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This paper is a study of the neurotic interreactions of individuals who are in frequent and intimate contact, and an attempt to evaluate the therapeutic necessity of analyzing these reactions in the course of psychoanalytic treatment. Such reactions fall into the following groups: 1. Partnerships in which mutual needs are satisfied although the unconscious strivings are essentially neurotic. Even under these circumstances minor conflicts lead to distress, but the main result is that of gratification and security. 2. Those in which the needs of one individual are satisfied and his anxiety kept at a minimum by the behavior of the other who, in turn, is satisfied only in part while many of his cravings remain unsatisfied and his anxiety is aroused. Thus one individual appears well, whereas the other is manifestly sick. 3. Others in which one individual is motivated by marked anxiety and the other evaluates this fear in terms of his own inner conflicts and reacts to it in a manner which immediately or potentially increases the anxiety of the first person.
Mutually supportive attitudes are always present in the relationship even when the anxiety arousing reactions dominate the picture. In folie à deux both reaction patterns are intense, in fact the two individuals are forced on each other's exclusive support by their feelings of helplessness and mutual guilt. Identification and projection dominate the resulting picture and the overt symptoms are then directed towards the rest of the world instead of towards each other.
Relationships of the types described may occur between parents and children, between business partners, employer and