In psychosis the mother has rejected her child outright, while in psychosomatic illness the mother has rejected the child when it is healthy but encouraged its illness and rewarded it with love and attention when it has been ill. Illness has not brought such rewards to those children who later become psychotic, therefore they do not repress their destructive or pregenital libidinal drives. In children with psychosomatic illness these destructive drives are expressed in the physical symptoms. When a psychosomatic disturbance supersedes a psychotic state, or vice versa, one may assume a real or fantasied change in the relationship of mother and child. Analysis can reveal these dynamics, and it can free the libido from its fixations to the mother so that it may move on to genitality.