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Conversion disorder not about mould

Posted Jan 20 2012 12:00am
Le Roy, New York (CNN) -- Twelve female students from Le Roy Junior Senior High School in upstate New York are experiencing a mysterious medical condition. Their symptoms include stuttering, uncontrollable twitching movements and verbal outbursts.

Health officials say the symptoms are consistent with "conversion disorder."

Dr. Jennifer McVige, a pediatric neurologist at the DENT Neurologic Institute who is treating many of the students affected, said, "Conversion disorder is a physical manifestation of physiological symptoms where there is traditionally some kind of stress or multiple stressors that provoke a physical reaction within the body." McVige said the symptoms are real. "This is unconscious. It is not done purposefully."...

Officials at the school hired an independent third party to conduct mold and air quality tests but found no environmental cause for the girls' illnesses. A statement posted on the school's website said, in part, "The medical and environmental investigations have not uncovered any evidence that would link the neurological symptoms to anything in the environment or of an infectious nature."

Sanchez's mother, Melissa Phillips said she does not agree. "I don't think that all physical aspects of this have been exhausted; not enough testing has been done."

The media reaction is to express "surprise" that this puzzling phenomenon can't be traced to a contaminant in the physical environment, just like the medical community continues to be "puzzled" about the lack of clear cut medical evidence for schizophrenia. Here's what the media should say about conversion disorder, but shies away from:



Conversion disorder: the modern hysteria
Colm Owens and Simon Dein

Conversion disorder is thought to occur primarily in societies with strict social systems that prevent individuals from directly expressing feelings and emotions towards others. Temporary somatic dysfunction is one possible mode of communication, particularly for those who are oppressed or underprivileged. The ‘psychological mindedness’ and ease of emotional expression typical of modern developed societies have led to the increasing rarity of conversion disorders in developed countries ( Tseng, 2001

Conversion has been attributed to many different mechanisms. One influential theory, dating back to Ancient Greek physicians who thought the symptoms specific to women, invoked as their cause the wandering of the uterus (hustera), from which the word hysteria derives. The term conversion was first used by Freud and Breuer to refer to the substitution of a somatic symptom for a repressed idea (Freud, 1894). This behaviour exemplifies the psychological concept of ‘primary gain’, i.e. psychological anxiety is converted into somatic symptomatology, which lessens the anxiety and gives rise la belle indifference, where a patient seems surprisingly unconcerned about their physical symptoms. The ‘secondary gain’ of such a reaction is the subsequent benefit that a patient may derive from being in the sick role.

As David & Halligan (2000) point out, the concept of conversion disorder has raised great controversy between the proponents of psychological and physiological models of mental states. Conversion disorder raises the intriguing philosophical problem of how it is that psychological or mental states can effect long-term motor, sensory and cognitive changes in people claiming not to be consciously responsible for them. Theories falls into three main groups: psychoanalytic, learning theory and sociocultural formulations

Psychoanalytic theories

Psychoanalytic explanations of conversion disorder emphasise unconscious drives, including sexuality, aggression or dependency, and the internalised prohibition against their expression (Hollander, 1980). A classic paradigm of this theory is the case of Anna O., who was treated by Freud (Breuer & Freud, 1895). Physical symptoms allow for the expression of the forbidden wish or urge but also disguise it. Other psychoanalytic explanations focus on the need to suffer or identification with a lost object (Ford & Folks 1985). An analytic therapist would attempt to treat a conversion disorder by helping the patient move to more mature defence mechanisms.

Management

It is crucial in any approach to patients with conversion disorder to establish a therapeutic alliance and to allow recovery with dignity and without loss of face. It is important that nursing and medical staff avoid labelling these individuals as manipulative, dependent or as exaggerating their difficulties.

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