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Psychosomatic Medicine 2:276-285 (1940)
© 1940 American Psychosomatic Society

Treatment of a Case of Ulcerative Colitis Associated with Hysterical Depression

GEORGE E. DANIELS M.D.1

1 Departments of Medicine and Psychiatry, Columbia University Medical Center, New York City

A Jewish housewife of 32 with a history of three previous attacks of ulcerative colitis has been followed psychiatrically during most of the five years of her fourth attack. Between the third and last attack the patient had two pregnancies. The first was terminated by her giving birth to the foetus into the toilet, the second initiated a prolonged attack of tachycardia and a period of partial amnesia.

Psychiatric exploration revealed deep unconscious hostile trends and suicidal drives. She was given nine months of intensive psychotherapy, three months of which was in the form of free association on the couch. Through psychotherapy she was able to significantly emancipate herself from her family. Social Service assisted her in reëstablishing her own home which was an essential step in treatment. Hay fever and asthma appeared for the first time during this transition and there was an acuteflare-up of palpitation and diarrhea when she made the actual step of moving to a new home three and a half years ago. Since then she has had only occasional psychiatric following. Though some frequency of stools persists and she has occasional diarrhea which is usually conditioned by emotional factors, any serious recurrence has been avoided. The colon shows chronic changes which make complete recovery improbable and the persistence of depressive trends further modifies the prognosis. The greater severity and duration of her last attack seems to have been due to an altered life situation with conflict related to a neurotically conditioned marriage reënforced by childbirth for which she was ill prepared. Various medical procedures tried have thus far had relatively little effect on the disease process and it seems fair to assume, in view of the severity of the colitis at the beginning of the fourth and last attack, that psychotherapy has been an important factor in the arrest of the disease and in her social recovery.

Note:

Read at the Joint Meeting of the New York Neurological Society and the Section of Neurology and Psychiatry of the New York Academy of Medicine, New York City, May 2, 1939.




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