In DSM-IV, conversion disorder is described as distressful symptoms (or symptom) of voluntary motor or sensory function that “suggest” a neurological or other illness even though no actual pathology is present, and there is reason to believe that the problem is psychological in origin. It has sometimes been called hysterical blindness, hysterical paralysis, hysterical anesthesia, etc… This diagnosis is being retained in DSM-5
Prevalence estimates vary from 1 in 10,000 to 50 in 10,000.
The Mayo Clinic offers the following treatment suggestions: counseling, physical therapy, stress reduction, anxiolytics, antidepressants, hypnosis, and transcranial magnetic stimulation.
In my entire career, I have come across only one person who carried this “diagnosis.” She was a small, frail-looking woman of about 40 who reportedly hadn’t walked for years, and was pushed in a wheelchair wherever she went. Let’s call her Betty.
I encountered Betty in a county mental health center in the eastern United States. The center was housed in a good-sized building with a large room on the lower floor that had been set up for training clients in various social and other skills.
Betty attended pretty much every day, and clearly enjoyed the various activities, but she had to be pushed everywhere in her wheelchair by a staff member or another client.
At some point Betty came to the attention of our behavior analyst who, having watched the dynamics for a few days, instructed the staff not to push Betty in her wheelchair, and also to dissuade the other clients from doing so. This took some coaxing and persuading, as Betty was very well-liked.
For a day or two Betty sat rather forlornly in one place, but then it was noticed that she began to propel herself slowly by shuffling her feet against the floor. As the days followed, she became more adept in this technique, and then it was noticed that she began standing up if she wanted to reach something, on the other side of a table, for instance.
I don’t remember how long it took – I think a few weeks – but eventually the wheelchair was left by the door on arrival, and she walked around the room normally for the rest of the day.
It’s tempting to see this as the staff tricking her into abandoning the wheelchair. But, in my view, there’s a better way to conceptualize the matter.
For Betty, the wheelchair brought her some very important things: human contact; care and solicitousness; a sense that she was valued; etc… These are things that we all need, and that we learn to acquire in various ways. For some reason Betty wasn’t finding these expressions of human comfort in conventional activities, and the wheelchair was a kind of prop which helped fill these needs.
What’s also important to note is that the staff didn’t try to coax or pressure Betty to leave the wheelchair. They just created a situation where she could find the strength to help herself. And she did.
The essential point is that the people who are labeled as mentally ill can usually find within themselves the solutions to their problems and a more fulfilling life if they receive the right kind of help.