Psychological Correlates of Depression

In the course of the psychoanalytic treatment of patients with neurotic-depressive reactions, it was noted that there was a high incidence of dreams with unpleasant content. This unpleasant content was of a particular kind; namely, the dreamer was the recipient of rejection, disappointment, humiliation, or similar unpleasant experiences in the dream content. A rating scale was constructed for the objective identification of these unpleasant themes, which were labelled “masochistic.” This rating scale was applied to the first 20 dreams in treatment of 6 patients who had the diagnosis of neurotic depression and to the dreams of 6 nondepressed patients. The 2 groups were matched as closely as possible on the basis of sex, age, and estimated degree of psychopathology. The total sample of 240 dreams was randomized and then subjected to a “blind” scoring by the junior author. The dreams were also scored by the senior author for a reliability check, and 95 per cent agreement was obtained. The depressed patients showed a significantly higher number of dreams with “masochistic” content than the nondepressed patients (P=.025). Cross-validation and multiple-validation studies are necessary to confirm these findings. These results appear to be consistent with the psychoanalytic concept of inverted hostility in depressed patients. Future studies will attempt to establish whether there is any correlation between other clinical manifestations of masochism and the occurrence of “masochistic” dream content.