Depression and the Depressive Position in an Adolescent Boy

The clinical material in this paper will be centred around a dream, which was dreamt and reported by a boy of 151/2 after some 31/2 years of analysis. In its context the dream, which was an important and vivid experience for him, typically conveys, I think, the picture of a patient struggling against those aspects of himself that perpetuate depression and inanition. He struggles to be able to face the conflict of ambivalence and the guilt it entails, and to maintain the depressive position, i.e. a state of integration, of responsibility for the conflicting emotions and parts of himself in relation to valued objects.

I am assuming that pathological depression ensues from an inability to face pain and to work through the depressive anxiety occasioned by some experience of loss or disappointment. This inability then leads to failure to rehabilitate the lost object or the object which has betrayed one, within the personality. In the course of treatment, early anxieties about loss and defences against experiencing these, come to be re-lived in the transference relationship at every break, and in the case of patients who are seen four or five times a week, at every week-end. The material which I would like to discuss in detail was stimulated by a forthcoming holiday.

First, however, I shall give a very brief account of Malcolm, although I do not propose to go into details of his history and of possible environmental factors in the aetiology of his depression. He is a highly intelligent boy with considerable artistic gifts, who has been able to use his intellect and talents fairly well. He was referred for analysis by unusually perceptive parents because of recurrent bronchial and catarrhal colds, behaviour that was a little too good, and a certain flatness of affect that convinced them he was not able to enjoy life as fully as he should have done.

In his analysis, he was from the start reliable and meticulously co-operative. He appeared to be appreciative and he