Influence of the Emotions upon Esophageal Function: A Comparison of Esophagoscopic and Roentgenologic Findings

Abstract

The majority of physicians and surgeons have been reluctant in accepting wholeheartedly the contention of the psychiatrists that emotions can so disturb organic function as to produce severe symptoms which are indistinguishable from those of definite organic disease. They all know, either from experience or otherwise, of patients who have been pronounced neurotic and so treated over long periods, and ultimately found to be victims of an undiagnosed ulcer, carcinoma, or other organic lesion. The danger of such a serious error justifies the skeptic scrutiny that has been given to these psychiatric theories. If the psychiatrist's idea of functional disturbances is correct, we should expect some objective evidence of alteration in the “emotionally affected” organ, and an unmistakable relationship between the emotion in question and the effect produced. At first glance, the approach to the study of this functional problem seems beset with obstacles, because in most of the bodily organs it is not easy to prove or disprove an alliance between the emotional cause and the dysfunction. This subject first claimed our attention some years ago during an esophagoscopic examination, in search of an organic lesion, in a patient who was exhibiting symptoms of esophageal dysfunction. We found a severe spasm of undetermined etiology, and then noticed that a chance statement of ours caused the spasm to disappear, while an opposite trend of conversation re-elicited it. It was difficult to believe that which we saw transpiring before our eyes, but the changes were unmistakable, and reversible. Spasm was brought about by the discussion of unpleasant subjects and the arousing of undesirable emotions, while its disappearance occurred when pleasant and “wished-for” situations were envisioned (1, 2). It was, of course, quite possible that this psychosomatic response was peculiar to this particular patient, and might be absent in all others, but our curiosity was awakened and we were anxious to settle the point if possible. Up to the present time, on esophagoscopic examinations, we have found such objective psychosomatic changes in 25 patients. Thirteen of these cases have been reported (3), but our discussion of them was solely from the standpoint of esophagoscopy. The present paper considers these same emotional alterations and dysfunctions from the point of view of roentgenologic study and interpretation. Every roentgenologist has occasionally observed fleeting, transient spasms of the esophagus during routine gastro-intestinal investigations; he also has a thorough acquaintance with the more permanent type of spasm called “cardiospasm.” These observations are not in themselves new, but doubt does exist as to the causes and real significance of these variegated esophageal spasms. Although the roentgenologist has assured himself that no organic lesion is present, he is at the same time quite aware that something has happened to disturb the normal esophageal action.