ABSTRACT
Paranoid psychotic reactions are elaborations of character pathology in the absence of depression sufficient to drive the psychosis. Many clinicians believe that all psychotic symptoms have an organic cause, which would make psychotic depression a disease of the 4th domain. The identity-creating power of paranoia is probably what makes this maladaptive reaction the most stable of the psychotic defenses, allowing patients to remain compensated in their delusions for long periods of time. If the nature of the psychosis produced depends on the person's 2nd domain character pathology, as Morel and Meyer implicitly believed, each person will become psychotic for their own reasons and in their own way. The designation depressive psychotic reaction, which lacks the modifying word dynamic, is not meant to ignore the dynamic forces that are clearly in play in this pathology.
