The favorable results of electroshock therapy result from discharge of destructive energies, pent up on a very primitive level. Only disorders in which such a dynamic need exists are benefited by this treatment. The improvement in psychotics depends on a change in the dynamic relationship between the erotic and the destructive (death) instincts, in favor of the former. The term 'primary constellation' refers to the quantitative relationship between these two instincts. The main problem in the treatment of psychotics is that the transference reaction is predominantly aggressive. This explains why manic-depressive psychosis reacts so favorably to shock: depression is the condition, par excellence, in which