This highly condensed paper, which won the 1958 Clinic Essay Prize of the London Institute of Psychoanalysis, reports the first two years of the analysis of a twenty-six-year-old pilot who came to treatment with symptoms of blushing, discomfort in walking when observed, and sexual difficulties. The patient had been subjected to an unusual amount of sexual excitement as a child by a very seductive mother and by his grandfather, a doctor who supposedly had affairs with his patients. Sandler's emphasis is on the patient's defenses against strong sexual feelings. He fantasied his body to be a phallus as a defense against getting erections; he also dissociated his phallus from his body as a defense against erections and sexual excitement. Sexual excitement was also defended against by inhibition of affect, by the wish for castration, and by fantasies of being castrated.