A Case of Smoke Phobia*

Otto W. is a twenty-three year old professional pianist. He has suffered for the past seven years from an unusual phobia; that of fear of the sight of smoke. He fears the sight of smoke because it instantly provokes a most intense pain in one of the eyes, sometimes the left and sometimes the right, which, when once started, may endure for several hours and exhaust the patient from its torturing effects. He was examined by a number of the great eye specialists in Vienna, but all of them, he says, were at a loss to know what the exact nature of his condition could be and were unable to do anything for him. One of the specialists even diagnosed his case as being trachoma.

The pain may be provoked by any sort of association with smoke or by anything that may irritate the face or nose. Shaving is thus a great source of annoynance; the irritation resulting therefrom induces pain at once in one of the eyes. Before entering a barbershop, he looks carefully in all directions to see if there is a smoker in sight. If he sees anyone smoking he must wait till the next day. If a smoker enters the shop while he is there, he suffers the greatest of anguish. Cold air or a sharp breeze touching his face after shaving gives rise to great pain in the eye. In this way a strange compulsion system almost arose; when he felt a particularly chilly blast of wind strike his face, he would turn his back to it and take a certain number (7) of steps backward and then a certain number (10) forward to get rid of the disturbing effects of the imagined irritation. Any irritation of the nose may also cause pain in the eye. He cannot tolerate the odor of perfume, especially if it is a bit sharp. One day his wife burned a rag with lysol on it in the stove of the sleeping room. A strong odor of lysol persisted there for several days. After that, he was unable to sleep in this room, for he assumed that the odor was still present, but imperceptible.