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I would like to make a few considerations concerning the passage from depression to mania in patients lacking a fully cohesive self. These were people whose stability and well-being depended on the possibility of maintaining a fusional bond with a real object. Every time the object which assured cohesion distanced itself, the patients suffered from fragmentation and varying degrees of depression.
I shall illustrate, by means of three brief clinical examples, the phantasy which preceded and accompanied the onset of the manic reaction.
My approach to the problem is based on the model elaborated by the Kleinian school, which places detailed unconscious phantasy at the centre of psychoanalytic observations. M. Klein's concept of projective identification, though applied in a rather restrictive sense, has always been of considerable help to me. However, I do not agree with the English school in considering depression a consequence of a primary attack against the object, and mania as secondary to failure of the reparative tendency towards the object. Moreover, I do not regard narcissistic rage as an aggressive attack, that is as a manifestation of envy towards the libidinous tie with the object. I have had occasion to question the validity of this concept in a previous paper (1988).