Editing Conversion disorder (section)

==History==

The first evidence of hysteria dates back to 1900 B.C., when the symptoms were blamed on the uterus moving within the female body. The treatment varied "depending on the position of the uterus, which must be forced to return to its natural position. If the uterus had moved upwards, this could be done by placing malodorous and acrid substances near the woman's mouth and nostrils, while scented ones were placed near her vagina; on the contrary, if the uterus had lowered, the document recommends placing the acrid substances near her vagina and the perfumed ones near her mouth and nostrils."<ref name="Tasca 110–119">{{Cite journal| last1 = Tasca| first1 = Cecilia| last2 = Rapetti| first2 = Mariangela| last3 = Carta| first3 = Mauro Giovanni| last4 = Fadda| first4 = Bianca| date = 2012-10-19| title = Women And Hysteria In The History Of Mental Health| journal = Clinical Practice and Epidemiology in Mental Health| volume = 8| pages = 110–119| doi = 10.2174/1745017901208010110| issn = 1745-0179| pmc = 3480686| pmid = 23115576}}</ref>

In Greek mythology, [[hysteria]], a similarly described condition, was thought to be caused by a lack of orgasms, uterine melancholy, and not procreating. [[Plato]], [[Aristotle]], and [[Hippocrates]] believed that a lack of sex causes complications in the uterus. Many Greeks believed it could be prevented and cured with [[wine]] and [[Orgy|orgies]]. Hippocrates argued that a lack of regular [[sexual intercourse]] led to the uterus producing toxic fumes, causing it to move in the body. Therefore, he argued, all women should be married and enjoy a satisfactory sexual life.<ref name="Tasca 110–119"/>

Donald Capps argues that the diseases [[Miracles of Jesus|Jesus allegedly healed]], such as paralysis and blindness, were actually forms of conversion disorder. He describes Jesus as a "village psychiatrist", who believed that his words had power.<ref>{{Cite journal |last=Capps |first=Donald |date=2010 |title=Jesus the village psychiatrist: a summary |url=http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0259-94222010000100028 |journal=HTS Theological Studies |volume=66 |issue=1 |via=Scielo}}</ref>

From the 13th century, women with hysteria were exorcised, as it was believed that they were possessed by the devil. It was believed that if doctors could not find the cause of a disease or illness, it must be caused by the devil.<ref name="Tasca 110–119"/>

At the beginning of the 16th century, women were sexually stimulated by midwives in order to relieve their symptoms. [[Gerolamo Cardano]] and [[Giambattista della Porta]] believed polluted water and fumes caused the symptoms of hysteria. Towards the end of the century, the role of the uterus was no longer thought central to the disorder, with [[Thomas Willis]] discovering that the brain and central nervous system were the cause of the symptoms. [[Thomas Sydenham]] argued that the symptoms of hysteria may have an organic cause. He also proved the uterus is not the cause of symptoms.<ref name="Tasca 110–119"/>

In 1692, in the U.S. town of [[Salem, Massachusetts]], there was a reported outbreak of hysteria. This led to the [[Salem witch trials]], where women who were accused of being witches had symptoms such as sudden movements, staring eyes, and uncontrollable jumping.<ref name="Tasca 110–119"/>

During the 18th century, there was a move from the idea of hysteria being caused by the uterus to it being caused by the brain. This led to an understanding that it could affect both sexes. [[Jean-Martin Charcot]] argued that hysteria was caused by "a hereditary degeneration of the nervous system, namely a neurological disorder".<ref name="Tasca 110–119"/>

In the 19th century, hysteria moved from being considered a neurological disorder to being considered a psychological disorder, when [[Pierre Janet]] argued that "dissociation appears autonomously for neurotic reasons, and in such a way as to adversely disturb the individual's everyday life".<ref name="Tasca 110–119"/> As early as 1874, doctors including [[William Benjamin Carpenter|W. B. Carpenter]] and J. A. Omerod began to speak out against the hysteria phenomenon as there was no evidence to prove its existence.<ref name="Webster">{{Cite web| url = http://www.richardwebster.net/freudandcharcot.html| archive-url = https://web.archive.org/web/20040511073634/http://www.richardwebster.net/freudandcharcot.html| url-status = usurped| archive-date = May 11, 2004| title = The hysteria diagnosis: Freud, Charcot, Breuer and Anna O| last = Webster| first = Richard| website = www.richardwebster.net| access-date = 2016-02-29}}</ref>

[[Sigmund Freud]] referred to the condition as both hysteria and conversion disorder throughout his career. He believed those with the condition could not live in a mature relationship, and that those with the condition were unwell in order to achieve a "secondary gain", in that they are able to manipulate their situation to fit their needs or desires. He also found that both men and women could have the disorder.<ref name="Tasca 110–119"/>

Freud's model<ref name="ReferenceA">Josef Breuer & Sigmund Freud, ''Studies in Hysteria'', 1895</ref> suggested the emotional charge deriving from painful experiences would be consciously repressed as a way of managing the pain, but that the emotional charge would be somehow "converted" into neurological symptoms. Freud later argued that the repressed experiences were of a sexual nature.<ref>{{cite book | author = Freud S | title = Fragment of an analysis of a case of hysteria. | year = 1905}}</ref> As Peter Halligan comments, conversion has "the doubtful distinction among psychiatric diagnoses of still invoking Freudian mechanisms".<ref name="pmid10834873">{{cite journal |vauthors=Halligan PW, Bass C, Wade DT | title = New approaches to conversion hysteria | journal = BMJ | volume = 320 | issue = 7248 | pages = 1488–9 | year = 2000 | pmid = 10834873 | pmc = 1118088 | doi = 10.1136/bmj.320.7248.1488}}</ref>

[[Pierre Janet]], a highly noted psychologist during the early 20th century, argued that symptoms arose through the power of suggestion, acting on a personality vulnerable to [[dissociation (psychology)|dissociation]].<ref>{{cite book | author = Janet P | title = The Major Symptoms of Hysteria | year = 1920 | edition = 2nd }}</ref> In this hypothetical process, the subject's experience of their leg, for example, is split off from the rest of their consciousness, resulting in paralysis or numbness in that leg.

