into effect, result in a surface pseudooedipification posing real threats for the subsequent edification of the personality Of the child.

Empty Behavior Syndrome:

The empty behavior syndrome is observed in children who may be slightly older than those affected by the white depression that we have just mentioned.

 

Like this one, the empty behavior syndrome falls within the framework of the qualitative relational deficiencies, but instead of being confronted with a secondary maternal depression, these children are living For a long time and chronically in contact with a depressed environment, dealing with what Kreisler calls a “usual desert relationship”.

The major semiological traits are comparable to those of the white depression, but with a tone of boredom, emptiness and more marked moroseness, as well as frequent psychomotor instability which seems to turn “empty”.

In this instability, it is necessary to see in this instability the child’s search for a motor substitutive envelope faced with the lack of a container, the sterile agitation – more induced by the perceptivomotor environment than by the imaginary or internal fantasy impulses – Also to evoke to certain authors the hypothesis of manic defenses covering the central depressive nucleus.

Psychosomatic disorganization also appears to be a great risk, and it is, for example, in this chronic depressive ambience that psychogenic growth retardation (or psychosocial dysfunction) can be progressively established.

Even in these dragging cases, the reversibility of the disturbances is an essential characteristic of these sometimes profound paintings. In the absence of effective therapy however, these empty behavior syndromes could make the bed, in the long run, of unmetalized neuroses, formerly referred to as “behavioral neuroses”.

Interactive discontinuities:

Currently, they are receiving the full attention of clinicians and researchers.

We have seen that they can dangerously combine aspects of mixed relational deficiency, both qualitative and quantitative.

The pathogenic impact of these relational discontinuities is mainly due to unpredictability. Indeed, the child lives alternately, and without any possibility of mastery, fertile moments of relational engagement and periods of interactive emptying directly damaging.

Depending on the physical or psychological prevalence of remoteness processes, the clinical picture in the baby is closer to anaclitic depressions or cold depressions and syndromes of empty behavior.

It is in this context that the pathologies described a long time ago by Guex take place in the “children-packets” brought to live multiple investments, displacements and replacements.

The author first chose the term “abandonment neurosis” but then replaced it with the term “abandonment syndrome” to take account of the very difficulties of mentalizing disorders in which she saw a possible germ of Subsequent psychopathic structure.

In a much more discreet manner, the observation of babies in community showed the intensity of the psychic work that the babies have to assume to adapt to the multiplicity of the interactive styles that are proposed to them or rather imposed, as shown The works of Athanassiou and Jouvet, for example, on infants in nurseries.

Their work shows us how these adaptive abilities vary from one child to another and how the relative effectiveness of “intracorporeal identifications” may or may not help children To overcome the real depressive moves that are played for him at the moment of the different separations or the different passages of hands in hands.

This work has the interest of drawing attention to the threshold of tolerance and sensitivity specific to each child with regard to the experiences of separation and the dividing line between the necessary experiments with constructive value and those which, on the contrary, do not May have a deleterious effect on the psychic structuring of the child.

To conclude this pedopsychiatric description of the depressive phenomena observed “in direct time” in children, we will now make a few remarks:

First note:

Maternal depressions may be involved in the determinism of many psychopathological panels of the child.

In other words, maternal depressions do not induce depressions in the baby.

But in addition, all the depressions of the baby are not due to maternal depressions, which we have already seen.

Maternal depressions are neither necessary nor sufficient and we have to take into account, as always in the register of psychopathology, “complementary series” (S. Freud) and not a simple linear determinism.

Moreover, certain mechanisms can protect the child from the impact of maternal difficulties, which Jeammet had very well formalized in his concepts of “reality-rearing”, “reality-exorcist” and “reality-prosthesis”.

The second observation is that many of these child psychiatric studies seem to have somewhat minimized the role of the observer’s countertransference in the diagnostic procedure. However, it is all the more important that the younger the child, the more intense the process of projection, bringing the adult to his contact to live by delegation and by proxy the affects that the baby n Is not yet able to be mentalised alone.

