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Conversion disorder

Conversion disorders, categorised under the heading of Somatoform Disorders in both DSM IV and ICD 10 have an historical heritage in the classical descriptions of hysteria as presented by, for example, Sigmund Freud. As a group of syndromes they are representative of the combined understanding of brain disorders, once again after decades of a dichotomous approach to the brain in medicine, being treated by the subspecialty of Neuropsychiatry. more...

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A Conversion disorder manifests itself in many different ways. Conversion disorders can be triggered by acute psychosocial stress that the individual cannot process psychologically. This overwhelming distress causes the brain to unconsciously disable or impair a bodily function which will relieve or prevent the patient from experiencing this stressor again. Therefore, the psychosocial stress could be seen to be "converted' into a physical symptom. The patient, by definition, is always unaware of this process, and is often not concerned with his deficit - a characteristic feature called 'la belle indifference'.

The possible presentations are endless, often approximating to similar neurological disorders which may include any one or more of the following:

  • Paralysis of a limb or the entire body hysterical paralysis or motor conversion disorders
  • Impaired hearing or vision
  • Loss of sensation
  • Impairment or loss of speech - hysterical aphonia
  • Psychogenic non-epileptic seizures
  • Psychogenic dystonias

It is often very difficult to diagnose these disorders, and it takes careful history taking and observation to rule out the possibility that the patient has a factitious disorder or is malingering or even an unrecognised biological cause. With this illness careful physical and particularly, neurological examination will reveal that there is no or not sufficient organic cause for the disability experienced. When organic disorders have been appropriately investigated and ruled out, the patient is often referred to a therapist for cognitive behavioural therapy to try and break the psychological barriers and cycles of behaviour that the stressors have produced. A multidisciplinary, goal oriented approach to treatment utilising the skills of Neurologists, Psychiatrists, Cognitive Therapists, Physiotherpaists, Occupational Therapists and Nursing staff is the most appropriate (but often unavailable) method of management. Such treatment programmes are exemplified in the UK by the teams at The National Hospital for Neurology & Neurosurgery and The Lishman Unit at The Maudsley Hospital, London.

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A big step for mental health: thirty years after homosexuality was declassified as a mental disorder, a gay man takes the helm of a major health association
From Advocate, The, 12/9/03

The American Psychiatric Association removed homosexuality from its Diagnostic and Statistical Manual of Mental Disorders in 1973. Almost 30 years later, the American Counseling Association, a professional group with 52,000 members nationwide, elected Mark Pope as its president--the first openly gay head of a major mental health association.

The revealing nature of that coincidence is not lost on Pope, an associate professor of counseling and family therapy at the University of Missouri's St. Louis campus. "I represent a final and total repudiation of that past," he says.

The 51-year-old Pope, whose long career includes the creation of counseling program in Chicago and San Francisco, describes himself as a "poor gay Cherokee boy from a rural area of southeast Missouri. "He spoke to The Advocate's Chris Bull during a recent stop in Washington, D.C., as he tours the country working to make his profession better for everyone.

Did sexual orientation become an issue in your election?

I've been openly gay since I stepped in the door of counseling. I knew that who I am would not be an obstacle to my advancement. A solid 53% majority elected me. But it's true that there are some members who undoubtedly voted against me on [antigay] grounds. That's just the reality. My tack is to focus on the issues that affect everyone in this profession. I can't be a one-note leader.

How will you win over holdouts?

Everything is pointing in the right direction. When the mental health profession labeled gays and lesbians as sick, it was based on religious and political prejudices, not on data. There were no legitimate studies that made the case for homosexuality as a mental illness, and that's even clearer today. A couple of years ago I was at a conference at the University of Indiana on sexual minority youth in the heartland. There was a panel of young people who said that the first person they came out to was their guidance counselor. It made it clear just how important our members are.

What happens when a counselor takes an antigay approach with a client?

When we find out about it, I call the counselor directly. I explain the research and the policies the association has adopted. I explain that there is no evidence that conversion and reparative, therapies work and that even if they did, what kind of message do they send to young people? I ask them why they are doing what they are doing. Usually that person will come around and stop pushing a personal agenda.

On the subject of reparative therapy, do you think any gay people would want to be straight if there weren't an antigay climate in this country?

There would be very, very few. It's really just a numeric issue. There are more of them than there are of us. We are between 4% and 10% of the population. We grow up around heterosexuals, so no matter how accepting they are, it's going to take some adjustment. I come from the Native American background of two-spirited people, which allows us to go against the dominant sexual orientation and gender roles of the majority. That's something the rest of the culture needs to work toward.

Did you come out to a guidance counselor?

I came out to my minister in high school. He'd always been open and accepting, so I wanted to share my story with him. I expected him to be joyous, but he wasn't at all. Then after I broke up with my first boyfriend in college, I decided to see a counselor. She was just the opposite: totally accepting. I saw the good side and bad side of counseling, and it gave me a desire to make it right. This is the chance I've been waiting for.

COPYRIGHT 2003 Liberation Publications, Inc.
COPYRIGHT 2004 Gale Group

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