The object of this paper is to call attention to the psychological side of the etiology of cardiospasm, or choking ("mal de engasgo"), a subject which has not yet been approached in Brazilian scientific circles. Though not putting aside other causal elements which may have been verified and which may act concomitantly, it is the Author's opinion that choking is a psychically conditioned functional disturbance, the organic consequences of which become irreversible after a certain time. The conclusions here presented are based on material furnished by some psychoanalysed patients with dysphagic phenomena, and several cases from the child guidance clinics, amongst the problems of which there are, besides the difficulty in swallowing, anorexia and bulimia. Regarding the typical emotional attitudes forming the psychological substratum of cardiospasm, the fundamental point consists in an ambivalent position toward the objects of the exterior world, linked to the conflict that includes, on one hand, intense passive-receptive desires - which according to Alexander are also at the basis of gastric neuroses - and, on the other hand, aggressive rejection tendencies. Choking represents, then, a compromise, expressed on the oral level, between passive-recptive tendencies and active-expulsive tendencies. To this psychological situation there correspond ambiental conditions, past or present, which in a rather contradictory manner favour an attitude of infantile dependence, while at the same time they bring repeated frustrations. In general the situation is one in which a dominant mother, while overprotecting the child, is too severe with him. The overprotection centers on everything concerning food, which in this way takes on a great emotional significance. The Author reports a case which supports his point of view. This subjective and environmental picture of cardiospasm corresponds, on general lines, to two other morbid types, which are opposed to each other: anorexia and bulimia. From the psychodynamic aspect, both conditions are related to the problem of attachment and emancipation and center on the mother and on food. However, the conflict is solved, in one case, by the rejection of food, and in the other, by greed. The means here chosen are extreme. Cardiospasm (choking) is a middle way between the two. Gastric neuroses and their direct consequence, the peptic ulcer, differ from choking in the way the conflict is solved. As Alexander showed, here also there are oral receptive desires which are strongly rejected as being incompatible with the individual aspirations of independence. The solution chosen, however, s a characterological reaction which consists in an attitude of enterprise and responsibility before others. Alexander's gastric type is, therefore, more complex and less primitive: while the other types mentioned try to solve their problems on the digestive level, he tries to do it on the social level. Though he does not succeed, the expression of his failure lies essentially in the bodily disturbances which occur. An important question remains outside the scope of the Author's material: the association, which often occurs, between the megaesophagus and the megacolon. Nevertheless, he believes that both correspond to different phases of libidinal development into which enter, in different proportions, oral and anal elements. Then, he refers to the anal component which exists, to a certain degree, in the emotional structure of the cardiospasm, and which is missing in the same proportion in other disorders of the upper digestive tract. The material does not elucidate anything on heart disorders and manifestations of other organs and systems. The Author does not enter into the interpretation of the histopathological alterations, saying only that there is no contradiction in considering them merely as secondary phenomena. He ends up by mentioning that he feels that many of the obscure points which interfere with the understanding of this important chapter of Pathology will, no doubt, be cleared up when psychoanalytically orientated psychiatrists and social workers collaborate with the other students of this subject.