Dr. EBNA HOCH, M.D.

Nur Manzil, Psychiatric Centre,

Lai Bagh, Lucknow.
(Continued from previous issue)
One of the most fascinating tasks would
of course consist in examining, whether a
patient' s belonging to a particular caste
affects the contents of his depressive ideas.
For many centuries, the caste has dictated
spheres of interest and activity. In terms
of the Bible (15), we can state: "Wher e
your treasure is, there will your heart be
also." Or, if, aspiring to be more modern,
we want to express a similar truth in
terms of existential philosophy, we can
quote Martin Heidegger (16), who, in
"Sei n und Zei t ", states; "Foremost and
most immediately, existence is out of that
which it takes care of." If this is true in
a positive sense, one might reasonably
expect that, in a depression, the universal
sense of loss would also be particularly
likely to be experienced in the sphere in
which the patient' s main interests and
activities lie. An investigation into the
influence of east*, on the contents of
depressive ideas, however, is again a very
doubtful enterprise. First of all, we shall
again have to split up our small case-
material into quite insignificant figures,
particularly if we want to keep men and
women separate. Then, quite apart from
this, one may object that nowadays very
few people still adhere to the old customs
and spheres of interest of t hei r castes.
Unless one supposes that originally caste
may have been based on certain constitu-
tional features, which possibly might
persist through a few generations even
Contents of Depressive
Ideas in Indian Patients
after the members have ceased to follow
a characteristic pattern of life, it might be
more rewarding to investigate the contents
of depressive ideas with regard to
profession than with regard to caste.
A glance at the distribution of our
depressive patients amongst the different
castes, however, justifies, if not the
assumption, at least the suspicion, that
caste still may have some significance.
Even without compiling any exact figures,
I had for some time past been under the
impression (2) that a quite disproportion-
ately great part of our manic-depressive
patients belong to the Kshattrya and the
Banya castes. My calculations now con-
firm this impression: If we take all the
patients of the whole manic-depressive
group, 31.6% of them are Kshattryas, 30%
Banyas. The Kaisth follow at a consider-
able distance with a share of only 18.3%,
the Brahmins with 16.6%. while the
Shndras only furnish 3.3% of the whole
group. If we only consider those patients
who were examined during a depressive
phase, this predominance of Kshattryas
and Banyas is even more obvious, as
amongst the depressed patients either of
these two castes claims 34.7%, while the
Brahmins make up 15.2%, the Kaisths,
having a higher proportion of manics than
of depressives, only 13% and the Shudras
2.1%. One might of course argue that
these proportions could be due to
accidental factors. One might for instance
suppose that the Kshattryas and Banyas
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April 1961"] Contents of Depressive Ideas in Indian PatientsHooh 121
might be equally predominant amongst the
total of onr patients, because they may be
more enlightened about the possibilities of
psychiatric treatment or financially better
equipped to afford it than others. Unfor-
tunately I cannot present the figures yet
for the distribution according to caste of
our whole patient material. A comparison
with the schizophrenic group, however, for
which we have calculated the caste-figures,
may corroborate my suspicion that this
distribution is not quite accidental.
While the proportion of Kaisths in the
schizophrenic and the manic-depressive
group of patients with 20% and 18.3% res-
pectively, is almost equal, we find a
distinct predominance of manic-depressive
patients amongst the Kshattryas and
Banyas. The share of the Kshattryas
amongst the schizophrenics is only 22.1%,
while amongst the manic-depressive
patients it is 31.6%; the corresponding
figures for the Banyas are 18.2% amongst
schizophrenics, 30% amongst manic-
depressives. The Brahmins seem to have
a great er affinity to illnesses of the
schizophrenic group, in which their share
is 28.7%, while in the manic-depressive
group it is only 16.6%.
A strange fact that emerges from our
figures is that in those caste-groups in
which the proportion of manic-depressive
patients is higher than that of schizophre-
nics, the number of patients seen in manic
phases or who reported previous manic
phases, is remarkably lower than the
number of patients examined during
depression, while in the groups, where
schizophrenia predominates, the share of
the manic patients in the manic-depressive
group is significantly higher than the
share of depressed patients. This same
observation is valid for the Muslims, while
the few Christians are equally distributed
in proportion amongst mania and
depression. I hesitate to give any figures
for the Shudras, as they are very few in
number and as probably most of the
patients in the schizophrenic group, whose
caste we were not able to identify, may
have been Shudras.
