Here’s a study that hits a little close to home….
Posted on May 13th, 2008 by blue collar scientistResearchers at Johns Hopkins and elsewhere published a study yesterday in Annals of Allergy, Asthma & Immunology1 which establishes that asthma is associated with higher levels of suicidal thoughts with attempted suicides.
Doesn’t surprise me one bit.
The Flying Trilobite recently had a posting about asthma, a response to some google traffic that was coming his way, and over there I outed myself as an asthmatic from a very young age. When I was a kid, I had asthma severe enough to result in airway remodeling - in my case decidedly not good remodeling, though there is legitimate scientific debate whether remodeling in general is beneficial or deleterious - and today I walk around with significantly reduced lung capacity, compared to what I should have for my height and body weight, or whatever the norms are based on.
The reason that I’m not surprised to see asthma associated with suicidal thought and attempts is manyfold.
First, not being able to breathe properly is frightening and extremely painful, especially to the muscles that are used to breath - the shoulders, chest, and back in particular. Educated patients understand that few people die of asthma - but we are also taught that those that do often die of suffocation over a period of days or weeks of continuous and gradually worsening asphyxiation. We also understand that normal use of our life-saving medications can lead to refractory asthma - which is usually especially severe and frequently results in death; if you can walk out of the ICU, you consider yourself lucky.
Faced with an uncertain future, I know that I would feel a lot more comfortable about my existence if I knew that palliative care was available in the event that I faced a severe, probably terminal bout of asthma. But such palliative care is denied to asthma patients. We must tough it out, and that’s that. I can easily imagine that after a week or two of continuous symptoms, a perfectly rational asthmatic who cannot get any pain relief might be in the mood to take what the medical establishment would consider to be a few too many sleeping pills. I’ve never been down that road myself, but I’ve thought quite a bit about end of life care, knowing that if I don’t die of an accident or other sudden cause, I’m likely to die of asthma and its complications, and I’m unhappy in every way with what I know of how medicine treats the dying asthmatic.
The researchers sum up what I’ve just said in this way:
“Researchers have speculated that the relationship between asthma and suicidal behaviors is possibly because of ensuing mood and anxiety that results from disability and discomfort associated with asthma, which can be a lifelong disease,” they note. “Individuals might have frequent thoughts of death with increasing severity solely because they have a potentially life-threatening illness.”
To which my response is, no shit.
Technically, my evidence is anecdotal and personal; this hypothesis should be tested properly. But it rings true and I don’t consider it a high-risk experiment.
Second, much of my society does not accept asthma as a legitimate condition. Through the 1950’s, asthma was considered a psychosomatic condition - a disease that was entirely in the sufferer’s head. Until the mid 1960’s, treatment for asthma was dispensed by psychiatrists and psychologists in this manner2:
At that time, psychoanalytic theories described the aetiology of asthma as psychological, with treatment often primarily involving psychoanalysis and other ‘talking cures’. As the asthmatic wheeze was interpreted as the child’s suppressed cry for his or her mother, psychoanalysts viewed the treatment of depression as especially important for individuals with asthma.
Cry for my mother, my ass.
Asthma is now proven to be a real disease. In fact, it is an immune disease, a consequence of a too-active immune system. Remember this the next time a quack medical cure purveyor tries to sell you something that “boosts the immune system” - I have a boosted immune system, and trust me, you don’t want one. Asthma is an immune response in the bronchial airways, leading to constriction of those airways, excess mucous production, and is topped off with inflammation. All three of these leave less room for air to enter and exit the lungs.
Despite the objectively measurable physiologic symptoms, and despite the ability to induce asthma in anyone using a Methacholine challenge or similar test, the condition was considered until recently3 to be all in the patient’s head. Although the medical establishment changed its mind and recognized the condition as a real disease - and kudos to the medical establishment for responding to evidence, I’m not trying to say they were negligent in any way - the rest of our society has been slow to follow in the time since.
Despite medical evidence that prompt use of a rescue inhaler is necessary to save the lives of asthmatics, despite federal laws that protect the rights of asthmatics, and despite state laws mandating that schools allow asthmatic children to carry inhalers, there are still people who are too short-sighted to notice, or care, about asthmatics.
This school used to have an outright ban on medication, until I and others pointed out the illegality of the situation to an asthma activist organization. In response to massive pressure, the school changed the policy, and now if you fill out a form, the school says you can, they guess, have your medicine, if it is absolutely necessary that, you know, the student continue to live, or something. See also here,
Here is a school (pdf) that illegally requires the inhaler to be kept in the nurses office, and explicitly calls the use of the inhaler a “privilege” - at this school, the right to continue living is suddenly no longer a right. They also give broad, draconian powers to teachers who think the inhaler isn’t needed to deny its use to students. Here’s a hint for you - school teachers are not qualified to make medical assessments of respiratory function. This kind of thing is pretty widespread - one survey found that about a third of asthmatic kids had their inhalers taken away from them by school officials.
