Sunday, March 10, 2013

2013: Is asthma really a neurosis?

In doing my asthma history, one of the first things I learned about the disease was that it was considered a nervous disorder, or a neurosis, for most of history.  When I learned this I was offended.  I was actually mad.

It brought me back to a time when I was a kid and my older brother called me a "useless waste of skin" because I was unable to play football one day.  Learning this also took me back to back to 1985 when I was a patient at National Jewish Health/ National Asthma Center, and instead of being discharged after 6-8 weeks as I was told, I was admitted to 2-May for further psychological evaluation.

The booklet for 2-may defined the unit as:  "'2-May is a 24 bed medical/ psychiatric floor divided into 2 units of 12 patients each. It is a patient care area for children who need extended treatment for psychological and family problems which may be related to chronic asthma.'" 

I had to read and sign a contract before being admitted to 2-May, and the following is what I agreed to:
  1. Better control of my asthma
  2. Work on learning to control feelings of anxiety
I had a hard time admitting the later, although I agreed to it because I wanted to avoid further debate.  Yet I really had a hard time with 2-May being referred to as a "psychiatric floor."  The irony of this is I had been seeing a psychiatrist weekly, and working with a social worker daily, and yet the transition to 2-may continued to be a major issue for me.  

In the end, though, fears don't amount to much, as I ended up liking it on 2-May.  I never accepted my psychologist, although every other part of it went rather well.  Still, when I was discharged in July of 1985, it was almost 25 years before I would talk about my time there.  I was actually embarrassed for having spent time in a psychiatric unit.  

Yet in retrospect, I see how it really benefited my life.  In retrospect, and after further studying the history of asthma, I now accept that asthma was considered a neurosis at an early age.  Scientists during the 19th century pretty much just assumed asthma was a neurosis, especially after Henry Hyde published his writings "On Asthma" in the 1950s.  Salter defined asthma as a disease of airway spasms and as a nervous disease.

As far back as the 19th century asthma physicians realized there was no permanent scarring in the lungs or anywhere else in the body of people who died of pure asthma.  There was something "invisible" going on, and the only rational way they could explain it was to call it a neurosis.  Back then, if the disease left no scars, such as epilepsy and asthma, it was a neurosis.  Even arthritis was referred to as a neurosis, because there was no underlying explanation for why it was caused.

But the immune system was not well understood until after the turn of the 20th century.  The immune system is rather invisible unless you have the ability to study and analyze the various hormones of the body, of which these physicians did not. So, in my opinion, it was fine for them to refer to it as a neurosis.  To them, any action by the immune system would simply be explained by some flaw of the mind.  

Once asthma was determined to be an auto-immune disease by the 1950s, and once it was learned that the bodies over-reaction to triggers in the environment in and around the individual, the nervous theory of asthma was disproved.  

And despite this understanding, by the 1980s it was observed by asthma physicians that poorly controlled asthma continued to effect the psychology of the person involved.  For example, if you are suffering from poorly controlled asthma and allergies, you won't be able to do things normal people do.  You won't be able to spend time with your dad in the woods.  You won't be able to participate in gym class and sports.  And when you did, you suffered as a result.  

And such suffering often results in psychological consequences.  Kids would pick on me and other asthmatics because we were different.  It was observed long ago that asthmatics tend to spend more time with women and their mothers.  It was observed asthmatics were more likely to cook and read, as opposed to do normal masculine activities.  So such hardluck asthmatics would need help catching up to his peers.

And that's what my doctors saw back in 1985.  That's what I interpret out of reading the reports of my psychologists.  Today there are much better asthma medicines, so asthma is much easier to control.  For this reason, most asthmatics shouldn't be psychologically deprived in this way.  Yet I'm sure there continue to be cases of hardluck asthma where the nervous system is involved.

For example, I continue to have anxiety.  And, based on studies that I have read, a large portion of asthmatics have anxiety.  Some studies link asthma and anxiety.  Surely the asthma attack will provoke some anxiety, but I'm talking about between the attacks.  Some modern experts believe asthma is more than just the lungs, that also involved the stomach, and the mind.  Yes, asthma continues to be a nervous disease.

So the 21st century is much like the 19th and 20th centuries where physicians and scientists continue to come up with new scientific evidence, new medicines, and new theories about the disease.  The debate as to what asthma really is may not be solved for many years to come.  

But the nervous component is obvious.  When a person is diagnosed with asthma, or has a long history of the disease, a wise physician must also consider the nervous component of the disease too.  And this is important, I think, because most people aren't open about this aspect.  Most people think of nervous disorders as bad and embarrassing, when in truth they are diseases, or, in the case of asthma, part of the disease.  If diagnosed properly, they can be treated.

Keep in mind here that this is just my opinion.  However, I base on my study of the history of this disease, the scientific evidence available up to this time, and my own experience with this disease (43 years and counting).

Today I openly discuss my experience at what is now called National Jewish Hospital.  I also have no problem with asthma being considered a nervous disease, and for the reasons as noted above.  If anything, I am now proud for my experience there.  I feel very fortunate.  I see how that place has benefited me, as I note in this post

Further reading:

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