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In the domain of gastro-intestinal disturbances one constantly meets with this interrelationship of the physical and psychical. In the great majority of cases, the analyst sees the patient only after many months of ineffectual gastro-enteric therapy. Under such circumstances the need for analysis is obvious. Gastrointestinal references are the most frequent in the psychoneuroses. “Man lives to eat” and probably more libido enters into the average man's gastronomic ceremonials than into any other type of expression. It is not to be wondered at, therefore, that the “stomach” should play such a large part in the neuroses and that such a mass of ignorance and superstition should still be found in all classes of society relative to the nutritive instinct. Extremely primitive and animistic notions concerning the food function and the processes of digestion, still hold sway even among physicians. The dietary fads of the latter have been subjects for ridicule and satire for years and not without a certain measure of justification. Concerning these and the general subject of the nutritive instinct more will be said later.
Before passing to the consideration of the detailed history of the patient which is necessary from the psychoanalytic standpoint, attention should first be directed to those types of patients who should not be analyzed.
Perhaps the most important thing for the beginner to know is what not to analyze. Even the trained analyst may find to his distress that he has unwisely started a psychoanalytic procedure to learn later that the method in general will not bring about the hoped for result, i. e., the betterment of the patient.
Experience is rapidly accumulating relative to this matter and it is my purpose to discuss the bearings of this experience in the following paragraphs.