How to explain this strange inverted
relationship? Could it perhaps mean that
the same disintegrating factors that are at
work in schizophrenia also dispose more to
mania then to depression? Or should one
suspect that even the few depressive phases
found iu Kaisths and Brahmins might not
have been quite pure, but mixed with
schizophrenic elements? In fact there are
a few cases amongst our depressive
Kaisths, in which the diagnosis was some-
what doubtful. Some of the manias in
Kaisths were complicated by organic
factors, such as alcoholism, heavy smoking,
beginning arteriosclerosis. On the other
hand one might argue that, perhaps,
depressions might actually be more
frequent in Brahmins, Kaisths and
Muslims than would appear from our
material, but that they are less readily
recognized as illness or that they might
be borne with greater equanimity, so that
medical help is not sought as readily as by
the Kshattryas and Banyas in depression.
These, however, are probably idle specu-
lations. All we can say is, that the share
of the Kshattryas and the Banyas amongst
our manic-depressive patients is dispro-
portionately high, and that this may well
have a correlation with the pyknic and
pykno-athletic body-types, which one
frequently finds in these two castes.
Turning to psycho-dynamic interpretations
of manic-depressive illness, one might of
course point out that the Kshattrya, being
the ancient warrior, many still have a
considerable amount of aggression to
dispose of, which under the conditions of
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| 22 Indian Journal of Psychiatry [ Vol. Ill No. 2
modern civilization he cannot let out in
legitimate form. So the aggression may
be likely to turn inward and thus to cause
depression. The Banya, on the other hand,
might find the world of to-day rat her
frustrating, as his role of being a mere
mediator between the productive efforts
of other castes may no longer be possible
in its purest form and he may have to turn
to a way of life which involves more activa
effort and personal service. Such frus-
tration and consequent anger, if pre-
vented from finding an appropriate outlet,
might again be internalized in the form of
depression. Probably, however, matters
are not quite as simple as this, and frus-
trated aggression may only be one amongst
many faotors that lead to depression.
Ou trying to investigate, whether
patients of different castes tend to attach
their depressive thoughts to different
spheres of life, we find that our figures are
too small. All we can st at e, is that
amongst the Banyas, particularly the men,
there seems to be more concern about
loss of material possessions than in any
other group. In my letter to Dr. Lenz
(3) I bad expected this as a possible outcome
of a study of this kind. My other assump-
tion, however, namely that one might
expect worrying about guilt and religious
duties in Brahmins, has been entirely
disproved. There was not a single
Brahmin amongst our patients who expres-
ed any doubts about religion and only
one who voiced guilt-feelings.
While, thus, trying to demonstrate
caste-characteristics by analysing the
various spheres of interest affected by
depressive ideas leads to nothing in our
small case-material, I found that it pays to
group the various headings according to
some more central idea.
When thinking of depression, one
usually imagines that in this state of mind
all the energies and impulses, or what we
might call the "l i bi do" should be turned
inward in self-accusation and self-destruc-
tion. If, however, we consider the
contents of depressive ideas more closely,
we find that very few of them really re-
present a complete internalization. Some
depressive manifestations, such aspaianoid
ideas and concern about possessions, are
even quite definitely turned towards the
outward world while others, e. g. those
concerning body, family, work, to a certain
extent also religion, can face both ways.
