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Bloch, H.S. (1989). The Common Core of Paranoia and Depression. Psychoanal. Inq., 9(3):427-449.

(1989). Psychoanalytic Inquiry, 9(3):427-449

The Common Core of Paranoia and Depression

H. Spencer Bloch, M.D.

This is a study of patients who proved to be concomitantly paranoid and depressed, even though some of them had not sought treatment for either of these conditions. The existence of their paranoia and depression was often first identified in their transference, after the treatment seemed to have reached a stalemate. It turned out that the patients had mistrusted my motives to help them. And they had hidden this mistrust from me and from themselves because they felt guilty about mistrusting me. Therapeutic efforts to relieve their guilt over mistrusting me were gradually followed by reduction of their paranoia and depression and by progression in treatment.

From what proved to be very long but successful analyses (without parameters) and therapies, I arrived at the following paradigm for development in these patients: At some period during their childhood, they had experienced a seemingly insoluble developmental conflict. They had perceived that what was required to please their parents was stifling certain of their own strivings toward maturity.

This

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