Summary
Patients with striking physical symptoms suggestive of a neurological disease, but no evidence of nervous system damage are typically labelled as suffering from "hysterical conversion". Despite claims that conversion disorders have disappeared from clinical practice, patients with conversionsymptoms continue to present diagnostic conundrums to clinicians. The disorder accounts for 4% of all referrals to neurology services. This book covers aspects neglected by previous works on this controversial condition, moving away from traditional historico-sociological accounts towards neuroscientific theories about the causes and categorization of hysteria. Recent investigations using functional imaging and hypnosis arecovered, as are the neuropsychological accounts inspired by them, alongside more traditional psychodynamic accounts. A section on medico-legal aspects is innovative and timely. The key causal role of life events is also addressed, along with the influence of military conflict and culture in shapingand modifying clinical presentations, and changes in physical manifestations of hysteria through the centuries. With contributions from a distinguished international team, representative of all interested specialty groups, this books aims to demonstrate that hysterical conversion remains clinically important, with potential for empirical research in both social and medical sciences, as well as offering afertile source for advancing neuroscience.
Author Biography
Hiroko Akagi, Specialist Registrar in Psychiatry, Academic Unit of Psychiatry, University of Leeds Bal S. Athwal, Senior Research Fellow, Wellcome Department of Cognitive Neurology, Institute of Neurology, London. Christopher Bass, Consultant Liaison Psychiatrist, Department of Psychological Medicine (Barnes Unit), John Radcliffe Hospital, Oxford. German E. Berrios, Senior Lecturer, Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital Trudie Chalder, Academic Department of Psychological Medicine, Guy's, King's, and St Thomas' School of Medicine, London. C. Robert Cloninger, Departments of Psychiatry, Genetics, and Psychology, Washington University, St Louis. Tom Craig, Professor of Community Psychiatry, Guy's, King's and St Thomas' School of Medicine, London. Gereon R. Fink, Institut fur Medizin, Forschungszentrum Julich, Germany and Department of Neurology, RWTH Aachen, Aachen, Germany. Richard S.J. Frackowiak, Wellcome Department of Cognitive Neurology, Institute of Neurology, London. Peter W. Halligan, MRC Senior Research Fellow, Department of Psychology, Cardiff University Allan House, Professor of Liaison Psychiatry, Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds Michael A. Jones, Professor of Common Law, Faculty of Law, University of Liverpool Helen King, Departments of Classics and History, Faculty of Letters and Social Sciences, University of Reading, Whiteknights Laurence J. Kirmayer, Institute of Community and Family Psychiatry, Montreal, Quebec. Chris Mace, Senior Lecturer in Psychotherapy, University of Warwick, Coventry and Consultant Psychotherapist, South Warwickshire Combined Care NHS Trust. John C. Marshall, Neuropsychology Unit, University Department of Clinical Neurology, Radcliffe Infirmary, Oxford. Kevin M. McConkey, School of Psychology, University of New South Wales, Sydney. Harold Merskey, Professor Emeritus of Psychiatry, University of Western Ontario, London Health Sciences Centre, University Campus, London, Ontario. David A. Oakley, Hypnosis Unit, Department of Psychology, University College London Ian P. Palmer, Tri-Service Professor of Defence Psychiatry, Royal Defence Medical College, Fort Blockhouse, Gosport, Hampshire. Maria A. Ron, Professor of Neuropsychiatry, University Department of Clinical Neurology, Institute of Neurology, London; National Hospital for Neurology and Neurosurgery, London. Radhika Santhanam, Institute of Community and Family Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Quebec. Peter Shoenberg, Consultant Psychotherapist, Department of Psychological Medicine, University College Hospital, London. Mauricio Sierra, Clinical Researcher, Institute of Psychiatry, King's College London. Sean A. Spence, Senior Lecturer in Psychiatry, University of Sheffield, Academic Department of Psychiatry, Northern General Hospital Alan Sprince, Lecturer in Law, Faculty of Law, University of Liverpool Jon Stone, Research Fellow in Neurology, Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh. Nick Temple, Consultant Psychiatrist in Psychotherapy, Adult Department, Tavistock Clinic, London; Psychoanalyst; Chairman, Tavistock Clinic, London. Michael R. Trimble, Professor of Behavioural Neurology, Institute of Neurology, National Hospitals for Neurology and Neurosurgery, London. Derick T. Wade, Consultant and Professor in Neurological Disability, Rivermead Rehabilitation Centre, Oxford. Simon Wessely, Professor of Epidemiological and Liaison Psychiatry, Guy's, King's and St Thomas' Hospital Medical School and the Institute of Psychiatry, London. Adam Zeman, Consultant Neurologist and Senior Lecturer, Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital
Table of Contents
List of contributors | p. vii |
Acknowledgements | p. ix |
Introduction | p. x |
History | |
All in the mind? the history of hysterical conversion as a clinical concept | p. 1 |
War based hysteria--the military perspective | p. 12 |
Recovering hysteria from history: Herodotus and 'the first case of shell-shock' | p. 36 |
Classification and Epidemiology | |
The origins of DSM and ICD--criteria for conversion and somatization disorders | p. 49 |
Discrepancies between diagnostic criteria and clinical practice | p. 63 |
The epidemiology of hysterical conversion | p. 73 |
Aeteological, Clinical and Legal Perspectives | |
Life events: meanings and precursors | p. 88 |
Hysterical conversion--a view from clinical neurology | p. 102 |
Factitious disorders and malingering | p. 126 |
Non-epileptic seizures | p. 143 |
Conversion hysteria: a legal diagnosis | p. 155 |
Theoretical Perspectives | |
Conversion, dissociation, or doxomorphic disorder | p. 171 |
Psychodynamic theories in conversion hysteria | p. 184 |
Conversion hysteria: the relevance of attentional awareness | p. 192 |
Hysteria and hypnosis: cognitive and social influences | p. 203 |
Imaging hysterical paralysis | p. 216 |
Disorders of willed action | p. 235 |
The anthropology of hysteria | p. 251 |
Prognosis and Management | |
The prognosis of hysteria/somatization disorder | p. 271 |
Psychodynamic psychotherapy in the treatment of conversion hysteria | p. 283 |
Cognitive behavioural therapy as a treatment for conversion disorders | p. 298 |
Hypnosis and suggestion in the treatment of hysteria | p. 312 |
Rehabilitation for hysterical conversion | p. 330 |
Index | p. 347 |
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