I shall try to explain this by taking a look
at each group of contents in turn, Fi rst ,
however, I should like to point out that
the syndrome of depression itself, though
the patient seems to be the one to suffer
most, very often has a quite high
' nuisance val ue" with regard to the persons
of the patient' s environment. Anyone
who has experienced, how difficult it is to
keep one' s patience and sympathetic under-
standing, when looking after a depressive
patient and listening to his continuous
complaints, will know t hat such patients do
not only inflict torture on themselves, but
equally on their surroundings. I have
seen patients who were quite disappointed,
when in our staff-members they could not
elicit any signs of impatience, displeasure
or anger by their behaviour. Other
patients have admitted to us quite openly
that they get a certain amount of satisfac-
tion by troubling their family-members
with their constant complaints or their
restlessness and anxiety. Such patients
often find quite good sleep during the day,
when most of the family-members are out
of the house, while at night they disturb
the whole household by their moaning,
fidgeting and restless roaming.
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April 1961 "] Contents of Depressive Ideas in Indian PatientsKoch 128
Depressive ideas concerning the body
and its functions, which were most
frequent in our patients, cannot be said to
be entirely turned inward either. The
body, of course, on the one hand is an
integral part of the person, the outermost
circle of our individual sphere. At the
same time, however, through its material
nature, the body also represents the closest
layer of the outside world. Any depres-
sive symptom referred to physical func-
tions is therefore already, in some way, a
projection into the outside world. The
degree of this externalization will of course
depend on the attitude a person has to his
body. Someone who is his body, will be
less likely to use it as a scapegoat than a
patient who merely has a body. In gene-
ral we have only listed such complaints
under the heading "body" which definitely
had this character of hypochondriac
projection into the physical sphere.
Amongst Indian people much more than
in the individualized West, the next layer
that surrounds a person, once we proceed
beyond the body, is no doubt the family.
In many of our patients we find that they
consider the family as a kind of extension
of their own person. What happens with-
in the family, does not really count, is still
considered as an "i nt ernal " matter. If one
gives vent to one' s emotions within the
family, this is in a way an outlet, but at
the same time nothing that "leaks out",
or that is of real consequence. Concern
for the welfare of one' s family is a very
personal mat t er that can affect a patient
to his very core. The limit set between
family and outsiders may in some oases
seem to be more definite than the limits
between the individual and his family.
Considering this, we again can say that
depressive concern about one' s family is
neither quite externalized nor entirely
internalized. If one is careful to note the
way in which patients express such com-
plaints, one will find that some of them are
turned to a note of self-accusation, while
in others the element of reproach or appre-
hension is plainly turned outward. On the
one hand we get the patient who blames
himself for neglecting his children, for
having lost all feeling for bis near and
dear ones; on the other hand patients may
express their grudge about the lack of
attention by family-members or their
apprehension that some disaster might
befall them. Sometimes we even get
surprisingly open confessions by patients
that they are fed up with the burden of
looking after a family, that they wish
their children were already grown up and
able to take care of themselves.
For women, the family-circle often
coincides with the sphere of work. In
those patients who have an occupation
apart from family-duties, i. e. in most of
the men and some of the educated women,
work represents a still wider circle of
interests than the family. In depres-
sive ideas concerning this sphere of work,
we again can distinguish two trends: on
the one hand the patient may curse his
burden for being too heavy, his superiors,
fellow-workers and subordinates for obs-
tructing him in his duties; on the other
band the patient may accuse himself for
his own inadequacy, lack of decision and
bearing-power in his work.
One may hesitate, whether one should
also place religion into the group of these
spheres of interest which lend themselves
equally to an internalization and an
externalization of depressive ideas.
According to the nature of the religious
beliefs, a patient may rather feel that
God has left him or is treating him
unkindly, while another one may express
deep remorse about his own inability to
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124 Indian Journal of Psychiatry [ Vol. Ill No. 2
perform his religious duties and to keep
up contact with Divine forces. I am
therefore inclined to leave religion in
this ambitendent group.
What now, after having already
indicated that paranoid ideas and concern
about material possessions can be regarded
as entirely turned outward, remains for a
genuine internalization of depressive
ideas? I should consider that only ideas
of guilt and sinfulness, apprehension
about loss of mental power and balance
and suicidal thoughts and tendencies can
be listed in this category. Even about
suicide one might have one' s doubts:
Does the patient think of ending his life,
because it has become too much of a
burden for him or because he no longer
feels worthy of living? Should we, even
in the suicidal act, consider the
externalization of thought into determina-
tion and violent action, or rather the tarn
ing inward of the movement towards the
subject himself? And with regard to mind:
will the patient in all cases be quite
identified with that mind he fears to lose,
or does he consider it as a kind of
attribute, similar to his body? Aud finally,
where does guilt point to? Towards mere
non-fulfilment of an obligation or a
custom imposed by the outward world, or
towards one' s own innermost being?
