Conversion disorder in childhood and adolescence: Part II. Therapeutic issues.

Abstract

The second of a two-part presentation is made based on findings drawn from a research project focused on the conversion family: a unit having at least one child or adolescent member exhibiting a disabling physical disorder for which no corresponding organic problem can be found. Data from 16 cases referred for treatment/consultation are examined from an ethnographic perspective aiming at a holistic description of the cultural configuration common to these families. Within the frame of this cultural approach to conversion families in therapy, a number of issues involved in working with them are described and discussed. On the basis of experience gained in this work, a list of principles for therapy with conversion families is proposed and discussed. Every family . . . is somewhat different from every other, the difference consisting in the manner in which each develops its own version of the general cultural configuration. A family's culture-its variant of the general culture-always contains something that makes for tranquility and well-being, and something that makes for anxiety and misery.

Specific Biases for Identifying Facial Expression of Emotion in Children and Adolescents With Conversion Disorders

“…This study found that participants with conversion disorders differed from healthy controls in four key ways: a) they reported higher rates of cumulative negative life events, with stressors such as parental conflict, loss events (by death or separation), discrete traumatic events, bullying, physical illness, maternal anxiety/depression being very common, and abuse and neglect being surprisingly uncommon 1 ; b) linguistic analysis of the autobiographical narratives by blinded coders likewise demonstrated high rates of unresolved loss or trauma with regard to the previously described life events; c) the designation of participants into nonnormative patterns of attachmentVan inhibitory subgroup (Type A+) and a coercivepreoccupied subgroup (Type C+)Vimplied a long-standing history of relational stress and a chronic disruption of what are normally comfortable and nurturing attachments (see Figure 1); and d) more detailed analysis of attachment by subclassification showed that almost all of the participants with conversion disorders used strategies that did not include open expressions of anger. This analysis confirmed clinical observations, complemented by the observations of Seltzer (28,29) about his cohort, that in this cohort of families with conversion disorder, overt expressions of anger were not the operative, valued currency for communication. 2 Guided by these earlier findings, this study had seven aims.…”

“…In parallel, the attachment narratives of children and adolescents with conversion disorders were distinctive in that episodes of conflict with their parents were generally lacking and that the attachment strategies used by the participants with conversion disorder to elicit comfort and protection did not involve explicit expressions of anger. Interestingly, Seltzer (28,29) made similar observations about the anger-averse nature of a cohort of families with conversion disorder that he treated in a Norwegian child and adolescent psychiatry department.…”

Good Children Presenting with Conversion Disorder

“…The sick child is frequently viewed as the most robust, capable, well-adjusted, aproblematic and promising member of the family in whom the parents have invested greatly, and who is to ensure the family's success in the future (Seltzer, 1985a(Seltzer, , 1985b.…”

Tales Full of Sound and Fury: A Cultural Approach to Family Therapeutic Work and Research in Rural Scandinavia*

“…In initiating therapy with whole families, there was much practical value in the modernist anthropological belief that cultures as codes and systems could be deciphered through observations of and participation in the lifeways of groups. Later, these formative approaches were joined by structural and linguistic anthropological perspectives stressing the links between the material signifiers and ideational signifieds of family cultures (see Falicov, 1995, 1998; Minuchin, 1976; W. Seltzer, 1985a,b; W.…”

“…Often these appeared to be markers providing definition and stability to groups impacted upon by forces that make their lives more fragmented and discontinuous. In the therapy room, inquiring about the meaning of key symbols often helped us elicit latent and otherwise subjugated themes bound up in what earlier have been termed “silent stories” of family cultures (W. Seltzer, 1985b).…”