“Freud’s ‘Open Wound’ of Melancholia:
Psychic Inflammation as Self-Healing”
Nancy C. Winters, MD, FIPA
Sigmund Freud’s “Mourning and Melancholia” (1917) remains the foundational psychoanalytic account of depression, offering enduring insights into its genesis and its notorious resistance to treatment. Nancy Winters revisits Freud’s intriguing observation that “the complex of melancholia behaves like an open wound, drawing to itself cathectic energies . . . from all directions, and emptying the ego until it is totally impoverished.” For Freud, this “open wound”—and what distinguishes it from mourning—is seen in the melancholic’s severe self-denigration. As Freud observes astutely, the true target of the melancholic’s self-reproaches is the lost love object, taken into the ego through identification.
Winters reconsiders the melancholic’s self-accusations as a mode of truth-seeking that may be understood as an attempt to heal this open wound, in line with Freud’s (1911) view of the symptom itself as an effort at recovery. She conceptualizes this process as a form of psychic inflammation, analogous to biological inflammation in its dual capacities for pain and healing, as well as its pathological extreme in the autoimmune self-attack (Winters, 2022). Clinical vignettes illustrate how this ‘inflammation’ can manifest as a search for the most damning truth about oneself—understood dynamically as an effort to loosen the identification with the introjected object and ultimately to restore life-enhancing libido to the depleted ego.
Learning Objectives:
1. Understand Freud’s metaphor of melancholia as an “open wound” that draws libidinal energy to it and impoverishes the ego.
2. Describe the melancholic’s self-accusations as a mode of truth-seeking that can be thought of as akin to “psychic inflammation”
3. Discuss clinical implications of the proposed psychic inflammatory process as an attempt to self-heal.
About the Presenter
Nancy C. Winters, MD, FIPA is a psychoanalyst practicing in Portland, Oregon. She is a training and supervising analyst on the faculty of the Oregon Psychoanalytic Institute (OPI) and the Northwestern Psychoanalytic Society and Institute (NPSI), and a Clinical Professor of Psychiatry and Child/Adolescent Psychiatry at the Oregon Health & Science University. She is on the Editorial Boards of the International Journal of Psychoanalysis and the Psychoanalytic Quarterly. Recent publications and presentations include: Co-editor and chapter author of Body as Psychoanalytic Object: Clinical Applications from Winnicott to Bion and Beyond (2022, Routledge); “Autoimmunity and its Expression in the Analytic Situation: Contemporary Reflections on Our Inherent Self-Destructiveness” (Int. J. Psychoanal, 2022); “A Home to the Lie: The Contemporary (Per)Version of Truth” (Am. J. Psychoanal., 2023); “Transformations in O Online: Group Process in the Virtual Realm” (Psychoanal. Q., 2024); and recent papers, “The Liar and the Truth-Teller: An Analytic Dialogue” (Lisbon, 2025), and “Schubert’s Final Piano Sonata in B Flat Major as a Metaphor for Analytic Termination” (Seattle, 2025).
About the Moderator
Drew Tillotson, PsyD, FIPA, BCPsa is a board-certified psychoanalyst in San Francisco, California. He is a graduate, Training and Supervising Analyst, faculty member, and Past President of the Psychoanalytic Institute of Northern California (PINC) and also serves as a Training and Supervising Analyst on the faculty of the Northwestern Psychoanalytic Society and Institute (NPSI). He is Past Vice-President of the North American Psychoanalytic Confederation and currently a board director for both the Confederation of Independent Psychoanalytic Societies and the North American Psychoanalytic Confederation. He teaches at PINC and NPSI and maintains a full-time private practice in San Francisco. Recent publications include co-editor and chapter author of the Gradiva Award–winning Body as Psychoanalytic Object: Clinical Applications from Winnicott to Bion and Beyond (2021); chapter author in Braving the Erotic Field in the Treatment of Adolescents and Children (2022); and contributions to Jonathan Sklar’s The Soft Power of Culture: Art, Transitional Space, Death and Play (2024).
