I believe I initially heard the term “conversion disorder” mentioned in the first pathology lecture I attended in medical school. That was many decades ago, and it may be a false memory, but I have learned to embrace my false memories and not dismiss the color they bring to my life. The term “conversion disorder” in that lecture applied to a medical student who became ill during his first year of school. This fact alone got the attention of all of us first year medical students, since we already were starting to believe that we had most of the diseases that were being discussed in our classes. I personally was convinced that I had leprosy and narcolepsy, but over the years to come, although I did have contact with people with leprosy, I never developed it. The narcolepsy is another situation entirely. That disorder involves a tendency to fall asleep frequently and at inopportune times. I nap so frequently that one of my colleagues gave me the nickname ‘gatico,’ which is Spanish for ‘little cat.’
Dr. O’Keefe, the pathology lecturer, told us the story of a first year medical student who was diagnosed with conversion disorder. This was after he announced that he would perform autopsies on any of us who died and requested his services. He offered this service free of charge. To emphasize his largesse, he noted that his offer to do autopsies without charge had been challenged in court by the local association of pathologists, who insisted that his offer was a restraint of trade or an unfair competitive practice or some such nonsense. That he offered anything for free struck me as refreshing in a field where so much was out of reach of people with limited resources. My take away from the lecture was that we could die without incurring any additional costs to our families: one less thing to worry about.
The case Dr. O’Keefe presented us with was of a man in his early 20s who developed severe fatigue, generalized body aches, and weight loss. The young man, whom we shall refer to as Steven, was evaluated by infectious disease specialists, as well as other internists, and no explanation was found for his complaints. Being a medical student, he had access to a variety of medical professionals who examined him and announced that this sick-feeling young man was actually healthy. The inevitable consequence of this clean bill of health was that Steven was referred to a psychiatrist. After meeting with Steven and reviewing his recent investigations and examinations, the psychiatrist decided that the underlying problem was a conversion disorder. Although this term is suggestive of a religious experience gone bad, it actually refers to developing a variety of symptoms related to psychological problems. Steven’s psychological problems were not apparent, and his psychiatric care was yielding no results. He then developed pain in his shoulder and went for an X-ray to see if he had arthritis. The X-ray showed destruction of his shoulder blade. A surgeon stuck a needle into the damaged area and found a type of cancer called Ewing sarcoma. Steven died of Ewing sarcoma shortly thereafter, and his diagnosis was revised.
The conclusion I drew from this case report was that when physicians do not know what is going on, they are likely to call in a psychiatrist. This struck me as a considerable advance over prior approaches to similar situations in which an exorcist would be called in to drive the devil out of the cursed individual or alternatively the cursed individual would simply be burned at the stake and thereby relieved of his or her complaints.
My conclusion regarding conversion disorders was confirmed that same year when I went to ‘study’ in London England. I found lodging (as they say in England) with a delightful, elderly, Swiss nurse who had a son who died in his late 20s. That son had developed increasing fatigue, generalized muscle aches, and weight loss and was investigated much the same as Steven had been investigated. Coincidentally, her son had been referred for psychiatric care, given that the physicians could not determine an obvious source of his discomfort, and, like Steven, her son ultimately was diagnosed with Ewing sarcoma and died from that cancer.
What I learned from these and subsequent medical misadventures was that doctors have a hard time admitting that they cannot explain what is making an individual sick and ultimately blame the individual or diagnose him or her with a kind of madness. There is much we still cannot easily identify or explain, and in many cases we label individuals with conversion disorders, rather than concluding that they are possessed by demons. In all fairness, one might conclude that cancer is a kind of demon that we still have difficulty identifying, and it is not until death intervenes that we recognize how limited our vision is and how fragile our lives are.
Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan. He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the U.S., as well as in England, Germany, and France.
