A Study of Structural and Instinctual Conflicts in Cases of Hay Fever*

An attempt has been made to demonstrate certain psychological similarities with particular emphasis upon the persistence of preoccupation with olfactory stimuli in seven cases of hay fever that were psychoanalytically studied. Significant unconscious material reported by one patient who suffered from severe seasonal hay fever preceding the advent of an attack of severe acute rhinitis is presented and discussed.8 in this case, material is presented to show that, when repressed sexual curiosity relating to the function of reproduction became mobilized in the analysis, the patient made an extreme attempt to sublimate the curiosity along visual, intellectual lines. This attempt represents and may be considered a normal process of sublimation. It was not the manner in which the patient tried to solve this conflict but the intensity of the effort and the emotional need to sublimate the curiosity that is significant. The material reported during this period shows that efforts at sublimation in the visual sphere did not succeed because the aggressive character of the visual curiosity necessitated the substitution of a more primary olfactory curiosity. The dreams demonstrated that external olfactory stimulation remained as an effective source of stimuli and conflict. This led to the establishment of a vicious circle that was temporarily terminated in the production of a conversion symptom which in varying degrees of intensity produced membranous congestion with a corresponding diminution in both olfactory and visual perception. An analysis of the unconscious material reported by the seven cases studied by the psychoanalytic method makes it possible to hypothecate the specific psychological factors in patients suffering from hay fever. The interplay between these inner conflicts, attempts at their solution and the external agents (specific pollen allergens) which precipitated the actual hay fever attack remains unknown. Either a specific constitutional hyperosmia leads to the sense of smell as a regressive solution to dangerous curiosity or the regression itself produced the hyperosmia and nasal sensitivity to pollen. The physiological principle relative to summation of eternal and internal stimuli may solve the problem of the interaction of psychological and allergic factors in hay fever. Patients who as a result of their psycho-sexual development have substituted olfactory for visual sexual curiosity may, because of this, become more sensitive to pollens. Olfactory curiosity that has never been relieved may be considered to be a constant irritant to the mucous membrane of the nose. An added irritation from an external agency such as pollen may produce an attack. It is possible that there are cases in which the local sensitivity alone in the absence of psychological stimulation may be sufficient to precipitate an attack. It may be assumed that sometimes, as in this case, when the psychological stimulation was increased by the mobilization of repressed sexual tension, this alone sufficed to produce an attack of rhinitis. This would explain the resistance to pollens that was obtained by patients who were exposed to psychoanalysis. When the genital inhibitions and the chronic psychological stimulus was eliminated the pollen irritation could no longer precipitate an attack.