NEUROTIC ASTHMA AND THE WILL
"Great minds of partial indulgence
To their benumbed wills."
_Troilus and Cressida_.
In closing a clinical lecture on bronchial asthma at the University of
Marburg some years ago, Professor Friedrich Mueller, who afterwards
became professor at Berlin, said, "Each asthmatic patient is a problem
by himself and must be studied as such; meantime, it must not be
forgotten what an important role suggestion plays in the treatment of
the disease." This represents very probably the reason why so many
remedies have been recommended for asthma and have proved very
successful in the hands of their inventors or discoverers as regards
the first certain number of patients who use them, and yet on
subsequent investigation have turned out to be of no special
therapeutic value and sometimes indeed to have no physical effect of
any significance.
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Of course this is said with regard to neurotic asthma only, and must
not be applied too particularly to other forms of the affection,
though there is no doubt at all that the symptoms of even the most
severe cases of organic asthma can be very much modified and often
very favorably, by suggestive methods.
The principal feature of asthma is a special form of severe difficulty
in breathing. It is known now that the beginning of the affection is
always as Strumpell said, "an extensive and quite rapid contraction of
the smaller and smallest bronchial branches, that is the terminal
twigs of the bronchial tubes." It is not so much air hunger, though
there is, of course, an element of that because the lungs are not
functioning properly, as an inability to empty the lungs of air
already there and get more for respiratory purposes. The spasm in
asthma has a tendency to hold the lungs too full of air and produce
the feeling of their getting ever fuller and fuller. What the old sea
captain said in the midst of his attack of asthma, when somebody
sympathized with him because he had so much difficulty in getting his
breath, was that he had lots of breath and would like to get rid of
some of it. {209} He added, "If I ever get all this breath that's in
me now out of me, I'll never draw another breath so long as I live, so
help me." The respiration spasm is usually at full inspiration and the
effort is mainly directed toward expiration and expulsion of air
present using the accessory respiratory muscles for that purpose.
The picture of a man suffering from asthma is that of a patient so
severely ill as to be very disturbing to one not accustomed to seeing
it. It would be almost impossible for any one not used to the attacks
to think that in an hour or two at the most the patient would be quite
comfortable and if he is accustomed to the attacks, that he will be
walking around the next day almost as if nothing had happened. All
that the affection consists in is a spasm of the bronchioles and as
soon as that lets up, the patient will be himself again. Some material
may have accumulated during the time when the spasm was on which will
still need to be disposed of, and there will be, of course, tiredness
of muscles unaccustomed to be used in that special way, but that will
be all.
We are still in the dark as to what causes the spasms but undoubtedly
psychic factors {210} play an important etiological role. For a good
many people, there is a distinct element of dread as the immediate
cause of their asthmatic attacks. Some people have it only when they
have gone through some disturbing neurotic experience. Occasionally it
is the result of physical factors combined with some psychic element.
Cat asthma is not very uncommon and occurs as a consequence of some
contact by the individual with a specimen of the cat tribe though
usually the large cats, the lions and tigers, do not cause it. There
is nearly always, in those who are liable to this form of asthma, a
special detestation of cats. There is probably some emanation from the
animal which produces the asthmatic fever, just as is true also of
horses in those cases where horse asthma occurs. In a few of these
latter cases, however, it was noted that the horse asthma did not
begin until after there had been some terrifying experience in
connection with the horse, as a runaway, a collision, or something of
that kind.
Any one who sees many asthmatic cases inevitably gets the impression
after a time that their very dread of the attacks has not a little to
do with predisposing them. {211} Occasionally the dread is associated
with some other organic disturbance, either of heart or kidneys, or
oftener still, with some solicitude with regard to these organs and
the persuasion that there is something serious the matter with them,
though there is at most only some functional disturbance. This is
particularly true of cases of palpitation of the heart where there has
been considerable dread of organic heart disease. In a certain number
of these cases, there is some emphysema present, that is,
overdistention of the lungs, such as is seen in high-chested people.
Owing to the long anterio-posterior diameter of the chest and the fact
that as a consequence it is nearly as thick through as it is wide,
this form of chest is sometimes spoken of as barrel-chest. Patients
who have it are particularly likely to suffer from asthma if they have
any dread of heart trouble or if they are of a nervous constitution.
I have known people with the dread of the dark to get an attack of
asthma if they were asked to sleep alone after having been accustomed
for years to sleep with somebody in the room. I have known even a
physician to have attacks of asthma of quite typical character as the
result of a dread of being {212} out after dark which had gradually
come over him. I have had a physician patient who was very
uncomfortable if alone on the streets of New York, even during the
day, and whose symptoms at their worst were distinctly dyspneic or
asthmatic. He used to have to bring his wife with him whenever he came
to see me for he lived out in one of the neighboring towns, because he
was so afraid that he might get an asthmatic attack that would
overcome him and he would feel helpless without some one to aid him.
In practically all these cases, the treatment of asthma becomes
largely that of treating the accompanying dread. Once the acute
symptoms of the attack itself manifest themselves, they have to be
treated in any way that experience has shown will relieve the patient.
The general condition, however, needs very often an awakening of the
will to regulate the life, to get out into the air more than before,
to avoid disturbing neurotic elements, and worrying conditions of
various kinds. Thin people need to be made to gain in weight, using
their will for that purpose; stout people who eat too much and take
too little exercise need to have their lives {213} regulated in the
opposite direction. In the meantime, anything that arouses the patient
to believe firmly that his condition will be improved by some remedy
or mode of treatment, will help him to make the intervals between
attacks longer and the attacks themselves less disturbing. The will
undoubtedly plays a distinct role in this matter which patients who
have been through a series of asthmatic attacks recognize very
clearly.
The many remedies for asthma which have been lauded highly even by
physicians, and that have cured or relieved a great many patients and
yet after a while have proved to be without much beneficial effect,
make it very clear how much the affection depends on the will power to
face it and throw it off. Nothing will be curative in asthma unless
the patient has confidence in his power and uses his own will energy
to help it. He must overcome the element of dread which occurs in
connection with all asthmatic attacks, even those due to organic
disease of heart or kidneys. No matter how frequent the attacks have
been, there is always an element of fright that enters into an
affection which interferes with the respiration. This must {214} be
overcome by psychic means to help out the physical remedies that are
employed. Sometimes the psychic remedies will succeed of themselves
where more material means have failed completely.
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