Talk:Conversion disorder

From Wikipedia, the free encyclopedia

This article is within the scope of WikiProject Psychology, which collaborates on Psychology and related subjects on Wikipedia. To participate, help improve this article or visit the project page for details on the project.

B	This article has been rated as B-Class on the quality scale.
Mid	This article has been rated as Mid-importance on the importance scale.
Article Grading: The article has been rated for quality and/or importance but has no comments yet. If appropriate, please review the article and then leave comments to identify the strengths and weaknesses of the article and what work it needs.

	This article is within the scope of WikiProject Medicine. Please visit the project page for details or ask questions at the doctor's mess.
B	This page has been rated as B-Class on the quality assessment scale
Mid	This article has been rated as Mid-importance on the importance assessment scale

[edit] Grammar!

A hyphen should never be used when an ndash or an mdash is meant. Example of a hyphen: dumb-dork. Example of an ndash: 1984 -- 2001. Example of an mdash: This could be the moment--- or maybe not.

Rory Coker

[edit] Anonymous edits

Could 82.26.155.12 please register? It would make it much easier to discuss some of the edits you have made recently. I think there's some interesting stuff in there but bits of it could be interpreted as POV. I'm doing a little bit of preliminary research in this area and might be able to provide some more references. --PaulWicks 19:31, 16 February 2006 (UTC)

[edit] Anonymous edits, part the second

Here's the provocative paragraph in question:

NB: The existence of this as a disorder is now largely discredited (see Richard Webster's "Why Freud was Wrong"). It remains as a diagnosis of convenience however with its chief proponents being Jon Stone And Michael Sharpe. To quote Stone himself "The truth is we do not know what is causing these symptoms". In the light of this and current research showing disruptions in blood flow within the brain science is at last reaching towards the realisation first envisaged by Charcot that functional symptoms were in fact organic in origin and not caused by repressed emotions or emotional trauma. Indeed since as Stone's research shows most patients are more distressed by their symptoms than any hypothesised stressor the diagnosis appears more and more a historical anachronism. EDITING IN PROGRESS

I've reverted this for the time being. One of the problems is that a single source is being used to "discredit" centuries of prior work. Believe it or not, there is more than Jon Stone's point of view to consider when considering the issue of conversion disorder.

Another problem is that the citations are inadequate. To cite a work, at a minimum the following must be included: author, title, publisher, and year of publication. Without this information, other editors cannot verify the citation.

This is an exciting time for those interested in the organic basis of psychiatric disease. I share the anonymous contributor's excitement and strongly desire to see the cutting-edge of research included in this article - in a well-referenced verifiable way compatible with the usual Wikipedia style guidelines. -ikkyu2 (talk)

I agree. Just last Friday I attended the British Neuropsychiatry Association annual conference where a whole afternoon was devoted to functional movement disorders which included presentations by Alan Carson, Jon Stone, Günther Deuschl, Christopher Bass, and Ned Shorter. I will take the liberty of emailing them for their input if they would like to join our endeavour. --PaulWicks 09:42, 17 February 2006 (UTC)

[edit] Misunderstood history

Sorry folks but conversion disorder is a condition invented by Freud. Charcot was looking for an organic cause to the symptoms he faced. Prior to this the condition, hysteria, was seen as predominantly as female illness. It was viewed by Hippocrates as having an organic basis- problems with blood flow in the brain. Recent research supports this (I'll look up the reference). There is absolutely NO emotional aetiology behind these symptoms. Stone and Sharpe live in the same diagnostic land as Freud. Their phenomenological understanding of the condition is muddled in the extreme. To say "the truth is we do not know what is causing these symptoms" (Stone) then to hypothesise a psychogenic cause based on flawed Freudian ideas is not science. Ironically the neurologist Arthur Hurst working in 1st World War had a more profound understanding of symptoms classified as "hysterical". He saw them as essentially shadows on the brain caused by disorders of attention or volition. He even hypothesises the organic basis behind this. To assert emotional causes converted into the physical is to sink back into the dark ages of cartesian dualism. Read Webster's "Why Freud Was Wrong" for a comprehensive review of the misdiagnosis of hysteria and the flawed thinking behind conversion disorder.

