Symposium on Disturbances of the Digestive Tract—V. Psychosomatic Disorders, Psychosis, and Therapeutic Accessibility1

In this presentation four intertwining problems will be discussed, based on six peptic ulcer patients: (i) the specific dynamics of psychosomatic disorders; (ii) their relationship to psychosis; (iii) their psychophysiology; and (iv) the problem of therapeutic accessibility.

Both the specific psychodynamics of and the relationship between psychosomatic disorders and psychosis can often be constructed on the basis of dominant behaviour patterns and dreams. In other instances they are constructed on the basis of current reactions or memories, both emerging in the course of psycho-analytic treatment. A brief example of the latter kind will be given here. A 35-year-old physician did an excellent job as Second-in-Command of a military hospital. The old Commander was then replaced by a high-handed martinet, who cancelled most of my patient's orders, and caused confusion and uncertainty in the hospital. My patient was caught in the double conflict of letting down the whole staff by not standing up against the Commander and thus incurring their disapproval, or standing up against the Commander and risking his whole military position. In this dilemma he developed a peptic ulcer on the posterior wall of the duodenum. There was no flavour of psychosis in his emotional reaction at this point.

As a result of considerable analytic work, two dominant memories emerged from his childhood. One was seeing his sister two years younger being nursed by his mother, with the patient tugging at her skirt. The second, dating from the age of 5, was that a pet duck loved by the little boy and his sister was served up for dinner by the mother as a surprise. When the children found this out neither of them could eat. The first of these memories clearly indicates oral rejection and frustration of dependence needs; the second, danger of being devoured by hostile forces.

As regards psychotic reactions, in the course of the analysis transference reactions were so much in the foreground that