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Two chapters of this book are addressed to the psychoanalyst, the rest to the general public. It contains a brief review of research into the problem of gastric and duodenal ulcers, notes on the theory of instincts, excerpts from case reports, application of the author's theories to La ulcera, a novel by A. J. Zunzunegui, and a bibliography. The author concludes that psychoanalytic treatment is essential for ulcer, particularly if the patient has required surgery.
A new theoretical concept is introduced, the 'oral digestive' phase of libidinal organization. The oral erotic zone is extended to include the stomach and duodenum. All the characteristics ascribed by psychoanalytic theory to the oral zone are attributed to this segment by the author. Oral wishes are merely the superficial and conscious manifestations of much more important unconscious wishes to receive and to digest inside the gastrointestinal tract. The language of the oral zone must be translated into a gastroduodenal language. The author's psychological formulations are strongly influenced by the theories of Melanie Klein.
Dr. Garma agrees with the views of Alexander and his associates as far as they go, but feels that his own theories have a much broader foundation. The most important predisposing psychological factor in the genesis of gastric and duodenal ulcers is a deep 'oral digestive' fixation. The premature severance of the umbilicus is also of great pathogenic importance, but this hypothesis Garma has not yet verified. When the libido regresses to the 'oral digestive' phase—as regularly happens in patients with gastric and duodenal ulcers—the ingested food represents the frustrating, bad mother, the gastroduodenal segment the penis, the digestive processes the incestuous act, and the ulcer the punishment by castration. Because of the regression, the revived imagoes of the frustrating parents discharge their aggression 'digestively' against the gastroduodenal segment. Gastric hypermoti