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It is difficult to know for whom this book is primarily intended. The author, a recognized authority in this field, may be endeavouring to convince organically-minded doctors that the aetiology of peptic ulcer cannot be dealt with unless due weight is given to deep-seated unconscious emotional factors stemming from the earliest phases of life and expressing themselves as a reaction to contemporary stresses. The end result of those stresses acting upon a susceptible individual is that psycho-somatic syndrome known as peptic ulcer.
The wealth of references to other work in the field of peptic ulcer, together with numerous asides and pieces of anecdotal material, suggest that the author's intention is to convince the organically minded that emotional factors and unconscious ones at that are the main aetiological determinants of peptic ulcer. On the other hand he swings a long way into the deeper psychopathology of peptic ulcer to carry with him such an unconverted public, and these parts of the book would be more acceptable to and more easily understood by people who, if not psycho-analysts, are at least familiar with psycho-analytic concepts. Even here, however, there are difficulties. The situation suitable for the subsequent development of peptic ulcer is expressed somewhat as follows. There is a regression from a frustrating genital situation to an oral-digestive fixation point, which causes the internally directed aggression to attack the gastric mucosa, and the biting of the inside represents an attack by the bad aspect of the internalized mother-figure. There is also a view which regards the denial of a great dependency need, with consequent frustration as a state which results in the ulcer syndrome. The peptic ulcer patient, genitally speaking, seems to be a boy trying to do a man's job. Thus any set-back, quite often due to the marriage partner, cannot be tolerated or overcome, but rather causes the unconscious pattern of behaviour enunciated above and