Monday, March 20, 2017

1951: Alexander defines asthma as one of seven psychosomatic disorders

The idea of asthma as a nervous disorder is an age old concept that was postulated by various physicians over the years. This "nervous theory of asthma," or asthma nervosa, as it was so often called, gained momentum among leading physicians. This idea became deeply embedded in the minds of asthma physicians in the 1850s when a famous asthma doctor by the name of Dr. Henry Hyde Salter wrote on the subject.

The idea seemed to wane somewhat in favor of other theories at the turn of the 20th century, only to gradually begin its comeback in the 1930s after a famous German psychoanalyst by the name of Franz Alexander began talking about asthma as a psychosomatic disorder.

According to dictionary.com, psych is a Greek root for the mind and somatic means of the body or physical. Psychosomatic medicine, therefore, is the study of physical conditions that are thought to be caused by strong emotions of the mind, such as anxiety, stress, and depression.

In 1920, Hans Alexander (originally from Hungary) became the first student at the Berlin Psychoanalytic Institute, an organization whose goals were to train psychoanalysts, offer psychoanalytical treatment for those suffering from neurosis (manic depressive illness), and to conduct research on the subject. Their ultimate goal was to continue the great works of Dr. Sigmund Freud (1856-1939). (1, Alexander.)

As a quick side note, Sigmund Freud started the study of psychoanalysis around the turn of the 20th century. This involved a patient lying on a couch and talking freely about whatever comes to mind, while the therapist analyzes what the patient says. Freud was infatuated with sexual desires, and he believed males had an inert sexual desire for their mothers. Perhaps out of this is where Alexander derived some of his ideas about asthma.

Alexander and his psychoanalyst colleagues became infatuated with psychosomatic disorders. Among their works was to inspire an uptick in the idea that asthma was a nervous condition. It was here that the idea of asthma as a "suppressed cry for the mother" was born. 

This research was lead by Alexander, who "advanced the hypothesis that bronchial asthma might result, in part, from a threat of detachment from the mother." (1, Alexander)

Dr. Alexander, along with many of his colleagues, migrated to the United States. (1, Alexander) (3, page 771) He moved to Chicago where he set up a psychoanalytic workshop similar to what he left behind in Germany. His work here would inspired interest in psychosomatic medicine in the United States, including the of asthma as a psychological disorder. (1, Alexander.) 

By the 1930s and 40s, the idea that asthma was an allergic disorder was another theory that heavily influenced physicians at this time. While most physicians believed asthma was triggered by emotions, the majority of their efforts in the clinical setting were aimed at gaining control of allergies. (8, page ?)

The psychosomatic theory, combined with the allergic theory, was what ultimately lead the idea of parentectomy during the 1940s. This was an idea of abducting asthmatic children from their homes (with the permission of their doctors and parents) and placing them in asthma institutions, such as the one in Denver, Colorado. 

In 1950, Alexander would list what he considered to be the seven psychosomatic disorders: (2, page 771)
  1. Psychosocial dwarfism (sometimes known as Grave's disease, hyperthyroidism)
  2. Ulcerative colitis
  3. Hypertension (high blood pressure)
  4. Peptic ulcer
  5. Dermatitis
  6. Eczema
  7. Asthma
Alexander essentially believed that, along with actual organic (of the body) processes, these disorders may also be caused, or exacerbated, by strong emotions such as anxiety and stress. (8, page 222-223)

He essentially noted that few people with these seven disorders (or very few asthmatics) received "psychoanalytic therapy." Because of this fact, he was unable to describe the benefits of this type of therapy on any of these disorders, including asthma. (6, page 222-223)

This psychosomatic view of asthma became well accepted among the medical profession. And, as we have observed throughout this history, once something becomes embedded in the mind's of physicians, it's difficult to extricate it out of their heads. It's just the way people are. It's just the way the medical profession is.

In 1968, Alexander linked the seven disorders with a personality conflict. For instance, asthma was a constant yearning for the mother or the fear of losing the mother. Wheezing was a sign that this person was having this conflict. The treatment was 

I think that Gregory K. Fritz describes it best. He said: 
I was a general psychiatry resident in 1974 and new to the psychiatric consultation service at a large public hospital. As I was preparing to do one of my first consultations, my attending, in an effort to be helpful, said, "You're in luck: An asthmatic patient. Asthma is a psychosomatic illness." He went on to describe the intrapsychic conflict that was said to be the psychological cause of asthma (a hostile/ dependent relationship between mother and child; the wheeze was a suppressed cry for nurturance.) I remember being both relieved and skeptical that such rote theory would make my job as a psychiatric consultant so simple."  (7, page xix)
Dr. Fritz said he went on to spent the next 30 years as an adolescent psychiatrist at various children's hospitals and as a researcher for pediatric illness. He explained how the next 30 years saw major advances in the relationship between the mind and the body. This would include asthma.

References:
  1. Alexander,  Ilonka Venier, ""The Life And Times Of Hans Alexander: From Budapest To Alexander,"2015, Karnac, Great Britain
  2. "Psychosomatic." Dictionary.com. http://www.dictionary.com/browse/somatic. accessed 3/19/17
  3. Craighead, Edward W., Charles B. Nemeroff, editors, "The Concise Corsini Encyclopedia of Psychology and Behavioral Science," 3rd edition, 2004, Wiley, page 771
  4. "Franz Alexander. Britannica.com, https://www.britannica.com/biography/Franz-Alexander#ref838920, accessed 3/19/17
  5. Alexander, Franz, "Psychosomatic Medicine: It's Principles and Applications," 1951, Pediatrics, volume 8, issue 6, 
  6. "Book Review. Psychosomatic Medicine: It's Principles and Applications," California Medicine, 1951, March, 74 (3): pages 222-223
  7. Shaw, Richard J., David R. DeMaso, editors, "Textbook of Pediatric Psychosomatic Medicine," 2010, American Psychiatric Publishing, page xix
  8. Jackson, Mark, "Health and Modern Home," 2007, Routledge

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