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A detailed psychoanalytic study of a case of neurodermatitis corroborates many of the findings in the literature. The specific way in which the repressed aggression toward father figures was handled by this patient was by attacking himself through the skin and exhibiting an unconscious passive feminine attitude. The regressive fantasies underlying the feminine attitude were an expression of early infantile sadistic attitudes toward female figures and an identification with them in an attempt to deal with the problem of aggression toward male members of the family.
Fear and rage at the frustration of competitive attitudes had been repressed since childhood, but these emotions were expressed in the skin eruptions which occurred at times when aggression toward stronger men was inhibited.
Scratching tended to become a reflex method of expressing rage and frustration, and its control by the patient was therapeutically important. Scratching during sleep stopped when the aggression connected with it could be expressed in the analysis. An allergic state was present, but not specific, and seemed to change with the emotional state.
Miller's present patient differs from both of his previously published cases in the severity of the repression which allowed the entire vicious cycle of aggression, masochism, and feminine identification to mount into a frustrating chain of reactions. In addition the present case seems to throw more light on how the skin became the organ of choice for the expression of this particular character neurosis. In this patient there was greater integrative capacity of the ego.