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The organ involved in an organ neurosis was first affected in childhood in connection with an instinctual conflict. Out of the psychic conflict and the function of the organ a 'psychosomatic unit' is created so that, if later the instincts in question become mobilized, the organ and the function thereof are
automatically mobilized too. This is demonstrated in examples relating to the respiratory and the circulatory systems. The earlier the 'psychosomatic unit' is created, the more rigid are the organ symptoms. Deutsch calls attention to the fact that the fixation of organ symptoms also depends on the attitude of the child's environment, so that three factors should be considered. 'If then the three factors coincide, the extrinsic organic factor, the personality organization at the time, and the action of the neurosis of the environment, the direction in which the choice of organ tends is definitely laid down.' The development of the symptoms depends on the interrelationship of these three factors so that, if all three factors are known, the course can be prophesied. Not very clear are the author's discussions about the relations between the organ neurotic symptom and the conversion symptom, which not only is the consequence of unconscious instinctual attitudes of the patient, but has a 'meaning' and expresses in a somatic form certain psychic ideas. Deutsch writes: 'We are inclined to believe that the difference between these two types is one of the degree of elasticity or rigidity with which the organic symptoms are bound to the neurosis'. Highly important ideas pertaining to this question were expressed by Freud in his early paper, Psychogenic Visual Disturbances According to Psychoanalytical Conceptions, which are too little heeded by authors who undertake to discuss these questions.