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Sperling, M. (1960). Symposium on Disturbances of the Digestive Tract—Ii. Unconscious Phantasy Life and Object-Relationships in Ulcerative Colitis. Int. J. Psycho-Anal., 41:450-454.
(1960). International Journal of Psycho-Analysis, 41:450-454
Symposium on Disturbances of the Digestive Tract—Ii. Unconscious Phantasy Life and Object-Relationships in Ulcerative Colitis
The etiological significance of sexual fantasies and conflicts in the genesis of conversion hysteria was established by Freud in 1895 (5). Since then the link between fantasy and conversion has occupied considerable psycho-analytic interest (3). In the psycho-analytic treatment of children suffering from ulcerative colitis, I had arrived at the conclusion that ulcerative colitis is an organ neurosis with pregenitalconversionsymptoms
(4), (8). I should like to reaffirm this with the case just presented.
In the case of this patient, as in hysteria, the colon (as the organ associated with elimination) had assumed the role of a sexual organ. Yet, unlike the hysteric, she did not manifest sexual fears or inhibitions. She could have sexual intercourse and even have the thought that it would be pleasant to be pregnant all the time. In fact, when she gave birth she refused anaesthesia and regretted that she did not have her eyeglasses to watch the birth process more closely. She was not bothered by oedipal fears or conflicts, and sexual intercourse, pregnancy, and childbirth did not appear forbidden or dangerous. Her sexual fears and phantasies were of a pregenital, namely oral and anal nature, and were acted out repetitively in the symptoms of her ulcerative colitis. Nothing happened to her genitally. The damage took place in her bowel. When her pregenital sexual phantasies were exposed in the analysis, a shift from the bowel to the vagina took place, and she developed genital symptoms similar to those of the colon together with some manifest anxiety. With the mobilization of anxiety leading to manifest genital fears and inhibitions, there was a decrease and finally a cessation of the somatic symptoms. One could say that the analysis was transforming her into an hysteric. I have found this dynamic constellation in every case of ulcerative colitis which I have treated psycho-analytically (9), (10), (11).
Are there genetic factors which determine the specific pathogenicity of such phantasies in the lives of these patients, and if so, what are they? Why do these patients react with these specific somatic symptoms when regressing under the impact of a precipitating traumatic situation (in the case of this patient, marriage and leaving mother), rather than with depression, psychosis or a manifest perversion? This brings me to the second topic indicated in the title of this paper, namely, the role of object-relationship in ulcerative colitis. The object-relationship of the ulcerative colitis patient gets its particular colouring from the fact that the libidinal ties to the mother or her substitute are overemphasized, while the destructive impulses directed against her are completely denied (9). This patient's major problem was that of separation from her mother. Separation was unconsciously equated with birth. To separate was extremely dangerous. It was safer to remain inside her mother's body. Her mother did not tolerate any overt manifestation of anxiety or emotional behaviour when the patient was a child, but was very attentive to her when she complained of bellyaches. When she began to feel anxious and to display emotions during her analysis, she once said, 'My mother would have no use for such behaviour'. She felt that she gave up 'part of her personality' to please her husband because she could not be 'her true self' with him.
The unconscious phantasies, anxieties, and perverse needs of her mother had transmitted themselves to the patient, stimulating and reinforcing her own fantasies and anxieties. This relationship with the mother I consider an important factor in determining the fixation points and the choice of defence mechanisms which the child will use in the struggle with his instincts.
I consider the variations in the severity of the somatic manifestations and the variations in the personalitystructure of patients with ulcerative colitis as being determined by the level of fixation. Dependent upon whether there is a predominantly oral or anal fixation, there will be a greater or lesser diffusion between the libidinal and destructive energies. The psychological equivalents of the somatic manifestations in ulcerative colitis can range from melancholic depression and paranoid schizophrenia to perversion and psychopathy.
I consider the somatic symptoms of idiopathic ulcerative colitis as pregenital conversions based on specific unconscious phantasies and conflicts in persons predisposed to such a reaction by a specific mother-child relationship in early life.
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