下痢を主訴とする一患者の分析治療例

A CASE OF PSYCHO-ANALYTIC TREATMENT OF A PATIENT WHOSE CHIEF COMPLAINT WAS DIARRHEA

（1）症状及び病歴

　患者は34才の外国人。職業は会社員。現在独身。主訴は下痢。凡そ10分位の間隔で常に便意を催し，便所に行かざるを得ない。便の内容は放屁を主とした薄い粘液様の物で，実質的な内容は少ない。便意が頻繁にあるので何処へ行つても，便所の所在を確めて置かなければ不安であると言う状態で，生活面でも極めて苦痛であるし，常に気に掛つて仕事にも集中出来ない。来院前，約3カ月前より次第に激化し，苦痛となつたので内科医を訪問し，治療を求めて薬物を貰つたが，その直後は強度の便秘に悩み，その薬物を取らないと再び同様の下痢が現われて来た。更に他の内科医を歴訪したが，結局同様の結果となり，最後に神経性のものではないかと言われて訪れて来た。患者の既往の症歴としては，虫垂炎の手術を受けた他は，極めて健康であつたし，現在も主訴を除いては良好な状態にあり栄養もよい。

　診察の第1回の始めに当つて便所に行く許可を求め，帰つて来てから患者は急に大声を挙げて，顔を蔽い泣き始めた。そして　"自分は不幸である""自分の生涯は目茶目茶である"等の表現をし，約5分位その様な状態が続いた。その後で落着いて，大変失礼をしたと言い，自分の病状を語り始めたが，再び便所に行く許可を求めた。便所から帰つてから病状の発生の時期その他を問うと，その時期が，患者の離婚直後からである事が判明した。

A case study was presented regarding a patient whose chief complaint was diarrhea. The patient was treated by psychoanalytic therapy. The patient is a man of thirty-four years old. He had been suffering from diar-rhea from the time of his divorce. He had compulsively felt the need to go to the toilet almost every ten minutes. This compulsive need had become quite troublesome for the patient.

The therapist found during the analytic interviews that the patient had remarkable feelings of anxiety, depression, self-hate, and lonesomeness. The analytic approach was made, first, from the point of the patient's attitude toward human-relationship, which could be more easily done because of the patient's feeling of failure in his marriage life. In this first phase his symptom of diarrhea became diminished. Then his compliant atti-tude, his compulsive need for security in the form of marriage, and his egocentric posse-sisveness were exposed. It was clarified also that they had been due to his feelings of lonesomeness and insecurity, which is to be attributed to his basic anxiety. In connection with hisanxiety, his own evaluation of him-self came to the foreground as his central problem.