Some Observations on a Case of Vertigo1

At the age of 45 a married man, who despite lifelong neurotic difficulties had always enjoyed excellent physical health, began to suffer from attacks of vertigo, in which the world appeared to be rotating on a vertical plane in front of him. During and intermittently between attacks he was deaf in his left ear and suffered from tinnitus. Some attacks lasted only a few minutes, others for as long as twenty-four hours. The more severe ones were accompanied by vomiting and signs of vasomotor collapse. When he was examined by an otologist the only demonstrable physical signs were slight middle-ear deafness on the left side, insufficient to account for the degree of deafness subjectively experienced, and a perforated left ear-drum, which was presumed to be the result of otitis media in childhood. The occurrence of the classical triad of symptoms, vertigo, deafness, and tinnitus in association with typical physical signs, led to a diagnosis of Ménière's Disease being made.

A year later, for reasons apparently unconnected with his attacks of vertigo, he was referred to me for analysis. Fairly soon after beginning treatment it became clear to both of us that the attacks formed an integral part of his neurosis and that the vertigo, tinnitus, and deafness all had a psychological meaning.

By this I do not mean that they were purely psychological phenomena lacking any organic basis. There were, on the contrary, several reasons for supposing that the vertigo at least was a physiological event, presumably due to central, psychic stimuli acting on a hypersensitive inner ear. He certainly suffered all the usual physiological concomitants and aftereffects of true vertigo, such as vomiting and pallor, and although a certain psychological state was a necessary pre-condition for an attack, the immediate precipitating factor was often a physical stimulus such as blowing his nose violently. His physiological threshold for vertigo was undoubtedly unusually low, but vertigo-inducin