The Hysteria Over Conversion Disorder
The Hysteria Over Conversion Disorder
Scientists in fields connected to neurobiology and psychiatry remain mystified about the cause of Conversion Disorder. The disorder is characterized by physical symptoms of a neurological disorder, yet no direct problem can be found in the nervous system or other related systems of the body. This fact alone is not unusual; many diseases and symptoms have unknown origins. Conversion Disorder, however, seems to stem from "trivial" to traumatic psychological events and emotions rather than biological events. The extreme symptoms often disappear as quickly as they appear without the patient consciously controlling or feigning them. Thus, Conversion Disorder serves as a significant example of how blurred the conceived demarcated divisions of mind/body/behavior can be.
Conversion Disorder is diagnosed solely by its physical symptoms seen in patients. Symptoms can be divided up into three groups: sensory, motor and visceral. Sensory symptoms include anesthesia, analgesia, tingling, and blindness. Motor symptoms may consist of disorganized mobility, tremors, tics, or paralysis of any muscle groups including vocal cords. Visceral functions include spells of coughing, vomiting belching, and trouble swallowing (1). Most of these symptoms are strikingly similar to existing neurological disorders that have definitive organic causes. Conversion Disorder, on the other hand, defies the nerve patterns and functions from which the symptoms should follow. CT scans and MRIs of patients with Conversion Disorder exclude the possibility of a lesion in the brain or spinal cord, an electroencephalograph rules out a true seizure disorder, and spinal fluid eliminates the possibility of infections or other causes of neurological symptoms (2). The abnormal behavior shown in Conversion Disorder cannot be accounted for biologically, and this fact has set off even more scientific theories about the many ways in which biology must explain the phenomena.
Optokinetic nystagmus (sub-cortically controlled steady tracking the eye followed by the fixation of the eye on another object) can still be observed in patients with apparent blindness when they are shown a rotating striped drum thus proving their correct operation (2). Numb hands characterize a type of conversion disorder called "glove anesthesia"; the sensitivity stops at the patient's wrists. This clear demarcation does not correlate to any known nerve pattern or function. Also, patients who show paralyzed arms with functioning shoulder muscles that work normally to correct posture of their truck contradicts what we know about how the nervous system is structured (3). These examples demonstrate how the symptoms the patients express belie a properly working nervous system. Knowledge of neurobiology, or lack of it, seems to influence how the symptoms play out in the patients. It has been shown that symptoms become more biologically traceable when the patient knows more about the body's physiological functioning. Learned information stored in the mind is used to determine the physical symptoms unconsciously expressed by the patient. The conscious functions of the mind can work unconsciously through the nervous system to effect behavior.
Treatment of Conversion Disorder primarily involves psychotherapy. Often patients go into spontaneous remission, or they have a complete recovery shortly after visiting a psychiatrist (2). Despite the effective psychological treatment, the patients are often incredulous when told their symptoms are "imaginary" or "mental". Because this is often counterproductive in the doctor-patient relationship, patients are not told that their condition is thought to be psychological; they are first treated as if the symptoms are organic (3). Associating "mental" with "imaginary" in the minds of the doctors indicates a powerful assumption that something that is controlled by the mind and expressed through the body is not "real" and therefore a feigned illness. The mind, with its intimate connection to the nervous system and behavior by way of the larger structure of the brain, is more than a superficial layer of us as humans. It too is a part of the body, and a schism in the mind, whether it initiates from military trauma, sexual abuse, or depression remains a very real source of physical and medical illness.
This discussion of the distinctions of the mind and body are not new. Conversion Disorder was originally called "hysteria," and it has been described by documents hundreds of years old. The ancient Egyptians attributed it to a malpositioned or "wandering" uterus, and the name derives its meaning from this distinctly feminine problem. In the 1560's, the first documented study was done that claimed that "hysteria" was located in the mind rather than the body. Two hundred years later, the French neurologist Charcot hypothesized that hysteria originated from an organic weakness of the nervous system. Sigmund Freud became captivated by this idea and eventually replaced "hysteria" with the term "conversion" because he theorized that the symptoms were "intrapsychic conflicts" manifested (or converted) physically in the patient (3). This progression towards the psychological has been reflectively inverted in recent theory.
Increasingly, Conversion Disorder is being thought of and researched biologically rather than psychologically. Technology has supplied methods of testing elements of the nervous system, and yet no definitive causes have been identified. It has only recently become common thought that Conversion Disorder arises from some sort of collaboration between the mind and the nervous system (3). This distinction between the "mind" and the "nervous system " (and the revelatory idea that they are indeed related) demonstrates a crucial partition that most scientists seem to make between the two. In my view, the mind is the cognitive function of a larger concept, which can be called, as we do in class, "the brain". The brain encompasses both the biological stratum of the nervous system as well as the cognitive stratum of the mind. As debates over Conversion Disorder show, they are interrelated. The nervous system does not only determine the mind, but it too can be influenced by the mind. To attempt to divide them for study may be useful, but their ultimate relationship should not be permanently separated. Parobek describes the state of Conversion Disorder as a "Tower of Babel that obscures accurate identification and nomenclature" (3). This is true in that, like the myth, the relationship between the two elements of the brain create a confusing cacophony of precise causation because that is its inherent structure. Nomenclature is a system of understanding and representing, and if the construction of the Tower of Babel and Conversion Disorder cannot be contained within one language or one scientific discipline, then perhaps the nomenclature and the building of scientific research needs to broadened to include more "multi-lingiustic" elements. The total functioning of the nervous system and the mind meets, exists, and functions together in what is more appropriately called "the brain," and the brain, as a whole, determines behavior.
