ON BRONCHIALASTHMA:A CASEREPORT B Y ALBEt~T E. SCtIEFLEN~ M. D.

Emotional disturbances ~n asthma have been reviewed and discussed by such authors as Alexander, 1 French and Alexander/ Dunbar, ~and Weiss? Weiss felt that the attack represented a suppressed cry for the mother. Alexander emphasized the "repressed dependency upon the mother," rejection or frustration, as a precipitating cause, and the termination of an attack with confession or crying. He poin.ted out the respiratory difficulties that may be seen when a child attempts to suppress crying.

CAs~ R.EPoR:r Mary was born in rural Delaware in 1904. Her father used alcohol excessively, and the mother had heart disease. Mary was the youngest of four children. One brother was seven, a sister five, and another brother three years older. The older boy had asthma. The older sister gradually assumed responsibility for the household and for Mary. The brothers have detached themselves from the family. The writer can give no objective portrait of these people. Mary alternately idealizes and berates them for their intolerance and rejection. To the sister, who is apparently identified with the mother, Mary is ambivalent and overdependent, and seems to have been for years. Mary didn't like school. She "couldn't learn," made poor progress, and quit at the legal age. She felt rejected by her teachers and once transferred to parochial school to "get more attention from the teachers." As an adolescent she was evidently overmodest, passive, outgoing, unhappy, "easily upset, inclined to cry, sickly, and pampered." The mother died when Mary was 16. The sister assumed responsibility mad Mary fell into conflict with her. She became sexually promiscuous and, on occasions, drank heavily. After a day's drinking, it is said that she was "sick for days." She once had .a lover's name tattoed on her thigh and she feels this makes her unlovable. At 20 she had a hysterec{omy, presumably because of pelvic inflammatory disease. In Mary's early 20's, the si,ster married and left the house. The patient became the father's housekeeper. She did a very poor job --between wandering away, apathy, and parapraetic behavior or errors in judgment. She developed "spells" of falling and thrash-

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ing in a clear state of consciousness, and these still occur, predictably, when she is rejected. She became increasingly withdrawn, preoccupied, autistic, and inappropriate in affect. At the age of 35, she was admitted to a colony for the feebleminded. Her Stanford Binet was 51 ;the Stanford Vocabulary 62, and the Army Performance Test 47. When "frustrated," she h a d a "spell," but she achieved a semi-employee status and commendably carried out her duties in the care of children. She was very dependent on the matron and untiring and ,solicitous to her small charges. At the age of 41, however, she developed the delusion that she had killed the superintendent. She became depressed, self-deprecatory, and agitated. She plucked out her eyebrows. She was transferred to Delaw4are State Hospital, Farnhurst, Del., in 1945. On arrival she was mute, stuporous, and incontinent. She exhibited waxy flexibility. In the next five years there were repeated catatonic episodes, which responded to electric shock. During remissions, she was childish, overdependent, and autistic, but, when praised, worked diligently in the ward kitchen as a waitress. Since 1951, no catatonic symptoms have been observed. She is still childish and autistic, and she exhibits swings from mild hypomania to mild depression. She visits 'her sister on week-ends. Every Monday, She decides the sister doesn't care for her and resolves never to go home again; .and every Friday, she accuses the physician of disinterest and asks to be discharged. For some 10 months, she became~increasingly dependent upon the writer. She sought my attention in a hundred childish ways. She insisted upon having her room next to the therapy office, and she jealously watched each patient entering for interview. She fantasied that I kissed them. The slightest Iejection resulted in a "thrashing spell," sulking or depression, anger displaced to another patient, or a host of somatic complaints. H e r dependency or transference, how.ev,er, w a s m o r e intense to m y wife, w h o m slve had n e v e r met. Incessantly she extolled virtues she presumed my wife to have, remarked on the good fortune of my children in having such a mother, identified with them, and begged to be taken into the household--presumably as a maid. In January 1952, Mary had coryza, and I expressed concern over a cough. She developed a "whoop" with laryngeal stridor. She produced it regularly and almost exclusively when I was with an-

652

OiW BROI~C]~IAL

A S T I I M A : A CASE REPORT

other patient in the therapy office. One physician thought she might have whooping cough. On March 14, another patient began working at my home as a maid. During the lunch hour Mary heard this and realized, though I had repeatedly prepared her, that she was not to be "Mrs. Scheflen's maid." She looked for the other p a t i e n t in order to attack her, then asked the nurse to allow them to be roommates. She complained bitterly to the attendants about my decision, then went to her room and went to bed. After lunch, I returned to my office and began a therapeutic session with another patient. There was a loud crying, exactly typical of the hungry i/nfast, and I found it was coming from Mary's room. The nurse and three attendants later revealed that they had at first shared my belief that someone had smuggled an infant into the ward: When I entered the room, Mary stopped this crying and began deep inspiratory gasps with laryngeal stridor. She was thrashing about in one of the "spells" described previously. I firmly held her face and called her name. She replied,-"I'm all right. Leave me alone. I'm just dreaming." I asked her what she was dreaming, but she refused to answer. I confronted her with the fact that she was feeling rejected. At this point, she began to have wheezing typical of bronchial asthma. She said, "No, I don't care." An attendant said, "Don't lie to the doctor, Mary, you do care." Mary's wheezing b,ecame viol,en~t. It .,was typically asthmatic. I put my ear to her chest and heard classic sibilant rules. She managed to gasp out, "It's my sister. Last week-end she told me to stop laughing. She said I act like a child. She won't take me home if I act like that. I won't go home. I'll stay right here." At this point she began to sob and produced tears. The wheezing iramediately stopped. It lasted the length of the verbatim quotations. Between sobs she said, "Let me up. I have work to do in the dining room." She broke away forcibly and ran out of the room. In May, she learned I was leaving for another position. She begged me to "adopt" her and take her with us. When I tried to explain that I could not, she had another asthmatic attack and "thrashing spell." She denied previous attacks and no history of them could be obtained. Since I knew I was leaving I resisted the temptation to explore the personality and history i n t,herapeutic sessions.

ALBERT E. S C H E F L E ~ ~ . D.

653

SUMk~cIARu

The history of a patient of deficient intelligence who had had a catatanic t:/pe of schizophrenic breakdown is recorded. She was extremely dependent and had an intense transference to the physician and his wife. When rejected, she cried with expiratory screams exactly like an infant, and then had a classical attack of bronchial asthma. The asthma immediately disappeared when she began ~o sob and shed tears. During the attack, she blamed her sister for rejecting her. Later, in a similar situation, she had another attack. 111 North 49th Street Philadelphia, Pa. REFERENCES 1. Alexander, F.: Psychosomatic Medicine. Page 133. Norton. New York. 1950. 2. French, T. M., Alexander, F., et al.: Psychogenic Factors in Bronchial Asthma, Parts I and II. Psychosom. Med. Monographs IV and II, Nos. 1 and II. National Research Council. Washington, D.C. 1941. 3. Dunbar, F. : Psychoanalytic notes relating to syndrcme of asthma and hay fever. Psychoan. Quart., 7:25, 1938. 4. Weiss, Eduardo: Psychoanalyse ernes Falles yon Nervoesem Asthma. Int. Ztschr. f. Psychoan., 8:440, 1922.