Psychogenesis of Emesis

Abstract

1. Emesis, or vomiting, considered historically, can be seen in three roles. First it was induced for convivial reasons, to permit continued gormandizing, secondly, on cultural grounds, as part of purification rites and thirdly for curative purposes in the treatment of illness, including mental disorders. Its importance in medicine stems from the fact that it is probably second only to pain in frequency as a symptom of emotional disturbances. Its importance in psychiatry lies in the fact that it is observed in a variety of situations in which its occurrence has different psychological meanings and since it occupies a controversial position in the conceptualizing about conversion phenomena. 2. The physiology of emesis is reviewed and the sequential participation of autonomic and somatic factors is detailed. Psychophysiological aspects of nausea are briefly considered. The roles of various neurophysiological functions, including the limbic system, are discussed in connection with the psychogenic aspects of emesis. 3. Reference is made to pertinent papers on ‘neurotic vomiting’ and to some offering psychodynamic explanations. The relevance of organ language to emesis or ‘neurotic vomiting’ is mentioned. 4. An endeavour is made to separate reflex from psychogenic emesis and a classification of the latter is presented. This shows an increasing complexity as one passes from states in which the mechanism is characterized as arousal to those designated symbolic, expressive and disintegrative. 5. Some semantic implications of the words symbolic, conversion, hysteria, and expressive, are discussed and the unsatisfactory state of ambiguity which surrounds the first three in the psychiatric literature is noted. 6. Certain psychodynamic characteristics of those patients in whom vomiting was a major psychiatric symptom are summarized from the psychiatric literature.