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7 February 1923
Vienna IX, Berggasse 19
133F
Prof. Dr. Freud
Dear Dr. Binswanger,
Before I reply to your kind letter of the day before yesterday, I would like to dispose of a professional matter, which is one of the reasons for my writing.
I am currently treating a very distinguished American, N. To. from S. Francisco, a retired businessman with slight sexual inhibitions. The man we are sending to you is his older brother, whom I know only from his brother's reports and from the cousin who is looking after him. He is said to be a confirmed homosexual, obstinate, intractable and to suffer from the gravest guilt feelings after every sexual encounter. The enclosed letter from Dr. Deutsch1 will show you to what extent his organic complaints are mere excuses or are being used as such.
Since he is unmistakably sinking ever deeper into hypochondria, dissipation and a compulsion for tormenting those relatives who are at his mercy, I have suggested separating him from his cousin, a selfless, simple and kindly lady, and handing him over to you for care and psychic guidance. The intention is not, of course, to try to redress his perversions - that would be hopeless - but to find some way of reconciling him with life on a homosexual basis and hence to find a possible modus vivendi for him. Since he is very rich even by American standards, you have a free hand to do everything you can for him. Above all, keep a firm hold on him, since otherwise his guilt feelings and sadism will lead him to a bad end.
The good news about your family - good except for that about your stepmother - gave me much pleasure. Unfortunately I can see few prospects of visiting you again in the near future since a consultation trip to Bellevue would not easily make up for what would be lost here. So don't count on it too much.
Your book2 has impressed me greatly - but has, admittedly, also been a disappointment for it is not what you have repeatedly led me to expect in correspondence. I anticipated that you would b