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In an extensive review of the psychoanalytic literature pertaining to theories of depression, Rosenfeld was struck by the recurrence of certain themes. These were: the role of constitutional factors; the importance of aggression or increased ambivalence; the importance of oral elements, the role of introjection and identification; the importance of narcissism; the nature of the early object relations; the importance of processes of splitting of objects and the self into good and bad parts; the origin and nature of the depressive superego; the importance of certain infantile phases; and the relation of paranoia and mania to depression. He concludes that most writers agree on the importance of constitutional factors, the role of aggression, fixation to some period in the first year, the role of narcissism, and the importance of certain early object relations and mechanisms such as splitting of the mother into a good and a bad image. There is controversy about how the superego develops. The author favors the Kleinian explanation that the severity of the melancholic's superego is due to the retention of sadistic impulses formed at the end of the first year of life.