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I have been invited to stimulate our discussion today by a brief communication on my analytic experiences with severe cases of depression. I was very reluctant to accept this suggestion because I feel that what I have to say and can say in the available time is not substantial enough to deserve being presented.
May I first briefly define the type of cases which I want to discuss. Of course, almost all neurotics tend to develop temporary depressive reactions. But the patients to whom I shall refer were persons whose whole life problems hinged on their predisposition for severe depressive conditions, and who sought treatment because of such states.
Among the depressive cases which I accepted for psychoanalysis proper have been only a few true manic-depressives; most of them were cases with psychotic features, but not to the point of permitting, even under long observation, a clear-cut differential diagnosis of psychotic versus neurotic depression. Clinically, they presented largely differing syndromes. They were chronic depressives, patients with irregular mood vacillations, depressives with severe anxiety states, patients with hypochondriacal and paranoid forms of depression, or with severe reactive depressive states, schizoid types of depression, and so on, and so forth.
In other words, most of these patients were borderline cases, ranging from borderline to both manic-depressive and schizophrenic psychosis.