A Conversion Reaction is a sudden onset of symptoms which serve to escape an unbearable situation. The person is not at all “faking it;” they have no conscious control of what they feel or do. It’s different from “Factitious Disorder,” like Munchausen’s Syndrome, when patients consciously manufacture illness to gain attention or sympathy. It’s also different from “Malingering,” which is simply a form of lying, in order to get something concrete, like disability or a school excuse.
Symptoms of Conversion Reaction can be almost anything, including blindness; coma, seizures; paralysis; inability to speak, walk, etc; virtually anything. Some examples can be illustrative.
1. In my small Appalachian ER, a woman was brought in “comatose,” surrounded by worried family. Not the first time; we knew her conversion reactions well, which occurred in the setting of major family arguments. I asked the family [who were likely triggers] to please step out, and they said, “OK, but don’t stick needles in her.” Huh? Apparently the last time this happened, a temporary physician had tried to provoke a pain response [not a good way]. The patient was of course conscious, felt it, told her family after, but the psychological force was so strong at the time that she didn’t even react!
2. A 25-year-old man cam to the ER with “chest pain.” I inquired what he was doing at the time: “Playing poker,” then mentioned a man who “raised him.” Sounded interesting, and I used to play in high school, so I asked, “How much did he raise you;” it turned out he was referring to the man who’d raised him as a child, a father figure.
This “father” had had a heart attack a month before, and now was losing heavily in the game. So the patient developed chest pain, an unconscious attempt to get his “father” out of the game. And “Dad” kept on playing another hour, with “son” clutching his chest, until finally driving him to the ER!
3. One of my regular AIDS patients, first diagnosed far away during a brain infection, but now completely stable on HIV medications, was sent to me by a desperate outside neurologist “for brain surgery” [!!!!!]. The patient had new weakness, a CT scan showed a tumor, and the local neurosurgeon refused to operate because tumor location didn’t match neurological symptoms. I sent him by phone to our local ER, which hospitalized him “with major neurological deficits.”
Neurology promptly discharged him, saying all his weakness was factitious, i.e. not real. The “tumor” was nothing more than a scar from the old brain infection. I saw him back a day later, and sure enough, on exam all his “weakness” was simply not real. It wasn’t “faked,” he really felt weak, but his body was fine.
Then it turned out that his partner had just broken up with him, so this was his subconscious mind’s way of trying to salvage the relationship. Didn’t work; and the partner, who’d come along during his visit with me, kept asking, “Do you think it might be all in his head? Like, it’s all in his head? …” I just hemmed and hawed, since treatment for Conversion Reactions is empathetic reassurance and frequent follow-up. The partner kept going on, the patient sat quietly with a blank smile.
Post-Script: The patient flew back to his very first hospital, they represcribed treatment for the original infection (potentially toxic, completely unwarranted), and the patient “miraculously” recovered. I slowly discontinued those multiple medications, patient did fine; independently from all this, the 2 lovers reunited.
Conversion Reactions are challenging.