Psychosomatic Medicine 16:47-55 (1954)
© 1954 American Psychosomatic Society

Psychodynamics of Peptic Ulcer Pathogenesis in Hospitalized Schizophrenic Patients

¹ Veterans Administration Hospital Northport, Long Island, New York

In this study the personality of schizophrenics with peptic ulcer is investigated by means of a clinical psychological test battery and individual clinical histories to determine why, in addition to their schizophrenic psychosis, these patients develop a peptic ulcer in the course of their neuropsychiatric hospitalization.

The subjects of the study are 60 male schizophrenic patients between the ages of 44 and 64, institutionalized at three Veterans Administration NP Hospitals. The experimental group of 30 schizophrenic patients had a supplementary diagnosis of an active peptic ulcer within a year prior to testing, demonstrable by conclusive x-ray evidence of an ulcer crater. The 30 schizophrenic patients in the control group were carefully screened so that only patients with no history of gastrointestinal dysfunction were accepted. The research populations are equated for NP diagnosis, age, educational level, and length of hospitalization.

A comparative analysis of Rorschach, Thematic Apperception, and Man-Woman Drawing test results reveals significant clinical and statistical differences and trends in the structural and dynamic organization of the personality to distinguish between ulcer and nonulcer schizophrenic patient groups. The basic personality picture of both groups remains schizophrenic and no "ulcer personality type" is discernible, although differences in handling defensive systems are present. Evidence is cited to show that the ulcer schizophrenic generally tends to react to the threatening external world by repressing his emotional impulses, while the nonulcer schizophrenic tends to deny the external world and obey his emotional impulses.

In this study, the predominant difference arrived at is the fact that the ulcer schizophrenic patients lean toward a greater awareness of and rapport with environmental reality and may be considered to be "better adjusted" or "less regressed" than schizophrenics without peptic ulcer. The prognostic significance of this finding is discussed.

The psychodynamic formulation of peptic ulcer pathogenesis in schizophrenia is presented. For the ulcer schizophrenic patient, reality breaks through the protection of his schizophrenic defensive system because withdrawal defenses are not firmly established at the onset of his psychosis or they have been weakened during the course of the schizophrenic process. Subjected to the additional stresses which a better cognizance of reality presents him, the ulcer schizophrenic patient is faced with the conflict of either dealing with environmental problems on a relatively mature level or regressing further into psychotic estrangement. The evidence suggests that he tends to select the former reaction at the expense of visceral dysfunction which eventuated in the structural damage of a peptic ulcer.

The conclusions regarding basic personality differences between the psychotic ulcer patients of this study and the nonpsychotic ulcer patients of other investigations are summarized and the implications of these differences are presented. Based on these findings, the need for psychosomatic research in schizophrenia and the comparison with studies on nonpsychotic ulcer patients is briefly stated.

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