[edit] Forthcoming publication

Mr. Webster is currently at work on a new book about hysteria and its misdiagnosis

[edit] Bias

This article, as written, is terrible. It is heavily biased, gives no introduction, and does not directly define what a conversion disorder is. Had I not already known the definition, I would have been completely lost. Heavy editing is needed, along with introductory material. A total re-write may not be unwarranted. March 25, 2006

This article, as has been updated, is now worse. I will ask for contributions from more writers as at present we seem to have a bit of a quagmire... --PaulWicks 11:25, 6 April 2006 (UTC)

Yes I agree, I have clarified the meaning further that conversion disorder is an historic diagnosis. I think to suggest that any disorder is psychogenic or non-organic is essentially absurd and leads to allegations of dualism of form and function ie "the central nervous system is intact it's just not working properly" which is a tautology as Webster would agree.

You could do no worse than ask Richard Webster (he has just been asked to lecture alongside Simon Wessely on the subject.). Richard has studied the history of conversion disorder as a Freud scholar and basically it is to quote Richard "a belief system" ie no substantial scientific evidence for the traditional and ultimately Freudian understanding ascribed to this group of symptoms. He is at work on a book on the subject as I type.

Personally I think no neurologist can really comment without reading Hurst's work on the subject, I assume you have read this? functional motor disorders have nothing to do with the conversion of unresolved, repressed crisis into physical symptoms. In my own opinion I agree with Hurst in that they are alterations of attention and volition, I also agree with Hurst that there is frequently an organic stimulus and an organic mechanism by which they are sustained. We think that Hurst had a much better understanding of functional disorders than is currently prevalent. I should also add that I did entirely accept the reality of conversion disorder but discussion with one neurologist in Newcastle and with Webster changed my mind.

Alpinist 10.49, 12 April 2006 (rainy cumbria=slippery rock)

[edit] It does now!

Definition now included. I agree it still needs editing to clarify that conversion disorders are disorders of attention and volition. Conversion disorder as put forward by Freud simply does not exist. To claim otherwise is to be ignorant of the history behind its diagnosis, in particular to be ignorant of Freud and Charcot (Le Log is also considered to have suffered from organic disease). Most neurologists freely admit they "cannot get a handle on the cause of these symptoms" (Bateman). I would assert along with Webster that the jump to an emotional aetiology is historic rather than scientific.

I therefore think the article is not biased at all and with minor edits to clarify meaning should stand. The original article was very inaccurate. An archaeology of the disorder supports this as already stated. It also has references to the unconscious, the existence of which in its modern and Freudian sense is phenomenologically doubtful (Binswanger, Heidegger also Dennett for alternative models).

From an evolutionary point of view there is also the question as to how a disorder which supposedly afflicts 40% of neurological referrals could persist at all. Neuro-paeleontology demonstrates that there are no differences between the CNS of ourselves and our neolithic ancestors. Thus faced with an acute stressor neolithic man converts this emotion into functional weakness and is too slow to run away from the tiger. Is the secondary gain the sympathy of his peers as he is eaten? Remember that with Functional weakness we are talking about real changes in tone and movement. It would perhaps be helpful to carry out a study of functional (as in of undetermined aetiology OED) symptoms in other mammals, especially chimpanzees. Humans are not uniquely conscious after all.

But how about irritable bowel syndrome, for example? (Even recognizing that it has also a neurophysiological explanation). The neolithic man would suffer from abdominal pain and other symptoms, if he has to run away from animals too frequently? I don't think we can compare; even if the CNS is the same, the environment (all facets of it) is too different..--Guruclef 09:28, 2 December 2006 (UTC)

[edit] Update and reverts

Hi guys, I've tried to integrate both Alpinists' and Boris' information. I think we should resist doing total reverts as there will always be some good information and importantly hard work that is lost each time. I would request for the time being that we let this article cool down for a bit and focus on improving the quality of the references; at the moment they suck! If you take a look at the references at Orbitofrontal cortex I would suggest they would be a good way to go. A full explanation is here: http://en.wikipedia.org/wiki/WP:CITE#Complete_citations_in_a_.22References.22_section, and the templates are here: http://en.wikipedia.org/wiki/Wikipedia:Template_messages/Sources_of_articles/Generic_citations. Alternatively just see what I did on Orbitofrontal cortex and do some copy-pasting. Enjoy!--PaulWicks 13:13, 18 April 2006 (UTC)

