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DISCUSSION: Dr. Abram Blau noted that hair pulling and hair eating are symptoms which are probably not as uncommon as is generally thought. He wondered whether the good therapeutic result in Dr. Sperling's case was due primarily
to the direct analysis of the symptoms or whether much of the improvement was due to the constructive development of the ego and personality arising from a good anaclitic relation with the analyst and release from primitive infantile ideas and fixations.
Dr. Lawrence Deutsch discussed the need to find parallels between patients suffering from psychosomatic illnesses and those suffering from other psychological illnesses. He felt that one of the valuable aspects of Dr. Sperling's paper was that by stressing the dynamic structure of psychosomatic symptoms, she encouraged analysts not only to treat such patients but also not to ignore specific psychosomatic symptoms that arise during the analysis of neurotic or characterological conditions. Dr. Deutsch also discussed the psychic structure underlying the somatic syndrome, which he feels to be that of phobia in many of these patients.
Dr. Max Schur questioned the specificity of psychoanalysis as the curative factor in the case presented, but added that there was no further need for defense of analysis as a treatment for psychosomatic disorders since it has been used for years. He agreed that Dr. Sperling's patient resembled the conversion hysteria cases treated by Freud; for instance, Emma experienced vomiting, epistaxis, etc. In commenting on Dr. Sperling's remarks about a connection between hair pulling and addiction, such as alcoholism, Dr. Schur recalled a letter from Freud to Fliess (1897), in which Freud stated that masturbation is the primary addiction and that all other addictions, including the tobacco addiction, fall into the same category.