Conversion

The conversion of conflicts in the uncon­scious mind into physical symptoms of illness is one of the most commonly employed of all mental mechanisms. Physicians estimate that at least half the patients they see are suffer­ing from complaints in which psychic or emotional factors are the prime if not the sole complaint.

The student who always gets a headache when faced with an examination is displaying a conversion symptom- So, too, is the soldier who suffers from hysterical blindness when he sees his buddy blown up a few feet away from him. Conversion reactions are in fact more common in wartime than peacetime, and they are the explanation of such condi­tions as hysterical paralysis, convulsions, loss of voice, deafness, ''shellshock," "soldier's heart," and "battle fatigue."

Illness becomes a way out of an intolerable situation. Physical pain is substituted for in­ner anxiety. The patient is unaware of the source of his pain. It is just as real to him as if it had a definite basis in a recognizable bodily defect. For example, a patient with a severe backache of purely psychogenic orign feels just as bad as if X-ray evidence actually showed a fracture in his spine.

Conversion symptoms are often difficult to relieve for the added reason that they offer some secondary gains or benefits to the pa­tient. He gets sympathy because he is "sick"; he may be relieved from the pressure of ordi­nary duties and responsibilities; he may even collect unearned money because of his "afflic­tion." For example, some people who have been involved in accidents do not recover from their symptoms until they receive a substantial cash settlement from an insur­ance company.

The "chronic invalid," the hypochondriac always worried about his health, and the neurotic who "enjoys" poor health offer fur­ther examples of conversion reactions. There is no accounting for their long lists of vague aches, pains, and other complaints except on a psychological basis. Fatigue is one of the commonest complaints.

Nevertheless actual impairment of bodily functions may result from prolonged un­conscious conflicts. Practically any organ or system of the body can be affected by "psycho­physiological disorders." Many emotional reactions, for example, are visibly ex­pressed in skin troubles. Other diseases which may be initiated or aggravated by uncon­scious anxiety include bronchial asthma, peptic ulcer, chronic colitis, and heart dis­ease (especially disease of the coronary arteries). Bodily illnesses wholly or partly of psychic origin are often described as "psychosomatic" —from pysche, for mind, and soma, for body.