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Szasz, T.S. (1951). Oral Mechanisms in Constipation and Diarrhoea. Int. J. Psycho-Anal., 32:196-203.

(1951). International Journal of Psycho-Analysis, 32:196-203

Oral Mechanisms in Constipation and Diarrhoea

Thomas S. Szasz, M.D.

SUMMARY

Psycho-analytic observations in a case of anorexic-bulimic eating disturbance showed that during periods of bulimia the patient was constipated. Significantly, eating, even large quantities of food, did not relieve the constipation; this is consistent with the fact that eating does not actually lead to satiation in such cases, since the powerful oral-incorporative tendencies are not motivated by a biological need for food. Accordingly, we postulate a persistent vagal excitation in the patient, during such periods, and this in turn leads to inhibition of colonic and rectal activity, and finally to constipation. When the intaking needs were satisfied in the transference situation, the constipation disappeared. The interpersonal relationship in the analysis affected the patient's gastric functions as food affects the stomach of the infant, with a resulting feeling of satisfaction and decreased vagal activity which, in turn, leads to parasympathetic stimulation of the colon and rectum, and to defæcation. Finally, in a patient with ulcerative colitis, attacks of diarrhoea could be traced to an intense inhibition, on account of guilt, of powerful oral-sadistic (cannibalistic) tendencies; this psychological 'inhibition' is postulated to be paralleled by an inhibition of the vagi and thus, through the chain of events described above, diarrhoea results.

The foregoing considerations are proposed as a new theory of the psychogenesis of constipation and diarrhoea due to colonic dysfunction. According to this theory, the symptoms do not express any primary psychological meaning, but are interpreted as manifestations of a vegetative (organ) neurosis, i.e. as the remote physiological sequeloe of oral tensions.

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