On A Physical Form of Periodic Depression

Since Kraepelin arranged groups of psychic symptoms into clinical entities, a number of mental ailments have been classified as manic-depressive psychosis. Accompanying physical complaints are included in the symptomatology of these disorders.

Fatigue, amenorrhoe and disturbances pertaining to the gastrointestinal tract are among the symptoms observed to a greater or lesser degree in the depressive phase of this condition. When there are no severe emotional disturbances and when physical aspects dominate the clinical picture so that “one is reminded of a somatic rather than a psychic disorder” (13), the term cyclothymia is applied. Pletnef (22) stressed that physical complaints, even when they appear discociated from the mood affection, are an integral part of the disease. He held endocrine disturbances to be the underlying cause of the physical pathology. But no proof that cycloid conditions are due to endocrine unbalance has, as yet, been set forth. Attempts to find somatic lesions have resulted in failure. No characteristic toxic or metabolic changes have been discovered, nor have brain lesions or definite abnormalities in the vegetative nervous or vaso-motor systems been proven a cause of cyclic disorders.

In addition to physical symptoms, other considerations suggest the presence of somatic biological factors: the periodicity in the alternations of mood, the spontaneity of the attacks independent of external influences, and the frequency of cases of depressive conditions in the history of antecedent and immediate members of the same family. Whenever obvious precipitating events do occur, such as loss of someone or something, or disappointment, the intensity of the depressive reaction is far out of affective proportion.

However, affective changes in the absence of observable causes, as well as undue reaction to external events, and the hereditary factor, fit in well with the concept of depression provided by psychoanalysis. Psychic developments may occur without an