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The term depression is used in many different ways. It may be used to denote a clinical illness, a passing emotion, or, as Mrs. Klein used it, to designate anxieties found in the depressive position. The case given here is an example of depressive illness with other symptoms derived from anxieties in the paranoid-schizoid position. This paper describes the opening phase of treatment of an adolescent girl who had had an earlier overt depressive illness at the age of five.
Lilian, a girl of low average intelligence, started coming to me when she was fourteen years old with the presenting problem of school phobia. She had not attended school for five months and she was terrified of returning. She also had a number of other fears. She was afraid of boys. A few boys in the street immediately became mods or rockers to her and she would refuse to go into that street. She was frightened of going on buses alone as she thought she would get lost. She was sometimes scared of walking down a road alone and, if she did so, would feel “as if the other people, houses and things were not there”. She felt she was there, but the outside world seemed unreal. She was also frightened of the dark, even in the familiar environment of home.
In addition to these fears Lilian had become increasingly depressed in the weeks before starting treatment. For over a month, not only had she not attended school, but she had felt too depressed to do anything. She had sat listessly at home all day doing nothing, though in the evenings when her younger sister came back from school, she could play or be active together with her.
The main points in Lilian's history, as given by her mother, are as follows. The parents, who are poor Irish Catholics, married late in life. They live in cramped conditions and have only one bedroom for themselves and the two children. The mother was depressed during the pregnancy but the birth was normal. She did not, however, want to breast feed the baby and Lilian was bottle fed.