Patterns of Meaning in Psychiatric Patients

SIR,-I read with interest Dr. Margaret Turner-Warwick's admirable article on the diagnosis and management of asthma (12 February, p. 403), and wish to endorse the opinion there expressed that, once it has become necessary to employ steroid therapy, it is better to stabilize most patients on low daily dosages than to risk relapse and perhaps even fatal asthma by repeated attempts at steroid withdrawal. Viewed over months or years it is very occasionally possible to withdraw slowly milligram by milligram, while leaving the person subjectively free from bronchospasm. Referring to the controlled trial of hypnosis in asthma, Dr. Turner Warwick quotes correctly the conclusion that mild cases and those with emotional triggers did best, but I would like to point out, by reference to the trial,' that very good responses were also observed in the other categories-that is, cases of medium and severe degrees of asthma triggered by antigens, infections, and physical conditions. I delayed writing this letter until I had asked the opinions of other chest physicians and a psychiatrist, all of whom use the hypno-autohypnotic technique described in that paper. It has been our unanimous experience that the technique can be invaluable in advanced cases of episodic as well as chronic asthma-in fact, as consultants, we are rarely asked to see asthma in its milder forms-provided that steroid therapy has not yet been started. With very few exceptions, once a person has been given steroids we have found hypnosis to be of little value in weaning them from their steroid dependency. We felt that the point needed emphasizing, since up to seven years of follow-up show how many cases can be relieved of the symptoms of asthma, thereafter leading healthy and useful lives, who otherwise might still have bronchospasm which was merely suppressed by steroids-I am, etc.,