The Psycho-Analytic Treatment of Ulcerative Colitis

The disease medically known as non-specific idiopathic ulcerative colitis hardly appears to be a classical subject for psycho-analytic investigation or treatment, and it is not surprising that psycho-analytic interest in it is relatively recent (1), (8), (5). The disease, still clinically puzzling to internists, is characterized by bloody diarrhoea and abdominal spasms, follows a chronic or acute course often with high fever, and is sometimes fatal. At first glance, this description seems to preclude considering ulcerative colitis as a psychiatric disorder. It has, however, certain features, particularly the onset and the spontaneous exacerbations and remissions, that are definitely related to certain significant life situations. This relationship attracted psychiatric attention some twenty-five years ago (4), (11), (12).

The life situations that precede the onset of ulcerative colitis seem to resemble those that precede another baffling disorder—the group of schizophrenias. There appears to be a similarity in the circumstances under which the break with reality occurs in schizophrenia and the somatic break occurs in ulcerative colitis. Many important questions are suggested by this similarity. Why does one person react with a psychotic break and another with a somatic break? Why is the somatic break specifically ulcerative colitis? What precipitating factors in the onset of schizophrenia and ulcerative colitis are of determining importance? Is there a similarity in the personality structure of patients with these two disorders, and consequently a similarity in the dynamics of their reactions to traumatic experiences? If so, other questions arise. What is the significant factor—specific experiences or constitutional and hereditary conditions?

Because projective tests of patients with ulcerative colitis almost invariably point to a latent psychosis, there is a resistance to—one might say, a fear of—utilizing psycho-analytic techniques in such ca