We can partly answer this last question
by examining the ideas of guilt and
sinfulness expressed by our patients. As
I mentioned in the beginning, we found
such ideas plainly expressed in 32% of our
patients. In others, of course, an element
of guilt may have been involved in their
ideas about family, work and religion.
Under the heading of guilt, however, we
have only listed such self-accusations that
were very clearly defined as such, and
that did not seem to fit readily into any of
the other categories. In these ideas of
guilt we can distinguish two definite
groups: On the one band compunction
about not having followed custom in one
particular instance or on several occasions.
Most of these self-accusations concern
sexual excesses, juvenile masturbation,
extramarital and incestuous relationships,
having committed abortions, having
caused someone' s death by unkind
behaviour. One young man reproached
himself for having urinated in the Ganges
while taking a bath. It is interesting to
note t hat some of these themes are quite
similar to those mentioned by Western
authors, e. g. Wyrsch. (17). On the other
hand we find vague feelings of sinfulness,
expressed in such terms as "having
committed some cri me", "having done
all wrong in the past", "bei ng sinful,
punished by the Gods" "having neglected
one' s religions dut i es". In one instance
a female patient of the younger genera-
tion accused herself for selfishness.
Another patient, but this only after we
had guided her psychotherapeutically
through several phases of depression
with manic admixtures, came to recognize
her laziness and childishness and
reproached herself for it, while first she
had blamed her little son for not advancing
quickly enough in his education.
Dr. Lenz' s statement t hat no guilt-
feelings are to be found in Indian patients
is disproved by the fact t hat 68.7^ of
the listed guilt-feelings were found in
Indian patients, who constitute 86.2%
of all depressed patients examined. Since
I have undertaken this study, I have been
more careful in asking depressive patients
about possible guilt-feelings. Two Indian
patients, not included in this study,
answered my question by explaining that,
of course, they felt that they had done
some wrong in the past. As in the Indian
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April 196l~\ Contents of Depressive Ideas in Indian PatientsHoch, 125
view of life one shapes one' s fate oneself
by one' s deeds, one would not be afflicted
with so painful a depression, unless, by
some wrongdoing, one had deserved it.
This concept of being responsible for
one' sown fate seems to be so naturally
accepted by many Indian patients, that
perhaps they take it too much for granted
to talk about it. Others, however, may
actually wish to forget about it and to put
the blame on something outside them-
selves.
Though we have seen that there is
hardly any depressive idea that can be
declared to be entirely turned inward, we
might be justified in considering the
ideas concerning mind, guilt and suicide
as most internalized. If to this group
we oppose those ideas that are most
definitely directed outward, i. e. those
concerning material possessions and
paranoid elaborations, we find some
interesting trends.
In a first table I calculated the propor-
tion of externalized to internalized ideas
in the different groups of patients. We
then find amongst the few Muslims and
Christians, but also amongst the Kaisths,
a complete absence of externalized ideas,
both amongst men and women. In the
other groups, if we put the number of
externalized ideas as one and calculate
the quotient of internalized ideas on this
basis, we get the following figures: In
men the quotient is 3,5, while in
women only 1,9. If, however, we ionly
t ake the most educated group, we find
almost similar figures for men and
women, i. e. 4,2 for the men, 4,5
for the women, while the quotient for
the less educated group is only 1,1.
Amongst the Hindus, for whom the
quotient is 2,0 in the whole group,
we find the following distribution:
Brahmins 2,0, mostly on account of the
men; Kshattryas 2,3, again with a
predominance of intarnalization in men;
for the Banya men th figure of 2,25 is
close to the average of Hindus, while in
the Banya women, all little educated, the
ratio sinks below 1, which means thai
externalized ideas are 3 times as frequent
as internalized ones. The one Shudra
woman follows this same pattern. In the
Kaisths, as already mentioned, exter-
nalized ideas are completely absent.