What happens when such practices are put into place? Students die. It has happened a number of times, but I’ll only link to the story of Catrina Lewis Michele Gaudin. Catrina died while school officials prevented her accessing her inhaler and spent a half hour trying to telephone her mother, before finally calling 911 to pick up the body. The life-saving murderous advice they gave to Catrina before she died was to go outside and get some fresh air. Her inhaler was locked in the school nurse’s office the whole time - they just wouldn’t let her use it.
Leaving the schools behind, there are still numerous examples of the asthmatic prejudice in the wider society that I’m sure any asthmatic could invoke. One of my favorites involves any time I was having an attack as a kid, and was told - and this happened often - to “just breathe” by some knowedgeable dumb-ass adult. I think I heard this from my gym teachers, parents of my childhood friends, extended relatives, and other well meaning, but very ignorant, people in my community.
Today, I’m active in athletics, despite having a significantly reduced lung capacity. Specifically, I like to ride bikes, and I have a high performance, tricked-out, all-carbon road bike with some nice components that weighs approximate 6/10ths of an ounce that I like to ride as fast as I can. I ride in groups with some pretty fit riders, most of them about half my age. I can keep up, except when we hit the longer hills. Then my lungs just don’t allow it. I arrange ahead of time with my riding companions, telling them they can wait for me at the top, or they can just keep going and we need not finish together - it doesn’t matter to me. The few that wait? Well, when I get there, I’ve heard “just breath” a few too many times.
If we could breath, folks, we would.
Another is the admonishment that I’ve heard numerous times to just relax, and not sit up so straight during an attack. Got news for you - if I lay down during an attack, it gets way worse. If I recline on my couch, perhaps with some grapes and a couple of Roman slaves waving some white feather fans over me, the best that can be said is that I will have died in style. A kind of anachronistic, perverse style, but you see the point. Ignorant advice that I should just relax isn’t really needed here: Asthma isn’t a result of being high-strung. Being high-strung is a result of having to deal with idiots while I’m having an asthma attack.
The bottom line is that our culture views asthma in different ways; some see it as a medical condition and nothing more, and that’s fine. Others see it as a sign of personal weakness and a character flaw, and that’s not fine. That’s the heritage of the old establishment view of asthma as psychosomatic, requiring treatment with Freudian psychotherapy in order to make a better-adjusted person with fewer mental hang-ups.
Now, if you spent your life explaining to close friends and activity companions about certain of your limitations, in a responsible way so that they could make informed choices and not panic when confronted by these limitations - OR if you spent your life not disclosing these things and forcing others to deal in ignorance with what they considered to be unexpected and unexplained behavior on your part - and you had about half the people respond from the perspective of the “personal weakness” meme, would you consider suicide? How about some of your friends? I have no problem believing that this kind of social challenge would lead at least some people to suicidal thoughts and attempts.
Don’t get me wrong - I’m not piling on the researchers here. It is about time that someone took a look at the mental health attributes of asthma, now that 1 in 4 kids are getting it, and these researchers are doing a good thing. I reserve my ire solely for the irresponsible behavior and prejudices of people confronted by asthma. Fortunately, it is getting rarer as I age. Unfortunately, not as fast as I’d like, and until things get straightened out in the culture, an asthma-suicide link is going to have the ring of the obvious to me.
- Clarke DE, Goodwin RD, Messias E, Eaton WW. Asthma and suicidal ideation with and without suicide attempts among adults in the United States: What is the role of cigarette smoking and mental disorders? Ann Allergy Asthma Immunol 2008;100:439-446. [↩]
- Asthma and depression: a pragmatic review of the literature and recommendations for future research Clin Pract Epidemol Ment Health. 2005; 1: 18. Published online 2005 September 27. doi: 10.1186/1745-0179-1-18. PMCID: PMC1253523 Copyright © 2005 Opolski and Wilson; licensee BioMed Central Ltd. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1253523 [↩]
- Within my lifetime. [↩]
Tags: asthma, culture, prejudice, psychosomatic, suicide
May 13th, 2008 at 5:55 am
“Asthma isn’t a result of being high-strung. Being high-strung is a result of having to deal with idiots while I’m having an asthma attack.”
This line was awesome. I want a t-shirt.
