On Sadness and Grief in Infancy and Childhood—Loss and Restoration of the Symbiotic Love Object1

There is a conspicuous gap in our understanding of the connecting links between those conditions which Spitz (1946) has described as "anaclitic depression" and other psychotic pictures in early infancy. While anaclitic depressions occur in the second half of the first year of life, the other psychotic conditions may, or may not, have their prestages in the first year of life; however, they definitely develop during the separation-individuation phase of normal development, that is, from twelve to thirty-six months of age.

According to Spitz, anaclitic depression is the equivalent of "primal parathymia," which was described by Abraham (1924) as the infantile prototype of a later depressive psychosis. Spitz considers the syndrome of anaclitic depression a psychosis, although, due to the immaturity of the psychic apparatus, the signs and symptoms differ from those manifested in the psychoses of later life. He feels that by the second half of the first year of life, the ego is sufficiently well organized to control motility and express negative and positive affects. An extreme disturbance in these ego functions could therefore be considered to be psychotic. The chief signs of anaclitic depression in the infants Spitz observed were a dejected expression and posture, and a distaste for motility.

We are all agreed that the cardinal etiological agent in this syndrome, as in other forms of infantile psychosis, is the object loss