Chapter 7. The Mechanism of Dissociation (2) Conversion ------ Dissociation on the Physical Level (1)

In this chapter, we will discuss dissociation manifested on the physical level: so-called conversion or conversive symptoms. This topic covers a very wide range of phenomena, including psychiatric and apparently physical (medical) illnesses. The term conversion is very ambiguous and inconsistently used by different specialists. Therefore, In order to discuss the issue of conversion, we need to understand the origin of this term as well as validity and ambiguity of the way that this term is currently used by the clinicians.
On the one hand, we are so much used to dividing illnesses and symptoms into physical and mental, and we don’t question much about this. Seventeenth Century Cartesian Mind-body dualism has been carried over this way until today. On the other hand, physicians have been proposing a new way of classifying illness since the end of last century in order to discard this dualism. As biological findings on mental illnesses have been accumulated, it appears to be less and less reasonable to divide illnesses simply into mental and physical. One of the rationales for the elimination of this dualism is that many psychiatric illness which have primarily psychiatric symptoms have, in fact, many physical manifestations as well. Sometimes physical symptoms are in the foreground in their clinical picture.
Let us take depression for example. It is well known that depression accompany sleep problems, appetite change and many other physical symptoms. Recently there are some types of physical illnesses such as fibromyalgia and chronic fatigue syndrome which resemble very much like depression in their emotional manifestations. These conditions literally stride over psychiatric and physical illnesses and symptoms, which cannot be classified in an either/or fashion.
So long as many illnesses manifest themselves on the mind and the body whereas we keep somewhere in our mind the Cartesian dualism of mind and body, it is natural for us to have a notion which implies that there is some mechanism in which mental symptoms and physical symptoms are transformed or converted to each other.
The concept of conversion came from Freud (1894). What Freud had in his mind is that mental conflict and excitation is converted to somatic symptoms (1894, p49.)(*)
Although modern clinicians are not altogether agreeing with Freud’s original ideas, they are at least aware that serious stress or trauma leaves symptoms on the physical level and continue to use this notion. Studies and researches on the traumatic mental illnesses for the past century have been amassing the data which endorses Kardiner’s idea (Kardiner, 1941) that traumatic neurosis of war is a “physioneurosis”.
Freud, S. (1894). The neuro-psychoses of defense. SE, 3: 45-61.
*"In hysteria the incompatible idea rendered innocuous by its sum of excitation being transformed into something somatic, for this I should like to propose the name of conversion ....By this means the ego succeeds in freeing itself from the contradiction [with which it is confronted]; but instead, it has burdened itself with a mnemic symbol which finds a lodgement in consciousness, like a sort of parasite, either in the form of an unresolvable motor innervation or as a constantly recurring hallucinatory sensation" (Freud, S. 1894p. 49).
Kardiner A. (1941) The Traumatic Neurosis of War. New-York, Hoeber, 1941