Psychotic depression is an alloy of psychosis and depression that is not separable into psychosis and depression. Psychosis is a symptom that thought and behavior have become unrelated to reality. It is, in other words, a symptom of madness just as biological as delirium. Psychologists and psychodynamicists often understand illnesses as psychological conditions, caused by psychological conflicts and blamed on unconscious psychological mechanisms. Saying “illness” does not denote “biological” to them. We should like readers to perceive the old-time biological meaning of madness, not through the psychology of the unconscious. Depression is an illness that includes, among other symptoms, the loss of ability to think things through. Patients with psychotic depression have an illness with symptoms of disordered thought, behavior, and mood. They are both delusional and suffer a mood disorder. They are truly physically ill, and their illness represents a terrible suffering for patients and their families, worse so because they cannot describe it. This book aims to help health care professionals find the words to describe their observations of psychotic depression, to work together with their patients to formulate treatment, and to express expectations of recovery from illness. The following pages contain the past, the present, and the future of patient-centered concerns about conventional, and some not entirely conventional, ideas concerning its diagnosis and treatment.

We are trying to reach mainly physicians here, because it is upon their shoulders that responsibility for diagnosis and treatment rests.