The Role of the Internist in the Psychosomatic Approach to Peptic Ulcer

If our propositions are not altogether wrong, it would appear that the modern psychosomatic theory of the origin of peptic ulcer in its various aspects should be accepted with many restrictions only and cannot claim to have general validity. Apparently it neither is the internist's business, nor would he be competent, to examine the exact personality structure of peptic ulcer patients, or the specifity of emotional factors. But his contributions to the psychosomatic approach of ulcer patients points out the multi-conditionality of peptic ulcer. Within the frame-work of psychosomatic theory this means that recent emotional influences often play an evident part, that, to internists, certainly not all ulcer patients appear to be neurotics in the general eense of the word, and that long standing gastric neurosis is absent in a high percentage of ulcer patients. According to our experience, we must agree with Smith and Rivers that "peptic ulcer is not limited to certain types, to certain ages, to certain seasons or to a certain sex" (p. 124). These authors do not even regard peptic ulcer disease as an entity. Though the assumption that various types of peptic ulcer disease must be distinguished may prove too bold, we would recommend to grant it a serious trial. As for the various types, on the one hand we see cases with an extremely chronic course, in which possibly childhood-factors play a part (though there are authors who mentioned that in infants and young adults with peptic ulcer the hereditary disposition is often obvious from the family anamnesis), and on the other hand, acute peptic ulcers with a tendency to massive bleeding, in which an interfering emotional strain often seems to be an important factor. Zwar enthalten die modernen psychosomatischen Theorien über die Ursachen des ulcus pepticum manches Richtige, doch können sie nicht allgemeine Gültigkeit beanspruchen. So gewiß die genaue Untersuchung der Persönlichkeitsstruktur und der emotionalen Faktoren bei Ulcuskranken nicht zu den Aufgaben der Internisten und in ihre Kompetenz gehören, so machen sie doch die Erfahrung, daß sicher nicht alle Ulcuskranken im weitern Sinne neurotisch sind und daß bei einem großen Prozentsatz eine lange vorbestehende gastrische Neurose fehlt. Mit Smith und Rivers teilen wir die Erfahrung, daß das Ulcus weder auf einen bestimmten Typus, noch auf ein bestimmtes Alter oder eine Jahreszeit oder ein Geschlecht beschränkt ist. Die Ansicht dieser Autoren, es handle sich beim