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The facts before us seem to be as follows:
(A)There are striking connections between melancholia and [sexual] anaesthesia. This is borne out (1) by the finding that with many melancholics there has been a long previous history of anaesthesia, (2) by the discovery that everything that provokes anaesthesia encourages the generation of melancholia, (3) by the existence of a type of women, very demanding psychically, in whom longing easily changes over into melancholia and who are anaesthetic.
(B)Melancholia is generated as an intensification of neurasthenia through masturbation.
(C)Melancholia appears in typical combination with severe anxiety.
(D)The type and extreme form3 of melancholia seems to be the periodic or cyclical hereditary form.
In order to make anything of this material, we need some fixed points of departure. These seem to be provided by the following considerations:
The affect corresponding to melancholia is that of mourning-that is, longing for something lost. Thus in melancholia it must be a question of a loss-a loss in instinctual life.
The nutritional neurosis parallel to melancholia is anorexia. The famous anorexia nervosa of young girls seems to me (on careful observation) to be a melancholia where sexuality is undeveloped. The patient asserted that she had not eaten, simply because she had no appetite, and for no other reason. Loss of appetite-in sexual terms, loss of libido.