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I have used the case of the leg ulcers in an attempt to demonstrate that the early established psychosomatic relationship with the mother was the mainspring for this patient's illnesses, somatic and mental. As a result of this relationship a special mechanism in dealing with the destructive impulses had been adopted by the patient early in life. This mechanism was referred to in the paper as repression of destructive
impulses, yet it would seem to be more closely related to the mechanism of denial. In denial it would seem that the denied impulses are split off from and barred access to the ego. This means that they cannot undergo the modifications which the derivatives of the repressed impulses undergo in neurotic symptom formations. It would seem that only in this way can the ego of such a patient develop and maintain itself in what would appear to be a reality-adjusted manner (non-psychotic).