Calculating also the corresponding figures
for the two age groups mentioned earlier, I
was able to corroborate my statement
about the greater awareness of self aud
tendency towards internalization in the
younger generation. Though the group
of patients below the age of 35 contains
less educated people than the older group,
we find a quotient of internalization as
high as 5,25, while in the patients above
the age of 35 it only amounts to 1,7. We
might therefore conclude, as far as this is
permitted with our small figures, that edu-
cation, Christian and Muslim religion,
belonging to the younger generation, are
factors that promote internalization of
depressive idea& as manifested in concern
about guilt, mental functions and suicidal
tendencies, while lack of education and
belonging to the older generation seem to
predispose towards paranoid elaborations
and worry about material possessions.
One might wonder, whether those
patients who have also had manic phases
differ in the degree of internalization of
depressive ideas. One might assume that,
as they get a chance of total externaliza-
tion during mania, they might be more
closed to the outside world in depression.
This seems to hold true for the men:
While the quotient of internalization in
those with manic phases is as high as 1:18,
it is only 1:1,1 in those patients who
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126
Indian Journal of Psychiatry [ Vol. Ill No. 3
had experienced depressions only. In the
women, however, we find an inverted ratio:
Those with manic phases show au inter-
nalization quotient below 1, namely only
0.66, while those with depressions only
have a quotient of 2.4. I do not feel
competent to attempt an interpretation of
this strange fact. Bnt it might be worth-
while investigating this ratio in a bigger
case-material.
If we suppose that internalization and
externaiization of depressive ideas are
trends towards opposite directions, we
might well expect to find some incompati-
bility between them in the same subject.
In a graph(Table 2) I tried to represent the
frequency with which two different themes
occur in combination in one and the same
patient. To give combinations of more
than two groups of i deas. - and in some
patients we find as many as 6 or even 7
themes combined,would have been too
complicated. But even our table of
combinations of 2 themes shows that the
squares, in which the columns for external-
izing and internalizing tendencies meet,
are very poorly occupied or even vacant.
What now, can we conclude from all
these figures, which may possibly seem
rather confusing? Going back to onr
starting point, i. e. Dr. Lenz' s letter and
paper, we can safely state that guilt-
feelings are not unknown amongst Indian
patients, though in many cases they may
be more governed by eonoepts of custom
and tradition than by a real inward call
of conscience. We can further state that
the growing awareness of the self as a
responsible, independent agent, which is
promoted by Western influence and new
standards of education, seems to favour
tendencies of internalization, while in
more primitive people paranoid mechan-
iema of externalisgatiott still seem to Ue
more frequent. This is actnally, what
one might expect during a gradual
emancipation of man from a creature
more or less empathically linked with his
surroundings into a well defined and
differentiated subject who feels responsible
for his own thoughts aDd actions. One
might of course object that such ideals of
becoming responsible for oneself, of
being "swasth", i. e self-reliant did not
have to be imported from the West, as
Hindu philosophy has known them for
centuries. The question, then, might be
asked, whether perhaps the people who
have been following those spiritual
disciplines of Hinduism that lead to self-
awareness, may have been spared from
depressive illness? and whether amongst
onr depressive patients we may find exactly
those who, in some way or other, are
trying to shirk this responsibility?
The phenomenon of guilt, which earlier
authors considered to be at the bottom
of depression, nowadays seems to
disappear in t he western depressive
patient. Does this really mean that the
importance of guilt has become superan-
nuated like some old-fashioned ghost!
Could it not much rather mean that man,
inflated with his own importance and his
power over the material forces of this
universe, is increasingly hiding and
escaping from his true human responsi-
bility? I think we have to consider two
thoughts, if we want to penetrate a little
more deeply into this problem:
First: any symptom of illness, as
ultimately any phenomenon in this world,
is a mixture of revealing and concealing.
The varying proportion in which these two
elements are thrown together, determi-
nes, whether a conflict is to be expressed
more openly, for instance in the form of a
dramatic hysterical manifestation, or
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April 1961~\
Contents of Depressive Ideas in Indian Patients
COMBINATIONS OF DEPRESSIVE IDEAS.'
