Saturday, February 18, 2012

The Other "Conversion" and What We Can Learn From It

The issue of the power of mental illness and specifically "conversion reaction" has been on my mind of late.  There are several factors for that.

The first thing that brought this to mind was the case of the teenage girls in LeRoy, New York.  If you didn't catch the story, this group of girls suddenly developed a Tourettes-like syndrome.  When I watched them on TV, I knew within a second that it was a conversion (or what we now call "functional") disorder.  It's not being judgmental. For us who work in medicine, especially neurology, we have seen this so many times, usually on a daily basis, that it becomes a no-brainer. It also represents one of the most difficult situation we face. It is a sum loss . . . damned if you do . . . damned if you don't type of situation.  The reason is, virtually always bonded with this form of mental illness is the absolute certainty, on the behalf of the sufferer, that it is a real-physical disease.  So, if you try to tell them the truth, they react in rage.  The only time I was ever assaulted in my career was when I told a patient that the seizure, which they had just faked, wasn't real.  I didn't tell her to be cruel but . . . it's a long story. Just I had no choice in that situation.

I watched a school board meeting with the parents of the teenage girls in that small town. The parents were screaming in rage that no one is finding the chemical . . . or whatever . . . that they believe is causing their children to be sick.  The poor school board in between a rock and a hard place. I can understand the perceptive of the parents, especially if they don't know a lot about psychiatric illness, that someone is accusing their sweet little girl of faking it.

But this is where it gets complicated.  In true conversation reactions, you don't consciously decide one day you will start faking a physical illness. It is a deep, self-deception. That's why it is offensive to them to be told that they are having a mental illness rather than a physical one.

Now, for most of us, to be told that something we perceive as physical was really mental, I think we would at least be open to that idea, but to them, they totally reject that possibility.

The lay person may think, or ask, maybe we are the ones messed up. You know, the great Medical-Industrial-Complex where we either are not smart enough (like House, MD), don't care enough or are paid off by the Medical-Industrial-Complex, that we miss it. That it really is some strange environmental toxin that is making people sick.  Sorry. In cases like this that is never true. We do, collectively, have almost certainty because human psychological phenomena have been well studied as have the true neurological diseases. But I'm getting entangled in a side-bar and I want to move back to my main point.

The other reason that this has been on my mind is that I've spent a lot of time with several patients with "conversion reactions" or what we mostly now refer to as functional illness or somatization disorders, in the past two weeks. But this thought is much more than about those specific mental health issues. There's a lot to think about here regarding psychology in general, and back to epistemology.

First to the psychological. Why are we (and I sincerely mean "we") so prone to the hologram of physical suffering being projected around us by the inner id?  It's simply because there is so much reward riding on it. As an adult, the only way that we can enjoy child-like nurturing . . . is to be sick. For many, they never got the nurturing which God intended for us to have . . . as a child.  A quick way to inject meaning into our lives, and value, is to be innocent victims of suffering . . .  especially if that suffering is dramatic.

A couple of years ago, the hiccup girl made national news. Later, after she was arrested for murder-related charges she talked about how addictive it was to be on the main stage of national news in her 15 minutes of fame. It is part of that insatiable hunger for re-valuation of ourselves.  So, being unable to stop her hiccups (or so it seems) made her a hero-type, which gave her a sense of value.

On a less grand scale, I've been a part of many church prayer chains over the years. Invariably there are those people who are frequently sharing dramatic prayer requests, often they consist of--thinly veiled--self praises. "Pray for my dear friend Ann. I've shared the gospel with her many times over the years and she says that I am her greatest friend and God has allowed me to be such a good example of godliness for her. Pray for her salvation."   But more often they are about strange medical problems. They have concerns about serious and strange (local doctors can't figure it out . . . so they are flying in experts from all over the world to figure it out) medical problems. I've made huge evangel-o-blunders when I've spoken up and gave much more simple explanations for someone.  I know that I sound cynical . . . but I know that I've done the same behavior when I was an evangelical. It is groping for that attention, some massaging of the ego, to let me know that I have value. But isn't that what the Gospel is really for? I am not talking about the sharing of prayer request for real serious illnesses, cancer, heart disease, seizures our you name it. I'm talking about when those things are embellished.

I wanted to take this conversation about conversion to the last level, and that is the level of knowing. But I'm running out of time. But I will end this posting with the question, if we can mentally induce medical disease (even blindness), how can we trust our minds about anything?  I will pick up on that . . . but I'm late to work. Sorry, no time to proof read again.   


Jaimie said...

I guess the answer to your last question is... we know we aren't faking if we are genuinely evaluating ourselves (or we know as well as we know anything). Another thing I think is key: We know we aren't faking if we want to be free of our illness. Do I want to be free of my anxiety? Yes. Yes I do. I don't give a crap about any "attention" I get from it -- if anything, the attention is negative. I'd rather go back to when I was 19 or 20 and didn't have to deal with this. And so I know I'm not faking it, because I'm always surprised and frustrated whenever it shows up. And my first reaction when it shows up is never to tell someone. I've been having anxiety since 6:00 this evening. This is the number of people I've told: 0

Well, except you.

Looking forward to the follow-up.

jmj said...

I think you are right Jaimie. Also, I don't think anxiety would be the "illness of choice" if someone wanted to fake something. Like you said, having anxiety, unfortunately, is not highly appraised in our society (and as you know I am a sufferer of it) nor will it make you a celebrity like suffering from jerking and twisting and fainting from some mystery environmental toxin.