The Influence of Sociopathology in Childhood Asthma

Abstract

Asthmatic children do not constitute a homogeneous group. They show wide variations in severity of physiological involvement, in parental attitudes to the disorder and in the attitude of the child himself to his disability. Each of these factors has been shown to affect the therapeutic outcome. This paper seeks to demonstrate that in addition, adversity of life circumstances may equally influence the pattern of clinical response. Two groups of juvenile asthmatics were studied; 161 referred to a children’s hospital, and 55 accomodated within a residental open-air school. Both groups showed the characteristic alternation between relative improvement under hospital supervision or in boarding school and the tendency to relapse if discharged prematurely. Both groups were similarly comparable in their constituent physiological grades. By contrast, a much higher incidence of sociopathic stress was found to operate within the residential open-air school group than within the hospital based group, this difference being highly significant statistically. Among a number of general implications, which emerge from this study, the conclusion of most immediate import is that sociopathology, where it exists, should never be dismissed as trivial or irrelevant to the clinical course of the individual asthmatic case. On the contrary, adverse life circumstances can be shown on occasion to be as important in the genesis of clinical intractability as the more familiar variants of psychopathology based upon interpersonal or intrapsychic considerations. In effect, we have to consider the whole patient within his family and social environment rather than just his efficiency in ventilatory function if we are to achieve the optimum therapeutic response in childhood asthma.

Heterogeneity of Bronchial Asthma

“…^ . ° Psychological aspects bronchial provocation testing one can also distinguish between different reaction types ( nality patterns have concerning asthma has There is the one type with immediate reac-been discussed in many papers (6,45,46,47). In tions and the one with slowly developing ob-this discussion a clear distinction has to be made struction.…”

“…The patient with severe bronchial asthma can hardly be looked on as detached from his environment and life situation. Various environmental and social influences may have more or less impact on the disease as such, or on the patients ability to cope with the disease (30,45). Such factors should also be taken into consideration when selecting sub-populations with asthma for inclusion in various research programs.…”

Childhood asthma: family therapy as an adjunct to routine management

“…(1 0) Sociopathology Pinkerton (1970) has stated that 'adverse life circumstances can be shown to be as important in the genesis of clinical intractability as the more familiar variants of psychopathology based upon interpersonal or intrapsychic considerations'. Where such factors as broken home, death of one (or both) parents, neglect, or overcrowding, operate then the family will commonly be preoccupied with such problems.…”

Psychosomatic Inter-Relationships in the Management of Childhood Asthma

“…Such circumstances, of course, will vary in personal significance from case to case but, as a guiding principle, events leading to the breakup of normal home life for the asthmatic child, i.e. sociopathic breakdown, can exert a disruptive effect upon his clinical stability at least equal to the more covert tensions inherent in family dynamics [Pinkerton, 1970].…”