Shirah Vollmer MD

The Musings of Dr. Vollmer

Karl Abraham MD

Posted by Dr. Vollmer on November 12, 2013


Depression, Dr. Abraham says, is the frustration of gratification, be it a loss of a loved one, or a loss of an anticipated goal. With this loss comes a feeling that he is both unloved and incapable of loving, and with this he despairs of his life and his future. This state of mind lasts until a new state of mind enters in which the patient can feel a connection, and hence a gratification, and hence a lovableness, thereby lifting his depressed state. Elena, twenty-four, comes to mind. She is happy when she goes on OK Cupid and she feels she has met her “match” and she is depressed when she meets her “match” only to find out that he has some significant issue, such as substance abuse, or lack of employment. When she feels she can find love, and hence be loved, her mood is bright, and her energy level is good. When she hits frustration in this department, she despairs to the point of not getting out of bed, and not wanting to eat. This up and down, or this baby manic/depressive experience, reinforces Dr. Abraham’s ideas that depression, at least at times, reflects a lack of love, both going out and coming in. Feeling love and feeling lovable are two essential features of self-esteem. The emptiness without this creates the mental state of depression, like a depressed ground that needs to be filled with dirt, to make it whole. My job with Elena is to help her understand how her ups and downs are reflections of her state of feeling love and lovable, and with this insight, she can then have a greater anticipation of her triggers, both for high and low-functioning times. This understanding will help Elena know that OK Cupid puts her up and down, and so if she had a more reasonable set of expectations, her moods would fluctuate mildly and not severely. After many months of work, Elena understands this and she feels better. Dr. Abraham, a founder of psychoanalytic work, rings true.


6 Responses to “Karl Abraham MD”

  1. Holly said

    Your post has me thinking of Kohut’s notion being mirrored/loved, so essential to life that he calls this need “psychological oxygen”. The challenge is to still feel good about oneself when one is not mirrored by another.

  2. Jon said

    Is it really this simple?

    Frustration of gratification implies
    feeling both unloved and incapable of loving implies
    despair of the future which is

    It seems possible, as I cannot think of immediate counterexamples. What a clean chain of reasoning.

  3. Shelly said

    Your post makes me wonder if what you describe for Elena is depression at all. Please educate me. Can clinical depression be caused by events (such as a death in the family, a job layoff, not finding a life partner, etc…) or are you simply using the term loosely here? Does Elena suffer from low mood or a mood disorder?

    • This post calls into question the DSM notion of depression. Perhaps depression is more of a deficit feeling which is triggered by a loss, be it of a relationship, a job, or something meaningful. I think that returning to seeing depression as a “depression of the ego” thereby needing to be re-built, is a helpful way of thinking about the despairing person, at least sometimes.

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