This is all the merit of the work of an author like Carel to have included the countertransference of the clinician within the semiotic approach. As an example, Carel emphasizes the importance but also the subtlety of the difference of the clinician’s feelings in the interaction with a depressed baby or with a baby preautiste.

With the first, the countertransferential experience of suffering is paradoxically accentuated during the interactive releases and falls of the psychic holding, whereas with the second, this countertransferential modification occurs mainly during the interactive forcings, a little as if the The main problem of the depressed baby was a problem of fear of being abandoned while that of the baby autistic or preautiste was rather a problem of anxiety of instrusion.

– Third remark, the depression of the baby as a reflection of a traumatic relationship, even of a hollow traumatism, invariably poses the metapsychological question of the post-coup. Indeed, given the very early age of the children involved, should we rethink the Freudian theory of trauma in two stages or, on the contrary, hold on to it? (As in the case of traumas or primary mourning in general)?

If we renounce it, we are inevitably led to consider early trauma only from a purely economic point of view, that is to say, from a simple quantitative overflow of the child’s defense mechanisms Confronted with an extreme situation. The greater or lesser tolerance of the child in relation to given conditions refers mainly to his temperament or constitution, in the present Anglo-Saxon sense of the term.

On the other hand, if one wishes to stick to the Freudian theory of the after-blow, then one is forced to modify the chronology of the two times of the traumatism with respect to the schema which S. Freud Of neurosis.

Recall that S. Freud situated the second period of trauma around Puberty even though, in his later writings, he admitted the possibility of a second time earlier.

The fundamental point was that maturation of the subject’s psychic apparatus must have had time to take place between the two stages of trauma, for the pathogenic power of the second stroke was linked in its conception to the resumption of Certain traits of the first blow but on another register of psychic functioning.

In this case, we must admit either a dilation of this intermediate time over two generations or a contraction of this time within the interactive functioning.

In the first hypothesis – which is a transgenerational hypothesis – the first blow to the child’s level is in fact a second strike at the level of the parents or the family system whose baby is still not very differentiated.

In the second hypothesis, it is necessary to conceive that within the interactive system, any repetition of procedure, script or scenario is immediately inscribed in an after-the-fact dynamic and successive translations into different psychic registers, And this with the effects of cumulative microtrauma (to repeat here and otherwise a concept of Kahn).

Deepening of this second hypothesis could probably be envisaged by resorting to the concept of “interactive symptomatic sequence” proposed by Cramer and Palacio.

Reconstructive analysis of baby depression:

Above all, we will say that by another route, it confirms magnificently the observations of the clinicians “in direct time”.

These are analytical works which, on the basis of material derived from adult cures and based on the transferor-countertransferential dynamics, reconstruct a posteriori the early depressive history of the subjects under treatment.

Consider, for example, the work of Green on the “depression of transfer” in his article on “the complex of the dead mother”: the convergence with the work of Kreisler is truly striking.

We may also think of Cournut’s work on the transgenerational effects of “failed bereavement”, which show how the child’s borrowing from the child of an unconscious feeling of guilt can lead a subject – through an early depression – to To establish pathological introjects which will appear in the long term under the traits of, for example, the two stereotypes dear to Cournut: the “desert” and the “broken”.

Numerous other works could be cited which all trace the long-term effects of these reconstructed early depressions.

Let us mention only those of Tisseron who, in the perspective of the “Visitors of the Self”, de Mijolla examined the psychoanalytic study of Tintin and the transgenerational mandates of Captain Haddock.

But Tisseron also gave us a very interesting study of the technical concept of “inverted transfer”, a particular transfer in which the patient places the analyst in an infantile position to communicate to him and make him live in a preverbal mode prevail what he, As a child, he had to live or believed to live in front of his parental instances.

If one is attentive to this mode of transfer, surely there is a means of access privileged to the early depressive movements of the patient who replay here in the transferential projection and which can, for example, Analyst in phenomena of fatigue, inertia or drowsiness recalling those which we have described above in the depressed babies observed.

DEVELOPMENT AND STRUCTURE

At the end of this descriptive analysis, whether through observation or reconstruction, we can now examine the developmental or structuralist positions underlying the various descriptions.

