A Psychoanalytic note on a Specific Delusion of time in Psychotic Depression

Abstract

1) The specific delusion of the eternity of the depressed state presented by psychotic depressed patients in all aspects of their behaviour and thought during their illness, is described and discussed. It consists of the conviction that their depressed state will never end and will continue for an eternity. 2) The hopelessness and helplessness of such patients are directly linked with this delusion (cf. text). 3) The findings of the author, based on psychoanalytically-oriented psychotherapy and psychoanalysis differ from those presented in the existentialist literature (cf. text). Time is neither regularly ‘speeded up’ nor ‘slowed down’, ‘stagnant’ nor ‘dammed up’, nor is the ‘future blocked’ as reported by the existentialist phenomenologists. Rather, patients perceive their future in the deluded conviction that it is an unending depression that will continue unabated forever or for eternity. 4) The author considers the nature of this delusion. For him, the delusion of the permanence of the depressed state results from a marked regression to fixations in the earliest oral phase, in which the passage of time can only be measured by changes in the biological rhythms of the organ system denoting such change. Thus a state continues ‘forever’ until it is succeeded by a new organic state of function, e.g. sleep to wakefulness, feeding to satiation and very rapid sleep, etc. (cf. text). This regression explains the nature and form of the cathexis present in the patient's depressed state. Helplessness is felt to be a marked regression of aggressive cathexis to a late oral (pre-anal) stage—one prior to the development of sphincter control and mastery (cf. text). 5) The author also discusses some aspects of technique in using the above concepts in psychotherapy and psycho-analysis, of this aspect of their illness, of such patients (cf. text). 6) The patients' poor motivation to continue on-going psychotherapy once out of the depressed state, and the specific psychodynamic reasons for this, are discussed (cf. text).