We have been conditioned to believe that medical problems have causes. If a limb hurts it must be injured. If your stomach aches you’re probably sick. But what happens when you have symptoms that can’t be explained?
Take the pregnant teenager who shows up to the emergency room unable to move her pointed toe or closed elbow, but who says only that “I’ll get used to it.” Or the young man who comes in with numbness that only covers his hands, despite the fact that the body doesn’t have any such clear border between the nerves. Then there’s the group of girls in Iran who suddenly found themselves unable to walk after receiving tetanus shots. All of these patients had something clearly wrong with them and yet there was seemingly no physical cause for their ills.
So what is it then? These are patients who have been run through the entire gamut of tests. As soon as they showed signs of neurological disorders they were subjected to CT scans and MRIs to show that they were free of lesions in the brain or spinal cord, they had an electroencephalograph performed to remove the possibility of seizures, and had samples taken of their spinal fluids to show that there weren’t any infections in their neurological systems. But all of these tests came up negative.
Well, it turns out that it is all in their head, but not in the way you might think. None of these patients were making up their symptoms, and they didn’t have any conscious control over their ailing body parts. Rather, they have conversion disorder.
Conversion disorder is, at its most basic, simply the presence of symptoms without an organic cause. But it’s more than just that, it seems that the disorder is an unconscious expression of a psychological cause. Something is bothering the patient, whether its trauma, anxiety, stress, etc., and that root cause ends up being converted into a physical bodily symptom. Conversion disorder can take a wide variety of forms, from blindness and paralysis, to hallucinations and motor tics.
Strangely enough, like the teen mother in the example above, many of the patients who show evidence of conversion disorder exhibit a kind of la belle indifference. That French phrase is a psychological term that is defined as “a naive, inappropriate lack of emotionor concern for the perceptions by others of one’s disability.” The idea is that the conversion of the psychological stress into a physical symptom actually benefits the patient because they get rid of the stress that was causing them all the problems in the first place. What’s a physical problem compared to a psychological one?
In the case of the young mother, she had just found out that her boyfriend was seeing another girl. She was incredibly angry with him and wanted to hit and kick him, but couldn’t because of her locked leg and elbow. Her symptoms kept her from the actions that she desperately wanted to take.
But how can you really tell if someone has conversion disorder? Even after running all the tests in the world it’s hardly possible to rule out every possible problem. Well, one thing doctors do is check for strange symptoms like those of the young man with the numb hands. There is no real physical problem that would cause just the hands of the man’s arm to turn numb, parts of the rest of the arm should be affected. But the man didn’t know that and thus the unconscious part of his brain controlling the symptoms didn’t know that either.
If a patient complains of blindness doctors can move a mirror in front of their eyes and see if the patient follows it unconsciously. Or they can show them a rotating striped drum and observe if the eyes track the motion. With paralysis doctors can do a drop test, holding the arm of the patient over their face and letting go. If the patient has conversion disorder the arm will fall in a way that allows it to avoid the face.
It seems that many patients who show signs of conversion disorder are unable to express their emotions normally. This may be because of societal or family expectations that it’s not proper to show certain emotions, such as rage or violent feelings on the part of a woman or anxiety or depression on the part of a man.
In practice it seems that conversion disorder strikes more women than men, from everything from a 2:1 to a 10:1 ratio depending on the study. But this might just be because the disorder seems to affect those with less power in society more heavily, including the uneducated and those of a lower socioeconomic status.
Given that there’s no physical problem at play, how does one go about treating the disorder? Well, it’s very important that doctors emphasize that the problem is genuine. Just because it’s caused by the brain doesn’t mean that it is imaginary, and many patients automatically take offense- rightly so- when told that their problems are all made up. Studies have shown that explaining that the patient has temporarily lost conscious control of parts of their body because of psychological issues helps matters immensely.
Once that’s out of the way most treatments take a psychiatric bent. Psychotherapy is one of the best treatments, as well as occupational therapy to help with body parts that might have atrophied and possible medication to treat psychological conditions like depression or anxiety.
But while it’s comforting to know that the problems associated with conversion disorder can be reversed and cured it’s still terrifying to know that the brain is able to manifest such strange disorders, seemingly at the drop of the hat.