The Process of Introjection in Melancholia

A study of the standard works on the subject of melancholia by Freud, 1 Abraham, 2 Radó 3 and others affords us a very considerable insight into both the psychic structure and the mechanism of this disease. Fenichel 4 gives an epitome of these earlier works in chronological order and suggests for discussion several important points which have not so far been satisfactorily elucidated.

Freud and Abraham discovered that the most marked characteristics of persons suffering from melancholia were the following: ambivalence, sadism directed against the subject's own ego, and orality. In 'Mourning and Melancholia' Freud proceeded to formulate a theory on the occurrence of the disease. His theory was that it arises when the 'loss of the object' is followed by its introjection. He had discovered that the patient's self-reproaches are really applicable to the object, and that utterances which seem quite meaningless acquire a meaning, if for the word 'I' in the patient's complaints we substitute the name of the lost object.

We thus came to realize that the self-accusations which constitute the principal symptoms of melancholia are nothing but disguised accusations against the lost, and now introjected, object. Here we can observe the process of so-called narcissistic regression: a part of the patient's ego becomes his object, and his super-ego then treats his ego precisely as he unconsciously desired to treat the love-object which he has now lost. His sadism, once directed against that object, has suddenly passed into the possession of the super-ego and rages against the ego, which has been transformed by the process of introjection. There can be no doubt that in a large number of cases of melancholia Freud's formula is valid. Helene Deutsch 5 describes a particularly instructive case of this sort.

In Abraham's view, however, it often happens that the patient's complaints are not aimed at, but proceed from, the introjected object. For instance, they may be a repetition