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This elegantly documented, long-term psychophysiologic study of a sixty-year-old female patient with a chronic gastric fistula should stand alongside those of Engel, Wolff, and Margolin. After a preliminary study showed a persistent hyperchlorhydria, continuous gastric observations were made while the patient was in therapy with a separate individual. In an attempt to predict fluctuation in HCl secretion, the interviews were scored for the strength of the patient's basic oral aggressive drives and the status of her defenses in regard to them. There was agreement on the former, but the latter were difficult to assess.
Eight months after the start of therapy, there was a sudden drop in HCl secretion which persisted throughout the next eighteen months. At this time the patient was beginning to verbalize many of her oral aggressive fantasies, and the physiological change may have been due to this. However, the change also occurred during a period of deterioration in her relationship to the key figure of the physiologist. In this type of combined study, the erotization of the physiological procedure invests the physiologist with the major portion of the transference. Thus the drop in gastric secretion resembles the 'withdrawal-depression' type found in Monica. Although such factors add to the difficulty in predicting physiological effects, they should not prevent continued efforts in this type of individual case study.