Psych Doc: What is Psychogenic cough

I am an 11-year-old boy with asthma. I have been to an asthma specialist and a pulmonary specialist. I cough from October until March with hard body shaking coughing. I am reactive to cleaning odors and perfumes. One doctor suggested I have psychogenic cough. I am not doing this on purpose. I am in the honors program at school and in the gifted program. I love school and hate missing out on a lot of the activities in my school. I play baseball (and deal with the effects of asthma attacks), raise exotic chickens, swim, and enjoy other normal activities for a boy. I feel as though I am a well-rounded person. I don’t like this disease at all. Do I need therapy for this?

“Psychogenic cough” (or “psychogenic” anything) is one of those archaic terms that some physicians use when they don’t know what is causing a symptom for a patient and they think it is all psychological (see previous question/answer about globus hystericus). Technically, psychogenic cough means there is no medical cause for the cough, and the cause is “all in your head.” This kind of label is outdated and not useful, as it neglects the fact that brain, mind, and body are all deeply interconnected, even when we cannot find a simple medical cause for something. It does nothing to help either the physician or the patient understand the symptom, nor figure out how to heal from it.

What is Psychogenic cough

Psych Doc: What is Psychogenic cough

I very much doubt that the cough you describe is psychogenic, no matter how you consider the term. For starters, there are too many things about it that suggest that it may be part of an allergic or reactive airway picture. It only occurs from October to March — if it were all “in your head,” then it would be present constantly, or at least off and on throughout most of the year. You already know you are reactive to cleaning odors and perfumes, and it is therefore likely that you are reactive to other allergens as well. For example, you mention that you raise exotic chickens — have you and your physicians looked into the possibility that this is a source of allergens for you? It is wonderful that you are working with an asthma specialist and a pulmonary specialist; I assume you are also working with an allergist. The important thing is that you have good communication with these specialists, and that you feel they are looking into the whole picture of your cough. If this is not the case, find other specialists.

The fact that your coughing occurs during the winter months might provide you and your physicians with some helpful leads. You do not mention what part of the country you live in, but in parts of the West, air pollution can become pretty bad during September through November, and also in the early spring; winter rains cause all sorts of molds and spores to bloom. In the Midwest and East, indoor heating and closed windows can lead to reactions to dusty heating systems as well as to indoor molds. The increased exposure to respiratory viruses during the winter can also be a real problem for people with reactive airways.

In any case, no matter what the cause or causes turn out to be, your cough is still pretty bad when you have it, and the question remains: Are there any “psychological” or self-healing approaches you can take so that it isn’t so overwhelming? Like globus hystericus which I discussed in an earlier column, where some women seem to be unusually sensitive in their throat area, it may be that there are some people who are more prone to cough reactions than others. Once that cough pathway has been established in the body and brain of such a person, it can be hard to shift away from it.

Once you have started to work with your physicians on understanding and eliminating or treating any possible allergic or reactive aspects to the cough, you may find it helpful to try some non-traditional methods to help shift your body and brain away from the violent cough reaction. For example, non-Western medicine would see your cough as the expression of an imbalance in the natural energy flow of your body. Acupuncture might be very helpful to you, along with the use of some Chinese herbs that will help restore the natural balance of energy in your system. Deep breathing and relaxation techniques will help relax your body so that it doesn’t jump as quickly into the cough reaction. There are also a number of herbal remedies (such as teas) which are very soothing and healing for the throat (slippery elm bark, licorice, honey and lemon) which could be helpful to you.

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