Ulcerative Colitis: Studies of Personality

Abstract

THE BRITISH 1357 MEDICAL JOURNAL for each patient the presence or absence of thirty-seven numbered character traits. The columns were numbered and not named after character traits, and mathematical examination allowed an unbiased division of the patients into certain groups. Selecting a column obviously belonging to a frequent characteristic, this was repeatedly-correlated with columns indicating other characteristics. Three groups of associated characteristics slowly emerged. On decoding these from numbers to the character traits, they signified the groups to be as follows: Group 1.-This group comprises seventeen patients who had described themselves as over-conscientious and/ or over-scrupulous children. Correlated with this, more than ten were shy, timid, over-sensitive, and withdrawn. They shunned games and parties and preferred reading. At school they worked very hard, were exceedingly ambitious, and worried unduly about their achievements. They were accurate, reliable, clean, and tidy. A fair number stressed spontaneously their horror of dirt. The following abstracts may illustrate some of these features: C. H.; 12 years old.-Mother's report: "Connie is very clean and tidy in her habits and very conscientious and extremely ambitious in her school work. She cannot bear to see anyone better than herself. If there was someone better, she used to say: ' I do want to beat her.' She is prone to underestimate her own abilities. At school she always used to wonder if she would pass her examinations. Connie is not a very good mixer. She would rather read than play; it has always been difficult to get her out to play." Group 11. Twelve patients described themselves as ex-citable in childhood. Seven of these were obstinate, stubborn, argumentative, cantankerous, and overtly aggressive. In general they were jolly, happy-go-lucky, and did not care very much about their appearance or achievements. At school they were often noisy and up to mischief frequently the dread of their teachers. In contrast to Group I, they had " heaps " of friends, liked to perform, and enjoyed " showing off." They were prone to display their emotions and apt to produce explosive affects when frustrated. A typical instance is given in the following: A. S.; 23 years old.-" From the day I was born until I was over a year old I never stopped crying. Later on I was obstinate, argumentative, quarrelsome, always up to mischief, always getting into trouble. I ran up and down stairs and made a terrible noise to annoy the others. At school I was a great nuisance. I was inattentive, fidgety, and used to talk when I was not supposed to, and would whisper, giggle, throw notes, or eat sweets during lessons. I hated going to school, and made many excuses to stay away. Often I pretended to be ill or deliberately hurt myself to find an excuse." Group 111.-This group embraces six cases. Their common characteristics were their quiet, unassuming, accommodating behaviour in childhood. They were polite, courteous, and respectful, and extremely anxious not to hurt anybody's feelings. They kept in the background as much as possible and blushed on the slightest occasion. Their feeling of inferiority prevented them from association with other children. They were apt to take dffence easily, and would brood over an often imaginary slight for days without showing it outwardly. The group is typified by the following example: L. S.; 34 years old.-This patient was shy and retiring as a child. She never liked going to parties and felt uncomfortable with a lot of other children. She always let others go first; she preferred to keep back, and if she was called in front of others she would go red. If anyone said anything harsh to her she would brood over it for days. There remained five cases of the total which did not fit in with any of the above three groups, and which are here classed as Group IV. ADULT ADJUSTMENT In the patients as adults, the groups seen in childhood remained unchanged in composition and often showed an accentuation of the differentiating characteristics. As adults, the majority of patients in Group I were energetic and efficient. Their facial expression was often hard, determined, tense, and sometimes drawn, sullen, and dissatisfied. As a result of unreasonable feelings of inferiority and an acute sense of their obligations, their sole aim in life was to achieve safety and security, working long hours and finding it difficult to relax during their rare holidays. Despite this they were often dissatisfied with their achievements. Reliable and over-conscientious, they were always anxious to set an example, and tended to expect from others the same standards as they set for themselves. Most commonly they were over-careful with money and unable even to owe " a penny"; a few were foolishly generous or oscillated between these two attitudes. Their attitude to religion and sexuality was unusually stern and rigid, and lapses, whether trivial or severe, brought disproportionate and prolonged feeling of guilt. Metaphysical problems similarly appealed strongly to them. Their high principles could be seen in their dogmatism, teetotalism, and their abhorrence of bad language and the " dirty " joke. Over-orderly, they liked everything to be done by method and could not bear to see things out of place. They were careful about their belongings and apt to keep things of little value. Thus a 52-year-old patient still kept his toys and school books, " which contained material which is very well written and spelled." They were sticklers for punctuality, and often arrived unnecessarily early for appointments in case they might be late. The majority were unusually neat, clean, and tidy in their appearance even if this strained their finances. Characteristically , one man, a clerk, invariably polished his boots whenever he went into his house. On the other hand, two of them were definitely dirty by any standards. Two others conspicuously broke down at one point by wearing a dirty collar or through dirty fingernails. A common feature of all members of the group was a failure to express emotion. They "bottle up " emotions and "worry inwardly." In their rare emotional moments by far the commonest feeling expressed was anger. As a result, in their social relations they were unable to adapt themselves to others and tended to live for the most part in a world of their own. Some were shy, timid, and self-contained. They disliked social gatherings, preferring reading or sitting in a corner and tjiinking about the conditions of the world. Others were resentful, obstinately sullen, or openly defiant. They were self-willed, and unable to admit that they were wrong. " I stick to my guns," a patient told us, "even if I think the other is right." Grossly abnormal attachment to one parent was common. Considering their age and income, relatively few were married. In any case, their moral code was of such a nature as to interfere with normal sexual functioning , in many cases even to the point of sexual disorders. Fourteen out of the seventeen members of this group displayed certain features which are grossly pathological-obsessional thoughts, fears, impulses, and actions. In