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In this contribution I shall concentrate mainly on depression as experienced by the paranoid schizophrenic. My first point arises from my contention, expressed in 1935 (1), that the paranoid position (which I later termed the paranoid-schizoid position) is bound up with splitting processes and contains the fixation points for the group of schizophrenias, while and still hold the view that paranoid and schizoid anxieties and depressive feelings, as they may occur in more normal people under external or internal pressure, go back to these early positions which are revived in such situations.
The often-observed connexion between the groups of schizophrenic and manic-depressive illnesses can in my view be explained by the developmental link existing in infancy between the paranoid-schizoid and depressive positions. The persecutory anxieties and splitting processes characteristic of the paranoid-schizoid position continue, though changed in strength and form, into the depressive position. Emotions of depression and guilt, which develop more fully at the stage when the depressive position arises, are already (according to my newer concepts) in some measure operative during the paranoid-schizoid phase. The link between these two positions—with all the changes in the ego which they imply—is that they are both the outcome of the struggle between the life and death instincts. In the earlier stage (extending over the first three or four months of life) the anxieties arising from this struggle take on a paranoid form, and the still incoherent ego is driven to reinforce splitting processes. With the growing strength of the ego, the depressive position arises. During this stage paranoid anxieties and schizoid mechanisms diminish and depressive anxiety gains in strength. Here, too, we can see the working of the conflict between life and death instincts. The changes which have taken place are the result of alterations in the states of fusion between the two instincts.
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