Hysterical conversion disorders. The conversion is hysterical. Hysteria and conversion symptoms. Psychotherapy of hysteria. What is hysterical conversion

Conversion disorder is presented as a loss or deformity of motor or sensory function, indicating a physiological problem, when in fact no physical impairment is found.

Symptoms are the result of a psychological need or psychological conflict. As for the term "conversion" itself, it should be taken as the cause of the pathology, which expresses itself in somatic symptoms, being purely psychological.

A detailed study by science of this phenomenon, formerly called hysteria, begins in the 19th century, while earlier the disease was perceived as an ordinary simulation.

After the sensational conclusion of J.-M. Charcot changed everything when, after observing patients, he concluded that patients actually experience the symptoms of a certain disease and do not pretend to

Pathogenesis

Dissociative states are characterized by a sudden onset and end, and they can be observed only under the influence of hypnosis or specially designed methods of interaction.

The duration of such procedures is capable of changing or eliminating the complete conversion states. Often considered pathologies are able to imitate the lack of sensitivity of certain parts of the body, loss of smell, deafness, blindness, a sharp narrowing of the field of view. Loss of motor functions, paralysis, inability to stand, walk, loss of voice are no less typical for such situations.

There is a coexistence of sensory disturbances and paralysis, for example, at the same time the patient may lose sensation in the arms and legs, as well as the ability to move them.

Behavioral manifestations of the pathology may be more severe, for example, fainting episodes, epileptic-like seizures, and coordination disorders.

Previously, conversion disorder was also defined as a symptom of pain, but modern psychiatric practice does not recognize this symptom as a symptom of a dissociative seizure. All types of phenomena considered remit after a few months or weeks, especially if the cause of their initial manifestation is represented by a traumatic event in life.

Chronic disorders that develop gradually, characterized by amnesia and paralysis, often associated with disrupted interpersonal relationships and intractable problems. The resistance of dissociative states in relation to therapy is detected if, before contacting a specialist, they manifested themselves for 1-2 years.

Types of conversion disorders

Conversion disorders manifest themselves as the following conditions.

1. The imbalance is presented as a permanent or short-term inability to control the position of one's own body in space. Signs are characterized by lack of coordination, swaying, unexpected falls and unsteady gait.
2. Convulsive seizures also take place, but they should be differentiated from true epilepsy. The duration of attacks can be from a couple of seconds to several minutes, and the reasons for their occurrence may be the following:

• unusual memories;
• violent movements;
• a sudden feeling of fear;
• feeling of a strange taste or smell;
• tingling or twitching in a particular part of the body.

Weakness in the limbs is characterized by a decrease in muscle strength in a certain part of the body, in other words, paresis. Paraparesis - weakness in both legs, hemiparesis - weakness of one limb - arm or leg. This category should also include paralysis, the manifestations of which are represented by the loss of the ability to move due to a violation of the connections between nerves and muscles or disorders of the nervous system. The frequency of paresis in medical practice is significantly higher than the frequency of paralysis.

Violation of the sensitivity of the limbs - tingling or numbness. The sensations in question are characteristic of the surface of the skin in a certain area and most often they are accompanied by tightening, burning or chilliness.

Amnesia is characterized by an inability to remember names, dates, and current events. With such a symptom, it is important not to forget about the possibility of diagnosing alcoholism, Alzheimer's disease or multiple sclerosis.

Causes

It is generally accepted that people with the most unstable emotional state - the elderly and adolescents - are susceptible to the disease. Statistics indicate that among men this phenomenon is much less common than among women. The following are two key reasons:

1. First of all, it is necessary to mention the psychological conflict, which contributes to the increase in the requirements of a person to others, there is no critical assessment of the situation. Own personality is also underestimated, and therefore the individual seeks to attract attention to himself at a subconscious level at any cost. Even at the expense of illness, he wants to be the center of attention.
2. The psychological need to avoid social stress or some kind of psychological conflict can also be a reason to use physical illness as a shield.

The causes under consideration belong to the category of unconscious, it is impossible to control them, therefore even the patient himself is completely convinced that he is subject to physical illness. In his opinion, everything is logical - the tested symptoms perfectly correspond to the real disease.

