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UNDERSTANDING STRESS BREAKDOWN: CONVERSION SYMPTOMS

Sometimes third stage stress breakdown can cause the switching off of large groups of brain cells in the cerebral cortex. As a result, the patient may experience a sudden loss of function of a limb, loss of a sensory modality or loss of some mental function, such as memory. This sudden loss of function, which can be proven by medical tests not to be due to any disease process, used to be called hysterical, an ancient term which associated strange symptoms with the womb or uterus. Presumably the ancient Greeks thought the uterus used to wander round the body bumping into things, so presumably only women could suffer in this way. The word 'hysteria' is derived from the same word root as is 'hysterectomy' (removal of the uterus).

The patterns of disturbed function formerly described as hysterical disorders are these days labeled conversion or dissociative disorders. The word 'conversion' is derived from the theories of Sigmund Freud, whose concept was that a forgotten conflict deeply buried in the unconscious mind is 'converted' into a body symptom. The theory is that when the patient can be helped to solve the deep inner conflict, the symptom which symbolizes this conflict will disappear. When the loss of function involves a mental function like memory, or where reality perception is impaired under stress, the term dissociative state is usually employed.

Because conversion symptoms are caused by switching-off mechanisms trying to protect the over-stimulated, over-stressed cerebral cortex, these symptoms will therefore be limited to loss of function, and will include paralysis, numbness, blindness, deafness and loss of memory, which can be shown by medical tests not to be caused by any disease process.

To prove medically that the sometimes bizarre symptoms of a conversion disorder are reversible under certain conditions and are therefore not due to structural damage or disease of the brain, the patient may be hypnotized or given an injection with a 'truth drug' under which conditions the lost functions may return.

The 'truth drug' or 'truth serum', so beloved of the writers of fiction, is simply a general anesthetic agent given slowly intravenously. A not uncommon example would be a case of hysterical or dissociative amnesia. Here the patient may be found somewhere wandering perplexed, unable to remember anything about the details of his personal life for some period in the immediate past. Under the influence of the sedative, the patient with a dissociative state may be able to reveal the forgotten facts. However, when the drug wears off, he tends to forget everything again.

Presumably the drug interferes with the function of the inhibitory cell circuits in the cerebral cortex, which have been operating as circuit breakers to switch off response capability of large groups of cells.

In planning treatment for a conversion symptom, the therapist must be sensitive to the fact that gross conversion symptoms under relatively low stress levels can indicate that the nervous system's function is impaired. Thus the paradox arises that the occurrence of conversion symptoms which can be proven to be reversible might nevertheless be a sign of brain disease. Sometimes a brain tumour or some other disease process may so affect brain function as to predispose the person to develop conversion symptoms under stress before the behavioural changes of the three stages of stress breakdown have become apparent.

However, people with perfectly normal brains can develop conversion symptoms under high levels of stress. For example, conversion symptoms are common in soldiers with combat fatigue (another name for stress breakdown).

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