Understanding hysterical conversion an interdisciplinary approach

Author: Patricia Albrecht

Albrecht, Patricia, 2009 Understanding hysterical conversion an interdisciplinary approach, Flinders University, School of Humanities and Creative Arts

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According to current psychiatric classificatory systems, 'conversion hysteria' or in its present clinical incarnation, 'conversion disorder', refers to neurological deficits such as paralysis or somatosensory losses, for which an organic medical explanation cannot be found, and for which a psychological rather than organic cause is presumed.

The assumption of psychogenesis on the basis of the absence of disease is misleading. It assumes that if there is a lack of significant structural damage in organ systems implied by the complaints of the patient, the problem must therefore be 'all in the mind'.

Yet explanations are rising in number in terms of the biological, especially neural, and endocrine regulatory processes that underlie the subjective experience of chronic physical symptoms. These processes are organic despite the fact that there is no evidence of damage or disease to either the brain and central nervous system, or peripheral organ systems.

The simplistic reduction of complex systemic processes to the psyche or imagination can no longer be sustained in light of such evidence. Current biopsychosocial models of hysteria, and somatoform disorders in general (disorders that take the form of 'real' diseases) explain the somatic phenomena

observed in terms of innate defense reactions to threat, seen throughout the animal kingdom.

This conceptualization is not new. In 1926 Kretschmer suggested that conversion reactions were related to the instinct for self-preservation and likened the motor and sensory diperceptions, and in humans, mental entities, such as memories, might activate affective systems, resulting in physiological disturbances that are mistakenly interpreted by the patient as symptomatic of disease. In the present

work, I shall argue that to understand the systems and processes involved in creating the illusion of illness is to understand the problem of hysteria.

However, as things stand, a lack of biomedical explanation for such gross abnormalities has led many practitioners to believe that the patient who claims to be ill in the absence of disease, is either attempting to deceive them or is self-deceived. In other words, many practitioners do not accept that the patient's condition is beyond her control. The problem of hysteria, on this view, will not be resolved by explaining symptoms; rather, what needs to be explained is why some individuals, for various motives, continue to insist they are ill despite medical findings to the contrary. Medical practitioners readily admit that they do not like dealing with 'somatizers', setting the scene for irritation and unsatisfactory interactions. As often observed, the patient's condition may worsen as a result of the doctor-patient relationship.

It is the view of the author, that education is the key to resolving both problems. Patient and doctor require conceptual models that will allow them to understand how neurotransmitters and hormones secreted in response to a stressor (physical, psychological, or social) can, under certain circumstances, alter bodily representations creating sensory and motor disturbances. Such models can also explain why it is that nonnally transient reactions to threat can become chronic in some individuals and the mechanisms involved. To answer these questions requires knowledge of the principles of associative learning (classical and operant conditioning).

Hysterical symptoms will continue to be misunderstood and their sufferers maligned until both practitioner and patient understand the inextricable interconnections between body, mind and the social environment suggested by emergent biopsychosocial models.

To understand the issues and controversies that abound in studies on hysteria, philosophers also need to acquaint themselves with the different aspects of what is a complex phenomenon. The following represents one such attempt.

Keywords: Conversion disorder, Hysteria, Somatoform disorders, Thought and thinking

Subject: Philosophy thesis

Thesis type: Doctor of Philosophy
Completed: 2009
School: School of Humanities and Creative Arts
Supervisor: Dr Ian Ravenscroft