Studies on the Physiology of Awareness

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Abstract
Summary Thirty selected patients suffering from undisputed attacks of bronchial asthma were investigated medically, by clinical examination and a number of pathological and radiological techniques, and psychiatrically by a series of interviews during the course of psychotherapy. Twenty-five of these patients were also examined by a technique of spectroscopic oximetry, readings being taken frequently during the course of a psychiatric interview. Medically, it was found that a past history of pertussis or other severe chest infection had occurred in some 60 per cent of the patients, other "allergic" affections in 20 per cent, and a family history of such affections in 50 per cent. Psychiatrically, 75 per cent of the patients showed evidence of an affective disorder (depression) and 50 per cent of their near relatives also had some mental instability. Physiologically, oximetric measurements showed the basal, resting arterial oxygen saturation levels of the blood of asthmatic patients to lie in the low normal range of 94.5 per cent. Their efficiency scores similarly were low, approaching but not reaching those of other physically or neurotically ill patients. Evidence is presented which suggests the following conclusions regarding the nature and mechanisms underlying the asthma attack: (a) Pent-up emotional tension is accompanied by anoxemia. This may be present as such or may be inhibited in suitably predisposed subjects by the homeostatic production of asthmatic dyspnea. (b) Simulated asthmatoid breathing actually increases arterial oxygen saturation levels. (c) The anoxemia accompanying emotional tension can be overcome by means of the motor expression of the emotion, i.e., by weeping, laughing, the acting out of anger, confession-or by asthma, (d) A condition resembling neurogenic shock exists as an alternate of the asthma attack under conditions of intense emotion, (e) Depression and rage predominate as the affects associated with asthmogenic patients. Their evocation at psychiatric interview produces quantifiable intensities of anoxemia equivalent to those induced when significant interpersonal relationships are discussed, (f) Bronchial asthma may alternate with clinical depression when stress is brought to bear on predisposed subjects. The interrelationships between these findings and the known psychophysiology of bronchial asthma are discussed.

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