[Psyche and gastrointestinal diseases: hypotheses and facts]

The notion that the development of certain gastrointestinal disorders and diseases can, at least in part, be ascribed to specific psychological characteristics of the patient, to an antecedent psychologically important event or to an unconscious conflict, is very popular both in the public and the medical profession. One of its earliest formulations was the conversion theory forwarded by Sigmund Freud, who assumed that the accumulation of a traumatic and unabreacted quota of affect induced defense or repression and caused a somatic conversion of emotion, i.e., a transformation into bodily symptoms. Subsequently, disorders such as globus sensation, diffuse oesophageal spasms and achalasia, the latter misconceived as "cardiospasm", were viewed as conversion symptoms. However, it has become clear that these disorders are the consequence of organic lesions and not of conversion. Similarly, concepts of an aetiological role of a specific psychological factor, a specific conflict, of certain affective states or live events and of "inappropriate perpetuations of organ reactions adaptive to, or protective against, some stress in human life" could not be verified. Although psychological characteristics and states have been shown to affect normal gastrointestinal function, there is no evidence to suggest that such influences can lead to gastrointestinal disorders or diseases. The fact that the validity of the concepts claiming such aetiological relationships remained to be tested has been repressed to such an extent in some quarters that these concepts still are advocated so as if they had been proven since long.