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The fundamentals of the psychogenesis of depressive states were first described by Freud; with the elaborations upon them by the detailed studies of Abraham and Rado, among others, they have made possible our present valid insight into the condition of melancholia. To carry ad absurdum the theoretical speculations, as is done with so many analytical problems, is not the aim of this paper, which will, instead, stress certain points about the dynamics of depression. Probably because of the insufficiency of adequate clinical material these points have in the past been somewhat overlooked. In addition this paper will attempt to indicate certain important features of the technical approach, which is an extremely difficult one.
Abraham was the first to point out that in manic-depressive states the patient regresses to a fixation point at the oral stage of his libidinal development, and that this fixation point is closely connected with the stage to which the obsessional neurotic regresses, namely, the anal stage. It follows from this formulation, that both points of fixation—oral and anal—are prominent and of the greatest importance in such states. And the more nearly contemporaneous the oral is with the anal, the better the chances for readjustment and analytical treatment; the more remote, the more difficult the treatment and the more dubious the outcome.
We may take it for granted that patients who come for the treatment of depression usually have had several similar phases before; but it is of cardinal importance to stress the fact that the