Masked depression in chronic schizophrenia

Summary A depressive variant found in some chronic schizophrenics is described. It is characterized by inner deadness, total hopelessness, total worthlessness. Biological factors do not seem to be of major importance. Other features are helplessness, somatic complaints, fatigue or exhaustion. Inner deadness seems to be a form of permanent depersonalization. Total hopelessness is indicative that all attempts at psychic gratification have failed. It is tied up with worthlessness. The self is so involved in its own guilt and shame that it cannot accept objects and gratifications even if provided over extended periods of time. Implications for therapy are the ability to resist psychological withdrawal from these patients.From the National Institute of Mental Health-National Center for Mental Health Services, Training and Research-Seymour D. Vestermark Division of Intramural Training, Saint Elizabeths Hospital, Washington, D.C.