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Conversions

Conversion patterns showed further differences between male and female groups. More examples of a particular pattern among women may be a result of the greater number of women in the study rather than a reflection of true incidence.

In the patients from this sample, the conversion reactions were not entirely devoid of concomitant or appropriate concern about the disability. The classic “la belle indifference” was not encountered. This may be related to the fact that these conversions were of fairly recent duration. There was no case with any tell-tale signs of chronicity. In contrast to this, patients at the Philippine General Hospital OPD psychiatry clinic tend to demonstrate much more the classic indifference; furthermore, some conversion symptoms described by female patients in the PGH group levels little doubt that it is an orgiastic equivalent. Such frank degree of sexual symbolism was not encountered in any patient in this study.

The following is a list of conversion patterns among patients whose symptoms were labeled conversions not only because they involved actual disturbance or dysfunction in the sensory or motor areas but also because they were particularly symbolic of the patient’s conflict.

A. CONVERSION SYMPTOMS IN THE MALE GROUP

1. Sensory Disturbances

Eye Pains                                  5
Low Back and Groin Pains            4
Pain from Navel to Genital and
during Micturition                      2
                                          _________
                                             11

                           
2. Motor Disturbances

 Motor Incoordination in Walking                      4
Difficulty in Talking (In Tagalog— “neutral”)        3
Paresis of One Hand (writer’s cramp)                2
Difficulties in Starting Urination                         2
Repetitive Belching, Burping                            3
Vomiting                                                       2
Facial Tics                                                     1
                                                           _________
                                                                 17

Total……………………………………………………………28


B. CONVERSION SYMPTOMS IN THE FEMALE GROUP

1. Sensory Disturbances
Numbness (Hand, Legs, Head, etc.)        11
Choking Sensations                                8
Circum-oral Numbness                            4
Unusual Sensations around Tongue (Warm,
Thickening, etc.)                                  4
Hypogastric Pain                                   4
Sensation of “Ngio”                              2
                                               _________
                                                        33

(“Ngilo” is a Tagalog term for an unpleasant sensation in one’s teeth, usually experienced after eating too many sour fruits or when biting on ice. The English “goose pimples” are similar, except that such apply to skin, not teeth).

2. Motor Disturbances

“Convulsions,” tremors                               11
Nausea and Vomiting (not hyperremesis        7
gravidarum)
Lockjaw                                                  2
Inability to Close Mouth                             2
Torticollis                                                 2
Facial Tics                               
Palpebral Prosis                                        1
Partial Aphonia                                         1
                                                            ____
                                                               28

Total …………………………………………………………61

There are more conversions in the list than there are patients diagnosed simply because the list includes conversions in other diagnostic groups. The conversion occurred only as a small part of the entire clinical picture. Some patients also gave a history of conversion episodes from which they had apparently recovered, with or without medication.

A glance at the list of conversion symptoms readily conveys much of the involved symbolism. The transparency and directness of the mechanism, emotional conflict to somatic expression, were quite striking in many patients. These emotional conflicts are discussed in the next chapter but a brief correlation may be made here, in view of the close relationship between conflict and symptom in conversion reactions.

The sensory disturbances among the men involved pain in areas heavily invested with sexual meaning. Castration fears quickly came to mind as their psychological origin. However, the significant incidents leading to the illness had little to do with libidinal strivings or sexual impulses. They were largely rage-provoking experiences which were interpreted by the patient as demeaning, humiliating, and emasculating. Thus, being replaced at a job by a hated rival swindled in business by an associate, unfairly treated by one’s parents in property distribution, committing a costly blunder in work or business, disqualification from a much wanted position — was some of the precipitating incidents. One would probably hypothesize that the symptom of pain represents a reenactment of the traumatic, emasculating, experience.

Several motor disturbances among male patients were suggestive of punishment, mutilation and, in some cases, castration in the true spirit of the talion law. However, as in the sensory disturbances, underlying rage was an even more frequent causative agent. Two patients with difficulty in starting urination were an adolescent who came after his first visit to a prostitute and a middle-aged businessman who had the complaint after each extramarital sex experience. The guilt feelings about violating taboos were paramount in their minds. The, businessman felt even more guilty when the sexual experience was with young girls. The adolescent was upset about the experience, but particularly because the prostitute happened to be about as old as his mother. Each had overtones of guilt over incestuous impulses.

