Losing your sight even while you’re not blind

Have you ever wondered what it would be like to be blind? I have. My world would be quite limited without my sight. I think what I would miss most is seeing my boyfriend’s face, reading (even if I would probably learn Braille, I would miss letters) and I would miss using my computer, among lots of other things.

In the DSM-IV-TR, there is a section of disorders called the “somatoform disorders”. Among them are hypochondriasis, pain disorder and body dismorphic disorder. One of the most interesting among them is conversion disorder.

Essentially, what happens when a conversion disorder presents itself is that the patient suffers from blindness, paralysis (either in a specific limb or the entire body), non-epileptic seizures or loss (or impairment) of speech or sensation, without any physiological explanation.

The DSM definition of conversion disorder:

• One or more symptoms or deficits are present that affect voluntary motor or sensory function suggestive of a neurologic or other general medical condition.

• Psychological factors are judged, in the clinician’s belief, to be associated with the symptom or deficit because conflicts or other stressors precede the initiation or exacerbation of the symptom or deficit. A diagnosis where the stressor precedes the onset of symptoms by up to 15 years is not unusual.

• The symptom or deficit is not intentionally produced or feigned (as in factitious disorder or malingering).

• The symptom or deficit, after appropriate investigation, cannot be explained fully by a general medical condition, the direct effects of a substance, or as a culturally sanctioned behavior or experience.

• The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.

• The symptom or deficit is not limited to pain or sexual dysfunction, does not occur exclusively during the course of somatization disorder, and is not better accounted for by another mental disorder.

It is thought that the cause for these somatic symptoms are responses to difficulties in the patient’s life. They have often repressed anxiety or an instinctual impulse (such as aggression or sexuality) for very long times, or they have experienced something very traumatic. The symptoms the patients show are partial expressions of the forbidden wish or urge, but in a way it is a disguise; the patient does not have to confront their fear or impulses.

This disorder was long ago called (female) hysteria and supposedly, only women could suffer from it. While women do still predominate, it has increasingly been recognized in men.

The main problem of diagnosing conversion, however, is the difficulty of definitely ruling out a medical disorder. 25-50% of conversion disorder patients are eventually diagnosed with a neurological or non-psychiatric disorder, which could have explained their previous symptoms. This means that whenever a patient is suspected of having conversion disorder, they need to get a thorough medical and neurological exam.

In some cases of conversion disorder, hypnosis is effective in treating it. In most cases, however, resolution of the disorder is spontaneous, although these people usually have had insight-oriented supportive or behavioral therapy. If the symptoms are relieved spontaneously or with hypnosis or therapy, a medical condition can be ruled out.

The most important feature of the therapy is a good relationship with a caring and confident therapist. Telling patients with conversion disorder that their symptoms are imaginary usually makes the problem worse. The longer the person has been in the “sick role”, the harder it is to treat them.

When I was in elementary school, my fellow pupils and I would have endless discussions about the question “would you rather be blind or deaf?”

Which would you choose?