From the record of a man with moderately severe perennial asthma, psychoanalytic process notes just before 37 reported episodes of asthmatic exacerbation were compared with process notes from 44 periods when he was asthma-free. All were edited to remove medical cues. Two psychoanalyst judges had limited statistical success in separating "asthmatic" from "nonasthmatic" contexts, doing best when subjective confidence was high and after feedback. Two medical judges had less "training," examining only the last 50 occasions. They were not helped by feedback and followed a slightly different, less successful pattern of rating, mainly searching for contaminating medical information. Evidence of this was found in eight instances, although only three of these actually proved to be "asthmatic." Post hoc study of both successful and unsuccessful judgments helped refine the hypothesis that stress, emotional arousal, and failing defenses activate a postulated "primitive core" of unconscious conflict to form the psychological context of asthmatic exacerbations.
A 33-year-old male, severely ill with bronchial asthma, suddenly died on the day he was to resume psychoanalytic treatment after a summer interruption. Postmortem examination showed diffuse bronchiolar obstruction.Prolonged psychoanalytic therapy had led to many gains but had resulted in a sort of "interminable treatment." Steroid medication, which he had also received, may palliate but not resolve this type of therapeutic dilemma.His psychological structure was melancholic. Manifest helpless and dependent attitudes were accompanied by secret craving for erotized excitement and explosive urges toward violence. His final remarks in psychoanalysis were about a murderer who had been detected by analysis of his painting of a beautiful woman. These associations suggested an attempt to solve intolerable conflict over loss by maintaining an idealized image of his mother, an effort jeopardized by hidden destructive impulses. Cases of typhoid take the following course: When the fever is at its height, life calls to the patient: calls out to him as he wanders in his distant dream, and summons him in no uncertain voice. The harsh, imperious call reaches the spirit on that, remote path that leads into the shadows, the coolness and peace. He hears ihe call of life, the clear, fresh, mocking summons to return to that distant scene which he had already left so far behind him, and already forgotten. And there may well up in him something like a feeling of shame for a neglected duty; a sense of renewed energy, courage, and hope; he may recognize a bond existing still between him and that stirring, colourful, callous existence which he thought he had left so far behind him. Then, however far he may have wandered on his distant path, he will turn hack-and live. But if he shudders when he hears life's voice, if the memory of that vanished scene and the sound of that lusty summons make him shake his head, make him put out his hand to ivard off as he flies forward in the way of escape that has opened to him-then it is clear that the patient will die.
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