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Lewin, B.D. (1941). Comments on Hypomanic and Related States. Psychoanal. Rev., 28(1):86-91.
    

(1941). Psychoanalytic Review, 28(1):86-91

Comments on Hypomanic and Related States

Bertram D. Lewin, M.D.

Psychoanalysis has had less to say of states of elation and euphoria than of states of depression. Whether this is so because elated persons more rarely come to analysis, or whether it is because they prove relatively inaccessible to our methods when they do, it remains true that our knowledge of the psychology and dynamics of elation in its finer details lags considerably behind our under standing of the depressions. We have, to be sure, many sidelights on the problem of elation, due mainly to the work of Freud and Abraham, especially in regard to the role of narcissism and oral regression, and Rado has given us an excellent formulation of the narcissistic economy of this state, but these contributions have been in a sense incidental to the main focus of interest, which was on the depressive state.

Some years ago the present writer was able to report on a very transient hypomania, which intervened during the analysis of a case of hysteria, and in understanding this case he was much aided by a report by Brill of an analogous hypomania, or rather of a “miniature manic-depressive attack” which interrupted the analysis of a compulsion neurosis. Brill's case, my own, and one reported by Nunberg had much in common in the way of provocative antecedents: the transient affective disturbance in each case was a reaction to a coitus observation and its content represented a reliving of this scene. The patient identified himself simultaneously with both of the sexual partners.

The writer was able to show that the patient's ego had regressed to the stage designated by Freud, the “purified pleasure-ego” (purifiziertes Lustich), and that it was making extensive use of the defense-mechanism which Freud called denial (Verneinung). The patient was denying a part of his own experience, certain facts or events perfectly well known to him, the acknowledgment of which would commit him to the recognition of his own anxiety, guilt, or aggression.

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