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It is the purpose of this paper to present in some detail important situations arising in the course of the analysis of a manic-depressive psychosis, hoping especially to make clear the nature of the factors contributing to the transition from depression to elation and back again; hoping also to make clear the nature of the repressed impulses which the psychosis symbolizes and conceals.
A brief history of the case prior to the psychosis will make the description of the analysis clearer.
The case used as illustration is that of a young woman, unmarried, in the early twenties. During the period of analytic study the patient has been observed in three depressions and three elations. During one of the depressions and one of the elations it was necessary for the patient to be in an institution for a time. The patient has been observed for three and one-half years. This, however, gives an erroneous impression of the duration of analysis for for only ten months was she able to come six times a week. For two periods, one of six months and one of four months, there was no analysis. Both of these periods were during elations. During the remainder of the time she has been analyzed three times a week. This irregular course was due to external circumstances.
The patient's immediate family contains 100 per cent psychosis. However, there is no history of mental disease in other members of the father's or mother's family, and as the history unfolds one is impressed—not so much with the hereditary factor as with the deep traumatic significance of a childhood spent under the care of two psychotic parents.
The father is the obsessional type of man, pedantic and over-correct, always emphasizing to his children the need of making a correct impression. Marian's childhood is full of memories of agony over doing the wrong thing. She remembers only criticism, never praise. The father has had several periods of depression, some requiring sanatorium treatment. There seems always to have been an u