[edit] Much better

I think Paul has done a great job here

Simon 15:58, 18 April 2006 (UTC)Alpinist

[edit] Reversions

Whilst I agree in principle with "be bold", I think this article tends to be rather stop-start in terms of someone making a contribution and it being reverted almost immediately. This is fine in the case of vandalism, but not in the case of someone's hard work and effort which were well intentioned. In my opinion WalkerTexasRngr has made some good contributions that add to a lay person's understanding of what psychiatrists mean when they say conversion disorder. If in another editor's opinion his contributions lack clarity then the proper step must surely be to increase the clarity, not to remove them all together? --PaulWicks 21:16, 8 May 2006 (UTC)

[edit] So badly written

It is so badly written as it stands- Key Stage 3 in style, fragmented and confused. An article can become so lengthy as to be worthless. Hard work is no substitute for good work. Do psychiatrist's really know what they mean when they say "conversion disorder"?? etymologically I don't think so. Simonalpinist

Hi Simon. Whilst I agree there is not much flow between different paragraphs I think it's also important to recognise that editors may feel reluctant to contribute when it's likely to end in a revert war. --PaulWicks 08:15, 26 May 2006 (UTC)

Hi Paul, fair comment- I'm trying to improve the flow and have included more information about charcot and the general history of conversion disorder. I've also tried to highlight that as a diagnosis it is controversial. I haven't had time to work on it but have been in discussion with several patients who've had this diagnosis. Interestingly the ones who pushed and pushed eventually got a different diagnosis. Correspondence also suggests that demographically it is the educated and motivated who are able to pursue this. The incompetence and crassness of neurologists also comes across quite strongly. I still feel that there is indeed a unique disorder of attention and volition as Hurst recognised, and that this is of course organic and not a "conversion". I do feel though that misdiagnosis is probably massively under estimated and is a caused by diagnostic poverty and socio-economic factors. I would be interested to know the percentage of private neurology patients who receive this diagnosis.

Simon 19:52, 16 June 2006 (UTC)alpinist

[edit] Video

There's quite a good video of this available through a search on yahoo http://uk.wrs.yahoo.com/_ylt=A9ibyJKeKJpETxEAcVR1BQx./SIG=13fsbnusm/EXP=1151040030/**http%3a//education.hsc.wvu.edu/som/psych3/charleston-pbl/schizophrenia_and_other_psychoti.htm Supposed 05:36, 22 June 2006 (UTC)

these links don't work

Simon 17:24, 10 July 2006 (UTC)alpinist

[edit] Interesting but please quote sources

The part on Aetiology is terrible, would it be possible to add references, the bacterial hypothesis sounds interesting but how prooven is it? Also other possible causes should be stated is they exist in the litterature. In its present form this section is biased and badly referenced. Also wikipedia should not be the place to advertise forthcoming publications, please use accessible sources. By using forthcoming publications and manuscripts in preparation one can also write an article about the habits of unicorns living on the dark side of the moon...

JMB

Once upon a time there was a unicorn who lived on the dark side of the moon. Unfortunately a lunar lander decided to make its descent above the place where the unicorn was grazing. Paralysed by fear the unicorn was unable to move. Luckily the astronaut piloting the lander noticed the unicorn at the last moment and avoided a collision. However the unicorn still failed to move and indeed is there to this day turned to stone.

Moral- psychic events do not extend beyond the moment at which in heideggerian terms they are at hand. Only In fairy tales are thinfs frozen to stone by fear. In reality the longevity of so called conversion symptoms beyond the hypothesised stressor is an indicator, as slater realised of the false nature of any suggestion of relation.

Fair point on references- the neuropsychiatric nature of lyme disease is well documented. There is also of course Hughes syndrome and a myriad other disorders that mimic conversion symptoms. Hence the well documented work of B. Hyde in "The difficulties of diagnosis" in both finding organic symptoms and treating them in "conversin disorder" patients.

