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Monday, July 26, 2010

Your asthma is not all in your head

What would it be like living with asthma before modern medicine? This was a question I pondered until I read Mornings on Horseback by David McCoullough. Chapter 4 in particular gave an impressive view of a young Teddy Roosevelt's struggles with asthma.

Imagine, for a moment, the year is 1865 and you are a 7 year old Teddy. Now imagine your worst asthma attack -- not pretty, but bare with me. With no other options (no Ventolin), your dad assists you onto the horse driven buggy, and takes you for a bumpy ride in the cool spring air.

This seems to give you some relief, but your chest remains tight. When you arrive home, as the squeeky screen door slams shut, you notice an elderly man with a scruffy gray beard standing alongside your mother.

You recognize the man as your doctor, and he motions you to the chaise lounge in the far corner, and you hop up. You grab the edges and hold your shoulders high, huffing for air.

After examing you, the doc says, "It's all in your head, Teedy. We have some medicine that will help you relax your mind"

You grimace and think, "No doc, it's real." But you respectfully keep quiet.

Now looking at your dad, the doc says, "Take him for a ride, the fresh air will do his mind good. While you're out stop by the drug store and pick up some morphine. That should do the trick."

"Is there anything simpler that might work," your dad asks.

"Well," the doc says, "Have him smoke a pack of cigarettes until he pukes, and maybe a daily cigar and cup of coffee. If that and the morphine don't work, and you're desperite, try giving him a few shots of Whisky.

You gulp! None of that sounds appealing. The morphine relaxes you some, but when you try the other asthma cures you puke. Yet, when your dad asks how they worked you lie: "Great!"

Teddy's doc wasn't just grasping at straws, as these medicines were common asthma cures at that time. And he wasn't just making it up that asthma was in Teddy's head, as McCullough explains:

"As early as 1819.. the famous French physician Rene Laennec, inventor of the stethescope... perceived no organic causes to which asthma could be attributed, but listed 'mental emotion' among the primary probable causes."

Starting in 1866 many studies were done that proved asthma was a psychological disease brought on by a child's "'supressed cry for the mother.' A cry of rage as well as a cry for help. The child has an intense fear of being abondoned by the mother or of any form of rivalry for her affection"

To me this is an understandable theory since I, like many kid asthmatics, grew especially attached to my mom as outings with my dad -- hauling wood, camping -- often resulted in a tight chest.

One physician who advised the Roosevelts about Teedy's asthma was Dr. Henry Hyde Salter. He was an ardent supporter of this "pschosomatic theory of asthma". In fact, he later wrote a book called, "
On Asthma," which was the most well respected book on asthma in the 19th century.

He noticed many of Teddy's attacks came on Sundays, and surmised the reason for this was because asthmatic kids became anxious about school the next day.

Even up to 1982, McCollough writes, "Recent investigations strongly suggest that the disease is psychological in origin... the attack is not deliberate (though it can be), rather it is provoked by certain painful feelings -- burried anger, guilt, fear of abandonment, fears of all kinds -- or of tensions that need not necessarily be unpleasant, the approach of a birthday or Christmas, for example."

Fortunately for you and me, this falacious theory was disproven in the 1950s, and by the 1980s it was abandoned altogether by most doctors. Yet, while we now know asthma is not caused by anxiety, it has been proven
stress and anxiety can act as an asthma trigger.

When I was a kid there were a few people who did tell me my asthma was all in my head. Now that I've read this book I have a better understanding of why that might have been.

"Mornings on Horseback" was a great read in general, but it provides an impeccable image of what it was like living with asthma when meds like Ventolin and Xoponex were merely a pipe dream.

1 comment:

Respiratory Therapy School said...

Thanks for the interesting and informative post. I enjoyed reading it and look forward to more in the future.