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A depression occurring in a six-year-old boy with acute lower extremity paralytic poliomyelitis was studied as part of a long-term investigation of a series of children with poliomyelitis. The illness was perceived by the patient as a specified injury to the legs, as a more generalized injury to the body, and symbolically as a castration. He suffered a fall in self-esteem similar to that found in depressed adults. Both the child and his mother had phantasies about an oral cause, nature, and cure of poliomyelitis. Orality played an important part in the depression, oral-incorporative and oral-aggressive phantasies being prominent. Conflict was engendered by his oral-aggressive phantasies. The patient's mother showed both a depriving and overcompensating attitude toward the patient in regard to food.
A tentative formulation of the psychodynamics of the depression is offered. The hospitalization was perceived as a separation from and loss of the ambivalently loved mother who supplied narcissistic gratification. The patient's supplies from two sources of narcissistic gratification, his mother and his body, were partially cut off. The ingestion of food led sometimes to a restored state of omnipotence, at other times to vomiting, stemming from the patient's oral-aggressive desires. The expulsion of the introjected object took place orally instead of in the anal manner usual in adult depressives. Because of his propensity to restore the lost object in an orally incorporative manner, one may suppose that the lost object had been introjected and now resided in his stomach, the co-victim along with himself of the disproportionately severe parental punishment. The alignment of forces corresponds to the formula, superego v. ego plus introject.
While in infantile depressions so far studied there is an absence of data concerning the fall in self-esteem, the lowered self-esteem in this patient was comparable to that in the adult melancholic. In part this seemed to deriv