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4A
Zurich
9 August 1907
Dear Professor Freud,
Today, once again, I have to ask for your understanding for not having replied to your letter any sooner. As both my superiors, Bleuler and Jung,1 were away at the same time, I have had no opportunity for anything but hospital duties during the last fortnight. I was very glad indeed to hear that you identify with the views I expressed in the last letter. However, I would add some comments regarding the two main points of your last letter.
The communication of phantasies, delusional ideas, etc., happens without resistance in certain phases of dementia præcox. Right at this moment I am treating a lady who reels off her most intimate affairs, including her religious delusion of grandeur, as an outsider would speak of some commonly known incident. Many mental patients behave like this in a particular phase. At other times, however, it is impossible to elicit even a single word about these matters. On yet other occasions, one easily obtains information about the delusional constructions, but not the least about the “voices”. This alternating behaviour is not clear to me. I would be ready to admit that the revelation of the most intimate secrets is a sign of the onset of dementia, if the concept of dementia had been clarified; so far, however, this is not the case. I believe what in cases of chronic mental illness is called dementia is nothing but the patient shutting himself away from the world, the withdrawal of libido from persons and objects. In organic psychoses and in epilepsy, one also speaks of dementia. This is unfortunate, since we are dealing with two completely different things. The epileptic becomes demented in a completely different way: in his case the mental impoverishment is progressive. Yet he retains the capacity to react emotionally, which is lost in the patient suffering from dementia præcox. In spite of all the dementia, even in deepest imbecility, the epileptic shows definite object-love. He is full of exagge