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Brodsky, B. (1954). Revista De Psicoanálisis. VIII, 1951: La Genesis affectiva de la ulcera gastroduodenal. (The Emotional Genesis of Peptic Ulcer.) Angel Garma. Pp. 311-357.. Psychoanal Q., 23:301-303.
Psychoanalytic Electronic Publishing: Revista De Psicoanálisis. VIII, 1951: La Genesis affectiva de la ulcera gastroduodenal. (The Emotional Genesis of Peptic Ulcer.) Angel Garma. Pp. 311-357.
In this paper Garma explains his hypothesis of the psychogenesis of peptic ulcer.1 Alexander supposed that rejected passive tendencies persist in the unconscious and take on an infantile character; an unconscious urge to be fed, representing the wish for mother's affection, provokes in the individual predisposed to ulcer a continuous secretion of gastroduodenal juices which irritate the mucosa. Garma believes that the cause of ulcer is the unconscious psychic representation of an aggressive and frustrating mother. This imago originates in infancy and forms part of the patient's superego. The patient suffers damage in the digestive tract because, as a result of inner prohibitions and frustrations, he has regressed from genitality to oral digestive behavior. This theory considers ulcer an illness precipitated by external frustrations and aggressions of many kinds which the patient is unable to reject because in his infancy he was obliged to accept the aggression of his parents. The patient fails to direct counteraggression toward external sources of hostility. Instead, the consequences of parental aggressions, especially those of the mother, are reactivated in him. These primordial aggressions are still active within him because they have been incorporated into his superego. The superego directs all aggressions, those coming from without as well as his own activated infantile ones, against the gastrointestinal tract. The instinctual regression is accompanied by regression of the superego and reactivation of the terrifying infantile images of the bad mother of the first month of life who, according to the fantasy of the infant, cuts the umbilical cord in an attack, deprives the infant of its nourishment, or gives it harmful foods, and also sucks, bites, claws or perforates the inside of the gastrointestinal tract, especially of the stomach and the duodenum. These cruel representations of the superego produce their effect upon the stomach and duodenum through the trophic nerves, making use of diverse organic processes, such as hypersecretion, muscular spasms, and local diminution of the protective gastroduodenal mucus. These cruel images also endow food with noxious psychic cathexis, making it seem dirty, harmful, or indigestible. Thus digestion is disturbed. As a consequence of one or the other process, the patient suffers lesions of stomach and duodenum which may amount to ulcer. To summarize: the individual in a state of oral digestive regression submits masochistically to external frustrations and aggressions and to bad maternal images in the superego, which attack him in the digestive tract, producing ulcer.
Garma, like other investigators, stresses the importance of aggression in peptic ulcer. But he seems to overstep the legitimate bounds of psychoanalytic metaphor when he states that the superego picks out a part of the gastroduodenal mucosa upon which to wreak its hostility. This is an odd mixture of concepts both too anthropomorphic and too anatomically specific. Moreover, it seems to the abstracter unreasonable to suppose that a child in its earliest months includes in its body image a stomach and duodenum, and is aware of the loss of the umbilical cord. Garma is influenced by Melanie Klein's belief that the young infant produces detailed fantasies about his body image. Alexander's theories show greater internal consistency. He is aware that science cannot identify
fantasies and images as causes of strictly psychosomatic illness, which actually results from physiological disturbances consequent upon emotional states. Garma, dissatisfied with Alexander's theory, supplements it by supposing that a psychoanalytic structural concept, the superego, exerts its action directly upon a purely anatomical concept, the gastroduodenal tract.
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Brodsky, B. (1954). Revista De Psicoanálisis. VIII, 1951. Psychoanal. Q., 23:301-303