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Depression in a psychosomatic illness is not frequent, but it is nevertheless a distinct clinical entity which has not been sufficiently recognized. It differs from the reactive psychotic outbreak occurring subsequent to the dissolution of a psychosomatic disorder. Four psychoanalyzed cases are described in order to clarify the psychodynamics of depression concomitant with psychosomatic illness, and to shed further light on the nature of somatization of anxiety and on the problem of depression. In the syndrome described, the patient suffers from the characteristic affective symptoms of depression but believes they result from the primary psychosomatic ailment. These patients differ from hypochondriacs, in whom pain and dysfunction of an organ is the dominant complaint. The disappearance of the psychosomatic disorder usually causes the depression to be resolved. 'The most feasible explanation of psychosomatic disorders relates to their origin in the unconscious, where deeply disguised emotional conflicts are repressed, and from which they are only partially discharged somatically. Psychosomatic disturbances may be regarded, therefore, as symbolic representations of emotional conflicts completely warded off from consciousness by the mechanism of repression.'