Asthma, Melancholia, and Death

Abstract

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.