Complex Depression

In this empirical yet deeply humanistic work, Golan Shahar investigates the dynamic relationship between personality and social factors in complex depression, identifying avenues for research and offering hope for sufferers and treatment providers.

Shahar synthesizes research and clinical wisdom to enhance our understanding of complex depression, a mental illness defined by its chronicity, heterogeneity, and serious consequences including suicide. He focuses on Melanie Klein’s object relations theory and depressive position, reconceptualizing both from a transtheoretical perspective, with an emphasis on four key factors: demeaning affect; affect regulation; maladaptive schemas and scripts; and a time axis consisting of past, current, and projected future experiences. Shahar also explores how individuals externalize self-critical feelings, in turn creating a malignant social environment and a vicious cycle of self-recrimination. To explain this toxic relationship, Shahar presents ecodynamics, a novel theory examining relationship patterns between the self and their social contexts.

The book offers tools and procedures for assessing complex depression and guidelines for integrative psychotherapy. Case examples, including the author’s profound personal investigation into his stepfather’s suicide, vividly demonstrate the causes and consequences of complex depression.

Foreword
Thomas Joiner

An Introduction to the Personality and Social Dynamics of Complex Depression
Acknowledgments

Part I. Depression and Personality

• Chapter 1. The Complications of Depression
• Chapter 2. The Role of Personality in Complex Depression

Part II. Psychodynamics and Ecodynamics

• Chapter 3. Reformulating Klein’s Object Relations Theory and the Depressive Position
• Chapter 4. Human Ecology and Development Within Social Contexts: The Theory of Ecodynamics

Part III. The Ecodynamics of Complex Depression

• Chapter 5. Applying the Reformulated Depressive Position and Ecodynamics to Complex Depression
• Chapter 6. Suicidal Depression: A Case Study of Complex Depression’s Most Severe Consequence
• Chapter 7. Practical Implications for Assessment: Evaluating Complex Depression Via the Reformulated Depressive Position and Ecodynamics
• Chapter 8. Practical Implications for Psychotherapy: Specific Interventions for Treating Complex Depression

References
Index
About the Author

Golan Shahar, PhD, is professor of clinical-health psychology, Zlotovsky chair of neuropsychology, and adjunct professor of public health at Ben-Gurion University of the Negev where he also heads the Stress, Self & Health (STREALTH) research lab. He is also adjunct professor of child study and adult psychiatry at Yale University School of Medicine.

Prof. Shahar’s research focuses on the links between stress, depression and suicidality, and psychosomatics. He authored Erosion: The Psychopathology of Self-Criticism. Professor Shahar is also internationally known as a leading clinical theorist and practitioner, advancing an integrative framework for assessment and psychotherapy in complex psychopathological and psychosomatic conditions.

More information is available on his ResearchGateopens in new window page.

The book reflects an extraordinary innovative, integrative effort. It gracefully bridges the yawning divide between cognitive, social, and psychodynamic approaches to depression and presents a crystal clear, novel, and immediately practically helpful approach to support clinical work with some of the most challenging clients. Potentially a massive contribution to the work of clinicians, from the most experienced to novice therapists. It should be on the shelf of every clinical psychologist.
—Peter Fonagy, PhD, Executive Clinical Director, UCL Partners Mental Health Programme, London, England; Chief Executive, Anna Freud National Centre for Children & Families, London, England

Only Golan Shahar could write this unique book. He courageously draws upon his own family history. He is very knowledgeable about psychoanalysis and does not hesitate to revise its formulations. His vast experience in empirical research into depression and suicidality is utilized to develop innovative psychotherapeutic strategies.
—Emanuel Berman, PhD, Professor Emeritus of Psychology, University of Haifa, Haifa, Israel

Golan Shahar has one of the best integrative minds in contemporary psychoanalysis. He weaves together a potent brew of approaches to address one of the most intractable disorders extant—complex depression. With his ecodynamics theory, he breaks fresh ground in the expansion and deepening of integrative psychoanalysis so it embraces the developmental, relational, and social-cultural dimensions of complex depression often overlooked by conventional formulations. For an innovative, methodical, and notably personal integrative inquiry, I can think of few rivals.
—Kirk J. Schneider, PhD, editor of Existential-Integrative Psychotherapy: Guideposts to the Core of Practice, coauthor of Existential–Humanistic Therapy, Second Edition with Orah T. Krug, and author of Life-Enhancing Anxiety: Key to a Sane World

Complex Depression addresses a huge public health problem: People with depression are not getting better despite 60 years of antidepressant availability. It offers an alternative perspective to reductionistic models, such as the NIMH RDOC Initiative, that focus primarily on aspects of depression that can be studied in animals. Instead, it brings the same scientific rigor to a reconsideration of the complexity of the people who experience depression and offers informed stratagem for intervention. Reading this book reminded me, once again, that to treat depression most effectively, you need to deeply understand the person experiencing this symptom and their social context.
—John H. Krystal, MD, Robert L. McNeil, Jr., Professor of Translational Research; Professor of Psychiatry, Neuroscience, and Psychology; Chair, Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States

In this dense volume, Golan Shahar draws on extensive research and clinical experience to help clinicians and researchers understand and focus on patient and systematic aspects that complicate and sustain complex depression. Invaluable insights for clinicians and depression researchers alike.
—Allan Abbass, MD, FRCPC, author of Reaching Through Resistance: Advanced Psychotherapy Techniques; Professor of Psychiatry and Psychology, Dalhousie University, Halifax, Nova Scotia, Canada