Bronchial asthma is a dramatic syndromevisible, audible, and frequent. For years, clinicians, and later research workers, have suspected that emotional factors played a role in it. Search for these has paralleled, in ways recapitulated, work done with other so-called "psychosomatic states." Yet, like them, the disorder presents unsolved problems, which concern the personality of its sufferers, the precise sources of their emotional tension, and the ways by which such tension may lead to physiological derangement.We will defer our answer to the latter questions and deal in this paper with the first one, which is broad and deceptively simple: What sort of person develops asthma? The From the

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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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