This is a brief description of a case of serious automutilation, which led to more than 10 years of hospitalization. Af ter a survey of the case history as a whole, a number of suppositions are formulated more or less explicitly. The preoedipal fixation, the weakness of the ego and the disturbed contact with reality are considered as dominating aspects. L.S.D. sessions brought forward material, which proved relevant to the subsequent analysis of the patient's Dasein. Yap presumes that the psychotherapy, preceding the leucotomy, was aimed at a level of personality development, which had actually not been reached by the patient, implying that the failure of the treatment was partly due to this. As to the leucotomy Yap suggests that it decreased the inhibition. However, De Wit thinks that the patient was made more vulnerable; both suppose that a greater openness to therapy resulted from it. One could also suppose that pathogenic circuits were severed by the leucotomy, so that new possibilities of experience came into being, which presented themselves to the therapist as openness to the treatment. Psychotherapeutically a symbolic realization (M. A. Sechehaye) was used in a modified form, after a preliminary period of autogenic training (Schultz) and followed by an eclectic reeducative and reconstructive form of psychotherapy. The patient's improvement has been shown objectively by a series of psychological tests and described subjectively in her autobiography.