127
BODY
FAKtlX
WORK
SUICIDE
imJeuitl
SEtlGIOB
PARANOID
j P o s a E s s r o w s
BOW
FAMILY
VOCK
3UICI9B
It<6(JItI
msv
RE1IG10JJ
IPARAllOlD
e*tJ
JPOSSESSIOHS
B. p. w. <T.
JS&s
G. M. R.
r-****
? a^ ? oJ ' MALE PATIENTS
HF
71
'jafifaw*'
P II IF J ^
B W W W*!
p i 1
E l *
1
f F p
I
II
HT""
y
r^
>
s
1
1 "
i
i p -
1
Pa
1 '
I
K
v. ry: Tir> R. / T a T To> . FEMALE PATIENTS
Table 2
Tabl e 2 : Shows, how frequently the different themes of depressive ideas are com-
bined with each other. The more "i nt er nal i zed" themes: suicide, gnilt, mind are
joined into a group by a bracket; equally the two most "ext er nal i zed" themes:
Paranoid, possessions, are also joined by a bracket. In the chart produced, when
the lecture was first given, these columns were marked in yellow and blue respectively.
Where they crossed, the colouring became green. In these green fields very few
cases were located, demonstrating the incompatibility between internalizing and
externalizing tendencies within the same depressive patient.
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128 Indian Journal of Psychiatry
[ Vol. Ill No. 2
whether it is to be hidden deeply in the
physical sphere in the disguise of a
psychosomatic organ-lesion or perhaps a
biologically founded endogenous depres-
sion. Secondly, I think it is a fruitful
concept to accept existential, fundamental
guilt in the sense of one's constant debt
to life and one's remaining behind one's
possibilities as the point of origin of
most illnesses and other human imperfec-
tions. If, however, this existential guilt
is being faced openly and consciously, and
if this leads to an equally open and
responsible acceptance of the call of
of conscience and of all the anxiety and
suffering possibly associated with it, this,
though it might cause painful emotions at
certain stages, is not likely to be felt as an
illness, but perhaps rather as spiritual
crisis. It would be a revelation or a
movement of active penetration into
depth, but not an experience of being
pressed down or of falling. Illness only
occurs, when this call is misunderstood,
avoided or covered up.
In depression, at least in those patients
who feel some personal responsibility,
either to an outward moral or religious
convention or to an inward authority, this
basic guilt is perhaps revealed more clearly
than in other forms of illness. But yet, if
it is a symptom of illness, it has to be dis-
guised. It may show itself as guilt, but
shifted from its real place, with a changed
emphasis, out of proportion, dated back
in time instead of being experienced as a
universal ever present reality. It is in-
teresting in this connection to remember
that the German word for "mad, insane",
namely "verruckt", simply means that
something has been shifted from its
normal place. Freud taught us much
about the importance of displacements in
the formation of neurotic symptoms.
Perhaps, however, we have to give a far
more general meaning to such manoeuvres
of shifting and disguising, which man
commonly utilizes in his escape from his
conscience. Where guilt appears in
depression, we often find it,as we have
seen in our case-material,minimized
and restricted to one particular incident
or sphere of life, at any rate to a size and
a position, in which one can still safely
tolerate it. The more guilt-feelings are
universal, the more we find that the
patient is bearing his depression with
dignity, ready to turn it into an experi-
ence that leads to inward growth. All
the patients in our material, who had the
courage to experience guilt in a more or
less universal form, were people with
deep religions attachments, no matter
whether they were Hindu, Christian or
Muslim. If this maturity of mind is not
present, we see patients reacting to their
depressions in very childish and hysterical
fashion.
