Correlating physiologic with psychodynamic data in the study and management of childhood asthma

Asthmatic children do not constitute a homogeneous group. They show wide variations in severity of physiological involvement, in parental attitudes to the disorder and in the attitude of the child himself to his disability. Each of these factors has been shown to affect the therapeutic outcome. This paper seeks to demonstrate that in addition, adversity of life circumstances may equally influence the pattern of clinical response. Two groups of juvenile asthmatics were studied; 161 referred to a children’s hospital, and 55 accomodated within a residental open-air school. Both groups showed the characteristic alternation between relative improvement under hospital supervision or in boarding school and the tendency to relapse if discharged prematurely. Both groups were similarly comparable in their constituent physiological grades. By contrast, a much higher incidence of sociopathic stress was found to operate within the residential open-air school group than within the hospital based group, this difference being highly significant statistically. Among a number of general implications, which emerge from this study, the conclusion of most immediate import is that sociopathology, where it exists, should never be dismissed as trivial or irrelevant to the clinical course of the individual asthmatic case. On the contrary, adverse life circumstances can be shown on occasion to be as important in the genesis of clinical intractability as the more familiar variants of psychopathology based upon interpersonal or intrapsychic considerations. In effect, we have to consider the whole patient within his family and social environment rather than just his efficiency in ventilatory function if we are to achieve the optimum therapeutic response in childhood asthma.

Section: Clinical Samplementioning

confidence: 99%

The Influence of Sociopathology in Childhood Asthma

Pinkerton¹

1970

“…In childhood asthma, for example, this is expressed as excessive lability of the bronchial system (Jones, 1971;Pinkerton, 1967); in migraine, as presumed neurovascular anomaly of the intracranial microcirculation; in atopic eczema, as constitutional hypersensitivity of the epidermis; in spastic colon, as neurohumoral hyperirritability of the large gut (Chaudhary and Truelove, 1961); while in peptic ulcer, it is reflected in raised serum pepsinogen levels ( Weiner et al, 1957).…”

Section: The Psychosomatic Sequencementioning

confidence: 99%

Symptom Formation Reconsidered in Psychosomatic Terms

Pinkerton¹

1974

Self Cite

A classifying system is presented for interpreting physical symptoms in childhood disorder under three main headings. The first of these is the somatopsychic sequence in which the basic substrate is an organic lesion giving rise secondarily to intellectual and emotional repercussions. The second pattern is the pseudosomatic sequence in which the symptom presentation, though physical, has a basis of purely emotional pathology. The third pattern is the psychosomatic sequence which, it is suggested, should be retained for those specific disorders like asthma, eczema, migraine and spastic colon, which have a pathophysiological substrate activated by emotional factors, so that the resulting disorder has a conjoint aetiology. The principle common to all three syndromes is that symptom formation is dependent first upon the lesion itself (its nature, duration and severity); secondly, upon the child’s attitude to it; and finally, upon the parental attitude to it.

“…gastric function (Connell and Waters, 1964), colonic motility (Connell, 1967), bronchial reactivity (Jones, 1966;Pinkerton, 1967), the behaviour of the meta bolic system as in labile diabetes (Baker and Barcai, 1970) and of intracranial microcirculation as in migraine (Blau and Davis, 1970). By contrast, there has been a lamentable lag in equivalent advances in the field of psychodiagnostics.…”

Section: Introductionmentioning

confidence: 99%

Videotape as an Instrument in Psychosomatic Methodology

Pinkerton¹,

Leytham²

1973

Previous studies of psychosomatic disorder in childhood have confirmed the importance of self attitude and family attitude as factors influencing prognosis and therapeutic response over and above pathophysiological involvement. Standard psychological tests, however, have proved disappointing in assessing these psychodynamic factors. Videotape, on the other hand, does record the interplay of family relationships, relevant to case management, and preserves this information in a form identifiable by other workers. Evidence is presented to support the claim that in the course of standard diagnostic viewing, similar impressions are conveyed to widely differing groups of observers. Videotape is claimed to be superior for this purpose both to audiotape and the written transcript.