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My second case would probably not have been classified as persecutory paranoia, apart from analysis; but I had to recognize the young man as a candidate for a terminal illness of that kind. In his attitude to his father there existed an ambivalence which in its range was quite extraordinary. On the one hand, he was the most pronounced rebel imaginable, and had developed manifestly in every direction in opposition to his father’s wishes and ideals; on the other hand, at a deeper level he was still the most submissive of sons, who after his father’s death denied himself all enjoyment of women out of a tender sense of guilt. His actual relations with men were clearly dominated by suspiciousness; his keen intellect easily rationalized this attitude; and he knew how to bring it about that both friends and acquaintances deceived and exploited him. The new thing I learned from studying him was that classical persecutory ideas may be present without finding belief or acceptance. They flashed up occasionally during the analysis, but he regarded them as unimportant and invariably scoffed at them. This may occur in many cases of paranoia; it may be that the delusions which we regard as new formations when the disease breaks out have already long been in existence.

It seems to me that we have here an important discovery - namely, that the qualitative factor, the presence of certain neurotic formations, has less practical significance than the quantitative factor, the degree of attention or, more correctly, the amount of cathexis that these structures are able to attract to themselves. Our consideration of the first case, the jealous paranoia, led to a similar estimate of the importance of the quantitative factor, by showing that there also the abnormality essentially consisted in the hypercathexis of the interpretations of someone else’s unconscious. We have long known of an analogous fact in the analysis of hysteria. The pathogenic phantasies, derivatives of repressed instinctual impulses, are for a long time tolerated alongside the normal life of the mind, and have no pathogenic effect until by a revolution in the libidinal economy they receive a hypercathexis; not till then does the conflict which leads to the formation of symptoms break out. Thus as our knowledge grows we are increasingly impelled to bring the economic point of view into the foreground. I should also like to throw out the question whether this quantitative factor that I am now dwelling on does not suffice to cover the phenomena which Bleuler and others have lately proposed to name switching’. One need only assume that an increase in resistance in the course taken by the psychical current in one direction results in a hypercathexis of another path and thus causes the flow to be switched into that path.