Psychosomatic Medicine 11:300-304 (1949)
© 1949 American Psychosomatic Society

Factors in the Pathogenesis of Peptic Ulcer

Some Critical Comments on a Recent Article by George F. Mahl

¹ Research Fellow, Chicago Institute for Psychoanalysis

In a recent paper Mahl suggested that the most important factor in the pathogenesis of peptic ulcer was "chronic anxiety or fear." The purpose of this paper was to present a critical re-examination of Mahl's findings.

It is concluded that the evidence from the literature on the subject does not warrant the conclusion that "fear" is a significant etiologic factor in peptic ulcer.

Fear and anxiety are terms which cannot be used interchangeably, according to the present author. It was further emphasized that anxiety is a nonspecific and ubiquitous reaction on the part of the organism and that in order to make meaningful psychosomatic correlations, it is not sufficient to refer to an emotional state as being characterized by "anxiety."

Mahl's experiments were aimed at producing "chronic fear" in dogs. According to our views, these experiments did not produce fear, but instead resulted in a massive disorganization of the animals' behavior. The experimental results are thus explained by regression, the latter being the result of overwhelming stimuli which the dogs could not master in any adaptive manner.

Reference is made to the occurrence of peptic ulcers in animals. The development of this syndrome in young calves prematurely weaned, and the relief of these ulcers by permitting the calves to continue on a milk diet, provides striking evidence for the correctness of the psychoanalytic theory of ulcer formation.