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The supreme need in psychiatry is the co-ordination of biological and psychological views—a synergic ætiology. In no field of medicine is there a greater conflict between the respective demands of scientific explanation and therapeutic aims. The appeal of pure causality leads many to prefer a false causality to a vague and complex conditionalism. It is a paradox that the most subjective of therapeutic techniques, i.e. psycho-analysis, should be based on a theory claiming complete objective validity. At the same time, in the illusory pursuit of scientific validity, the Freudian school renounces multiple ætiology, which involves not only the synergy of organic and psychic, but also the synergy of resultant and purposive factors. Thus, in his attempt to explain the phenomena of migraine in Chapter III of The Psychopathology of Everyday Life, Freud seeks to preserve the integrity of the psychic sequence apart from the conditioning organic sequence, which he nevertheless recognizes. Similarly Ernest Jones seeks, in his classic work, to explain the nightmare categorically as 'an expression of a mental conflict over an incestuous desire', although he apparently recognizes the possible influence of conditioning organic stimuli. By contrast, the author's own clinical experience leads him to regard the nightmare as essentially the result of somatic disturbance, whilst recognizing its content as the expression of affective and conative psychical patterns. He considers that a similar synergy of resultant and teleological factors must be recognized in the ætiology of all psycho-pathological conditions.