Notes on a Case of Ulcerative Colitis1

Although it has now been accepted by most analysts and many psychiatrists that ulcerative colitis is largely if not wholly psychogenically determined, the mechanism of conversion of psychological conflicts and anxieties into physical symptoms still remains to some extent obscure. Sperling believes that the disease is characterized by a double attitude in which libidinal ties to the mother or her substitute are over-emphasized, whilst the symptom expresses devaluation of and separation from her. In other words there is a split between the idealized and persecutory relationship to the mother, the latter being expressed in the physical symptom. She states that the fantasies, anxieties, and perverse needs of the mother transmit themselves to the patient, stimulating and reinforcing the latter's own fantasies and anxieties.

In discussion or papers relating to these cases, it is significant that the subject of schizophrenia invariably comes to be mentioned. Sperling herself tries to differentiate between the colitis case and the schizophrenic, and believes that whereas in the latter the patient's mother is rejecting, in the former she tends to be over-solicitous and to have a vested interest in keeping the patient ill. Although she says that analysis should not be avoided because of the fear of precipitating a latent psychosis, one case she described ended his analysis with what appeared to have been delusional ideas about the shape of his nose. (It will be remembered that the Wolf Man, who also had bowel symptoms described as dysentery by Brunswick, had intense hypochondriacal ideas about his nose.) Although the overt personalities of six cases studied by me but not fully treated were all markedly different, ranging from schizoid-obsessional and paranoid to anxious and hysterical in type, two cases analysed did show an underlying psychotic part of the personality. In the case to be described in this paper, this resulted in a clinical psychosis with confusional, ha