I'll try and find time to include the references. I think you can quote forthcoming publications- readers can use judgement and in a reasonable span time forthcoming will be a specific ISBN.

SJO

[edit] My opinion

As a medicine student, I can tell you that this diagnosis, as vague as it may seem, is very real. It's not an excuse for not knowing the real diagnosis, but rather, the (extreme) realization that a patient's illness is not only cells and organs malfunctioning. Nowadays, medicine is all about treating the person instead of the body; the mind, and even the environment, must be taken into account. And sometimes, what's wrong with the patient is not in the tissues but in his mind. We've all felt not only pain, but many weird sensations when under extreme stress or emotions, and in the same way, other processes can affect neurological function of the body (remember that nerves, hormones, and immune system cells, each have ways to communicate between sub-systems of the body). It's true that this is not a common diagnosis, and must be made only after exclusion of other possibilities, but most medicine students (and of course doctors) will see it more than once or twice during their lives. --Guruclef 09:23, 2 December 2006 (UTC)

The above is not really substantiated by medical evidence. We are talking severe and life long signs and symptoms here.

on autopsy 39% of patients have a serious undiagnosed condition (New Scientist)

Oh and 40% of patients seeing a neurologist in the UK receive this diagnosis. In my case a failure to spot a hereditary clotting disorder led to misdiagnosis.

Simonalpinist

Nowadays, medicine is all about treating the person instead of the body; the mind, and even the environment, must be taken into account

- The more I learn about medicine, the more I realise what a dangerous, ignorant and profoundly unscientific attitude this is

alpinist

[edit] Having a go at this article again

Dear all, in light of my very peripheral involvement with a functional movement disorder clinic I'm going to have another go at this article over the next couple of days. Regular editors please please please give me a couple of days to find sources etc before reverting. I intend to make the referencing style consistent, integrate some newer papers, and perhaps get some other editors involved.

Thanks

--PaulWicks 18:45, 22 February 2007 (UTC)

I really don't like this part at the end. "It should also be noted that psychoanalytic treatments, on which CBT is based, were singularly unaffective with Freud and Breuer's patients." All psychotherapy is based on Freud's psychoanalytic treatments, not just CBT. Jeff Vollmer LCPC

The article is a complete mess. Simon's assertions definitely hurt the article, mostly because they are poorly written, obviously biased, single-sourced, and/or poorly sourced (New Scientist? come on). In my opinion, the article needs a complete rewrite preferably by someone who has had direct experience with subjects who supposedly suffer from the disorder.

Justin N 13 June 2007

Justin- this is a completely ignorant thing to say. I do have direct experience- what makes you think I haven't???? Also I have to say not all the edits are mine and the page has gone down hill since a consensus was established sometime ago.

[edit] Another attempt at improving this article

Dear all,

In resposne to requests for improvements on this article to be made by someone with appropriate experience, please allow modifications on this article to be maintained over the next few days; some content will have to be cut before new stuff can be added.

Many thanks --PaulWicks (talk) 18:00, 7 December 2007 (UTC)

Just a reminder that Wikipedia is not meant to be the place to have a debate about the topic; going through this again I see a lot of NPOV material that is not helpful and we'll be endeavouring to come up with some more up-to-date references. --PaulWicks (talk) 10:32, 10 December 2007 (UTC)

[edit] Agree

Dear Paul,

Thank you for that. In order to preserve the NPOV this article could contain a section to allow those with a completely contrary view (i.e. conversion disorder does not exist) to have their (proportionate) say if they wish. Otherwise the article does need a lot of improvement to reflect the commonly described features of this condition (for example, that found at 'emedicine') and its history. I agree it will be helpful to cut it back first before adding too much - Boris69 (talk) 23:22, 12 December 2007 (UTC)

There seems to be a lot of room for improvement. The article as it is contains many weird views. Is there any evidence at all regarding the (non-)existence of this disorder? Guido den Broeder (talk) 00:30, 13 December 2007 (UTC)

It is an accepted diagnosis within neurology and psychiatry, with DSM-IV criteria. That's about as close to recognition of existence as we can get. The weird views were probably added by a user who has now left. JFW | T@lk 00:50, 13 December 2007 (UTC)