The detection of conversion symptoms is often associated with other psychological conditions.

An example is Briquet's syndrome or asocial personality disorders. The first disorder is considered somatized and manifests itself in the form of constant complaints about certain problems with a pronounced need for psychological support and help.

Rarely, there is an isolated conversion disorder developed by a situation of extreme psychological stress. The stability of the conversion symptoms can persist for many years and over time they turn into real physiological pathologies.

As an example, it is worth citing a situation where a patient suffers from hysterical paralysis of a leg or arm, and as a result, he develops a contracture of the muscles that hold the limb or severe atrophy of the muscles that are not involved. However, in most cases, the conversion symptom resolves much faster than the actual disease begins to develop.

Risk group

Among adolescents and women, the largest number of cases with the disease in question was determined. Among the most relevant factors are the following:

• passive-aggressive, passive-dependent or theatrical personality disorders;
• anxiety, depression or other additional psychiatric disorders;
• genetic predisposition due to the presence in the family of relatives with chronic diseases;
• sexual or physical abuse, especially in childhood;
• the presence of psychological or personality diseases in the past;
• low socioeconomic status, financial difficulties;

Symptoms of the disorder

Previously, the symptoms were represented exclusively by mental disorders, seizures, paralysis of varying severity and fainting, but with the help of subsequent studies, it was possible to prove that there are no boundaries in this matter and manifestations can relate to any human system or its organ.

As a result, the division of all symptoms into four groups:

1. Motor symptoms, represented by the absence or impairment of motor function. Among the manifestations of pseudo-paralysis, gait disturbances and much more. In the presence of other people, seizures often and suddenly occur, and they also suddenly disappear under the influence of some irritant. It could be the arrival of a new person or a loud sound. Seizures may be expressed by unnatural flexing, rolling on the floor, screaming or falling.
2. The second group includes sensory symptoms, represented by the absence or impairment of sensitivity to temperature or pain. Violation of smell, taste, as well as blindness and deafness are the most pronounced symptoms. The range of sensations and duration may vary.
3. The third group is represented by vegetative symptoms, which involves the patient feeling spasms of blood vessels or smooth muscles of internal organs. In this case, it is possible to imitate almost any disease.
4. Mental symptoms represent the fourth group. These may be memory lapses expressed by imaginary amnesia, hallucinations, delusions or harmless fantasies.

Diagnosis of the disease

Obtaining the most reliable diagnosis requires the following conditions:

• psychogenic conditioning should imply a clear relationship of disruption of relationships, problems or stressful events over time, even if the patient denies the existence of such;
• there must be no neurological or physical impairment associated in any way with the identified symptoms;
• for individual disorders, the clinical features should be outlined.

Problems that can be encountered during the diagnosis:

1. Since the symptoms of a particular disease do exist, it is quite difficult to detect the initial stage of development of the pathology in question. The doctor will not be able to completely exclude the real disease, so the only solution to the problem will be long-term observation, clinical trials and numerous tests.
2. The unconsciousness of the symptoms characteristic of conversion disorder makes it difficult to differentiate them from intentional ones, that is, a person can deliberately pass them off as real. If the patient does indeed have a conversion disorder, he may consciously exaggerate the significance of his unconscious symptoms.
3. Diagnosis can be complicated by the stereotype that a person in modern society does not have seizures and other obvious motor symptoms and is considered an anachronism. In any case, the definition of the disease requires careful and long-term observation and numerous examinations.

Treatment

As with any other psychological ailment, the treatment of conversion disorder must be as careful and carefully planned as possible. If the patient is told that all his symptoms are fiction, the risk of worsening the situation is high.

Modern medicine recognizes the complex treatment of dissociative seizures, which involves pharmacotherapy and psychotherapy.

These directions are equal in importance and are aimed at eliminating symptoms. Their character is rather pathogenetic, but clearly not etiotropic. The time factor may also have a curative effect, and drug improvement may contribute to sustained remission.

