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The importance of psychogenic factors in ulcerative colitis has been emphasized in recent years by several investigators. Cecil D. Murray first demonstrated that there exists a definite relationship between emotional disturbance and the onset of bloody diarrhoea; also he expressed the opinion that this disease tended to occur in a definite type of personality, characterized by emotional immaturity that shows itself in lifelong dependence upon parents, and in sexual maladjustment. His impressions have been confirmed in a number of case reports by A. J. Sullivan and E. R. Cullinan and others. In a personality study of forty patients, E. Wittkower could show that ulcerative colitis is a disease of the mentally ill. Almost all the patients showed character disorders, clinical neurosis, or psychosis. In his opinion, similar precipitating events would not lead to this symptom in other individuals.
Although a great deal of psychoanalytic study has been made of gastrointestinal disturbances, especially by Alexander and his coworkers, there exists very little analytic literature on ulcerative colitis. A case history published by G. E. Daniels on the treatment of a patient with ulcerative colitis and depression confirms my observations.
Although emotional disturbance as a precipitating and constant factor in the etiology of ulcerative colitis has been stressed by all investigators, the cause and nature of this illness have remained unknown.
Robert was first seen by me after he had been ill with ulcerative colitis for more than one year. He had developed colitis when he was about six years old, a few weeks after he had started school. Attempting to place him in kindergarten when he was