Some support for the Freudian model comes from findings of high rates of childhood sexual abuse in conversion patients.<ref name="pmid12411227">{{cite journal |vauthors=Roelofs K, Keijsers GP, Hoogduin KA, Näring GW, Moene FC | s2cid = 24809182 | title = Childhood abuse in patients with conversion disorder | journal = Am J Psychiatry | volume = 159 | issue = 11 | pages = 1908–13 | year = 2002 | pmid = 12411227 | doi = 10.1176/appi.ajp.159.11.1908| hdl = 1887/14240 | url = https://repository.ubn.ru.nl//bitstream/handle/2066/62161/62161.pdf | hdl-access = free }}</ref> Support for the dissociation model comes from studies showing heightened suggestibility in patients with conversion disorder.<ref name="pmid12003460">{{cite journal |vauthors=Roelofs K, Hoogduin KA, Keijsers GP, Näring GW, Moene FC, Sandijck P | title = Hypnotic susceptibility in patients with conversion disorder | journal = J Abnorm Psychol | volume = 111 | issue = 2 | pages = 390–5 | year = 2002 | pmid = 12003460 | doi = 10.1037/0021-843x.111.2.390| hdl = 1887/14289 | s2cid = 31958662 | url = https://repository.ubn.ru.nl//bitstream/handle/2066/62234/62234.pdf | hdl-access = free }}</ref> Critics argue that it can be challenging to find organic pathologies for all symptoms, and so the practice of diagnosing patients with such symptoms as having hysteria led to the disorder being meaningless, vague and a sham diagnosis, as it does not refer to any definable disease.<ref name=":44">{{Cite web |last=Webster |first=Richard |title=Sigmund Freud: hysteria, somatization, medicine and misdiagnosis |url=http://www.richardwebster.net/freudandhysteria.html |url-status=usurped |archive-url=https://web.archive.org/web/20040511073728/http://www.richardwebster.net/freudandhysteria.html |archive-date=May 11, 2004 |access-date=2016-02-21 |website=www.richardwebster.net}}</ref> 

Throughout its history, many patients have been misdiagnosed with hysteria or conversion disorder when they had organic disorders such as [[Neoplasm|tumors]], [[epilepsy]], or [[vascular diseases]]. This has led to patient deaths, a lack of appropriate care, and suffering for the patients.<ref name=":44" />

[[Eliot Slater]], after studying the condition in the 1950s, stated: "The diagnosis of 'hysteria' is all too often a way of avoiding a confrontation with our own ignorance. This is especially dangerous when there is an underlying organic pathology, not yet recognised. In this penumbra we find patients who know themselves to be ill but, coming up against the blank faces of doctors who refuse to believe in the reality of their illness, proceed by way of emotional lability, overstatement and demands for attention{{nbsp}}... Here is an area where catastrophic errors can be made. In fact it is often possible to recognise the presence though not the nature of the unrecognisable, to know that a man must be ill or in pain when all the tests are negative. But it is only possible to those who come to their task in a spirit of humility. In the main the diagnosis of 'hysteria' applies to a disorder of the doctor–patient relationship. It is evidence of non-communication, of a mutual misunderstanding{{nbsp}}... We are, often, unwilling to tell the full truth or to admit to ignorance{{nbsp}}... Evasions, even untruths, on the doctor's side are among the most powerful and frequently used methods he has for bringing about an efflorescence of 'hysteria'".<ref name=":44"/>

The onset of conversion disorder often correlates to a traumatic or stressful event. There are certain populations that are considered at risk for conversion disorder, including people with a medical illness or condition, people with [[personality disorder]]s or [[dissociative disorders]].<ref name="National Institute of Health, 2012"/> No [[biomarker]]s have yet been found to support the idea that conversion disorder is caused by a psychiatric condition.

There has been much recent interest in using [[functional neuroimaging]] to study conversion. As researchers identify the mechanisms which underlie conversion symptoms, it is hoped they will enable the development of a [[Neuropsychology|neuropsychological]] model. A number of such studies have been performed, including some which suggest the blood-flow in patients' brains may be abnormal while they are unwell. The studies have all been too small to be confident of the generalisability of their findings, so no neuropsychological model has been clearly established.

An [[evolutionary psychology]] explanation for conversion disorder is that the symptoms may have been evolutionarily advantageous during warfare. A non-combatant with these symptoms signals non-verbally, possibly to someone speaking a different language, that she or he is not dangerous as a combatant and also may be carrying some form of dangerous [[infectious disease]]. This can explain that conversion disorder may develop following a threatening situation, that there may be a group effect with many people simultaneously developing similar symptoms, as in [[mass psychogenic illness]], and the gender difference in prevalence.<ref>{{cite journal | author = Bracha HS | title = Human brain evolution and the "Neuroevolutionary Time-depth Principle:" Implications for the Reclassification of fear-circuitry-related traits in DSM-V and for studying resilience to warzone-related posttraumatic stress disorder | journal = Progress in Neuro-Psychopharmacology and Biological Psychiatry | volume = 30 | issue = 5 | pages = 827–853 | year = 2006 | pmid = 16563589 | pmc = 7130737| doi = 10.1016/j.pnpbp.2006.01.008 | url = http://cogprints.org/5013/1/2006_P.N.P._Neuro-evolution_of_fear_circuit_disorders.pdf }}</ref>