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I thank Dr Heimann for her response (Heimann, 1974) to my paper (Brenner, 1974). I appreciate particularly the clinical example which she included.
It seems to me that there is little substantial difference between Dr Heimann's expressed view and my own. The difference is rather one of language—of adherence to traditional, generally accepted modes of thought and expression. Dr Heimann writes,
What decides the issue between health and illness is the intensity and duration of the pathological episodes and the degree to which they destroy the individual's psychic and bodily functioning. At some dynamic moment quantitative factors induce a qualitative change.
Is this not the same in substance as saying that the symptom of depression is found in mental disorders of every degree of severity from very mild to very severe, but that as a practical matter one must draw the line somewhere between what one will call 'neurotic' and what one prefers to call 'psychotic', just as one must, for equally good practical reasons, arbitrarily draw a line between 'normal' and 'neurotic'? I believe that the answer to this question is an affirmative one. If I am correct in this belief, I can only say that I welcome Dr Heimann's support of the ideas I have advanced concerning depression, even though the language in which she expresses her views is different from my own.
A second question which Dr Heimann raised is a more familiar one: is depression in later life always related to traumata (or, more generally, to unfavourable psychological influences) in the first 12–18 months of life? Dr Heimann is in agreement with most psychoanalysts who have written on the subject in saying that such a relationship is at least the rule and may even be invariable—that it may be a necessary condition for later depression. In my paper I urged that this view be reconsidered and that a fresh and unprejudiced review of the available clinical evidence is in order.
I cannot help but be impressed by the fact t