The critical effect of object loss in the development of episodic manic illness

This article is a detailed psychoanalytically oriented case study of a patient whose mania followed the loss of a parent. Repetitive childhood trauma such as recurrent separations from parents because of political repression, fears of being abandoned, extremely contradictory parental expectations, multiple mothering, and restricted peer interaction forced the excessive use of primitive defense mechanisms, especially denial leading to grandiosity, resulting in po-rous ego boundaries and later serious conflict related to magical thinking and world destruction fantasies. These issues were compounded during latency by emigration to this country from eastern Europe and having to adapt to an entirely new culture. Successful mourning was precluded due to the blurring of self and object representations and the overwhelming need to minimize the finality of death by means of manic regression, the clinical stages of which are described precisely.