Development perspective:

Authors who view baby’s depression as a relatively straightforward consequence of the quantitative or qualitative theoretical theme are generally in a rather developmental perspective.

This is clear in Spitz, who theorizes anaclitic depression in relation to the genesis of the object relation.

This is also quite clear in the descriptions of cold depression and empty behavior syndrome in which the baby’s depression and maternal depression appear at bottom as the two sides of the same dyadic process.

The linearity of the etiopathogenic pattern is here refined only by the secondary circularity that is rapidly established, as we have said, insofar as maternal depression induces depression of the child, but where the latter reinforces maternal psychopathology since, remember The depressed child no longer responds to parental anticipatory illusions and can no longer serve as a place of deflection-projection or narcissistic resourcing for the mother.

From this point of view, many current works on maternal depression show that, under their cover, there is a low-level reintroduction of linear causality within childhood psychopathology, Even on the part of authors claiming to be psychoanalysts.

Structural point of view:

The studies that address the depression of the baby from a more structural point of view are probably those that take into account the issue of depressive vulnerability of the child according to its history and the rehearsals that are there.

Thus, it is often from the reconstructive point of view that the structural faults that may expose or have particularly exposed the baby to depressive risk will be considered, for example in reference to the Kleinian theories on the depressive position, or even to the concept Meltzérien of “aesthetic conflict” likely to hypostasize a depressive problematic prior to the schizoparanoid position. Let us note in passing that this elaboration of Meltzer undermines, as Houzel has shown, the Kleinian dogma of the primary aspect of the schizoparanoid position.

Opposition between observed baby and reconstructed baby:

As we said earlier, this opposition between a developmental approach and a more structural approach partly covers the opposition between the observed baby and the reconstructed baby.

– Of course, observing the baby does not require to be blind to the repetitions that can take place within the framework of its early interrelations. It all depends on the theoretical model to which the observer refers.

It should be noted, however, that the current Anglo-Saxon work favors a continuous model of development with the relative abandonment of the notions of regression and fixation, that they partially overlook the question of infantile sexuality in favor of the concepts of mastery and Of self-esteem, and that they give precedence to the Principle of Reality in relation to the Principle of Pleasure.

This is clear in the recent work of Emde and Sameroff and in the article by Zeanah, Anders, Seifer and Stern published in 1989 in the American Journal of Child and Adolescent Psychiatry, A very pertinent criticism by Diatkine in one of the recent issues of the magazine “Devenir”.

– In fact, one can advance the idea that Bowlby’s theory of attachment and especially its concept of “internal working models” offers, in a way, the possibility of a bridge between developmental and structural points of view. This is what Bretherton has shown in a recent article.

Revisiting Bowlby’s work, this author shows that the transmission of attachment patterns is actually played through the transmission of the representation of attachment links and that this representation engages not only the behavioral modalities of the attachment, Attachment itself but also the way in which the adult, throughout his life, will position himself in relation to the concept of attachment.

The “strange situation” paradigm as well as Main’s contributions are important here to address the understanding of the intergenerational transmission of attachment patterns and they provide a basis for what we discussed earlier about a transgenerational diffraction Of the aftermath.

In this diagram, for example, the depression of the baby would come to be the current consequence of a series of successive dysattaches, real or fantasies, over successive generations, ultimately referring to the concept of “negative attachment” By Anzieu.

At the end of the day, we can see that this notion of “working models” makes it possible to reconnect with a more psychodynamic and strictly eventnal historicity (Dayan).

CONCLUSIONS:

We will discuss some problems posed by the depression of the baby.

The first question: is the very term depression legitimate in the baby?

It is certainly convenient and obviously allows for some facilitation of dialogue between professionals. However, from a metapsychological point of view it can lend to two types of misunderstandings at least.

– First of all, depression says loss of object and it is clear that the baby, in the first months of his life at least, has not yet clearly established his objects, neither his external objects nor his internal objects .

Under these conditions, what can he already lose?

In other words, the patterns of K. Abraham and S. Freud in the work of mourning and the melancholic dynamics can hardly be applied to the baby, nor is the model of Denis based on a paralysis of the intrapsychic instances Through the “depressive object”.

