Case Study: Waiting To Inhale

Separating asthma from identity

By Leslie Goldman, published July 1, 2010 - last reviewed on June 9, 2016

Dan Keller* struggled with asthma his whole life, reaching for his inhaler six times a day and trying various medical interventions. Finally, he visited acupuncturist Jill Blakeway.

Asthma typically responds quickly to acupuncture, says Blakeway, director of the New York City-based YinOva Center. But Keller continued to gasp for air on the subway and to bow out of challenging social activities, citing lack of air.

Blakeway was stumped. Then she remembered a lesson from one of her old Chinese teachers. "The hardest part about treating a chronic, long-standing condition is that the illness has often become part of the patient's identity."

At the next session, Blakeway asked Keller about his childhood symptoms. He recalled his parents constantly being on alert for attacks and an ever-present fear of the E.R. He didn't have to vacuum or do other chores that might stir up dust. He got extra attention. "I realized that his asthma, although debilitating, was in some ways useful to him," Blakeway says.

She gave him a homework assignment: Record every time he used his inhaler over the following week. When Keller returned, they paged through his notes. An obvious pattern emerged: He'd get wheezy whenever he felt vulnerable or when facing a task he wanted to avoid, such as attending what might be a boring party with his girlfriend.

The illness-as-identity phenomenon is common, particularly among adults diagnosed as youngsters, who may have come to conflate being sick with being cared for, says Harold L. Pass, a psychologist at Stony Brook University in Stony Brook, NY. "These patients often view themselves as sick and it's hard to convince them that their illness is less intrusive and pervasive than they think. What began as a physiological illness now has a psychological component." Getting well not only means relearning how to assess one's own symptoms, but also giving up any external gains the illness might bring.

Once Keller recognized the link between his personal and pulmonary lives, the acupuncture and herbs "miraculously" worked. By week 12, he was down to using his inhaler every other day, and he stopped his treatment shortly thereafter. "If you ask him, he'll probably tell you that Chinese medicine cured his asthma," says Blakeway, "but honestly, I feel he just outgrew his need to be sick."

* Name changed to protect identity

My Symptoms, My Self

Are you susceptible to the illness-as-identity trap? Certain backgrounds and personality types make it more likely:

  • People who are controlling or prone to histrionics.
  • People who grew up in a family focused on illness.
  • Dependent types.
  • Highly anxious people.