By controlling the constitutional factor of gastric hypersecretion in the development of an ulcer, this identical twin study has shown how divergencies in development and environmental stress can contribute to the illness. Alexander's concept that ulcer develops in an individual in 'conflict over passive dependent needs, when the nurturance of these is compromised', continues to receive support in this follow-up study. Originally the more rigid, less adaptable twin had an ulcer. The more successful, flexible, and easygoing twin, who could accept gratification of his dependency needs from an adequate wife, developed an ulcer only when the wife lost her job and feared what appeared to be a late pregnancy. The lesion cleared rapidly with job improvements and assurance that the amenorrhea was menopausal. The subsequent maternal death was handled by this twin with appropriate grief reaction, whereas the rigid twin, in spite of growth during psychotherapy, had a recurrence of ulcer during his overtly depressive reaction.