Acute Bronchial Asthma

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Abstract
Four hundred and six asthmatic attacks occurred in 9 patients with severe, chronic bronchial asthma who had been studied intensively in psychiatric or (in two instances) psychoanalytic interviews. Feelings and fantasies concomitant with asthma tended to be dominated by absorption in the physical illness. At times this appeared to serve as a protection against obvious psychological problems. In somewhat more than half of the episodes other emotional concomitants appeared after asthma had become established. The vast majority of these were depressive--a sense of sadness, helplessness, and hopelessness, at times accompanied by ideas of a dangerous or poisonous inner substance. Contrasting with these, in somewhat less than half of the attacks there were prodromal emotionaxl manifestations which preceded and led directly into acute asthma. The principal prodromal feature was excitement, usually with an angry or anxious coloring, occasionally elated and erotic, resembling a miniature hypomania. We suggest that in asthma an initial phase of drive arousal and excitement is followed by a later phase of drive restraint and inhibition. Antecedent changes in the environment occurring in the 48 hours prior to an attack varied widely. Eight categories could be discerned, the two most prominent being loss of a person and closeness to a person. Most of the categories could be divided into one of two groups: events which seemed to lead to frustration of powerful impulses and those which seemed to stimulate erotized or dangerous wishes. We postulate that both types of event, although neither is of itself specific for asthma, might activate a respiratory apparatus having both intake and expulsion functions, which has become vulnerable to psychological as well as physiological stress.

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