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THREE YEARS AGO, DURING the spring, a 48 year old female was admitted to our hospital.1 She had been referred by the Department of Dermatology, Hadassah Hospital, Tel-Aviv, where she had received four months of medical treatment, without improvement.
Her dermatological diagnosis was neurodermatitis. A psychiatric consultant diagnosed the etiology of her illness as psychological, not organic and referred her to our institution for psychiatric treatment.
ON ADMISSION. The patient looked much older than her actual age. She was undernourished and neglected in outward appearance. Her clothes were covered with blood and pus. She spoke continuously and very aggressively, jumping from subject to subject and being unable to sit in one place. During the entire intake interview she scratched her legs which were covered with open, infected sores, caused by the incessant scratching by her long dirty fingernails. She was incapable of concentrating and shouted repeatedly, "My head is burning." From time to time she trembled as if she had rigours. She cried and knocked her head against the wall, shouting, "Cure me, cure me, " and "If you don't succeed in curing me, give me poison so that I can die." To emphasize her words, she opened her bag several times and took out various jars of medicine claiming that she had received all possible treatments, and that there was nothing left for her but death. She looked around her with an expression of disbelief in the possibility of ever being cured. Her mood was tinged with depression.
PHYSICAL EXAMINATION. The patient's entire body, particularly