title: [Swallowing the psyche].
abstract: Various swallowing disorders have been viewed to be psychogenic and an altered contractile activity of the oesophagus has been reported to occur during emotional stress. Non-propulsive activity and "cardiospasm" were suggested to represent a symbolic revulsion, referring to deep, unconscious conflict or an ambivalent attitude towards incorporation (Kronfeld, 1934; Weiss, 1944; Alexander, 1950). However, these concepts were not corroborated by subsequent research. "Globus hystericus" was shown to result from webs and folds in the hypopharynx or from gastrooesophageal reflux, whilst the term "cardiospasm" has even become obsolete: there is no spasm of the lower oesophageal sphincter but an "achalasia", i.e., a failure to relax upon swallowing, which is not induced by psychic factors, but by lesions affecting the intrinsic and extrinsic innervation. On the other hand, it has been shown that the oesophagus reacts with non-propulsive contractions not only emotional tension, but also to cold or hot food and even to stimuli not related to ingestion such as intense short sounds, and that these contractions are likely to form part of the defence reaction of the healthy organism. Despite this responsiveness of the oesophagus and the fact that strategies aimed at inducing relaxation and reassurance can help patients to cope with their swallowing disorders, the psychosomatic concept that "exaggerated" oesophageal responses can lead to organic diseases has remained purely speculative. Present knowledge of the physiology and pathophysiology of the oesophagus clearly indicates that disorders such as globus sensation, achalasia, and diffuse oesophageal spasm should not be treated by psychotherapeutic but by appropriate surgical, or medical, means.
mesh_terms: D000161:Acoustic Stimulation; D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000523:psychology*; D004106:Dilatation; D004576:Electromyography; D004931:Esophageal Achalasia / Q000628:therapy; D004935:Esophageal Diseases / Q000503:physiopathology; D004947:Esophagus / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D011602:Psychophysiologic Disorders; D013035:Spasm / Q000503:physiopathology
vernacular_title: Schlucken und Psyche.