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DISCUSSION: Dr. Renato Almansi commented on the rich clinical details reported, especially the profusion of oral and anal conflictual material. He recalled that Max Schur felt that aggression, primary process thinking, and unneutralized energy must all be present in psychosomatic illness, and that Dr. Karol's patient displayed them all. The primal scene experience obviously served to revitalize the
early fantasies of sadism and the patient's intense separation anxiety.
Dr. Ira Mintz mentioned Melitta Sperling's findings of the alternation of phobia, psychosomatic illness, and aggressive impulsivity at various times in the same patient. He emphasized that sexual conflict, aggression, and separation anxiety appear in all psychosomatic patients.
Dr. Henry Schneer described a female patient whom he treated for stuttering. She had asthma from age eight to thirteen which terminated abruptly when she first viewed the primal scene. The difference between this girl and Dr. Karol's patient was age and level of psychosexual development; for Dr. Schneer's patient, the primal scene was a trauma that spurred growth.
Dr. Jan Frank pointed out that we all have experienced primal scene trauma, in reality or in fantasy, and emphasized the importance of consideration of the level of ego development at the time of the trauma. Dr. Anita Bell spoke of the pregenital aspects of the trauma in one of her asthmatic patients; she had difficulty in developing the ability to master her own body from earliest infancy. The child was unable to master and to achieve a sense of independence and individuality. Dr. C. Philip Wilson emphasized the importance of dealing with sadomasochism in asthmatics. In such patients sadomasochistic oral and anal phase conflicts and fantasies predominate.