Letter 551 from Extracts from the Fliess Papers

… I am sending you, red-hot, two ideas which occurred to me today and which seem to me to be viable. They are based, of course, on analytic findings.

(1) What determines a psychosis (that is to say, amentia or a confusional psychosis-a psychosis of overwhelming, as I called it before2) instead of a neurosis seems to be that sexual abuse should occur before the end of the first intellectual stage-i.e. before the psychical apparatus has been completed in its first form (before 15 to 18 months).3 It is possible that the abuse may date back so far that these experiences may lie concealed behind the later ones, and that they may be recurred to from time to time. Epilepsy, I believe, goes back to the same period.… I shall have to deal differently with tic convulsif, which I used to assign to the same stage. This is how I arrived at this. One of my male hysterical patients … sent his eldest sister into a hysterical psychosis which ended in a state of complete confusion. I have now traced his own seducer, a man of genius who, however, had attacks of the severest dipsomania from his fiftieth year onwards. These attacks regularly started either with diarrhoea or with catarrh and hoarseness (the oral sexual system!)-that is, with the reproduction of his own passive experiences. Now, until he fell ill himself, the man had been a pervert and consequently healthy.4 The dipsomania arose through the strengthening-or rather through the substitution of the one impulse for the associated sexual one. (The same is probably true of the gambling mania of old F.)5 Now scenes took place between this seducer and my patient, at some of which his little sister, who was less than a year old, was present. My patient had relations with her later on and she became psychotic at puberty. You may gather from this how a neurosis increases to a psychosis in the next generation (this is what people call ‘degeneracy’) simply because someone of a more tender age is drawn in. Here, by the way, is the heredi