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Hostility Factors and Clinical Improvement in Depressed Patients

Alfred S. Friedman, PhD
Arch Gen Psychiatry. 1970;23(6):524-537. doi:10.1001/archpsyc.1970.01750060044005.
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IT HAS often been observed clinically that when a depressive reaction has lifted the patient regains his ability to express anger toward others in his environment.

The early psychoanalytic formulations of Abraham1 and Freud2 of the depressive reaction long ago became identified with the notions of self-accusation, guilt, and selfdestruction, so that nearly every depressive reaction was viewed either as resulting from or including the turning of the original object-directed aggression against the self, or from the internalized aggression against the incorporated loved and hated object. In such depressed patients, the tendency to express aggression against others has been seen as either denied, suppressed, or repressed, and hostile feelings toward the significant other not admitted into awareness where they would arouse painful guilt feelings.

One more recent psychoanalytic position3 is that depression is associated with denial, or repression of aggression, aimed at preserving the original love object


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