Many accepted diagnoses have no evidence to their existence, so that doesn't say much. Guido den Broeder (talk) 00:57, 13 December 2007 (UTC)

Such as? OBJECTIVE evidence is very hard to find for any psychological phenomenon. Wikipedia is not after THE TRUTH, it is after factual representation of the information available. Therefore, this article should not endeavour to demonstrate whether or not conversion disorder exists, but rather what reliable sources (in which I would include DSM) say about it. Unfortunately it is hard finding reliable sources that provide the opposing view. JFW | T@lk 01:18, 13 December 2007 (UTC)

If you have any sources, present them, so we can judge that for ourselves. Guido den Broeder (talk) 01:29, 13 December 2007 (UTC)

I'm just going to work on cleaning up the references now.--PaulWicks (talk) 22:32, 13 December 2007 (UTC)

[edit] New Mistakes

http://www.richardwebster.net/000HysteriaOpening.pdf

In short, the state of affairs which Sharpe and Stone describe, in which the rate of acknowledged or proven misdiagnosis in this area has de‐ clined significantly is exactly what one would hope for if Slater’s conclu‐ sions were a) right, and b) widely heeded by the generation of psychiatrists and neurologists who trained in the years immediately fol‐ lowing the publication of his 1965 paper. It is possible, however, that there is another factor at work. For it is also almost inevitably the case that an initial diagnosis of conversion disorder will tend significantly to reduce the number clinical tests and investigations which are performed on a patient, particularly investiga‐ tions of a non‐routine kind such as SPECT (Single Photon Emission Com‐ puted Tomography) scans. Indeed, one of the reasons psychiatrists are sometimes urged to make the diagnosis of conversion disorder or hys‐ teria is specifically in order to avoid expensive and supposedly unneces‐ sary medical investigations. There is therefore a significant danger that the label of conversion disorder can become self‐confirming as patients find themselves ‘trapped’ within a psychological diagnosis. Any non‐dogmatic treatment of the subject might at least be expected to consider these factors. It is interesting that Michael Sharpe, Jon Stone and their colleagues do not mention it. Instead they deliver themselves of the extraordinarily blunt claim that ‘Slater was wrong’.

[edit] Old mistakes

An anonymous editor has suggested that all interested editors familiarise themselves with this article: http://www.richardwebster.net/freudandcharcot.html --PaulWicks (talk) 23:35, 13 December 2007 (UTC)

Whilst I'm at it I think that the following prominent phrase in the introduction does address Guido's concerns proportionately to the level of evidence for his position: "The diagnosis remains controversial, however, as sufferers may disagree that their problems have a psychiatric basis." I think that the rather long quotation from Webster's book is interesting reading but it's an original synthesis rather than persuasive evidence. --PaulWicks (talk) 22:47, 13 December 2007 (UTC)

I concur with PaulWicks that Webster's analysis, while probably to the point, does not provide any evidence. But if there is no positive evidence either, the article should mention that, too. That patients may disagree with the diagnosis does not seem to fully address the problem with this diagnosis. The obvious reply would be that such disagreement is expected due to the nature of their disorder, which may show that this diagnosis is an unsolvable logical puzzle and evidence for the existence or non-existence of this disorder simply cannot exist. Guido den Broeder (talk) 23:12, 13 December 2007 (UTC)

I'm confused GdB; positive evidence of what exactly? --PaulWicks (talk) 23:36, 13 December 2007 (UTC)

Evidence of the existence or non-existence of patients that actually have this disorder, instead of being erroneously diagnosed with it. Obviously, the notion' of this disorder exists, but is it real or just in the mind of Freud & co? Regards, Guido den Broeder (talk) 23:40, 13 December 2007 (UTC)

Come to my hospital =) --PaulWicks (talk) 00:02, 14 December 2007 (UTC)

Thanks for the invite. :-)

I'll come if you are willing to do the SPECT scan that I have asked for in vain for over 12 years. Guido den Broeder (talk) 01:51, 14 December 2007 (UTC)

What are you hoping to see on a SPECT? It's a fairly blunt instrument...--PaulWicks (talk) 12:22, 14 December 2007 (UTC)

Blunt- depends on the scanner-http://www.biocompresearch.org/images/spect00sm1.jpg. The RVI is about to do a big study using PET. One neurologist there might need to be told- no that's the patient's feet- their head is at the other end. He is also good at magic and can make incriminating patient notes disappear. He also is a big freud fan and another of his colleagues was involved in an exorcism. Weird ideas!!

