Recent theories have ascribed the development of paranoid disorders to the use of denial and defensive projection of blame in some patients who have underlying feelings of poor self-esteem and inadequacy. The author proposes that the failure of other significant people in the patient's environment to provide the help he believes he needs accounts for the development of frank persecutory ideas; whereas the failure of denial and projection results in depression. Four cases of sequential or mixed paranoid-depressive illness are presented to support this proposition. Other relationships between paranoid and affective illnesses are suggested.
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