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While much has been written on the effects of frustration on ego functions, the mental consequences of dramatic good fortune are less well understood. This paper will describe several patients who were clearly perturbed by salutory, indeed consummate, events in their object relations and five explanatory models will be advanced to account for these reactions. The clinical observations augment the rule that just as an intended insult must at least approach one's self-regard to cause pain, so must good news find some inner receptivity in order to unambivalently gladden.
Durkheim counted sharp upturns in ones fortune, as well as reversals, among the causes of anomic suicide. He saw these changes as disrupting a person's equilibrium with his social milieu. The patients here described are primarily thrown out of synchrony with their internal milieu when their social relationships become particularly gratifying.
Freud (1923, 1924) described patients who could not endure any praise or appreciation. They assiduously resisted the analyst's assessment that the work was progressing satisfactorily by becoming worse. Discarding defiance of the physician and secondary gains from the illness as insignificant motivations, Freud called this negative therapeutic reaction a response to unconscious guilt and a particularly sadistic superego.