QEEG also- see Frank Duffy Prof. of neurology Harvard University. His evidence has been used in at least one legal case I know of. I was privy to the report. Ultimately you are not going to produce a convincing argument that ideas can cause long term disability without recourse to organic mechanisms. At this point treatment will switch to treating these faulty mechanisms in patients and functional symptoms will be re-classed as organic.

Au revoir! I just didn't like to see PW try to go all POV over GdB —Preceding unsigned comment added by 88.108.31.201 (talk) 12:26, 15 December 2007 (UTC)

Heh, some pov on talk pages is permitted, I wouldn't mind. Blunt is all I need, to show hypoperfusion. PET would be better, but is too much to hope for. Guido den Broeder (talk) 20:26, 15 December 2007 (UTC)

SPECT isn't useful at all for differentiating an organic from a psychiatric cause, as patients with depression have abnormal SPECT scans. --Sciencewatcher (talk) 00:12, 16 December 2007 (UTC) This user is on my ignore list since 20071213. Guido den Broeder (talk) 00:14, 16 December 2007 (UTC)

it can be correlated with vascular spasm via transcranial doppler. Also it is erroneous and insulting to suggest that depression is not organic also? Schizophrenia now has a well documented organic basis Duffy has made enormous strides in using QEEG to identify the organic basis of ADHD. To quote Byron Hyde "there is no such thing as disease". You classifying stuff is odd. —Preceding unsigned comment added by 88.108.103.75 (talk) 16:19, 16 December 2007 (UTC)

It is pretty well established that depression is psychiatric, and that certainly isn't 'insulting'. It is also pretty well established that all psychiatric conditions have biological componenents (how does the brain work?!) But the underlying cause is still psychiatric. --Sciencewatcher (talk) 16:39, 16 December 2007 (UTC)

I've got to say, unsigned comments from anonymous IP addresses citing special evidence only they have seen is neither likely to convince me nor ultimately all that helpful. --PaulWicks (talk) 21:00, 16 December 2007 (UTC)

[edit] Potential copyvio

During the course of editing the article and chasing down references, I have found that at least some of the text now being edited somewhat has been copied from this website: http://www.psychological.com/conversion.htm

Would all editors please be aware of the guidelines on copyright violations e.g. WP:REF--PaulWicks (talk) 23:33, 13 December 2007 (UTC)

oops- edited wrong bit- they lifted it from wikipedia, not the other way round —Preceding unsigned comment added by 88.108.103.75 (talk) 16:15, 16 December 2007 (UTC)

[edit] lifted from wikipedia

I found that as well- the truth is they have lifted the article from wikipedia. Which considering their status is rather worrying. I tell my students NEVER EVER USE WIKIPEDIA. This is general policy in education and most schools are banned from editing by wikipedia anyway.

JFW said something about Weird ideas? This seems to sum up wikipedia- just as someone said a platypus was an animal designed by committee. In terms of sociolinguistics it is so naive as to be laughable no POV- absurd!!! - I'll leave that to another JFW fan though. The last version was not written by one person. I do think the article is moving in the right direction.

Speaking of weird ideas lets start with judaism and progress through a virgin for every martyr in Islam to Jesus taking off like a space rocket. (In other words I heard that JFW and I thought you didn't do personal attacks!!!) and also- the world is full of odd ideas like Freud and conversion disorder- but I will leave the social anthropology to someone else also..

