Alexander the Great died at
the age of 32 years, with acute abdominal pain that began after several
days of binge drinking. Might it have been from a perforated peptic
Founding a great empire may be an extraordinary example of life
stress, but stress is currently out of fashion as a cause of
ulcer.1 For many years the dominant etiologic model was
exquisitely psychosomatic: a vulnerable person—on grounds of
personality and pepsinogen—encounters a major life stress, and a
duodenal ulcer is born.2 But after Helicobacter
pylori proved to be a key and curable element in the ulcer
diathesis, many concluded that the "real" cause had been found and
had nothing to do with psychology. Research into stress effects on
ulcer fell off precipitously, and the earlier literature was dismissed
as misguided and naive, given the new, respectable status of peptic
ulcer as an infectious disease. In a recent telephone survey of
ordinary Americans' views of what causes an ulcer, the authors seemed
to consider the widespread belief in a psychological component
tantamount to a superstition deserving eradication.3
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