Superego influences have been little considered in the current literature on psychosomatic illnesses; an archaic and sadistic superego, however, is often a dominating force in the maintenance of these painful bodily states. This dynamic is illustrated in the analysis of a dissociated and concrete patient, whose primary modes of defense, self-reparation, and object-relationship were at first erotized bodily pain and illness. Analysis of an intense, highly conflicted transference facilitated the gradual emergence of this patient's capacity to make use of a metaphorical interpretive process. Severe narcissistic injuries were integrated, allowing the evolution of a mourning process. This fostered individuation of the self, establishment of a differentiated body image, an integrated superego, consolidated object relations, and a more mature ego ideal.