Imitation and Avoidance of a Duodenal Ulcer*

In a recent article (7) the writer has raised the question why certain individuals, who might be expected to suffer from psychosomatic illnesses, escape with purely psycho-neurotic troubles. He has also pointed out how oral aggressive tendencies suitably displaced downwards combined with anal aggressive tendencies suitably displaced upwards and acted in the causation of a duodenal ulcer. The interest of these two problems is brought out by two cases which will now be discussed. The first is one concerning which there is little detail, but which shows apparently spontaneous change from the ulcer formation pattern towards the pattern of anxiety hysteria. The other is reported in some detail, and reveals the unconscious processes at work in a somewhat similar change, and is of special interest because the patient had an operation for “perforated duodenal ulcer” by mistake, and the psychological significance of this error is to some extent revealed. Both patients were of the physical type most frequently associated with the duodenal ulcer, being thin, rather strained, tense and watchful in appearance, and also showed the combination of anxious and obsessional personality traits characteristic of ulcer patients.

Case I: The Significance of Loss of Teeth.—A man of 37 years of age who was a machine operator, had had abdominal pains for three years. He did not go for treatment, but dieted himself very carefully. At the end of this period his teeth began to fall out easily, and, according to his own account, as his teeth came away “his stomach cleared up wonderful.” He ventured the opinion that perhaps it was the teeth which had upset his “stomach,” and, as soon as they fell out, the pains disappeared. He was fond of drink and of smoking, though not an alcoholic, and he was one of three men who were special friends and always went for drinks together and attended football matches on Saturday afternoons.