In the psychiatrist's chair: how neurologists understand conversion disorder

Brain. 2009 Oct;132(Pt 10):2889-96. doi: 10.1093/brain/awp060. Epub 2009 Mar 24.

Abstract

Conversion disorder ('hysteria') was largely considered to be a neurological problem in the 19th century, but without a neuropathological explanation it was commonly assimilated with malingering. The theories of Janet and Freud transformed hysteria into a psychiatric condition, but as such models decline in popularity and a neurobiology of conversion has yet to be found, today's neurologists once again face a disorder without an accepted model. This article explores how today's neurologists understand conversion through in-depth interviews with 22 neurology consultants. The neurologists endorsed psychological models but did not understand their patients in such terms. Rather, they distinguished conversion from other unexplained conditions clinically by its severity and inconsistency. While many did not see this as clearly distinct from feigning, they did not feel that this was their problem to resolve. They saw themselves as 'agnostic' regarding non-neuropathological explanations. However, since neurologists are in some ways more expert in conversion than psychiatrists, their continuing support for the deception model is important, and begs an explanation. One reason for the model's persistence may be that it is employed as a diagnostic device, used to differentiate between those unexplained symptoms that could, in principle, have a medical explanation and those that could not.

Publication types

  • Historical Article
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Conversion Disorder / epidemiology
  • Conversion Disorder / history
  • Conversion Disorder / psychology*
  • Deception
  • History, 19th Century
  • History, 20th Century
  • Humans
  • Hysteria / epidemiology
  • Neurologic Examination
  • Neurology
  • Physicians
  • United Kingdom / epidemiology