Asthmatic children away from home: a comparative psychological study.
The essential difference that emerged from a comparison of the fantasies of Rapidly Remitting and Nonremitting asthmatic children was found to be in the area of emotional awareness. The children who lost their asthmatic symptoms when separated from home were found to have some awareness of angry feelings toward parental figures whom they experienced as hostile and/or rejecting. They were also found to be aware, to some extent, of longings for a relationship with a person who would provide nurturing care or guidance. The Nonremitting children, on the other hand, were found to be lacking in any awareness of either angry feelings or longings for a nurturing relationship. A study of the test materials of both groups of children reveals that these feelings are present in all eight children. Yet they have been totally repressed in the Nonremitting children, while the Rapidly Remitting children have, apparently, not felt the need to resort to such massive repression. Thus a second area of difference, implied in the first, emerges when we compare these two groups of children in terms of defensive ego functioning. Abramson's emphasis on the central importance of the period in which the child's emotional conflict arose proved to be valid for this study. He predicted that those children whose asthma begins at or near the period of toilet training will be the same ones who will have most difficulty giving up their asthmatic symptoms. Although I have not been able to validate dates for onset of asthma, it's clear, I hope, from the foregoing discussion that the Nonremitting children all suffer from conflicts arising in the anal period of development. This is not so (or much less so) for the Rapidly Remitting children who, however, often have conflicts which are just as severe. Each of the Nonremitting children, on an unconscious level, is waging a battle with mother over who will get the upper hand: this is the central conflict. Though these children are outwardly compliant much of the time, they betray their inner antagonism by withholding and being stubborn. Each has developed very skillful, though passive, methods for resisting adult authority. What are the implications for these findings? Our Nonremitting children do not always show obvious signs of emotional disturbance. Because they tend to be well behaved, they are often considered healthy and well adjusted. While the Rapidly Remitting children are insisting (often dramatically) on getting help, the Nonremitters are busy "fitting in". Though they are slow to respond to individual psychotherapy and milieu treatment, they need it as much as do those who are more immediately reponsive to our therapeutic efforts.