Thursday, January 9, 2014

Lexicon of Madness -- Conversion Disorder

Conversion Disorder: The conversion of psychological distress into physical symptoms, such as blindness or paralysis. The process of conversion is unconscious, i.e., patients are not "faking it" and are not willfully producing their symptoms. Often, however, they seem strangely unconcerned about their physical symptoms ("la belle indifference"). Conversion symptoms were frequently found among Sigmund Freud's patients, and were observed in abundance in military personnel during the world wars (e.g., a front-line soldier is "struck blind" or becomes unable to walk, and thus has to be evacuated to a safer position). According to Freud, the conversion symptom is a "compromise formation" that provides a (less than ideal) solution to an unconscious conflict (e.g., the desire to flee from danger versus the desire to do one's duty). Conversion symptoms seem to have become more rare, but it is possible that they have simply become more subtle, and thus more difficult to detect. A large number of seizure patients evaluated in neurological clinics don't actually have epilepsy but rather demonstrate pseudoseizures. (Interestingly, these patients tend not to get hurt during their seizure episodes; similarly, patients who have been "struck blind" tend not to collide into walls or tumble down stairs). It has been suggested that the epidemic of chronic pain cases in the Western world actually represents an outbreak of conversion disorder, in which pain itself is the conversion symptom. Pain constitutes the perfect conversion symptom, because it cannot be objectively measured or evaluated. Telling conversion patients that their symptoms are "all in their head" can cause an exacerbation of symptoms. Symptoms usually resolve spontaneously in a few days, especially if the patient feels cared for, sympathized with, and understood.

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