The basic depressive conflict is that because the individual depends so mightily on his all-important others, he empowers them with the capacity to exert tremendous influence on him, and when they do this in ways that he finds frustrating, he begins to resent and feel angry and hostile toward them. These are very threatening feelings. He cannot express them, or even allow himself the critical thoughts that they give rise to, since he dare not risk doing anything that might displease the objects of his dependency and make them go away. Thus, instead of directing his anger and hostility at his all-good others, he turns it back against himself. If they are all-good, and they are turning away from him, then he must be a worthless, all-bad person. He becomes extremely self-critical, full of guilt, and, if his anger and hostility are intense, he may subject himself to painful punishments. In worst case instances, when all seems lost and there is no relief from the pain of unremitting helplessness, he may end up committing suicide.

Often, as a kind of life-saving mechanism, the depressed individual may find substitute sources of dependent gratification in the world around him. If he cannot get his needs for emotional nurturance met by some important person, he sometimes gets them met through dependent attachment to alcohol and/or drugs, which at least temporarily give him the feelings of security, self-worth, and self-confidence that he cannot find within himself. Because he uses such substances to lift himself out of depression, when their effects start wearing off, the depression returns, so he is driven to take more and more of the substances. As time goes on, due to the ruinous effects that alcohol and drugs have on all of his involvements, he has more reason than ever to be depressed, and a vicious-circle pattern is established.

In the image, the basic dependency on sources of nurturance is symbolized by the infant yearning toward a giant breast in the sky. The depressed individual in the foreground is out in the cold, symbolized by his nakedness and the snow-covered ground. He is reaching out to a gigantic, larger-than-life, turning-away, disapproving parent figure, who is situated on a bright, warm, green island, meant to symbolize the paradise that she/he has to offer, but can also take away. The broken mirror containing reflections of both himself and the parent figure is meant to represent the depressive person's pattern of directing anger and hostility aroused by the all-important significant other toward himself instead.