Description
Conversion is a defense mechanism, whereby the anxiety
caused by repressed impulses and feelings are ‘converted’ into a physical
complaint. The symptom may well be symbolic and dramatic and it often acts as a
communication about the situation. Extreme symptoms may include paralysis,
blindness, deafness, becoming mute or having a seizure. Lesser symptoms include
tiredness, headaches and twitches.
This phenomenon is sometimes called hysteria.
Freud Example
Freud observed this physical manifestation of anxieties
in clients such as Dora, who complained of a cough, losing her voice and
feelings resembling appendicitis. Upon investigation, Freud attributed her
cough to fixation during the oral stage of psychosexual development, and linked
her appendicitis to a “childbirth fantasy”.
Examples
A person's arm becomes suddenly paralyzed after they have
been threatening to hit someone else.
A woman witnesses her spouse engaging in an affair and
converts the anxiety of seeing that into blindness. The blindness alleviates
the anxiety.
A woman, invited for party, which may present an upsetting
situation to her, may develop sever illness symptoms and may excuse herself
from a party. Usually, when the party time is over, her symptoms resolve
themselves.
Specifics
Conversion is a subconscious effect that can be as scary
for the person as it is for those around them. It is different from
psychosomatic disorders where real health changes are seen (such as the
appearance of ulcers). It also is more than malingering, where conscious
exaggeration of reported symptoms are used to gain attention.
When a stressed person suddenly becomes paralyzed or
otherwise physically handicapped, consider the possibility that it may be a
case of conversion. With time, the symptom will go away, so act to reduce their
stress, for example taking them away from the initial situation. Explaining
conversion to them may help.
Conversion
Disorder
Conversion disorder (CD) is a diagnostic category
previously used in some psychiatric classification systems. It is sometimes
applied to patients who present with neurological symptoms, such as numbness,
blindness, paralysis, or fits, which are not consistent with a well-established
organic cause, and which cause significant distress. It is thought that these
symptoms arise in response to stressful situations affecting a patient's mental
health or an ongoing mental health condition such as depression. Conversion
disorder was retained in DSM-5, but given the subtitle functional neurological
symptom disorder. The new criteria cover the same range of symptoms, but remove
the requirements for a psychological stressor to be present and for feigning to
be disproved.
The theory of conversion disorder stems from ancient
Egypt, and was formerly known as "hysteria". The concept of
conversion disorder came to prominence at the end of the 19th century, when the
neurologists Jean-Martin Charcot and Sigmund Freud and psychologist Pierre
Janet focused their studies on the subject. Before their studies, people with
hysteria were often believed to be malingering. The term "conversion"
has its origins in Freud's doctrine that anxiety is "converted" into
physical symptoms. Though previously thought to have vanished from the west in
the 20th century, some research has suggested that conversion disorder is as
common as ever.
Historical Perspectives
In Greek mythology, hysteria, the original name for
functional neurological symptom disorder, was thought to be caused by a lack of
orgasms, uterine melancholy and not procreating. Plato, Aristotle and
Hippocrates believed that a lack of sex upset the uterus. The Greeks believed
that it could be prevented and cured with wine and orgies. Hippocrates argued
that a lack of regular sexual intercourse led to the uterus producing toxic
fumes and caused it to move in the body, and that this meant that all women
should be married and enjoy a satisfactory sexual life.
From the 13th century, women with hysteria were
exorcised, as it was believed that they were possessed by the devil. It was
believed that if doctors could not find the cause of a disease or illness, it
must be caused by the devil.
At the beginning of the 16th century, women were sexually
stimulated by midwives in order to relieve their symptoms. Gerolamo Cardano and
Giambattista della Porta believed that polluted water and fumes caused the
symptoms of hysteria. Towards the end of the century, however, the role of the
uterus was no longer thought central to the disorder, with Thomas Willis
discovering that the brain and central nervous system were the cause of the
symptoms. Thomas Sydenham argued that the symptoms of hysteria may have an
organic cause. He also proved that the uterus is not the cause of symptom.
In 1692, in Salem (MA), there was an outbreak of
hysteria. This led to the Salem witch trials, where the witches had symptoms
such as sudden movements, staring eyes and uncontrollable jumping.
During the 18th century, there was a move from the idea
of hysteria being caused by the uterus to it being caused by the brain. This
led to an understanding that it could affect both sexes. Jean-Martin Charcot
argued that hysteria was caused by "a hereditary degeneration of the
nervous system, namely a neurological disorder".
In the 19th century, hysteria moved from being considered
a neurological disorder to being considered a psychological disorder, when
Pierre Janet argued that "dissociation appears autonomously for neurotic
reasons, and in such a way as to adversely disturb the individual's everyday
life". However, as early as 1874, doctors including W. B. Carpenter and J.
A. Omerod began to speak out against the hysteria phenomenon as there was no
evidence to prove its existence.
Freud referred to the condition as both hysteria and
conversion disorder throughout his career. He believed that those with the
condition could not live in a mature relationship, and that those with the
condition were unwell in order to achieve a "secondary gain", in that
they are able to manipulate their situation to fit their needs or desires. He
also found that both men and women could suffer from the disorder. However,
throughout his career, Freud admitted that "he had not succeeded in curing
a single patient, and there was no clinical evidence that his theory had any
merit whatsoever". Freud frequently made serious diagnostic errors due to
his theory of hysteria. In 1901, a patient died of a sarcoma of the abdominal
glands, which had given her abdominal pain. One key feature of hysteria was
said to be abdominal pain, and so Freud treated her for this, and claimed her
condition had "cleared up". After her death, he then claimed that
hysteria had caused her tumor, but there is no evidence to support his claim.
Freud's model suggested that the emotional charge
deriving from painful experiences would be consciously repressed as a way of
managing the pain, but that the emotional charge would be somehow
"converted" into neurological symptoms. Freud later argued that the
repressed experiences were of a sexual nature.
Janet, the other great theoretician of hysteria, argued
that symptoms arose through the power of suggestion, acting on a personality
vulnerable to dissociation. In this hypothetical process, the subject's
experience of their leg, for example, is split off from the rest of their
consciousness, resulting in paralysis or numbness in that leg.
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