Have fun JFW- this is POV and coat-hanger so I award you the barnstar of broccoli for wielding cabbage in order to further your own rhubarb

Interesting you should suddenly pop up on this page??? —Preceding unsigned comment added by 88.108.31.201 (talk) 17:48, 14 December 2007 (UTC)

[edit] the sum of all knowledge

Dear Sirs, Paul Wicks and colleagues

It was once put to me that a neurologist is a bit like a car mechanic- he lifts up the bonnet and can find nothing wrong even though he might freely admit that the engine is not working properly. It is suggested by Sharpe and others that such analogies are a good start in building a therapeutic consensus with ultimate referral to a psychiatrist. Other metaphors also abound, software error for example. The ultimate failure of this article is manifold. It may be moving in the right direction in that we have some acknowledgement of the biological basis of these symptoms, there is obviously enormous distance still to be travelled in this direction. Shorter may state that a patient's demand for organicity and a physician's willingness to meet it condemns them to perpetual disability, such a value judgement is of course spurious in the extreme.

If I take my car to a mechanic I would rapidly lose confidence in his abilities if he was unable to uncover why the brakes did not work. Similarly any IT consultant who described the brain as a "computer" would ultimately gather equal derision- the brain is not a computer. With over 50 trillion cells in the human body the diagnosis of conversion disorder can never be more than one of arrogance and ignorance. Hysteria is not a theatre of disorder because patients are play acting, rather they are desperately trying to interpret the often vague warning lights from the body and brain that some of those 50 trillion cells are not working as they should, damaged diseased etc. Once organicity is recognised patients are liberated from the worry of suffering and the social attempt to convince others that they are actually ill. Their suffering is no longer played out within a cultural milieu of desperation and recourse to thearpists like Mesmer, Carson, Sharpe or Freud but rather it is understood in the context of measurable organic anomalies. Anomalies that they themselves can work to live with or overcome.

Frans De Waal informs me that persistent and long term "conversion symptoms" do not exist in primates. Like children apes may pretend to be hurt or feel weak when faced with fear but such aspects are transitory. Extreme emotional events may cause many diseases to be manifest, heart attack and stroke to name but two. It is only in conversion disorder that neurology and psychiatry, seemingly isolated within medicine, pursue the psychosocial at the expense of the biological. Carson, Sharpe and others view illness in others as a child-like act. We as a species are still children, Rita Carter has said that the map of the human brain is more akin to medieval maps of the world. Thus faced with a lack of understanding of ourselves and by others we do indeed act oddly, even immaturely when faced with illness we do not understand. This notion is not new: "Variability is the law of life, and as no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as disease. Medicine is a science of uncertainty and an art of probability." William Osler, Canadian Physician. What is new is the seeming willingness to embrace a psychosocial model at the expense of the biopsychosocial.

Blake depicted Newton as a demonic figure measuring all with his compasses. I accuse neurology of the reverse, it fails to use the compasses at its disposal, it decries the technological investigation of patients, it marginalizes cutting edge technology rather than embrace it. "No neurologist in the UK uses QEEG". Yet Prof. Duffy, neurologist at Harvard is quite happy to use it to benefit and liberate HIS patients from the stigma of not finding anything wrong.

Ahh yes my engine is indeed intact- but take it for a spin and you will find the oil is not circulating properly and the wheels fall off as you forgot to check the bolts- to do so would have only convinced me that there was something wrong, when of course in your opinion everything was A ok.

Finally I applaud you all. In a consumer market where the internet, social networking, even simply money can all buy that second opinion- it is a sure way to lose patients by writing an article that does not present organicity as a fundamental part of this spectrum of symptoms, that does not even acknowledge that the DSM was born out of intense controversy, more psychiatric cook book than scientific analysis. Unless the article is radically developed towards the controversy of these symptoms then even more patients will find it irrelevant to any discussion they could have with a neurologist or psychiatrist. Emily Dickinson said "Truth is Manifold". Alas on wikipedia truth is the school boy who can shout loudest, seem the cleverest, pass all the exams by putting down what sir told him to- yet in fact have not a single original idea in their head.

