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This is a paper based on studies at the Dermatological Department of Bellevue Hospital and New York University. The purpose of the studies was to establish the importance of emotional factors in the etiology of various dermatoses.
Analysis of representative cases of various entities was chosen as the main method. Among entities in which emotional factors might prove predominant, the entity under discussion invited close investigation because of its many peculiarities. It affects only men, starts in the mid-thirties, nearly always has its first lesion on the penis. Its main symptom is a maddening itch, and it is considered incurable.
The pertinent material of the analysis of two such patients is given. In both cases the somatic symptoms were precipitated by an acute traumatic situation. It was seemingly trivial in the first case but it created, due to its affinity to the main underlying conflict, an insoluble 'obsessional delirium'. The traumatic scene was colorful and dramatic in the second case. It reproduced in surprising detail the patient's life conflict. The somatic symptoms were in both cases fitting symbolic representations of neurotic conflicts. the faculty for somatic symbolism was the most striking feature of the two analyzed cases and of three other cases investigated with narcoanalysis and extensive interviews.
The choice of the organ could for both cases be at least hypothetically explained by the infantile material.
No specificity of the 'personality' or the type of neurosis could be found, yet they had in common the presence of compulsive features and a deep-seated, primitive anxiety. One patient, who could be classified as a hysterical personality, was permanently cured (probably the first case of a severe 'incurable' dermatitis cured by analysis). The second case presented a mixture of perversion, phobias, conversion symptoms, and most severe obsessional symptoms, with definite psychotic features. His skin was nearly cured.