Anxiety in patients with hysterical conversion symptoms.

In psychiatry, most diagnoses are descriptions of behaviour or of phenomena reported by the patient, whereas in somatic medicine a diagnosis usually includes the pathological process underlying a syndrome or a symptom. Consequently, when a group of conditions were delineated which appeared to be of somatic origin, yet for which no organic cause was apparent, it was not surprising that terms implying aetiology were used. The term 'hysteria' owes its derivation to the suggestion that the womb travels in the body and causes hysterical symptoms by settling in the brain. During the Middle Ages possession by demons was regarded as the cause of such symptoms and the sufferers were in peril of being denounced as witches. Later, the possible connexion between sexual emotion and hysteria was recognized, but in the nineteenth century such views were discounted in the prevailing medical climate of the time, which viewed all abnormal mental phenomena in terms of diseased brain structure. Charcot and Janet re-established hysteria as an essentially psychological illness and, more recently, new aetiological assumptions led to these conditions being labelled 'conversions' or 'conversion reactions'. In these theories, it is postulated that the 'psychic energy' associated with unacceptable urges can be 'converted' into somatic symptoms which allow the release of repressed affects, and the ego is protected from experiencing them and the resultant anxiety. In a similar way other neurotic symptoms are supposed to alternate with anxiety (Fenichel, 1945). In the course of time this model has been so widely adopted that it encompasses the wide range of psychosomatic illnesses, and even somatic diseases with clearly defined organic causes-for example, malignancies-have been partly or wholly explained along these lines (Deutsch, 1959). However plausible this mechanism of conversion may sound, the evidence for it resides mainly in a posteriori explanations and in anecdotal clinical material. Ziegler and Imboden (1962) survey the literature on the subject and state that the '.. . "defense mechanism" theory of conversion symptoms might actually be challenged on logical grounds since, except for abundant inferential clinical data, no experimental evidence or "proof" has heretofore been produced'. Similarly, the concept of 'conversion of psychic energy' has been criticized as having no biological foundation (Chodoff and Lyons, 1958). We have set out to test this psychodynamic hypothesis experimentally. According to psycho-analytical views, conversion symptoms are instrumental for the relief of anxiety. They serve a purpose in diminishing anxiety and protect the subject …