Sufferer of POTS with technological evidence of peripheral neuropathy in bladder and bowel also provisional suggestion of peripheral motor neuropathy in legs (may have yet more tests, further tests on bladder as neuropathy was severe). All initially diagnosed as conversion disorder despite family history of vascular defects etc, shouted at by one neurologist, victim of spurious freudian nonsense at the hand of another etc, etc. —Preceding unsigned comment added by 88.108.109.36 (talk) 12:49, 27 December 2007 (UTC)

Could we increase the signal:noise ratio of future diatribes please? Some of us are busy. --PaulWicks (talk) 19:23, 28 December 2007 (UTC)

It is well known that the sum of all knowledge is 42. Of course, that is after conversion. Guido den Broeder (talk) 19:31, 28 December 2007 (UTC)

Interesting monologue. The problem is that QEEG/SPECT/PET/etc are pretty much useless in understanding conversion disorder or any other psychiatric illnesses. And anyway, all psychiatric illnesses are ultimately biological (unless you believe we think with a soul). QEEG and similar are nice for patients who don't want to admit they have a psychiatric illness, but denying the cause of the illness isn't ultimately very useful in curing it. This seems to be what 88.108.109.36's comments boil down to. --Sciencewatcher (talk) 01:20, 15 January 2008 (UTC)

[edit] Recent edits / reverts

Dear all, I am conscious that this article is continually going back and forth and I think we should try and pin down some of the points of contention. To be clear about my own position, I think conversion disorder is a name applied by doctors to any number of things that they don't understand. In some cases these will be undiagnosed "organic" medical conditions. However, in other cases, and I've seen a few of them in neurology clinics, some people come in with what are clearly "functional" disorders. What I mean by that is that some process is making them walk funny, or be unable to move a part of their body properly, but not in a way that is associated with any known "medical" disorder. Sometimes their reports are inconsistent, so for instance they might present with a paralysed arm, and yet objective measurement shows it's clearly not paralysed. In that case (and again, I've seen a couple and heard of several more), the only remaining explanation is psychological. I don't mean they're faking it; it's often very distressing, sometimes even more so than a known neurological disorder. What I mean is I think that the mind can do amazing things; I've seen martial artists do incredible things with their bodies via the powe of the mind, and it seems obvious to me that that same mechanism pointed in a negative direction could potentially cause weakness or even paralysis. To me, the idea that these things may be psychological is not a cause for shame or stigma, but a positive thing. Thank goodness it's not motor neurone disease, or Huntington's, where there's little we can do.

So, to the article. Let's be clear: I'm not a Freudian. We didn't cover him for more than 10 minute in my psychology degree and I'm not interested in psychodynamics. I'm interested in neuroscience. I'm not a fan of drives, ids, etc, but that doesn't mean we should throw out the baby with the bathwater. The fact that some of these problems coincide with a trauma or stressful live event does suggest there may be some relationship between the two.

What does fMRI establish? Nothing really. If CBT can change my fMRI profile then BOLD signal alterations don't really prove whether something is "organic" or not. After all, the mind is not a special case. It's composed of just the same goop as everything else in the world. If I'm traumatised, I have a physical response and an emotional response. They're both real, one is not more "organic" than the other.

My understanding is that Simon (Alpinist) was diagnosed with conversion disorder, but it later turned out to be something else. Yes it's a stigmatising diagnosis and in the absence of a great deal of knowledge about conversion, a lot of doctors were probably quite unkind/unhelpful. But now that he's got this other diagnosis, why the obsession with conversion disorder? Just because his case was an incorrect diagnosis, it doesn't mean that a.) other people don't have it, b.) it doesn't exist, or c.) everyone with "psych-" in their job title is an evil git.

Why do I revert edits made by Simon (and partner)? Because they rely upon personal knowledge that is not verifiable by others, they tend to make flippant references to things that are not explained in the article itself and are relevant only to a handful of people in the world that know the ins and outs of this debate, and they muddy the waters for anyone reading the article as it is meant to be read, as an article in an encyclopedia. He's already got conversiondisorder.com to say absolutely whatever he likes. Why persist in trying to change this article which is finally getting some attention from a psychiatrist (Snargett) whose committing several years of his life to trying to discover more about conversion and actually trying to treat it properly and get more attention for it in the NHS? If you want to do something useful with your spare time, set up a charity for people diagnosed with conversion disorder. They don't have any real guidance or support and it's a lot more productive than pointless revert wars on Wikipedia. Thanks. --PaulWicks (talk) 16:32, 15 February 2008 (UTC)