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Psychosomatic Medicine 28:134-154 (1966)
© 1966 American Psychosomatic Society

Asthma, Melancholia, and Death

II. Psychosomatic Considerations

PETER H. KNAPP M.D.1, HERMAN E. CARR JR M.D.1, CECIL MUSHATT M.D.1, and S. JOSEPH NEMETZ M.D.1

1 Division of Psychiatry, Boston University School of Medicine

During two periods, serial 24-hr, urine levels from a psychoanalytic patient with severe, ultimately fatal asthma were compared to "blind" ratings of four emotions (anxiety, anger, sadness, and erotic affect) and four complex, largely unconscious constellations of self-other fantasy ("Progressive" compliance; "Depleted" emptiness; "Somatized" bodily preoccupation; and "Perverse-pseudogratified" impulsivity).

The 17-OHCS output fluctuated and, at times, was abnormally high, probably as a result of repeated ACTH treatment and possibly also as part of emotional turmoil, which may characterize asthmatic relapse.

"Perverse pseudogratified" and "anxiety" ratings showed a significant inverse relationship to 17-OHCS output in the first period of study.

An additional variable, "Loss of Defensive Control," rated during the second period, showed significantly positive correlation with 17-OHCS levels.

Fragmentary data from five further asthmatic fatalities and from cases reported by others suggest that, although specific biologic factors may play a role, so may overt despair and hidden self destructiveness.

Autopsy in ours and other cases has generally shown diffuse bronchiolar obstruction by thick mucus. Explosive parasympathetic nervous influences, possibly leading to cardiac dysrhythmia, may act in concert with the inflammatory pulmonary process to produce a rapidly fatal course.

Submitted on June 29, 1965




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