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Article   |    
Gerald H. J. Pearson
Am J Psychiatry 1928;85:289-335.
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Commonwealth Fellow in Neuropsychiatry; Graduate School of Medicine, University of Pennsylvania, Philadelphia

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A study of the productions of four cases of depression, three of involutional melancholia and one in the involutional period with a seventh attack of manic-depressive psychosis is reported here. These productions seem to indicate that the following mechanism produces the attack of depression. A precipitating situation arises in the patient's life whereby his ego receives a wound and the carefully built up compensations over many years fail. This precipitating situation reactivates a similar childhood situation and causes a regression of the libido to a more infantile level—one of oral eroticism. At this level the differentiation between subject and object is vague. The object seems to have signified the ego ideal—the inhibitions—and this projection of the ego ideal on the object seems to have made it possible for the ego to incorporate it (devour it) into a subordinate position where the hate element in the libido strivings can be vented on it. The patient flees from the precipitating situation into the psychosis and in the psychosis can give full play to his infantile hate against the object, his ego ideal and his inhibitions, but by doing this he increases his guilt which he is able to satisfy by punishing his ego for its subordination of the ego ideal.

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