Sunday, January 8, 2017

Conversion: Defense mechanisms by Sigmund Freud


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”.


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.


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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