Detached from attachment: neurobiology and phenomenology have a human face

Although at first glance melancholia and grief share some characteristics, the layperson of a century ago would have little difficulty distinguishing them. Paradoxically, the same layperson today might be confused, intuitively recognising a difference, yet forced perhaps to see both as forms of depression. Both have biological correlates and psychological parameters, but classical melancholia is immediately recognisable to an experienced clinician largely as a ‘biological disorder’, and grief, perhaps, as a relational process: a consequence of having been ‘attached’. Current diagnostic systems focus largely on reliable measurement of objective criteria in the present, despite widespread doubts about the validity of such an approach, and considerable interest in the doctrines of multicausality and equifinality. Meyer's earlier psychobiology stressed the importance of understanding a person's psychopathology and presenting phenomenology through their life story. We would argue that a failure to appreciate the functional significance of phenomenology, and the current and developmental context in which it developed, risks generating erroneous conclusions about the nature of the problem and potentially inappropriate treatment. Various theories are available in which to couch such an argument. Our emphasis is on attachment theory, which will be summarised briefly before reviewing some ambiguous clinical situations that can be informed by this understanding.Paul Dignam, Peter Parry and Michael Ber