Worry and Dyspepsia

Dominion, Volume 31, Issue 124, 19 February 1938, Page 1 (Supplement)

Worry and Dyspepsia

BSERVATIONS on the Life-history of Chronic Peptic Ulcer,” by Daniel T. Davies, M.D., Wales, F.R.C.P. Lond., Physician to B B to the Royal Free Hospital, London, and A. T. Macßeth Wilson, B.Sc., M.B. Glasg., Assistant Physician to the Tavistock Clinic, and Clinical Assistant to the Royal Free Hospital, is the title of an article printed in “The Lancet.” The following extracts should be of general interest: —

“In most of our patients the anxiety that preceded dyspepsia was related to security—money difficulties, increased responsibility at work, the possibility of dismissal, the illness of a near relation, the sudden death of a brother. Dyspepsia appears some 5-7 days after such events, and is soon followed by a demonstrable ulcer crater.

“Many are worried but few develop dyspepsia. There is no complete explanation why. But we know from experience that ulcer heals readily; we also know that frequent feeds and occasional administration of alkali soon dispel the early symptoms; and it may be that ulcer, in its early stages, is more common than we imagine.

“In the ulcer individual there is the soil and the seed. The soil is the tense, active personality, whose concern is more with things external than with his own health; the seed is acute anxiety, the result of some reverse in fortune or increased responsibility. He begins to suffer from or rather hunger pains, and if he eats regularly and frequently, he may quickly obtain relief.

“Or he may be engrossed in his work (perhaps more than usual, because of his anxiety), and be long hours without food, in which case there is a pouring forth of active juice undiluted by food, and an ulcer forms. With attention to frequent feeds and medication the ulcer heals, and the symptoms disappear. He goes his way and remains well, able to eat and drink what he will, with no pain or discomfort, until another upset brings a return of his symptoms, and with it all the signs of an active ulcer. “.Such are our examples, some of them in people in whom complete freedom from dyspepsia had been enjoyed for twenty or thirty years until a crisis was suddenly experienced. In some the dyspepsia and ulcer-formation occurred for the first time at the mature age of sixty—but in such cases, as a rule, the event preceding the symptoms was outstanding. . . . “By demonstrating to the patient the connection between his mind and his stomach, much may be accomplished. His anxieties may be lightened

by some adjustment of his work, and he may forestall damage to his gastric mucosa by frequent meals and regular habits. There is more in this than is apparent.

“It is not uncommon to hear from a patient who shows hypersecretion and hyperacidity that he breakfasts at 6 a.m. and has no food whatsoever until 1 p.m., and again is without any sustenance until sor 6 p.m. A simple alteration of his habits will do much. Moreover, when the clouds gather and worries accumulate, a rigid regime will do much to prevent recurrences and relapses. . . .

“Our patients’ troubles were those of people of small means—men and women who depend for their well-being on the money they earn each week—but we have found no difference in private practice where anxieties may be over matters of larger dimension.

“We were surprised to find that the patients failed to observe any connection between their anxiety and the dyspepsia, although in most cases it was blatantly obvious. But once the sequence of events is understood, success in treatment is far more certain. It may be that there is much suppression of their anxiety, and that emotional problems, thus put out of mind, retain their power to cause long-standing tension, defunction, and eventual structural changes.

“1. Inquiry into 205 cases of peptic ulcer showed that in 84 per cent, the symptoms began soon after some event affecting the patient’s work or finances or the health of his family. Only 22 of a control series of 100 patients with hernia gave a history of any such event preceding their illness “2. Of 52 relapses of peptic ulcers, proved by radiography, 42 were shown to date from some event causing anxiety to the patient.

“3. A group of 100 ulcer patients were compared psychologically with 100 hernia patients using Culpin’s system of group-scoring, and it was found that a significant excess of ulcer patients showed undue tension long antedating their ulcer symptoms.

“4. A description is given of the characteristics of the ulcer patient—his fancies, his constant activity, and his reaction to illness.

“5. It is concluded that chronic peptic ulcer is an example of the influence of the mind in producing structural change, and that successful therapy depends upon attention being given to the whole man—his work and his anxieties, as well as his diet.”