The Repetitive Cycle in Depression

This is a report on the psycho-analytic treatment of a young woman who had almost yearly depressive spells interspersed at times with mild hypomanic attacks. This type of repetitive pattern, fairly common in depressives, has never been explained adequately because most writers have reported on single attacks. This patient, on the other hand, was under treatment through a number of depressive episodes, each of several months' duration, many of them requiring hospital care, over a total treatment period of seven years. She had an unusual ability to talk freely during the depressed spell, so that the treatment could be uninterrupted.

The reason for the cyclical nature of the attacks seemed to be that there was a chronic internal state of severe dissatisfaction, creating a very sensitive balance which could be disturbed by slight traumata. It is to this chronic internal state that we direct our attention, but only after a long analysis of defences could it be reached.

The weakness of Ruth's ego was that she lived so much under the influence of fantasies, which she acted out, that much of the time she was in conflict with reality. Her libidinal organization was strongly oral-aggressive. oral drives pushed her into inevitably disappointing situations. Serious disappointments of her fantasies caused her to withdraw from the everyday activities which kept her in contact with reality, and she then became completely incapacitated and required hospital care.

The illness of Ruth W., the young woman here described, extended over fifteen years, with almost yearly depressive spells. Electroshock had been administered on two occasions in previous attacks before she entered analytic treatment, with temporary improvement in her mood. For several months of every year she became totally unable to look after herself and for a large part of the time was dependent upon her family.

There were fairly regular periods of mild hypomania between the depressive attacks.