Reflections on the Psychoanalytic Treatment of Patients with Bronchial Asthma

BRONCHIAL ASTHMA IS FAR MORE WIDESPREAD THAN IS APPARENT. It is not an infrequent condition in patients who are in psychotherapy or analysis for neurotic or characterological difficulties. Analysts whose patients present with physical symptoms, such as asthma, often regard these illnesses as external to the analytic situation and refer their patients for organic therapeutic intervention, dismissing the psychic meaning of the specific diseases. The internists frequently report that their asthmatic patients seem to them to be free of neurotic difficulties. This is not surprising since the intrapsychic needs of asthmatics may be handled symbolically and via fantasy by the somatic illness itself. Furthermore, during severe attacks, asthma functions in additional ways: (1) There is a narrowing cathexis of all aspects of life, as the patient focuses on the need to breathe. (2) In underlyingly phobic individuals, severe attacks necessitate and justify remaining homebound. (3) Analysts become partially decathected, and transferences are temporarily less workable. (4) The fantasies associated with the asthmatic process become further removed from consciousness. One of the aims of this paper is to demonstrate the nature of the relationship between asthma and intrapsychic conflict. This essay addresses some of the technical aspects of psychotherapy and compares the different goals of