ABSTRACT
We shall now quote some cases illustrating the appearance of depression as a reaction to infantile ideas which are the first evidence of an abnormal state, be these produced in the waking state or in dreams. It will be noted that neither these dreams nor delusions appear in a setting of equanimity.
The patient Millie B. was 40 years of age at the time of the psychosis. She had been married for 20 years and had had five children, two of whom had died. She had had a depression lasting for six months after the birth of her second baby. Three years before, a little girl had died, after which she was depressed for two weeks but then recovered completely.
Eight or nine months before admission, while the patient was pregnant, although she had not yet discovered it, she heard that her favourite brother, who had been operated on in a hospital, was likely to die. At once she became very anxious, thinking that if he died the shock would kill her mother. When questioned on this point, she insisted that her apprehensiveness was much more for her mother than for her brother. That night she had a dream in which she saw her brother lying dead. Her mother was there looking very frightened, crying and worried, and then she too seemed to be dying and under a white sheet. In the morning she felt “stiff-like” and for three days seems to have had a rather typical retarded depression. She spoke almost not at all, said she had no feeling, so that she could be cut up without knowing it. She felt no affection for her husband and children, and thought that the best thing she could do would be to kill herself so that her husband could marry again and get a good wife. We see, then, this depression was precipitated by a typical infantile idea, the death of the mother, which content disappeared in the depression, while other thoughts of an anti-social nature—the breaking up of the home—appeared in the guise of self-reproaches.
On the third day of this depression she cut her wrists, but was detected by her son and the wound dressed so that she suffered no serious physical injury. Her depression then changed rather interestingly from one of retardation and silence to a querulous, worrying state. This phenomenon will be discussed a little later with the heading of reactive depressions. She worried and talked continually about having cut her wrist and the crime that it involved. Learning of her pregnancy, she had some slight apprehensiveness about parturition, but was in general rather indifferent about this. Unconscious criminal ideas appeared in the form of injuries to her children which she worried about. For instance, she talked a great deal about the probability of the unborn child being insane and, when her small son got hold of some pills and ate them, she was convinced that he would die and dreamed of it.
During her pregnancy tihs worrying depressed condition gradually increased in severity and following the childbirth became so much worse that 19 days thereafter she had to be removed to the hospital.
Under observation she was found to be rather voluble in her complaints which were entirely taken up with the topics just mentioned. She cried a good deal and could, rarely, be moved to laughter although this was usually the sardonic type. On questioning she admitted feeling mixed up and stupid, and also that she had no feeling, no capacity for love, that she was incapable of happiness. Occupational therapy caused a gradual improvement in her condition, so that she was well enough to go home some seven months after admission and had entirely recovered three months later.
