The Psychoanalytic Treatment of Ulcerative Colitis Revisited

The attempt to understand ulcerative colitis by the application of psychoanalytic study has not been one of the brighter chapters in the history of psychoanalysis. There is a long history of psychodynamic observations on ulcerative colitis, and recent literature has contributed little more on the topic. Many of the studies are poorly designed and unconvincing, as others (North et al., 1990) have claimed, and there is no final agreement on the role, if any, of psychological factors in this disease. In this paper I will review some of the earlier reports more or less in chronological order to illustrate the shifts and changes in psychoanalytic thinking about the disorder and consider why this thinking has changed. I will then present a current unusual psychoanalytic case spanning many years of observations on a patient with ulcerative colitis. I have treated a number of patients with this disorder in psychoanalysis and psychotherapy and wish to share with the reader a perspective on what has developed in the last few decades in this area, not just out of interest in the history of medicine, but because I feel such treatment has much to offer patients with ulcerative colitis.

As early as the work of Murray (1930) it was noticed that there seemed to be striking psychopathological features in patients with ulcerative colitis. He investigated 12 patients who were suffering from bloody diarrhea or ulcerative colitis or both and noted “a close association in time between the emergence of a difficult psychologic situation and the onset of the symptoms” (p. 248). Alexander (1950), also citing references preliminary to the investigation he pioneered at the Chicago Institute for Psychoanalysis, brought the notion of the “specificity hypothesis” to its highest point in development by psychoanalytic investigators. For Alexander “the first symptom of ulcerative colitis frequently appears when the patient is facing a life situation