Mucous Colitis Associated with Phobias

The psychoanalysis of a boy of twelve is reported to demonstrate the interrelation between a somatic symptom (diarrhea)

and an anxiety hysteria (phobia). The phobia was a fear of being separated from his mother, protecting her against his unconscious death wishes, while in the diarrhea he was giving her up by identifying her unconsciously with feces. At the same time, however, the conflict whether to keep mother or to give her up continued in reality, expressing itself in these very symptoms—the phobic clinging and the diarrhea. The overdetermined psychodynamics of the diarrhea would seem to be as follows: 1, a retreat from the genital to the anal-sadistic level of libido organization which provided the possibility of discharging aggressive and sexual impulses (masturbatory substitute); 2, the direct release of sadistic impulses in an effort to protect himself from the overwhelming anxiety stemming from his own destructiveness (conversion on a pregenital level); 3, devaluation of the frustrating object (mother=feces) and getting rid of her; therefore, sadistic control over mother realized in the secondary gain derived from the illness (he could stay home with mother, take her away from the others, and have her accompany him wherever he went); 4, punishment through physical suffering and the restrictions imposed upon him by the diarrhea and his fears.