Psychosomatic Asthma and Acting Out—A Case of Bronchial Asthma that Developed De Novo in the Terminal Phase of Analysis1

Over a fifteen-year period I have analysed four adult patients with bronchial asthma as well as seeing many asthmatics in consultation and treating several in psychotherapy. The case that I am presenting in this paper, however, came as a surprise. The patient, who had no previous history of asthma, developed symptoms of bronchial asthma in the terminal phases of her analysis. The asthmatic attacks, some seventeen in all, responded to analysis; the patient terminated treatment successfully, free of asthma. It will, of course, be many years before a full follow-up on such a case can be made. In this paper, I shall focus on the genetics and dynamics underlying the asthma and in particular try to explain why the asthma did develop in this patient instead of another symptom.2

The patient, a 25-year-old woman, came to analysis with intense oral conflicts. An alcoholic who drank herself into a stupor every evening after work, she was severely depressed and suicidal. She lost one job after another. Behind a façade of helpless childlike behaviour was masked an overwhelming oral greed. Denial and exhibitionism characterized her neurotic parents' behaviour as she grew up. The wealthy socialite mother was an alcoholic whose drinking was denied completely by the family. The father, a very successful businessman, insisted that the family was poor and they lived in a rent-controlled building in an impoverished area. A compulsive man, he daily did exercises in the nude in ritualistic fashion in front of his wife, son, and daughter. These exercises, which were preceded by a large glass of water and followed by a copious urination dated from the time of the patient's earliest memory. The patient's brother, 2½ years her junior, developed schizophrenic symptoms in late adolescence.

The patient was a healthy but overactive child until her brother's birth, following which she became an intractable thumb-sucker. At 5 years she had pneumonia, apparently not severe enough to re