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From the experiences which the author derived from the study of the different cases of chronic diseases, including skin, lungs, kidney, bone and joint diseases, thyroid and spinal cord involvement, and eye disorders, he attempts to show how the life and death instinct and the conflict between them may become attached to an organ and may be carried on there, resulting in a partial or complete destruction of that organ.
The death instinct operates, in such cases, as an unconscious castration wish. It carries out the death instincts by inhibiting or completely checking the function of that organ.
Jelliffe combines his theoretical consideration with Freud's conclusion of the concept of life and death instincts after reviewing them in a lucid manner.
In one part of his study he discusses mental diseases which recovered following acute somatic diseases, such as typhoid fever, influenza, accidents and severe operations. In the author's opinion in such cases the improvements were the result of the carrying out of the castration threat on an organ or body which 'has been made the specific medium for sadistic encystment of primary narcissistic libido. …'
He cites a case of depression where he feels that should a gall bladder operation have been performed the patient would have been saved from a depression because a very strong death instinct of the patient would have been discharged through that channel.