Conversion Reaction

A Conversion Reaction is a sudden onset of symptoms which serve to escape an unbearable situation.ย  The person is not at all โ€œfaking it;โ€ they have no conscious control of what they feel or do.ย  Itโ€™s different from โ€œFactitious Disorder,โ€ like Munchausenโ€™s Syndrome, when patients consciously manufacture illness to gain attention or sympathy.ย  Itโ€™s also different from โ€œMalingering,โ€ 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 โ€œcomatose,โ€ surrounded by worried family.ย  Not the first time; we knew her conversion reactions well, which occurred in the setting of major family arguments.ย  I asked the family [who were likely triggers] to please step out, and they said, โ€œOK, but donโ€™t stick needles in her.โ€ ย Huh?ย  Apparently the last time this happened, a temporary physician had tried to provoke a pain response [not a good way].ย  The patient was of course conscious, felt it, told her family after, but the psychological force was so strong at the time that she didnโ€™t even react!

2. A 25-year-old man cam to the ER with โ€œchest pain.โ€  I inquired what he was doing at the time: โ€œPlaying poker,โ€ then mentioned a man who โ€œraised him.โ€  Sounded interesting, and I used to play in high school, so I asked, โ€œHow much did he raise you;โ€ it  turned out he was referring to the man whoโ€™d raised him as a child, a father figure.

This โ€œfatherโ€ 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 โ€œfatherโ€ out of the game.  And โ€œDadโ€ kept on playing another hour, with โ€œsonโ€ 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 โ€œfor brain surgeryโ€ [!!!!!].  The patient had new weakness, a CT scan showed a tumor, and the local neurosurgeon refused to operate because tumor location didnโ€™t match neurological symptoms.  I sent him by phone to our local ER, which hospitalized him โ€œwith major neurological deficits.โ€

Neurology promptly discharged him, saying all his weakness was factitious, i.e. not real.  The โ€œtumorโ€ 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 โ€œweaknessโ€ was simply not real.  It wasnโ€™t โ€œfaked,โ€ 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 mindโ€™s way of trying to salvage the relationship.  Didnโ€™t work; and the partner, whoโ€™d come along during his visit with me, kept asking, โ€œDo you think it might be all in his head?  Like, itโ€™s all in his head? โ€ฆโ€  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 โ€œmiraculouslyโ€ recovered.  I slowly discontinued those multiple medications, patient did fine; independently from all this, the 2 lovers reunited.

Conversion Reactions are challenging.

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