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In some types of neurotic depression1 there is no overt sense of guilt: the patient makes no self-accusations, nor is he consciously aware of any desire for self-punishment. Briefly, these patients do not manifest symptoms which are generally held to be characteristic of melancholia. In some cases they even protest against their 'undeserved destiny'. However, since the recognized clinical picture of melancholia often develops gradually, a melancholic affection in its early stages may not display these characteristic features.
Sadness, grief, mourning and despondency constitute the usual and quite understandable reaction to the loss of beloved objects, to distressing occurrences and to disillusionments of various kinds. If an individual fails to react with such emotions to serious losses or unhappy experiences, he is not considered mentally healthy.
In some neurotic persons sadness, discouragement and affective inhibition may appear as a direct and understandable consequence of some other neurotic or bodily disturbance. Therefore we would consider as an 'essential' depression a depressive state which is itself the immediate and chief reason for the complaint and which is not secondary to another neurotic condition. On the other hand, we would call a depressive state that is consciously due to some other neurotic condition a 'symptomatic' depression. Our difficulty, however, in maintaining such a distinction is inherent in the fact that all cases of so-called essential depression reveal, during analysis, deep neurotic conditions which are its bases. Thus