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Psychosomatic Medicine 19:466-485 (1957)
© 1957 American Psychosomatic Society

Sources of Tension in Bronchial Asthma

A Study of Forty Patients: Notes on Mood, Self-Image, and the Role of the Voice

PETER HOBART KNAPP M.D.1 and S. JOSEPH NEMETZ M.D.1

1 Departments of Psychiatry and Medicine of the Boston University School of Medicine, Boston, Mass.

In 40 chronic, nonseasonal asthmatics, we investigated sources of emotional tension described by other observers; as well as certain sources which appeared prominent in our material.

In respect to ordinal position in the family or age of younger siblings, they did not differ significantly from a comparable group of psychoneurotic patients. In comparison with the latter group, our subjects had married significantly more often, even though they were just as disturbed. In marriage, in treatment, and in other relationships, they showed an intense clinging dependence, which frequently constituted a major area of conflict.

Other sources of tension were their oral needs, which were often chronically unsatisfied, leading to depression and shame; closely related nasal and olfactory preoccupations; also concerns over crying, concealment, confession, and speech--not only for its content but for its motor and acoustic values. A final source for more than half our group seemed to be their previous exposure to respiratory illness in important persons. More often than not such illness was of a sort generally acknowledged to be nonallergic.

Each of these factors was important for many individuals but none had universal significance. We suggest that the oral-nasal-vocal-respiratory apparatus may be sensitized in different ways for different subjects, and that one such way may be by identification with the respiratory patterns of other individuals.

Submitted on April 25, 1957




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