The "one day at a time" syndrome in post-transplant evolution: the regressive megalomanic model versus the progressive hypomanic model.

After kidney transplantation patients experience an initial period of euphoria which is usually followed by a phase of disillusionment and depression. At this point the "one day at a time syndrome" appears as an attitude of adaptation and defense. It is proposed that there are two dynamically and prognostically different varieties of this syndrome: A first type represents a regressive megalomanic defense whereby depressive anxiety concerning the rejection of the part-self represented by the graft is conscious but depressive anxiety concerning the eventual death of the whole self is omnipotently denied. This variety of the syndrome is related to a more negative prognosis both psychologically and somatically. The second type of the "one day at a time syndrome" is a progressive hypomanic defense whereby depressive anxiety concerning the rejection of the part-self represented by the graft is present and conscious but relative and does not preclude the conscious depressive anxiety concerning the eventual death of the whole self, which once acknowledged can gradually be mastered, permitting the pursuit of as pleasurable a life as possible. This variety of the syndrome is prognostically more favourable both physically and psychologically.