A less hysterical reaction

There’s a fascinating article in The Guardian about one of the least understood aspects of human nature: experiences like blindness, paralysis and seizures that seem to mimic gross damage to the nervous system but aren’t explained by it. People can experience profound blindness, for example, but have no detectable damage to their visual system.

These difficulties have various names: conversion disorder, hysteria, dissociative disorder, medically unexplained symptoms, functional neurological symptoms, somatoform disorder, or are denoted by adding the word ‘functional’ or ‘psychogenic’ to the disability.

The original concept, usually falsely attributed to Freud but actually first suggested by French psychologist Pierre Janet, was that emotional disturbance was being expressed as a physical problem, potentially as a form of psychological defence mechanism.

This is the origin of one of the modern names – ‘conversion disorder’ – but it’s not clear that ’emotion being converted into a physical symptom’ is a good explanation. We do know, however, that these experiences are more likely in people with a history of trauma, stress or emotional difficulties.

Crucially, people affected by these conditions feel no voluntary control over their symptoms – they’re not faking – but if you understand the nervous system you can often see how the symptoms aren’t consistent with the disabilities they appear to mimic.

For example, in the article, the neurologist tests a patient’s blindness like so:

He took from his bag a small rotating drum painted in black and white stripes. He held it in front of Yvonne and spun it quickly. Her eyes flickered from side to side in response to it, involuntarily drawn to the spinning stripes.

If the patient was blind due to damage to the eye, retina or optic nerve, visual material wouldn’t cause an involuntary eye tracking response, because the visual information would never make it to the brain.

So strikingly, the visual information is clearly being perceived at one level but is not accessible to the conscious mind – and it is this dramatic dissociation between the conscious and unconscious which is at the core of the problem, and is so poorly understood.

Unfortunately, these problems have also been traditionally stigmatised within medicine with people affected by them sometimes treated as fakers or time-wasters.

Similarly, to patients, the problems often feel as if “something has gone wrong with their bodies” meaning it can be difficult to hear that the origin may be psychological – partly of course, due to the common misconception that ‘psychological’ means ‘under your control’.

So this is why The Guardian article is so interesting because it is a little discussed area that needs a wider understanding both clinically and scientifically.

It describes several people with exactly these difficulties and how they are experienced.

Apparently, it’s taken from a new book by the same neurologist which is entirely about ‘functional neurological symptoms’ which could be equally as interesting.
 

Link to ‘You think I’m mad?’ – the truth about psychosomatic illness.