The Love-Object in Mania

From consideration of a number of cases of manic-depressive psychosis confined in mental hospitals, it is clear that a desperate attempt is made, during the manic phase, to effect a transference. In their hostility and abusiveness, as well as in their euphoric expansiveness, they over-act their part. Positive transference is more apparent than real, and the underlying attempt at a negative transference is readily revealed. But even this requires to be bolstered up in an exaggerated manner. In severe cases there seems to be but little distinction between the sexes. They all behave and talk alike. Similarly, in their attitude to others, severe cases show no essential difference in their behaviour towards males and females. The surrogate of their object is ever-changing, and mistakes in identity are frequent. They will readily hate one person in mistake for another.

A.B., male, aged 58, with a history of mild alternations between depression and irresponsible elation, was admitted into a mental hospital because, after abusing and threatening several of his acquaintances and also strangers, he prepared to race the Cornish Riviera Express through its entire journey in a small car on a wet day. He had to be forcibly restrained from starting. On admission he was abusive and violent. He tore up his bedding and he urinated and defæcated all over his room. He was completely disorientated, and he refused food.

When the acute phase subsided he persistently called me by a surname not my own. He remained extremely hostile and abusive and he refused to converse except to say, with undue emphasis, that the last thing he wanted was to be under an obligation to me. His wife explained that the real owner of the surname referred to was a medical man in his neighbourhood who had incurred the hostility of the patient through refusing to attend him professionally. Any attempt to undermine the negative transference, to which he clung with desperation, resulted in a severe exace