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DEAR DOCTOR ESMAN,
I'm writing to add a few comments in reply to your letter about our article on enuresis:
I agree with you that there are, very likely, significant differences between primary and secondary enuresis. In fact, I'd go even further. I'd venture the prediction that when and if the full truth is known, 'enuresis' will turn out to describe merely a common symptomatic element among a spectrum of disorders with multiple important differences among them in regard to etiology and pathogenesis. I would expect one form or another constitutional disposition to be present in all—in some, so strong that enuresis is inevitable, and in others such that enuresis develops only under the stress of particular experimental factors. Obviously, cases of primary enuresis probably most often fall at the former, and secondary enuresis at the latter end of the spectrum.
I believe that we can allow for this view of enuresis without contradicting our proposition that a split in the ego plays a causative role in all forms of enuresis, primary or secondary. If you bear with me through a clarification of our hypotheses and use of terms, I think I can explain.
We use Freud's term, 'split in the ego', to denote the psychological consequences that occur when an archaic mode of thinking is preserved. Since 'ego' is a theoretical term, 'split in the ego' is too; but it is close to observation, and summarizes