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Guntrip (1971) refers to the erroneous application of the term 'depression' to schizoid states as well as to the inappropriate treatments which are predicated on that diagnosis. The diagnosis is often made on the basis of a predominant mood which may be referred to by the patient as being depressed. The dynamic picture in which this mood becomes evident is, by no means, a unitary one, and an accurate understanding of the meaning of the mood is critical to treatment.
Jacobson (1971) sees as the essential dynamic in depression a narcissistic injury due to the failure of the loved object to understand the subject followed by anger at his having failed to do so, and then by a sense of helplessness to do anything about the situation. She sees 'constitutional neurophysiological processes' as accounting for the difference between neurotic and psychotic depressions, although she does stress that 'such considerations must complement the psychological—i.e. psychoanalytic—assumptions' (p. 183).
However, there is no need to take recourse to any such deus ex machina explanations to account for divergent clinical pictures. If one approaches the issue from the theoretical vantage point of object relations, dynamic distinctions become self-evident. It is through an understanding of the developing self in the context of the mother–child matrix with the associated processes of attachment to, internalization of and individuation from the object that various clinical pictures come to make sense.
According to Melanie Klein (Segal, 1964), the 'depressive position' implies the ability 'to enter more fully into whole-object relationships, only to be exposed to guilt and depression over the discovery that he can hurt those he has become capable of loving'. This, of course, describes the more or less classical picture of the neurotic depressive in whom anger is turned toward the self in order not to jeopardize the relationship with the needed object. Such a patient has achieved a level o