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The facts on hand seem to be as follows:
There are striking connections between melancholia and [sexual] anesthesia. This is borne out (1) by the finding that in so many melancholics there has been a long previous history of anesthesia, (2) by the observation that everything that provokes anesthesia encourages the development of melancholia, (3) by the existence of a type of woman, very needy psychically, in whom longing easily changes into melancholia and who is anesthetic.
Melancholia develops as an intensification of neurasthenia through masturbation.
Melancholia occurs typically in combination with severe anxiety.
The typical and extreme form of melancholia seems to be the periodic or cyclic hereditary form.
In order to make anything of this material, one needs some secure 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 — that is, a loss in instinctual life.
The neurosis concerned with eating, 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.
It would not be so bad, therefore, to start from the idea: melancholia consists in mourning over the loss of libido.
It remains to be seen whether this formula explains the occurrence and characteristics of melancholia. This will be discussed on the basis of the schematic diagram of sexuality.