In the psychiatrist's chair: how neurologists understand conversion disorder

Conversion disorder (‘hysteria’) was largely considered to be a neurological problem in the 19th century, but without a neuropathological explanation it was commonly assimilated with malingering. The theories of Janet and Freud transformed hysteria into a psychiatric condition, but as such models de...

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Autores principales: Kanaan, Richard, Armstrong, David, Barnes, Philip, Wessely, Simon
Formato: Texto
Lenguaje:English
Publicado: Oxford University Press 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759333/
https://www.ncbi.nlm.nih.gov/pubmed/19321463
http://dx.doi.org/10.1093/brain/awp060
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author Kanaan, Richard
Armstrong, David
Barnes, Philip
Wessely, Simon
author_facet Kanaan, Richard
Armstrong, David
Barnes, Philip
Wessely, Simon
author_sort Kanaan, Richard
collection PubMed
description Conversion disorder (‘hysteria’) was largely considered to be a neurological problem in the 19th century, but without a neuropathological explanation it was commonly assimilated with malingering. The theories of Janet and Freud transformed hysteria into a psychiatric condition, but as such models decline in popularity and a neurobiology of conversion has yet to be found, today's neurologists once again face a disorder without an accepted model. This article explores how today's neurologists understand conversion through in-depth interviews with 22 neurology consultants. The neurologists endorsed psychological models but did not understand their patients in such terms. Rather, they distinguished conversion from other unexplained conditions clinically by its severity and inconsistency. While many did not see this as clearly distinct from feigning, they did not feel that this was their problem to resolve. They saw themselves as ‘agnostic’ regarding non-neuropathological explanations. However, since neurologists are in some ways more expert in conversion than psychiatrists, their continuing support for the deception model is important, and begs an explanation. One reason for the model's persistence may be that it is employed as a diagnostic device, used to differentiate between those unexplained symptoms that could, in principle, have a medical explanation and those that could not.
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spelling pubmed-27593332010-10-01 In the psychiatrist's chair: how neurologists understand conversion disorder Kanaan, Richard Armstrong, David Barnes, Philip Wessely, Simon Brain Occasional Paper Conversion disorder (‘hysteria’) was largely considered to be a neurological problem in the 19th century, but without a neuropathological explanation it was commonly assimilated with malingering. The theories of Janet and Freud transformed hysteria into a psychiatric condition, but as such models decline in popularity and a neurobiology of conversion has yet to be found, today's neurologists once again face a disorder without an accepted model. This article explores how today's neurologists understand conversion through in-depth interviews with 22 neurology consultants. The neurologists endorsed psychological models but did not understand their patients in such terms. Rather, they distinguished conversion from other unexplained conditions clinically by its severity and inconsistency. While many did not see this as clearly distinct from feigning, they did not feel that this was their problem to resolve. They saw themselves as ‘agnostic’ regarding non-neuropathological explanations. However, since neurologists are in some ways more expert in conversion than psychiatrists, their continuing support for the deception model is important, and begs an explanation. One reason for the model's persistence may be that it is employed as a diagnostic device, used to differentiate between those unexplained symptoms that could, in principle, have a medical explanation and those that could not. Oxford University Press 2009-10 2009-04-16 /pmc/articles/PMC2759333/ /pubmed/19321463 http://dx.doi.org/10.1093/brain/awp060 Text en © 2009 The Author(s). Published by Oxford University Press on behalf of Brain. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Occasional Paper
Kanaan, Richard
Armstrong, David
Barnes, Philip
Wessely, Simon
In the psychiatrist's chair: how neurologists understand conversion disorder
title In the psychiatrist's chair: how neurologists understand conversion disorder
title_full In the psychiatrist's chair: how neurologists understand conversion disorder
title_fullStr In the psychiatrist's chair: how neurologists understand conversion disorder
title_full_unstemmed In the psychiatrist's chair: how neurologists understand conversion disorder
title_short In the psychiatrist's chair: how neurologists understand conversion disorder
title_sort in the psychiatrist's chair: how neurologists understand conversion disorder
topic Occasional Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759333/
https://www.ncbi.nlm.nih.gov/pubmed/19321463
http://dx.doi.org/10.1093/brain/awp060
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