ASTHMA IN CONTEMPORARY MEDICINE AND PSYCHOANALYSIS

A fairly uncommon disease in 1900, a century later asthma represented a growing international health problem. Although the early psychosomatic models proposed by Alexander, Fenichel, and other first and second generation analysts were eventually supplanted, numerous research efforts in a variety of disciplines have failed to develop a comprehensive understanding of the disorder. Although asthma is treatable as a chronic condition, it remains poorly understood.

The original psychoanalytic research into asthma in American medicine represents a historical point of reference in subsequent reviews of the literature. But from a medical point of view, its specific hypotheses could not be easily refined for further research, while typology of the disorder itself changed considerably. In the mid-twentieth century Hans Selye's holistic concept of stress created grounds for a macrocosmic explanation that ultimately proved valuable, if unquantifiable. At the same time, investigations into the physiology, immunology, and genetics of asthma all yielded significant, though sometimes conflicting, results. Although this research helped create a pharmacological armamentarium for palliative treatment, studies in all these areas only reinforced the hypothesis that psychological factors play significant roles in asthma, which continues to qualify as a psychosomatic disorder. In this context, psychoanalysis remains a plausible treatment for reducing symptomatic attacks and alleviating frequently comorbid conditions, such as anxiety and depression, as do other modalities, including relaxation therapy, hypnosis, and other types of psychotherapy.

More recent psychoanalytic conceptualizations of asthma include work by Judith Mitrani (1993) from a post-Kleinian perspective; she describes asthma as one of a number of disorders that in some cases may be viewed as arising from persistent primitive mental states in the context of what Esther Bick terms "adhesive identification."

John Galbraith Simmons

See also: Asthma; Adhesive identification; Psychosomatic.

Bibliography

Fenichel, Otto. (1945). The psychoanalytic theory of neurosis. New York: Norton.

Gregerson, M. Banks. The curious 2000-year case of asthma. Psychosomatic Medicine, 62, 816-827.

Mitrani, J. (1993). "Unmentalized" experience in the etiology and treatment of psychosomatic asthma. Contemporary Psychoanalysis, 29 (2), 314-342.

Wright, R. J., Rodriguez, M., and Cohen, S. (1998). Review of psychosocial stress and asthma: an integrated biopsychosocial approach. Thorax, 53, 1066-1074.