1. Psychotherapy in this particular case should be aimed at correctly determining the situation in which the patient is located. This is done in order to discreetly and carefully eliminate the factors provoking the disease. It is equally important to determine the benefit that the patient receives from the disorder. Hypnosis is considered to be the most effective.
2. Drug treatment is most relevant in severe remission or relapse. Among the popular psychopharmacological agents are tranquilizers, neuroleptics, thymoleptics, nootropic drugs, as well as psychostimulants and antidepressants.

The main role in successful treatment is played by its timely initiation, since the longer the disorder lasts, the more rapidly the chances of recovery decrease.

"Simulator, pretender!" These insulting words are often heard against people who spend most of their lives in queues at doctors' offices. Today this person goes to see a surgeon, tomorrow to a therapist, the day after tomorrow to an immunologist. Complaints can be different - from hearing loss to sudden convulsions, but they have one thing in common. None of the tests confirms the presence of a somatic (bodily) disease. So what, after all, is a deception, a simulation? But these people really believe that they are seriously ill. The fact that the symptoms are phantom in nature and caused by the power of self-hypnosis does not alleviate their condition. The disease from which they suffer belongs to the group of dissociative (conversion) disorders. The most commonly used term for the diagnosis is conversion hysteria.

Conversion hysteria is not uncommon. In the list of the most common mental disorders, this disease is in sixth place. This fact made it possible to study well the causes, symptoms and features of the course of K.I.

Causes of psychosomatic disorder conversion hysteria

• Soul trauma. The news of the death of a loved one, an incurable disease, loss of housing.
• Internal conflict caused by a feeling of dissatisfaction. For example, the unconscious part of a person demands that others recognize his professional qualities, but the conscious part insists that society does not welcome those who openly "advertise" themselves. The daily struggle between the conscious and the unconscious destroys a person.
• secondary benefits. The primary benefit of the conversion hysteria patient is to protect the psyche from overload. This benefit is subconscious and does not need to be corrected. But there are also secondary ones. Strengthened guardianship of relatives, freedom from duties and responsibilities, increased attention. These benefits even attract a healthy person, let alone those with conversion disorders.

Trigger and classification of conversion disorders (conversion hysteria)

When the emotional experiences of the patient become unbearable, they begin to transform ("conversion" - change) into somatic and neurological symptoms. But in the process of diagnosis, it turns out that the disorder is of a psychomatic nature, therefore, it cannot cause disturbances in the work of human organs. But then in people suffering from K.I. a reasonable question arises: “What hurts me then?”. There is an answer, and it is quite simple. The fact is that the emotional state and well-being of a person are closely interconnected. With nervous overstrain, the body is always in a state of stress. This causes discord in the work of the autonomic nervous system. Violations of the nervous regulation lead to an increase in heart rate, an increase in the production of adrenaline, spasms of blood vessels. All of the above processes cause symptoms that patients with conversion disorders complain about - loss of sensitivity, pain, nausea.

Depending on the symptoms manifested, it was customary to divide conversion disorders into 4 groups.

1. Motor. Symptoms: dissociative tremor, gait disturbances, convulsions, involuntary twitching of the limbs, chills.
2. Touch. Deafness, blindness, loss of speech, loss of sensitivity of parts of the body, neuralgia of different localization.
3. Vegetative. Nausea, dizziness, spasms.
4. Dissociative. Caused by a violation of memory, the loss of one's own "I".

It has been observed that conversion symptoms reflect the essence of the emotional problem that caused them. Here is a real case from medical practice:

Kolya's mother died early, and he, along with his two older sisters, stayed with his father. He is a tough, even cruel man, he raised his children in fear and complete obedience. When one of the sisters was 20 years old, she became pregnant. Her father kicked her out of the house. Kolya came home from school and wanted to stand up for his sister, but the father looked at his son so that he lost his voice for several days and could only wheeze. A year later, the situation repeated itself. The second sister married a guy who categorically did not like his father. Her parent also disowned her. Kolya and this time could not express his anger and pain to his father. The result - the guy was numb again, and this time the voice never returned to him. At 22, the guy began to visit a psychotherapist and he was able to help him. But, as the doctor suggested, the return of the voice plunged the man into a prolonged depression. The dumbness syndrome was the compensatory mechanism that helped the boy survive the separation from his sisters. When he was gone, emotional experiences returned in full.