To understand Conversion Disorder completely will probably require a more multi-discipline approach instead of trying to locate its cause and process on a purely biologic level. When trying to pinpoint whether a patient's symptoms hail from "real" or malingering sources, the observed difficulty lies in the seeming dichotomy between mind and body. This dichotomy however remains a created one for the benefit of our own understanding. Yet, in the case of Conversion Disorder, delineated scientific thinking seems to have prevented our understanding rather than facilitating it; by inspecting the trees, we are missing the forest.
2)Emedicine: Instant access to the minds of medicine., Dufel, Susan M.D. "Conversion Disorder".
Virginia M."Distinguishing conversion disorder from neurologic
impairment".Journal of Neuroscience Nursing. 04/97. Volume 29. Number
2. p. 128.
Infotrack: Expanded Academic , scroll down to E-journals, select Science Direct and search for title
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11/04/2005, from a Reader on the Web
` I was just wandering the internet and I saw this page on conversion disorder. I've had that for a couple years as a result of being traumatized by torture. ` I knew that people could become blind from something horrible happening in their lives, and I figured that the sense of touch could be affected as well. ` I have fairly bad numbness all over my body wherever any part of me touches anything - the fronts of my fingertips, the bottoms of my feet, the upper parts of my ears (where my hair is), my eyeballs, the part of my tongue that presses against the roof of my mouth, etc, which is a pretty irritating handicap. Thankfully, my neurologist was unable to find anything. ` I must say it's a relief that I finally know what this... THING is called, though I understand why my psychiatrist didn't tell me what it's caused by - nobody knows! All I know is that I feel a cold numbness wherever any part of my body presses up against anything at all. ` It's very weird and annoying, lemme tell ya, and I hate it so much. I can't walk very easily with shoes on, I fall down a lot, I have trouble picking things up, tasting and smelling things, feeling textures, not to mention I'm completely uninterested in certain... activities. ` Luckily, from what I see on the page, I suppose I can expect this will lift one of these days - or at least over a series of days, perhaps. That makes me feel better about this, as it's only been getting worse after a couple of brief periods in the beginning when it nearly seemed to wear off. ` My doctor says I can acheive this through not being afraid to touch things. Sounds simple, but... it's not very easy, in my situation. ` Mental numbness... neurological inability to recognize anything in the world except for faces... or being able to recognize faces but not other things... It's really crazy how many bizarre disorders human brains can undergo, isn't it? S E E Quine
I was diagnosed with conversion disorder back in 2000. When the doctor stated to me that I had the ability to shut down my body with my mind, I did not want to believe him. The problem I had with this disease/disorder made it more difficult to pin point as to why or how I contracted this condition. It was hard to explain to people with it being closely related to symptoms of Multiple Sclorosis. It wasn't until 2003 after going from job to job and not understanding why I had such a difficult time in keeping a job that I was told this condition was effecting me through stress. I had positions that were highly stressful. I found out that it was true disability that qualifies me for social security. My very first episode occurred when I was in high school. It was right before a major music concert that I was required to participate in for a grade. My mother and my grandmother were still alive and they were called to my school. It was the most difficult thing I ever went through. I could not move my body. I felt as if I was frozen in time. I could hear and still see what was going on around me but I could not respond. My mother was a nurse and the only explaination she could come up with, was that I wanted some attention. I started to believe for a long time that I was going crazy and losing my mind. No one wanted to believe that something was wrong with me. Now that I am 34 years old and going on 35 I must keep my stress level under control or I will go into severe spells of loss of voice, I feel that I am going blind, but when I go to the eye doctor he tells me that I have not changed my eye sight except by a small degree. I pray that some day soon they will come up with a reason why the body does this. When I turn 50 or I am in a nursing home no one will understand why it is I go through what I go through. Thanks for the clear information that helps to explain in clear depth what is going on with me. Now I am able to refer others to this information so they to can understand me. My right hand is not fully functioning, so I will bid you a good night and god bless ... S. Bronson, 28 August 2006
I have been diagnosed with conversion disorder,after going to 6 Doctors. I thought I was going crazy for awhile but this is really a type of sickness.I've been in a wheelchair since May of 2006.It really gets frustrating,I thought Iwas the only one with this problem.I have something like seizures, sometimes they don't stop and whenthey do I'm very disoriented.I had to get a cather put in because I can no longer go to the bathroom by myself.Is there some type of group for people with this disorder.Please let me know how you get through this ... Renee Wright, 6 March 2007