Introduction

The concepts of conversion and dissociation are undergoing re-evaluation. They are insecure and, before long, may well become another part of the kaleidoscopic history of hysteria. Like many previous phenomena that have been called hysterical, they are part of a group of very varied items whose principal common features are as follows:

• they have been attributed to psychological illness in the absence of organic disorder

• they are thought to be due to ideas which the patient holds about illness

• they have been subject to changing interpretations as knowledge has increased and as received opinions have become challenged by demands for evidence. Today it appears that this group of phenomena can best be characterized as conditions with two main elements:

1. they lack evidence of proximate organic illness or pathophysiological disturbance;

2. the symptoms correspond to ideas of the patient about how parts of the body or mind malfunction or fail to function.

The most representative examples of this type of symptom include claims of blindness, deafness, paralysis, loss of speech, and certain types of memory disturbance, including fugue states. Loss of memory with respect to personal identity for circumscribed periods of time may extend to global memory loss but retention of many ordinary skills. These conditions are not based upon lesions or pathophysiological disturbances, but resemble ways in which people think that their bodies or minds can fail them. Neither are they due to delusions or hallucinations as conventionally defined.

This chapter begins with a review of the history of the ideas of hysteria, leading to the current concepts of conversion and dissociative disorders. The various clinical presentations are discussed next, followed by a critique of the theories of aetiology. The chapter ends with a discussion of prognosis and management.

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