The patient was a medical student who suffered from this syndrome most acutely when he had to read medical books. His migraine, nausea, and vomiting 'in his psychic life represented depressive states which alternated with paranoid anxieties (such as fear of being persecuted by the police or fear of being attacked while in the streets, and panic reactions). His obsessive mechanisms had failed because of the intensity of his anxieties.' He had severe anxiety about masturbation, which was accompanied by a feeling that he was destroying himself at the moment of seminal discharge. In one of his episodes of impotence his desperation was such that he banged his head against the wall. 'He equated a damaged finger with his circumcised penis' and finally understood why he at times felt