Comment on Dr Musaph's Paper1

Musaph has given us an interesting survey of a series of aspects relevant to psychoanalytic therapy and research into itching states. He referred to connexions with ethological findings, but here I would hesitate to follow him as analogies of animal and human behaviour must not be unduly stretched. The human psychic apparatus with its various object-relations and intrasystemic interactions is much too complicated for that.

It is always a predicament, I feel, when we psychoanalysts are asked to give an interpretation of symptoms appearing in so many different connexions. In our clinical work we meet the symptom of itching in a great number of internal, dermatological and psychiatric diseases. In everyday life itching is elicited by a host of more or less harmless irritants, e.g. sunburn, bug bites, mild and severe dermatoses; it is also present in hepatitis, leukemia and diabetes on the somatic side, and in slight psychic irritation, conversion symptomatology, up to severe hallucinatory states on the psychological side.

We cannot therefore ascribe one single psychological meaning to all occurrences of itching. Physiologically interested psychoanalysts have pointed out that the organism as a whole and its different organs have at their disposal only a restricted selection of responses to injuries of extremely varied genesis; the picture in the common somatic end-phases is not so very different. In order to make profitable use of Musaph's findings, we have to examine how to integrate them into our psychosomatic concepts and a good basis for that may be found in the correlations he observed between itching and the different phases of development of the instinctual drives.

Every analyst undertaking the treatment of skin patients will agree with the observations made by Musaph and other experts. We are confronted with frustrations, repression of libidinal and aggressive impulses on the different levels of instinctual development, with sadomasochistic autoplastic react