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Garma reports the data obtained from the psychoanalysis of six male patients with peptic ulcer. A reference, however, is made to an etiological situation in a female which is associated with subsequent ulcer formation. There is no
effort to account in psychological terms for the striking difference in the incidence of this illness in males and females.
He concludes that his patients had a genetically determined 'psychic complex' which 'may be called the situation of predisposition to ulcer'. This consists of the following factors: 1. Lack of gratification of derivatives of genital instinctual needs. This is experienced regressively as 'hunger' in an individual who has been orally fixated by a frustrating mother. 2. Possible psychic memory traces of the cutting of the umbilical cord at birth which make subsequent separations from parent imagos traumatically overdetermined. 3. Castration anxiety resulting from the prohibition of infantile genitality which is followed by regression involving the stomach in a previously orally fixated patient. 4. Remorse or 'pang of conscience' due to sadistic wishes against the mother imago introjected in the patient's superego. This is experienced as a 'digestive bite'.
In essence, any prohibition or frustration reactivates the archaic situation in which the infant contended with his orally bad and frustrating mother. His defense mechanisms of incorporation and introjection cause him to seek harmful foods, to eat irregularly, and to believe he can 'digest stones'. In this way he conquers the unacceptable aspects of the internalized mother imago and achieves a kind of independence. This contributes to his character structure by developing such traits as 'self-sufficiency', being a 'go-getter', and the assumption of responsibilities. When such a genetically predisposed individual meets a current actual conflict, the development of an ulcer is precipitated. These activating conflicts may be the death of a loved person,