These different conceptualizations presuppose a level of nitrapsychic differentiation which is not immediately attained, far from it.

On the other hand, which says depression and loss of object evokes the theme of separation and not just differentiation, a distinction which has just been very elegantly re-echoed by Quinodoz in his last work. Now to speak of separation – and not of differentiation – requires a certain level of extrapsychic differentiation this time which is not, nor is it, immediately instituted.

So what is there to lose before this double level of differentiation is reached?

Let us recall that there are now more than 30 years, Lebovici indicated that “the object is invested before being perceived”.

We can think that the depression of the baby refers not to a loss of object in the strict sense but rather to a situation of investment disruption, that is to say a loss of the benchmarks that condition the investment movement .

The alteration or modification of the phenomena of affective tuning due to maternal depression provides, as we have seen, an illustration of this situation of loss.

In any case, the use in the baby of the term depression remains possible if one sees a convenience of language but if one keeps in mind the different reservations that we have just mentioned, and knowing that This term derived from adult psychopathology was taken up in the baby more because of clinical analogies than because of superimposable psychodynamic hypotheses.

Second question: is there a manic equivalent in the baby?

This question is only mentioned here, but it is less unusual than it seems, since, as we know, Mr. Klein considers the influence of the depressive theme long before the child has to assume and integrate the depressive position properly so called.

Third question: how to situate the question of depressive responses in relation to true depressions?

We know that there are depressive responses of the baby in the face of pain or certain organic pathologies such as gluten intolerance, protein malnutrition or martial deficiency.

This raises the question of pain in relation to anxiety and depression, an issue opened by S. Freud himself in 1926 in an addendum to “Inhibition, Symptom and Anxiety”.

It is also known that Sandler and Joffe attempted to describe the baby’s depression in terms of a primary, basal response modality, as well as anxiety.

More recently, “still-face” experiments between mother and baby (Tronick et al.) Have suggested that depressive mimicry in the baby was equivalent to an ultra-precocious outbreak of depressive response.

Fourth question: what is the relationship between depressive pathology and psychosomatic decompensation?

Many things have been said and written about it. The psychosomatic school of the psychoanalytic society of Paris insisted on a reflection on this theme around authors like Fain, Marty, Kreisler, M’Uzan, Debray.

It is unthinkable to summarize here their many works, but two ideas emerge: on the one hand, the depressive problematic comes to unbalance the relative economy of the two great instinctual groups, life and death; On the other hand, depressive problems favor the corporeal outcome of affects, especially in the baby who does not yet have the means of psychization or mentalization adequate to link his affects to stable representations.

This model, certainly fruitful, nevertheless raises a whole series of problems.

By way of example:

We know that in the psychosomatic registry, the choice of organ or function can not be interpreted in symbolic terms as in the neurotic register.

Can we imagine, then, an influence of the interactive system on the localization of disorders in children according to the nature of unconscious maternal representations, and which one?

The depressive child would then be even more so than any other baby likely to materialize in his body the maternal fantasy dynamic, materialization that has been carefully described by Cramer.

Knowing from Green the close ties that bind affects to the process of bodily investment, and since Emde took into account the importance of the continuity of emotions as a witness and as the founder of the pre-representational self, can we imagine that the severe depression of Be able to alter the basis of the very identity of the child?

When one speaks of a non-mentalized bodily affect, can one think (as a number of direct observations of babies seem to indicate) that through its powerful projective system the child is capable of causing somatically To his mother a part of his own depressive affects?

Finally, given the lack of mentalization at the very heart of psychosomatic pathology, what is the baby’s place and the depressions that underlie it in terms of developmental disturbances or distortions For example, I am thinking of certain Anglo-Saxon currents of thought, notably that of the Anna Freud Center in London?

All this, as we can see, confers on the baby’s depression the place of an essential paradigm as regards the psychopathological reflection on the first age, especially since the long-term impact of the depressive process on the capacities of Mentalization and fantasmatization of the child still needs to be thoroughly studied.

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Editor-in-chief of the Medical Actu website; general practitioner graduated from the Faculty of Medicine of Algiers in 2005 currently practicing as a liberal.

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