Is Hay Fever A Neurosis?
( Originally Published 1943 )
Among the very early theories offered to explain the sudden appearance of hay fever in a previously normal individual was the idea that hay fever is a neurosis. Or in other words that it is a functional nervous disease. And what is a functional nervous disease? It is a condition in which an individual shows abnormal reasoning, judgment, and emotional behavior without any apparent defect in his organic or body structure to cause this behavior.
A neurosis is distinguished from a psychosis by the fact that the psychological distortion in the neurosis is not bad enough to hospitalize or institutionalize the individual.
The theory of neuroticism as a cause for the onset of hay fever might have been comprehensible in the 1860's when it was first advanced. At that time many doctors and others were unaware that pollens were the exciting cause. However, that the theory of neurosis should be entertained to this day is a source of never ending wonderment to the writer.
In 1923 a San Francisco doctor wrote in the New York Medical Journal, "Hay fever in itself is a true vasomotor neurosis and its sufferers are either primarily psychoneurotics or manifest a secondary psychosis following the hay fever attack." To support this idea, the writer states, "Fixed ideas and phobias are but a part of the syndrome. Then comes the excess of imagination. He (hay fever patient) has ideas that in certain localities his condition is provoked." As a cure this doctor recommends treating against pollen effects plus psychotherapy.
In this reference we see an example of one of the more positive claims made for the neurosis theory by an individual who is aware of pollens as the exciting cause.
Nevertheless, he refuses to accept the hay fever sufferer's complaint of aggravated symptoms in different localities. Rather than ascribe the cause of provoked symptoms in different localities to concentrations of pollens, the author of the article attributes it to excess imagination. No comment.
The neurosis idea did not die in the 1920's. As a matter of fact it is still very much alive. In 1941 and 1942 we reviewed no less than ten articles dedicated to the task of investigating the relationship between psychology and allergy. It appears that the woods are full of psychologists attempting to show that emotional-instability and other neurotic symptoms exist to a greater extent among allergic groups than among non-allergics. They cite comparisons of the higher rate of allergy among stutterers who in turn have been shown to be more neurotic than normals. One experiment showed a difference in personality patterns between allergics and a group of surgical cases. Another study showed that there were more allergic individuals among a group of cases complaining of enuresis (bed wet-zing) than among a group of normals. Here again the association between allergy and emotional instability is sup-posed to be inferred from the fact that enuresis is a symptom of emotional instability. It may not be amiss to point out that many cases of bed wetting in older children have been shown to be due to a protein sensitivity. Removal of the responsible food, causes the bed wetting to cease.
To date we have been unable to find a large scale, objective study, comparing the level of emotional stability or personality adjustment between a group of allergic persons and a group of normals. We have conducted such a study on a small scale. The results were reported in the previous chapter.
Assuming that allergic persons as a group were shown to be more emotionally unstable and maladjusted than non-allergics, it would still prove nothing in the way of a causal relationship. The fact that two conditions are found together, or are associated does not mean that one is the cause of the other.
It is well known that there are many cases of asthma and urticaria-like reactions brought about as a result of emotional disturbances. In these instances the psychological elements may be regarded as precipitating factors rather than underlying causes. Were these individuals not sensitized or allergic in the first place, no amount of psychological stress would enable them to have an asthmatic attack.
It seems to us that the writers who hold the view that hay fever or any other allergy is a neurosis, are misinterpreting what they see and read. Certainly, individuals who get choking asthmatic attacks are nervous. Who wouldn't be if they had spells of inability to breathe, in which they felt as if they were choking to death? When you see an allergic individual who has suddenly broken out with a rash, should you expect to see a calm person? Of course not. That person in his anxiety sees himself marred by a skin blemish which he erroneously fears may not clear up. The sufferer doesn't know what science knows, namely that the rash will disappear when the effects of the irritating substance have been eliminated.
THE CONDITIONED REFLEX
The advocates of the neurosis idea point to cases that have sneezing attacks on being shown an artificial rose. As we see it, this is not significant evidence for the claim that psychological instability is even a contributory cause of allergy.
Show a child a piece of chocolate and ring a bell before you give it to him. Watch his mouth water before he gets the chocolate. Do this in the same way every day for twenty days. Then on the twenty-first day just ring the bell and show no chocolate. The child's mouth will water just the same. Should we conclude from this that the child is neurotic. Of course not. We have set up what is known psychologically as a conditioned reflex. Similarly the allergic patient may manifest a conditioned reflex to the mere suggestion of the irritating substance, whether it be ragweed, or the sight of a fish that previously caused him to break out in hives.
HAY FEVER IS NOT A NEUROSIS
As an argument against the claim that hay fever or other allergies are in general caused by a neurotic or nervous personality we offer the following reasoning. The fact that hay fever and the allergies have been shown to be very largely hereditary precludes emotionality as a cause. In no case of any emotional, neurotic, or even psychotic ailment has any one been able to show a conclusive inheritance factor which even approaches that which exists in the allergies. Therefore, any claim that considers hay fever to be a neurosis implies a definite inheritance of the neuroses. And we know from an exhaustive study of the related literature that there is no positive evidence to show inheritance of even the major insanities let alone the minor neuroses.
To the above must be added Dr. Samuel Feinberg's comments in his annual review article published in the March, 1940, issue of the Journal of Allergy. Referring to the claims of those who emphasize the importance of the psychological factors as the cause of allergy he says, "We would accept them (the claims of the psychoanalysts) as proof of the importance of the psychic factor if, in case of such definitely demonstrable and reproduceable allergy as pollen sensitiveness, attention to the psychic difficulties would keep the patient from an attack if exposed to that pollen."
Whatever theory is finally accepted as an explanation for hay fever, we can at present be certain that a basic cause exists somewhere in the body fluids. Of this we have ample evidence. The recent crystal clear experiment with blood transfusions conducted by Dr. Mary Hewitt Love-less is testimony enough.
Her experiment was as intriguing as it was simple. She gave blood transfusions from ragweed hay fever sufferers to three non-sensitive hospital patients. Before the trans-fusions none of the three hospital patients gave any positive sign when tested with ragweed pollens and extracts. Within twenty-four hours after the transfusions she obtained positive reactions to ragweed by skin, eye, and nose tests in the transfused patients.
This excellent experiment is hailed by allergists as the essential confirmation of the fact that the basis of a per-son's sensitivity is borne in the blood stream of the body.
We should like to offer this piece of work as the final corroboration of the non-neurotic origin of hay fever or other allergies. For no amount of blood transfusions from a neurotic to a normal person will cause the normal individual to show signs of neuroticism.