BREATH-HOLDING

A behavior disturbance in which a child expresses anger by holding his breath; classified by the American Psychiatric Association (1952) as an “adjustive reaction of infancy,” under ‘Transient Situational Personality Disorders.”Few experiences are more frightening to parents than watching their child hold his breath, especially if he turns blue. Yet “this common condition probably is more alarming than dangerous” (Wittkower and White, 1959). Nevertheless, repeated breath-holding should be diagnosed and dealt with at an early stage to prevent more serious behavior problems or possible brain damage from occurring.Breath-holding attacks usually start within the first two years of life, and generally disappear spontaneously when the period of violent crying ends between the ages of four and six. This behavior pattern tends to occur in children who are tense and hyperactive; it affects both sexes equally. The attacks generally follow some disturbing or frustrating event, often minor in character, which precipitates disproportionate rage and uncontrolled crying. Sometimes the breath is held so long that the child turns blue (cyanosis) and becomes unconscious.Breath-holding attacks are considered a sign of disturbance in parent-child relations. Investigators have often found that the parents are usually overprotec- tive and at the same time tense in their insistence upon a rigid feeding schedule or premature toilet training. The attacks result from overwhelming rage and loss of control when the child feels he cannot cope with the situation.Treatment of this condition requires a study of the child’s relation to his family, and particularly situations in which conflict occurs and anger is aroused. Therapy directed at improving the parents’ own emotional adjustment is usually recommended.BRIGHAM, AMARIAH (1798-1849). Brigham was a distinguished physician, author and hospital administrator who exerted a widespread influence on the understanding and care of the mentally ill in the early days of American psychiatry. After teaching anatomy for several years at the College of Physicians and Surgeons in New York City, he became superintendent of the Hartford Retreat in 1840, and two years later was appointed to the same post at the New York State Lunatic Asylum in Ithaca. In 1844 he and twelve other superintendents, known as the “original thirteen,” organized the Association of Medical Superintendents of American Institutions for the Insane. This association was the first national society of physicians in this country, and later evolved into the American Psychiatric Association. In the year of its origin, Brigham became the founder and first editor of its official organ, the American Journal of Insanity, which changed its name to the American Journal of Psychiatry in 1921.The asylum at Ithaca was the first New York State institution for mental illness, and under Brigham’s leadership it became an outstanding training center for medical superintendents. He was a strong advocate of humane treatment, opposing blood-letting, and rarely recommending physical restraint. Along with other leading psychiatrists of his time, he accepted the idea that mental illness is basically curable, and claimed that “no fact relating to insanity appears better established than the general certainty of curing it in its early stages.” However, he cautioned against undue optimism and was considerably more conservative than some of his colleagues, such as William Awl, the superintendent of the Ohio State Asylum for the Insane, who actually claimed a recovery rate of 100 per cent.Brigham’s writings include A Treatise on Epidemic Cholera, Observations on the Influence of Religion on the Health of Mankind, and An Inquiry Concerning the Diseases and Functions of the Brain, the Spinal Cord and Nerves. His major psychiatric work, Remarks on the Influence of Mental Cultivation Upon Health attained a remarkably wide distribution in Europe as well as America.