Poor balance resulting in impaired use of legs and paresis of one hand followed very closely incidents ‘involving some release of rage. A father slapped his daughter; immediately after, he fell and could nor stand unless supported. One case of paresis of one hand was actually related to hostile impulses to strike the wife. The three cases regarding difficulty in talking were all young boys in whom the 5ymprom started during adolescence. The symptom was episodic, coming only at certain times. The young patient would start talking in a clear fashion; then, he would begin to mumble and as he explained it, his “tongue gets all twisted up.” These were related to class recitation, a general self-consciousness about movements and speech, and the entire problem of asserting oneself as a male. The gastro-intestinal conversions (belching, burping, vomiting) had guilt-expiating aspects and were also an expression of protest against being in a conflictual position usually involving great prestige or success value—president of his class, head of a firm, favorite of powerful grandparents—about which there was enormous guilt and anxiety.

The sensory conversion symptoms in women were diffused expressions of repressed and conflictual sexual impulses. Some conflicts were thinly disguised. One woman had a choking sensation each time she came from a date. One very prim and proper secretary had numbness alternating with hot and cold sensations up her legs each time her boss, who had a reputation for being a ladies’ man, would call her into his office. Hypogastric pains were likely to be found either in young, unmarried women or in women entering menopause, both groups being confronted with the problem of heightened sexual impulses. Circum-oral numbness and “ngilo” were found in women in whom the sexual problems had considerable elements of rage, frustration, and hostility involving the sexual partner. Unusual tongue sensations and choking sensations tended to appear in women with pronounced ambivalence towards sex, in the form of guilt, disgust, fear, or shame.

On the other hand, the motor conversions in women drew heavily from unexpressed anger as the significant etiological conflict. Experiences which thwarted the patient, leaving her too hurt and helpless to mobilize anger, brought out the somatic expressions. While the triggering factor was anger, the resulting symptom expressed more frustration and helplessness. As may be expected, many of these patients were also reacting with depression.

Facial tics, in both men and women, caused great embarrassment. The patients were more upset about other people noticing the tic than about the symptom itself. The three patients with facial tics were battling feelings of great frustrations, rage, and helplessness. One woman had discovered her husband’s extramarital affair and her father-in-law’s connivance in it to boot. Another woman suffered successive losses, through death, of two people who were closest to her, her mother and her husband and not long after, the sudden elopement of a daughter. The male patient with a facial tic was reeling from financial reverses, problems with a delinquent teenage son, and a bitter quarrel with his own father.

What kind of explanations did patients conjure in their own minds about these bodily symptoms? By and large, they had none. They were much puzzled and distressed at their mysteriousness and the doctor’s failure to pinpoint an organic cause. Very few, not more than two or three, thought about “kulam” (witchcraft) but even these patients did not persist in their suspicion. Frequently cited as possible causes were overwork, too much studying or physical exertion, missing meals, and poor sleep. Three patients mentioned drinking beer and menstrual aberrations or bad habits (taking a bath, washing hair) during menses. Epilepsy, of course, was quickly thought of to label abnormal movements although the patient and his family may have had little knowledge about what epilepsy is. The closest they came to suspecting psychological agents was in implicating too much worrying, getting angry, or a frightening experience Cited by two male patients as a provocative experience was handling or dressing the corpse of a friend or relative. Four women felt that over-excitement had helped precipitate their illness. In the Philippine General Hospital, among OPD patients, there was a great tendency to “blame” practically anything like  an injection one doctor gave, being frightened by a dog, drinking too much soft-drinks or even simply “nahipan ng hangin” (literally, the wind blew at him.)

It has been suggested by many workers that as the population grows more sophisticated and knowledgeable about body morphology and physiology, there will be less somatic conversions and more psycho physiologic symptoms. The latter closely approximate scientific notions about how the body works. A trend in that direction is apparent in this study. On the other hand, it may take more than knowledgeability and sophistication to bring about a decline in conversion reactions or the marked readiness to utilize somatization to express emotional conflict. Many of the patients in this study who had finished a college education had a facility for using body-language in most unscientific ways. One, a nurse, had “convulsions” and found the negative EEG’s hard to believe. Another, a lady doctor, had warm sensations over the tongue and fearful choking sensations. She properly labeled the latter as “globus hysterious,” but had little recognitions of underlying psychological determinants. Perhaps the changes will have to involve more than mere informational or educational processes and will have to implicate more basic factors, particularly early childrearing experiences when non-verbal or body language communication predominates.

 

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