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February 25, 1974. THE ROLE OF PRIMAL SCENE AND SADOMASOCHISTIC FANTASIES AS PRECIPITANTS OF ASTHMA ATTACKS IN AN ADOLESCENT GIRL. Cecilia K. Karol, M.D.
Dr. Karol described the analysis, over a period of four-and-a-half years, of a thirteen-year-old girl who had suffered from asthma since age four. Throughout the analysis, sadomasochistic fantasies and dreams were revealed, and sadomasochistic behavior at home and in the transference were evident. Several years after beginning treatment, the patient recalled observing parental intercourse at age four, shortly before her first attack of asthma.
The patient's fantasies and associations as well as the quality of her object relations illustrated the pervasive influence of magical thinking and sadomasochistic fantasies on the subsequent attempt at resolution of her Oedipal conflict. The asthmatic attacks, with wheezing and fear of suffocation, were seen to be at the confluence of a variety of impulses, including identification with both the victim and the aggressor—intercourse was perceived as a sadistic attack; displacement from the genitals to the respiratory apparatus; separation anxiety stemming from her own unacceptable aggressive impulses.