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The increased interest in psychosomatic medicine led Dr. Menninger to caution against direct cause and effect relationships in studying disease. Citing the influenza epidemics of 1918 and 1938, he points to the background of anxiety engendered by the world situation which may have contributed to the outbreak of physical illness. The very symptoms of influenza are suggestive of a suicidal fantasy—acuteness of onset, prostration, mental exhaustion, discouragement, and alarm, often followed by prompt recovery and then a long period of depression. Self-destruction and disease entities are always both psychological and physical. Freud's construct of the death instinct was one of his greatest contributions. The concept cannot be measured, quantified, or proved. Yet its operation can be observed in such clinical entities as suicide (an expression of the power of man's unconscious wish to die) and psychosomatic illness (an expression of partial suicide effected by the organs). The spectrum of self-destructiveness ranges from suicide (the most complete and irreversible form) through organic disease and hysterical disease, to such widespread and nearly normal activities as smoking. The sacrifice of an organ may be made to spare the life of the individual, and the hysterical symptom may develop to spare the life of the organ. Much of the objection to Freud's death instinct theory may be the result of repression of the observer's own self-destructive tendencies.