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Psychosomatic Medicine 9:331-336 (1947)
© 1947 American Psychosomatic Society

The Rôle of Hostility in the Pathogenesis of Peptic Ulcer: Theoretical Considerations with the Report of a Case

THOMAS S. SZASZ M.D.1, ERWIN LEVIN M.D.1, JOSEPH B. KIRSNER M.D.1, and WALTER LINCOLN PALMER M.D.1

1 Division of Psychiatry and the Frank Billings Medical Clinic, the Department of Medicine, University of Chicago

The present status of the rôle of psychogenic factors in peptic ulcer is briefly reviewed.

A case of peptic ulcer is presented. It is demonstrated that: a) anger stimulated the production of a large volume of hydrochloric acid; b) this effect was obtained after a period of complete inhibition of gastric acidity by enterogastrone; c) the stimulating effect of anger was abolished by bilateral vagus section.

A theoretical formulation is presented to account for the rôle of anger and fear in gastric function; a specific type of correlation between these affective states and feeding is emphasized. There exists in the infant a close emotional association (equation) between anger (crying) and receiving food on the one hand, and fear and what is feared (not receiving food) on the other. In the course of normal development, this equation is probably either broken or greatly weakened. In some ulcer patients, and probably also in some "normals," this association may persist and may then finds its expression through the process of "regressive innervation" (the recapitulation of an infantile pattern of physiologic responses to certain emotional stimuli, mediated by nervous pathways).

The rôle of anger in the pathogenesis of peptic ulcer is discussed and an attempt is made to evaluate its importance in relation to other causative factors. Anger (hostility) may be an important psychologic factor in the genesis of peptic ulcer.




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