Great article, and some scary stuff. I find my moods change quickly when I haven’t even noticed right away that my lungs are slowly constricting. Perhaps there is something specific about air intake and mood as well? Often, I am cranky and irrational. It doesn’t seem like a big stretch to depression and suicidal thoughts.
When I’ve had prednisone in the past to help with bronchitis-asthma tag teaming, I get all weepy. My wife hates when I’ve been on that stuff.
I wasn’t aware that some school nurses hold inhalers! That shocks me. It’s an outrage. My 6 year old nephew knows when to ask for his, and it’s in his knapsack while he’s in class.
May 13th, 2008 at 7:54 am
I hadn’t realized asthma was an auto immune problem. I wish I knew more about medicine to be able to understand why, but I also have autoimmune problems that result in completely different issues. In short I’ve had arthritic pain as long as I can remember (probably early teens), don’t respond to most antibiotics, have occasional nerve ticks, and had very little response to local anesthetics until recently. Those are just the things that are “yep, definately attributed to” category. Insomnia, and constant ringing in my ears are others that “maybe are because of.” I’m otherwise very healthy, active, and determined to not get eaten up by, or even be effected by such things. I consider all these things minor, at least for now, and the topic rarely gets lifted outside of a doctor’s office.
That said I’ve spent undue hospital time from doctors who didn’t bother to read the charts or listen when I pointed things out to them. I’ve argued with doctors over medications they’ve prescribed me for things like strep throat (things that are already known to be totally ineffective), only to have them trick me with an off brand name of the same thing. Surprise, I’m either back in their office a few days later (worse off) or in one case directly to the hospital with a throat on the verge of swelling shut.
As a child I also spent several weeks in the hospital with pneumonia after various forms of penaccillan were useless.
I made it through, added it to the list of experiences, and consider it minor. I have a friend who was confined to a wheelchair for about a year when his flavor of immune problem attacked his joints, making them extremely swollen and painful to move. Good news is he’s doing quite well now, and plays a mean guitar.
Occasionally I’ll get a flair up and have a hard time doing some day to day things (you tend to stay away from your engine building hobbies when your joints ache to move), and I’ve also been told that it was “in my head,” because a guy my age “can’t have joint pain.”
May 13th, 2008 at 8:52 am
The article gives the young woman’s name as Catrina Lewis. Michele Gaudin was the family’s attorney.
May 13th, 2008 at 11:31 am
Excellent post!
I’m forwarding this to my Dad, who was only very recently diagnosed with asthma.
May 13th, 2008 at 3:02 pm
Blake, thanks for the correction, which has been made in the post text. I’ve told the story so many times I should have known better, but it was a bit late last night when I wrote this.
May 13th, 2008 at 6:11 pm
Late-night posts always turn out a little. . . weird. Memorable, though. ;-)
May 14th, 2008 at 12:17 pm
I’ve only had one asthma attack (in a pool–that was scary), and it’s not fun! My doctor is always worried that I’ll develop asthma, but…I’m not too worried about it. It’s the kind of thing I’ll deal with when/if it happens.
May 16th, 2008 at 11:25 am
So you mention that suicidal thoughts are not uncommon among those who suffer from asthma … would you also say it’s true that homicidal thoughts toward stupid people are also not uncommon during (or, more likely, after) asthma attacks?
* * * * * * * * * * * * * * * * * * * * * * * *
Not to make light of a very serious condition — well, OK, I suppose I *am* — but you know me, J., I can never resist tossing in a clever comment when the opportunity presents itself. And we *both* know you could totally kick my non-asthma-suffering ass in any sort of cardio/long-distance challenge if it ever came down to that.
May 16th, 2008 at 7:12 pm
“would you also say it’s true that homicidal thoughts toward stupid people are also not uncommon during (or, more likely, after) asthma attacks?”
Homicidal? No. I don’t actually want to hurt anyone over their ignorance or stupidity; in fact I rather come down to the opinion that all suffering is bad and I should inflict as little of it as possible.
I will admit there are limits, though - sometimes it is simply necessary to point out that someone is being an ass, and doing that may indeed cause some suffering. I try hard to insure that in such cases what I dish out is deserved. So I would say that, yes, I occasionally want to make pointed remarks to ignorant or stupid people. You know, basically what I mean here is, sometimes I want to talk to people in real life the way I occasionally vent on this blog.
May 16th, 2008 at 10:02 pm
Asthma skepticism seems to be a US cultural thing. In Sweden, everybody’s treated asthma as a bona fide allergy symptom at least since the late 70s when I started school. A teacher or school principal confiscating an inhaler would be big news around here.
I realise that not every autoimmune condition need be an allergy, but at least everybody knows that the roots of the problem isn’t Freudian.