For centuries, we have looked at people whose symptoms lack a definite cause as crazy or "hysterical." But they might be experiencing conversion disorder.
A patient enters a hospital emergency room after having a seizure. The doctor sees her and orders the regular tests, expecting to find that the patient had epilepsy, had perhaps taken some drugs, or had been injured somehow.
But they come up with nothing.
As the patient comes around, more symptoms show up that doctors can’t explain. The patient is so weak she cannot walk; she experiences sudden deafness or even blindness, and she finds it difficult to form words when trying to speak. The patient is admitted for more tests but all of them come back normal. The doctors are at a complete loss.
What could be causing the patient’s mysterious symptoms?
A Brief History of Conversion Disorder
Today we might look at this patient’s symptoms and deem she is suffering from Conversion Disorder. But for much of medical history this cluster of symptoms would have been termed “hysteria” and later, “hysterical neurosis.” Since there were no detectable physical reasons, the belief was that the patient’s symptoms must be “all in their head.”
The connection between mind and body is much more complex than we historically have given it credit for. In modern medicine, we understand that our bodies are very demonstrably affected by our state of mind and vice versa. What’s not entirely understood, even now, is how our bodies convert our emotional pain into physical pain. All we know is that it does.
Most of what we know comes from studies that are not altogether recent, despite the fact that it’s supposed that as many as a quarter of us will experience conversion symptoms at some point in our lives. Since these symptoms tend to be classified under a much broader category of somatoform conditions, it can be tricky to suss out precisely why someone is experiencing them.
The earliest explanations for these types of conditions–wherein very physical symptoms presented without an organic cause–were linked specifically to women and, even more specifically, the uterus. The “wandering uterus” theory persisted as an explanation for hysteria for quite a long time. It was only during the Freudian renaissance of modern psychotherapy that it began to be termed “conversion”–implying that repressed emotions were quite literally being converted into physical symptoms.
Though, it should be made clear that in the case of conversion disorder, this is by no means a conscious effort on the part of the patient. It’s happening at a subconscious level, though the physical symptoms bring about a tangible, demonstrable symptomatology that doesn’t require the articulation of more deeply rooted emotional trauma.
By “converting” the unspoken, maybe even unrecognized, emotions into physical symptoms, the body and mind begin to connect–sometimes in an extremely jarring way.
Treating Conversion Disorder
One of the most prominent cases in psychoanalytic literature is Anna O., a twenty-one year old female who was of superior intelligence and treated primarily by Dr. Josef Breuer, and later, Sigmund Freud.
Source: Library Of Congress
Anna presented with a cluster of troubling symptoms, including paralysis, amnesia, aphasia, visual and auditory hallucinations, and at times, complete loss of consciousness. She experienced bouts of dissociation that often resulted in her communicating to Dr. Breuer in seemingly random mumbles; he began ending their sessions by allowing her to “chimney sweep” her thoughts, as she called it. This was the beginning of a modern psychological technique called “free association.”
For those tasked with treating patients with Conversion Disorder, empathy is paramount. For the patient, “converted” emotions into very real, often debilitating physical symptoms can be extremely frightening and frustrating. When medical professionals or therapists suggest to the patient that it’s “all in their head,” or implies that they are “malingering” or even being manipulative, it undermines the healing process. That being said, it can be challenging for mental health professionals and doctors to reach a consensus about treatment.
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Thus far, cognitive-behavioral therapy paired with medications to treat underlying or concurrent depression and anxiety seem to have been the most successful options for treatment.
It’s often beneficial to include physical therapy, as many patients experience symptoms that interfere with their ability to move about (walking, getting up and down stairs, tremors or shakes, etc.). When a patient has severe physical and neurological symptoms, their family is often heavily involved in their day-to-day care, and so family-based therapies are of the utmost importance in ensuring a good prognosis for the patient.
Another theory is that when a patient is enduring psychosocial stressors, their emotional pain may be converted into psychical systems that are related to an underlying, previously undiagnosed medical condition. By and large, one of the hallmark features of Conversion Disorder, and what has defined it, is the lack of an organic explanation of symptoms. Meaning that, when a patient is tested (using radiological imaging, blood work ups, etc) the tests consistently come up clean; nothing abnormal, or, abnormalities that can be otherwise explained and are not linked to the symptoms they are presenting with.
In terms of looking at the long-term prognosis for patients diagnosed with Conversion Disorder, it can be difficult to assess what little data has been collected–largely due to discrepancies in duration. Sometimes the symptoms are transient. Other times, they are persistent or even recurrent. Considering management techniques, medication and ongoing therapies can help reduce symptoms—but there have also been cases where chronic Conversion Disorder has spontaneously resolved.
Who Gets Conversion Disorder?
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While statistics show that Conversion Disorder appears to be more common in women, researchers caution against making gender a necessary factor in diagnosis. Many say that, frankly, women are just more likely to seek treatment—thereby receiving the diagnosis more frequently than men.
There may be a cultural component to the disorder as well. In countries where emotions are heavily repressed and social customs discourage displays of anger, sadness or even joy, the conversion of these emotions into physical dismay might be more likely.
For the patient, whether they are in an emotionally repressed society or not, the experience of living with Conversion Disorder is akin to any other patient’s experience of chronic pain, illness or trauma. For the patient, the symptoms are real, the pain is real and the need for empathy and treatment is great. The ongoing stigma attached to mental illness, chronic pain and other oft-termed “invisible illnesses” may prevent many from seeking treatment. And surely, it prevents all from feeling at home in their own minds and bodies.
