An obsessive and phobic woman of forty-two with disabling anxieties and profound masochism, seriously disturbed for at least twenty years, was freed of her anxieties and many of her other symptoms by topectomy and was studied at intervals for five years after the operation. She remained somewhat rigid and dependent, with a mild inclination to act out. Topectomy reduces the inhibition of constructive activity; it causes emotions and content of thought to become more closely related to real problems than to neurotic fears. Nevertheless, psychic complexes noted before operation were still present. The conflicts had not been altered qualitatively nor had genuine insight been gained. The major benefits apparently rested on preventing the integrative capacity of the ego from being disorganized by anxiety.