While in some cases of depression guilt is
still apparent, though shifted into a false
position, we perhaps have to assume that,
in other cases, the sense of inadequacy
and discomfort may retain its place in
a particular sphere of life, but show
itself disguised or distorted into resent-
ment and reproach directed outward. In
these eases the real nature of the conflict is
concealed, while the sphere in which it
appears may be revealing. In several
patients, e. g. who showed concern about
their families, either in the form of
anxiety or loss of emotional contact, it was
fairly obvious that the basis was a deep
unwillingness to face the burden of provid-
ing for them. The same may apply to
preoccupations about work, while the
suicidal patient draws the extreme con-
sequence of wiping out his debt by reject-
ing a life and killing a conscience that
has become too troublesome for him.
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April 1961 ] / Contents of Depressive Ideas in Indian PatientsBcch 129
I am jXainfully aware of the fact that
the smaAl number of patients about whom
I yp& able to report hardly provides a
S /sufficient base on which to build up such
elaborate reflections. I myself am far
from considering all questions asanswered
and closed. On the contrary, by pointing
out some of the problems and possibilities
suggested by our material, I merely hoped
to throw the doors open for further
discussion and for similar investigations
in more representative groups of patients.
If I have been able to stimulate interest
in this direction, I shall regard my labour
as richly rewarded.
Ref er ences
1. KIELHOLZ PAUL : "Klinik Differen-
tialdiagnose und Therapie der
depressiven Zustandsbilder.' ' Docu-
menta Geigy, Acta Psychosomatica
Nr. 2, Basel, May 1959.
2. HOCH BENA M. : "Psychiatric in
Indi en", "Pr axi s", Schweiz. Runds-
chau fur Medizin. Vol, 46, No. 52.
Dez. 1957.
3. LENZ HERMANN : Private Corres-
pondence with the author, July - Nov.
1959.
4. LENZ HERMANN : "Binfuhruug in die
Problematic der Diagnose und der
Therapie der Depressionen." Wiener
Klinishe Wochenschrift, Vol. 72, Nr.
IB, 1960.
5. VON ORELLI A. : "Der Wandel des
Inbaltes der depressiven Ideen bei
der reinen Melancholie unter beson-
derer Beriicksichtigung des Inhaltes
der Versundigungsideen." Schweiz.
Arch. Neurol. Psychiat., Vol. 173,
1954. (Quoted by KIELHOLZ (1) and
LENZ (4) ).
6. LEHMANN H. E. : "Psychiatric Con-
cepts of Depression: Nomenclature
and Classification." MCGI LL Univer-
sity Conference on Depression and
Allied States. Canadian Psychiatric
Association Journal, Vol, 4, Special
Supplement 1959.
7. VOEIKEL H. : "Neurotische Depres-
sion." Stuttgart, Thieme-Verlag,
1954. (Quoted by LENZ (4) ).
8. SCHNEIDER K, : "Die Untergrundde-
pression", Fortschr. Neurol., Vol. 17,
1949. (Quoted by KIELHOLZ (1) and
LENZ (4) ).
9. WYRSCH J. : In "Lehrbuch der
allgemeinen und speziellen Psychia-
tvie", M. Reichhardt, Stuttgart,
1955' (Quoted by LENZ 14) }.
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enarzt ", Vol. 1, 1928. ( Quoted by
LENZ (4) ).
11. STRAUSS E. : Monatsschrift fiir
Psychiatrie, Vol. 68, 1928. (Quoted
by LENZ (4) ).
12. HOCH ERNA M. ; "Psyehiatrische
Beobachtungen und Erfahrun?en an
indisohen Pat i ent en. " "Pr axi s",
Schweiz. Rundschau fur Medizin.
Vol. 48, No. 46, Nov. 1959.
13. R. B. DAVIS : Report of the Hospital
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the period 1st April 1949 to 31st
March 1951.
14. BLEULER EUGEN : "Lehrbuch der
Psychiatrie," 7. Aufl. Berlin, 1943.
15. BIBLE : Gospel of St. Matthew, Chapt.
6, Vol 21 j
16. HEIDEGGER MARTIN : "Sein und Zei t ".
8. .-.nfL, Tubingen 1957.
17. WYRSCH J. : "Ueber DepressioneD."
Documenta Geigy, Acta Psychosoma-
tica, Nr. 1, Basel, Dez. 1958.
This paper was read at the 10th meeting
of the Lucknow Psychiatrie Society on
August 5th 1960.
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