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Garma, A. (1950). On the Pathogenesis of Peptic Ulcer. Int. J. Psycho-Anal., 31:53-72.

(1950). International Journal of Psycho-Analysis, 31:53-72

On the Pathogenesis of Peptic Ulcer

Angel Garma

SUMMARY

A person with predisposition to ulcer has made a partial regression to the oral stage of the libidinous organization. Ulcer is an illness provoked by the psychic image of a bad and frustrating mother who, in the same way as food which is hard to digest, injures the patient in his digestive tract.

The future ulcer patient's mother does not, as a rule, provoke great oral frustrations in his childhood, but she usually worries excessively over his food, thus creating fixations in the oral instinctive organization. Later on, she often keeps him in a situation of Oedipal dependence on her, with the prohibition of extra-familiar genitality. At the same time she is apt to impel her child towards an active social life.

The situation of predisposition to ulcer is constituted by various factors. One of them is the lack of genital instinctive gratification which is experienced regressively as hunger due to the lack of food and which injures the digestive tract. The others are the possible psychic memory traces of the trauma of umbilical separation from the mother, fear of genital castration, carried out regressively in the digestive tract, and the remorse due to aggressive wishes against the mother, or related objects, which is felt as a digestive bite by the mother introjected in the super-ego.

Parental prohibitions of instinctive gratification regressively bring about prohibitions of digesting food, especially severe regarding the kind of food, e.g. meat, which may represent genital or aggressive objects. Thus difficulties in digestion are originated. Besides, the person predisposed to ulcer is usually irregular in his meals, or else chooses food which is harmful, driven by the infantile need of having to accept a frustrating and bad mother, and objects related to her, which, for him, are harmful food. He also seeks harmful food because to destroy it digestively has the meaning of overcoming the bad qualities of the mother or other objects. Similarly, the efforts made by the ulcer patient to maintain his normality are experienced regressively as having to digest difficult food.

In this way the future ulcer patient develops digestive trouble which, in his eagerness for independence, he tries to ignore. Besides, in order to overcome his digestive complications he is sometimes apt to develop gastric hyperactivity (hyperchlorhydria, hypersecretion and hypermotility) which is primarily a defence but which secondarily leads to remorse since it means an attempt to free himself from his infantile submission to his parents. The remorse due to gastric hyperactivity intensifies the already existing remorse in the situation of predisposition to ulcer which brings with it the introjected mother's digestive aggression. This aggression is carried out on a part of the gastroduodenal wall bereft of protecting mucus, and aided by gastric motility and secretion, and rough, undigested food.

The actual conflicts act upon the predisposing situation, this activating the development of the ulcer. These activating conflicts may be the loss of libidinal gratifications, such as the death of a loved person or bankruptcy, or external aggression such as an increase of business difficulties, or remorse on account of genitality, as, for instance, an unfavourable marriage. The former conflicts intensify the situation of hunger in the predisposing situation; the two latter, the digestive aggressiveness of the maternal super-ego.

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