Asthma, Melancholia, and Death

Abstract

During 2 periods, serial 24-hr. urine levels from a psychoanalytic patient with severe, ultimately fatal asthma were compared to "blind" ratings of 4 emotions (anxiety, anger, sadness, and erotic affect) and 4 complex, largely unconscious constellations of self-other fantasy ("Progressive" compliance; "Depleted" emptiness; "Somatized" bodily preoccupation; and "Perverse-pseudogratified" impulsivity). The 17-OHCS (hydroxycorti-costeroid) output flucutated and, at times, was abnormally high, probably as a result of repeated ACTH treatment and possibly also as part of emotional turmoil, which may characterize asthmatic relapse. "Perverse pseudogratified" and "anxiety" ratings showed a significant inverse relationship to 17-OHCS output in the 1st period of study. An additional variable, "Loss of Defensive Control," rated during the 2nd period, showed significantly positive correlation with 17-OHCS levels. Fragmentary data from 5 further asthmatic fatalities and from cases reported by others suggest that, although specific biologic factors may play a role, so may overt despair and hidden self-destructiveness. Autopsy in this and other cases has generally shown diffuse bronchiolar obstruction by thick mucus. Explosive parasympathetic nervous influences, possibly leading to cardiac dysrhythmia, may act in concert with the inflammatory pulmonary process to produce a rapidly fatal course.