The Context of Reported Asthma During Psychoanalysis

Abstract

From the record of a man with moderately severe perennial asthma, psychoanalytic process notes just before 37 reported episodes of asthmatic exacerbation were compared with process notes from 44 periods when he was asthma-free. All were edited to remove medical cues. Two psychoanalyst judges had limited statistical success in separating “asthmatic” from “nonasthmatic” contexts, doing best when subjective confidence was high and after feedback. Two medical judges had less “training,” examining only the last 50 occasions. They were not helped by feedback and followed a slightly different, less successful pattern of rating, mainly searching for contaminating medical information. Evidence of this was found in eight instances, although only three of these actually proved to be “asthmatic.” Post hoc study of both successful and unsuccessful judgments helped refine the hypothesis that stress, emotional arousal, and failing defenses activate a postulated “primitive core” of unconscious conflict to form the psychological context of asthmatic exacerbations.