Monday, February 6, 2012

If conversion disorder makes sense, so does schizophrenia

Bear with me while I try to collect my thoughts on why the opinion of this medical doctor on conversion disorder in a New York State high school should equally apply to the percentage of the population diagnosed with schizophrenia. You can read the full article here.

CNN--Dr. Charles Raison, CNNhealth's mental health expert, is an associate professor of psychiatry at the University of Arizona in Tucson.

Below I have extracted what Dr. Raison says about conversion disorder. Would he, using his own logic*,  agree with me that he could be talking about schizophrenia? No, of course he wouldn't agree with me. Schizophrenia is always a special case to a psychiatrist, isn't it?
  • strange behavior
  • no neural abnormalities
  • not manufacturing the problem
  • completely incapacitated by symptoms
  • makes psychological sense
  • age of onset often in teenage years
What is lacking in the diagnosis of schizophrenia, as opposed to the much rarer conversion disorder diagnosis, is "hope." The medical community is resoundingly united in its prediction that the girls in New York State will make a complete recovery. This is great news for those girls and their families! Now, how about the much larger population of those diagnosed with schizophrenia being given the same good news?

Dr. Raison
When I teach psychiatry to medical residents, the first thing I tell them is that patients' stories always make sense. No matter how bizarre a person's symptoms might be, our lives follow a human logic, and they follow a medical logic. When a story doesn't make sense, it means you don't know the real story.Medical stories that don't make sense are often big news makers, precisely because they don't make sense. Sometimes, they titillate our hunger for the unexplained. Sometimes, they capture our attention because the medical uncertainty frightens us. 

The essence of a conversion disorder is the development of a neurological symptom -- such as the tics seen in the young people of Le Roy -- for which no neural abnormality can be found. Typically, a simple neurological exam will confirm that the symptom doesn't result from any type of brain or nerve damage. And yet patients with conversion disorder have no conscious sense that the symptom is a production of their brains. That is, they are not manufacturing the problem. They are truly afflicted, and it can be horrible.

Only someone who has hypnotized people paralyzed for months and had them hop out of bed and run around the hospital room, or who has conducted "truth serum" interviews of people unable to speak, only to have them erupt into King's English, would believe that such bizarre conditions exist. But having conducted these interventions, and more, I can assure you that people can be completely incapacitated by symptoms with no obvious medical cause.

Read more here.


* his surname is French for "reason" 

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