The Psychopathology and Psychotherapy of Cardiospasm

During the past six years I have investigated 25 cases of cardiospasm at the Psychiatric Clinic in Prague. The group consisted of 18 females and 7 males. The average age was 47 years. The youngest patient was an 8-year-old girl, the oldest a 74-year-old woman. The average duration of the illness before psychiatric examination was 1-2 years. Out of the 25 patients investigated it was possible to demonstrate pronounced psychogenic factors in 22. In 7 patients it was a case of marital conflicts, in 6 of them distress and dissatisfaction at work were in the forefront, in 4 the illness arose in connection with events and stress of war, in two of whom there was a sudden onset during air raids. In 15 patients it was possible to trace retrospectively anxiety feelings related to the first signs of the illness; in the others investigation pointed rather to a state of chronic emotional tension and dissatisfaction. In 3 patients there was fear of cancer brought about by incorrect medical handling. Amongst the relatives of 4 patients there was a history of serious psychosis. One patient was herself a sufferer from periodic endogenous depression. With regard to occupation housewives and women with occasional, seasonal employment, mostly in agriculture, predominated. In the investigation of the personality of our patients 11 appeared conspicuously quiet, mild, rather serious, submissive and inclined to resignation, with inadequate ability to cope with life’s difficulties. Their reactivity was mostly defensive, conflicts were repressed, sometimes resentfully “chewed over”. They showed little inclination for humour and were suspicious. Only during more intensive narcoanalytic investigation did aggressive manifestations and desires for retaliation and revenge for real or imagined slights show up. In the remaining patients no further clear-cut type of personality was observed. Two were agile, active and extraverted people. The course of the illness was in the majority of the cases intermittent and new exacerbations were related to fresh psychological injuries. The dilated and elongated oesophagus with a defined obstruction appeared as the final stage of the pathological process brought on by repeated conditioned emotional stress. The reaction of closure of all the organismic orifices is one of the rimitive archaic reflexes in response to approaching danger. Repeated and pent up emotions of fear, anxiety and danger generally increase the tendency to spasticity. Spasm of the oesophageal musculature may be part of a biological reaction which 15 Gastroentcrologia, Vol. 86, No. 3 (1956) 212 Roubícek Congress 80 is appropriate to the ingestion of offensive food, but occurs also inappropriately in certain individuals in their adaptation to external stress. A special type of personality which would be