Why the voice? The child wanted to tell his father that he was a scoundrel, but fear closed his mouth. The unfulfilled desire to speak out hit his psyche so much that he lost his voice. If Kolya wanted to beat his father, and his consciousness, over and over again, stopped this intention, then the internal conflict could result in a conversion loss of hand sensitivity, etc.

Conversion hysteria and its dissociative disorders - amnesia, fugue, multiple personality syndrome

Memory, consciousness, awareness of a person as a person - all these parameters are integrated into the human psyche as a whole, dependent on each other. If one of the "bricks" falls out, a dissociative disorder begins to develop.

• Psychogenic amnesia. As a result of stress, the patient may lose some event, episode, or even complete information about his past life from memory. The person is aware of the fact of amnesia. He is confused and disoriented, although he can do simple work and he retains the ability to remember.
• dissociative fugue. A state of mind that is accompanied by selective amnesia. Arises as a defense mechanism after a severe psychotrauma. Lasts from several days to 2..3 months. The fugue takes place in two stages:

Stage 1. The person enters an altered hypnoid state. He does not remember his past life and begins to build a personality from scratch. When leaving this state (usually in the morning, after sleep), the patient experiences a strong shock, as the memory also returns the cause of the psychotrauma.

Stage 2. The memories that happened to the person during the fugue become inaccessible. The only way to get them out of consciousness is through hypnosis.

One day, Sergei Ivanovich paid another installment on the loan and decided to take a steam bath with friends in a new bathhouse, outside the city. The bath called him. When friends returned from the steam room, he was gone. Phone and documents remained. Sergei Ivanovich was found by detectives hired by relatives a few weeks later in one of the southern cities of Russia. Ragged and dirty, he slept in the station building. The man knew the names of the rivers in Russia and how “mental disturbance” was translated, but he had no idea what his name was and where he lived. After several sessions of hypnotherapy, he remembered his past life. The first thing he did after coming out of the trance was screaming terribly. It turned out that before he was overtaken by the state of the fugue, he was informed by telephone about the sudden death of his young son. The child grew up in another family and the man did not tell any of his relatives about him. The death of the baby turned out to be such a strong shock for the man that it caused dissociative amnesia.

• Multiple Personality Syndrome. It arises as a psychological defense mechanism in people who have been emotionally or sexually abused in childhood. The patient leaves the internal conflict, beginning to perceive the past and the present indirectly, through the personalities that allegedly exist in his mind.

In life, this mental disorder is extremely rare, but in cinema and literature at almost every step. More recently, the thriller Split was released, where up to 20 independent personalities coexist in the body of the protagonist, and not every one of them is white and fluffy.

conversion hysteria. Diagnosis and treatment

The diagnosis of "conversion hysteria" can cause certain difficulties, since:

A) it is impossible to immediately exclude a somatic disease.

B) in 40% of cases, conversion hysteria accompanies more severe mental illness.

C) the patient may feign illness, or deliberately exacerbate existing symptoms to get attention.

To clarify the diagnosis, a series of biochemical analyzes is carried out, the patient undergoes diagnostics on an electroencephalograph, tomograph, and x-ray machine.

Medical treatment

Medications are prescribed if the patient is in a state of prolonged depression or is experiencing severe anxiety. Prescribed:

• Antidepressants: fluoxetine, paroxetine, paroxetine, amitriptyline.
• Antipsychotics: alimemazine, teraligen.
• Bromine and valerian preparations. Strengthen the nervous system and soothe irritability. If the patient suffers from prolonged insomnia, then barbiturates are prescribed.
• B vitamins (riboflavin, niacin, pyridoxine). They normalize the biochemical processes of the brain, promote the regeneration of neurons, stop anxiety and excitability.

