Psychosomatic Medicine 16:156-162 (1954)
© 1954 American Psychosomatic Society

Levels of Communication in Ulcerative Colitis

A Case Study

¹ Psychiatric Institute, Department of Psychiatry, School of Medicine, University of Maryland Baltimore, Maryland

Using as an example a case of ulcerative colitis, which demonstrated not only lower bowel disease, but also duodenal ulcer, psychotic behavior, and extreme acting out of interpersonal difficulties in the social area, attention has been drawn to the characteristics of problems in the doctor-patient relationship with patients who use a variety of communication devices interchangeably, but who communicate predominantly at a nonverbal level. The failure of the practicing physician to recognize such communication patterns in patients with chronic medical disorders distorts history taking and results in common, but well-defined complications in medical management, such as shifting from doctor to doctor and remaining recalcitrant to treatment. Although this is not the only cause of problems in history taking and medical management, its occurrence is common enough to warrant consideration.

It is suggested that patients with chronic medical disorders may unconsciously utilize specific communication methods in correlation with specific areas of stress. Where somatic symptoms, psychotic behavior, or acting out in the social situation may serve as substitutes for verbal communication with the physician, each of these types of expression can assist the physician in ascertaining the typical interpersonal problem which provokes the expression. This is one of several ways that the patient can be helped to verbalize the problem.

Attention has also been called to the fact that intercommunicative patterns exist in the family group, associated with common constellations of clinical syndromes and characteristics of patient-doctor relationship.

It is suggested that factors of communication may be utilized as a descriptive frame of reference for codification of interpersonal relationships in the medical setting.

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