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Depression and moral masochism are inseparable, and originate in a particular climate of lived experience in which one or both parents suffer from a masochistic-depressive disposition. Developmentally, there has been a deficit in the child's experience of shared pleasure, and of being a source of enjoyment to the parent. Instead, the child experiences himself or herself as a source of pain and feels responsible for the parent's dysphoric, anhedonic state. This is not simply a fantasy construction of the child, as parental reproachfulness is characteristically encountered. The child makes reparative efforts, but they generally do not succeed.
Central psychological capacities are compromised under these conditions, particularly a sense of personal efficacy and of natural entitlement. The evolution of initiative, autonomy, and individuation are also significantly affected. The aggression, both conscious and unconscious, which is generated by these early conditions creates intrapsychic conflict which further inhibits the development of these essential psychological functions. Some therapeutic recommendations are proposed based on these considerations.