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A thirty-year-old unmarried clerk was referred for treatment as he was recovering from a depression of a type he had had each year for the past ten years. Although he knew he would be better in the spring and summer, he wanted to be treated so that the depressions would not recur. They began in August or September and continued about six months. During the spring and summer he was overactive and too confident without excitement or unseemly behavior. After the recurrence of the first few cycles he was never free from the fear of the autumnal depression. This constant threat interfered with his freedom of action in his business and in his relationship with women.
The depressions were heralded by the observation that he was sweating excessively; then he felt vague anxiety, followed by the fear that he would not be able to do his work. Later, came feelings of unworthiness and inefficiency. He was convinced his work suffered because he was slow because he had to check his work four times and he dreaded anything new and avoided making decisions. He tried to evade as much work as possible without attracting attention, and he avoided contact with superiors and fellow workers. Despite the great effort it cost him he never missed a day's work. He felt he had no right to indulge himself. He was certain that his deficiencies were apparent to everyone. If he could have afforded to do so he would have remained in hiding in the South for six months. If criticized, he would suffer keenly and be incapable of defending himself. Praise or affection caused him suffering because he felt he was an imposter not deserving such consideration. There were no ideas of suicide. He was haunted by the fear, 'Suppose my immediate superior died; how would I be able to take over his work?'