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The point which I want to select for discussion is the problem of the precipitating factor in the depressive illness which was raised by Dr Zetzel.
Analysts starting with Freud's views expressed in his paper on mourning and melancholia believe that depressive illness is almost always precipitated by an object loss. This object loss may be a severe one such as death, but any illness of or separation from or frustration by a loved object may produce the situation of 'loss of the loved object'. I have seen for consultation and analysed many cases where the outbreak of a depressive illness was caused by such an object loss. In such cases the patients unconsciously believed that their aggression had omnipotently produced the death or illness of the object in question. It is characteristic in such situations that all earlier experiences of object loss are mobilized leading back to the earliest anxieties of the infant-mother relationship, a factor which might be regarded as a confirmation of the central importance of the depressive position as outlined by Melanie Klein.
However, we might ask if it is only a disturbance in an object relation which may mobilize depression. Freud had raised the question early on whether an injury to the ego or to narcissism may alone precipitate depression. I found in some of the patients breaking down with acute depression that they were confronted with a situation which made them aware that they themselves or their lives had been incomplete in certain ways. The patients were overcome by an acute sense of failure. They felt they had not fulfilled the promise of their gifts or had not developed their personality sufficiently. They were suddenly overwhelmed by a conviction that it might now be too late for them to find themselves and their purpose in life. I have observed these depressions not only in women but in men between the age of 30 and 60. This depression may be regarded as an awareness that certain parts of the patient's pers