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The article begins by giving examples to shew that the mental picture even of general paralysis may be changed by psychical means. The theme of this paper is that even during the paralytic process the inner life history of the individual can be understood by psychological methods. The somatic influence may cause the personality to react with a mental symptom to the injury to its integrity. The organic illness cannot be the explanation of the mental changes and there still remains the obligation to explain psychic symptoms by psychic facts. For example, it is known that a drunken person may become suddenly sober under emotional stress although the somatic condition is not altered.
The author differs from Schilder in that he believes that psychic causality is not the same as physical causality. This also brings up the questionable difference between cause and motive, since a motive has a quality of subjective meaning. The law of causality is evident only in the physical world. In the psychological world we do not deal with unchanging facts: e.g. a person is called 'normal' if well adjusted to reality, but this is an ever-changing relation.
If there is a psychic reaction of the personality to the so-called influence of the organic sphere, we can explain juvenile general paralysis in psychoanalytic terms. In this disease there is the opportunity to study the race between the paretic process and the development of the juvenile personality. Dementia occupies a prominent position and is accompanied by a change in the child's behaviour. The child loses initiative and self-confidence and turns to younger playmates. The change is accompanied by a preconscious foreboding of severe illness. There is often a short severe depression with desperation and anxiety. This early warning is often felt during the Oedipus situation and is accepted as punishment for masturbation. At the beginning of mental change depression increases and is related to withdrawal of the parents