The Construction of Depression1

Cases of serious neurotic depression, though they may not yet have crossed the boundary to melancholia, are considered to be especially difficult therapeutically. Such patients often shew a most distinct negative therapeutic reaction. They will not be diverted from their self-accusations. They insist that they do not want to regain their health. Their masochism is so strong, the enjoyment of self-torment so strongly marked, that the serious view the analyst takes, the therapeutic pessimism he feels while approaching these cases, is fully comprehensible. This is why I am describing two cases where hopelessness was the prevailing feature for a long time and where a full therapeutic success was nevertheless attained. My description lays stress especially on technical questions which have been so far comparatively neglected in the treatment of this problem. Seen from the angle of technique, some of the theoretical problems appear indeed in a new light.

I shall describe how, in two cases, analysis succeeded in abolishing the depressive basis of reaction. The diagnosis was in both cases deep neurotic depression bordering on melancholia. In one case the depression was masked by an obsessional character, in the other the obsessional character was absent. The technical task is influenced by this difference in a manner that is not unimportant. Abraham considered the obsessional character a formation to be observed most clearly in the free interval. 'The psycho-analyst must emphasize particularly that with all patients whose diseases occur in cycles an abnormal character-formation can be observed in the interval. And this is unmistakeably that of the obsessional neurotic. In my experience at least a distinct separation between the melancholic character