Notes on Childhood Depression1

… a healthy person must have the capacity to suffer and be depressed. (Hartmann, 1939).

… what appears as 'pathological' in a cross-section of development may, viewed in the longitudinal dimension of development, represent the best possible solution of a given infantile conflict. (Hartmann, 1954).

The research worker who aims to investigate the subject of depression in childhood must inevitably find his task extraordinarily difficult. If he approaches it from the direction of the psychiatric classification of adult depressive illnesses he will find himself hampered from the outset by a lack of agreement among different authorities on the essential differences between the various pictures of depressive illness met with in clinical practice.2 The differentiation between psychotic and neurotic and between endogenous and reactive depression is far from easy, and it would seem that there is a whole spectrum of clinical conditions, all of which can legitimately be called depression. Yet there are, in this group of disorders, differences in clinical features which are obviously significant, particularly from the point of view of prognosis and treatment. If we apply the existing descriptive classifications of depression to children we are not helped a great deal, but we cannot fail to be struck by the relative absence, in young children, of any overt manifestation of the syndrome, consistently described over the past two millenia, of manic-depressive psychosis, or psychotic depression. It is only in the phases of prepuberty and puberty that occasional cases are described, and even then there is often cause to doubt the diagnosis.3

There have been many psycho-analytic studies of depression in adults, from Abraham (1911), (1916), (1924) and Freud (1917) onwards, and the understanding which these and later authors have afforded is of great help when we come to consider children. However, there is also much to confuse us in our task, for there has been a profound