Methods of psychotherapy

• Triggers are identified - psychotraumatic factors that served as the root cause of conversion hysteria. But is it worth pulling them to the surface ... The doctor decides this question individually each time. Conversion disorder is a safety valve that kicks in when the psyche cannot handle overexertion. Remove it, and who knows if the patient's thoughts will swing towards suicide.
• Methods of direct and indirect suggestion (suggestion) are used. When working with the hysterical type of patients, the impact is best carried out face to face. The doctor's task is to convince the patient with hysteria that his disease is temporary and serious progress is already being observed. Hypnosis is prescribed very carefully (it has many contraindications).
• Cognitive-behavioral psychotherapy. During the sessions, the patient learns to objectively assess their emotions and take steps to reduce their "heat".

The prognosis of conversion hysteria is favorable (an exception is the syndrome of multiple personality), but you should know that the longer the patient is in the role of the patient, the worse the treatment will progress. Again, when the doctor and relatives manage to remove the cause of the secondary benefit, the recovery process will be greatly accelerated.

And connected with the name of Sigmund Freud. Before Freud, the cause of neuroses was seen as a disease of the nerves. Today, as at the beginning of the twentieth century, the theory of neuroses, their symptoms and treatment are most fully explored within the framework of psychoanalysis.

From the point of view of psychoanalysis neurosis is the result of a conflict between unconscious desires, often of an aggressive and sexual nature, and a mental structure that evaluates the fulfillment of these desires as potentially dangerous. This definition is an adaptation of the formulation given by Sigmund Freud regarding the difference between neurosis and psychosis, which states that: neurosis is the result of a conflict between ego and id, while psychosis is a conflict in the relationship between ego and the external world.

In other words, in neurosis, a person does not want to know anything about his inner reality - about his fantasies and desires, while in psychosis testing of external reality is violated.

Thus, neurosis is a less severe psychopathological condition than psychosis. However, the degree of suffering caused by neurosis and its impact on the quality of life is impressive.

The description of mental states, which later became known as neurotic, began to appear at the end of the nineteenth century. But the ultimate recognition and exploration of neuroses came about through psychoanalysis.

Today, approaches to neuroses are different. The International Classification of Diseases of the Tenth Revision (ICD-10) includes a heading of neurotic disorders. Within the framework of domestic psychiatry, disorders of the neurotic level are considered. Whereas in the American manual for the diagnosis and statistics of mental disorders (DSM-5) there is no heading for neuroses, however, a number of disorders of a neurotic nature are provided.

2. In psychoanalysis, neuroses include:

Obsessions are aimed at preventing a certain event or the commission of a certain action. These events and actions are of an aggressive or sexual nature. In obsessive-compulsive disorder there is always a conflict of love and hate. In obsessive rituals, the realization of a love or aggressive desire and a ban on the realization of this desire are expressed. That is, the first action is canceled by the second, this is called the destruction of what has been done.

The result is that it is as if there was not a single action, when in reality there were both. Freud compared such magical thinking or animism to the rituals of primitive peoples trying to propitiate spirits. In the rituals of a person suffering from obsessive-compulsive disorder, the same tendency can be traced, when, for example, he performs a certain ritual action so that nothing happens to his relatives or to him. Such a person has an unconscious motive of hatred for a loved one and at the same time love for him. The stronger both, the stronger the obsessive symptoms.

Aggression in the symptoms of obsession is manifested in the desire to control not only oneself, but other people, forcing them to participate in the performance of their rituals.

The expectation of bad events, as well as the fear of injuring oneself, committing suicide, are associated with a sense of guilt for one's own hatred, which is not realized.

Contradictions in the mental life in obsessive-compulsive disorder are particularly pronounced. The world seems to be divided into good and evil. In compulsive rituals, there is a tendency to avoid "bad things" and deal only with "good" ones. Moreover, it can be difficult to understand the logic by which things are divided into good and bad.

People who suffer from obsessions are usually very energetic by nature, but the constant internal struggle leads them to indecision, doubt, lack of strength.

At their core, these are very conscientious people, as in all neuroses, in obsessive-compulsive disorder, guilt plays a large role. But there were events in their early history that prevented them from being in touch with their feelings, emotions, and desires. As a rule, these are psycho-traumatic events or circumstances that occurred at an age when the child did not have the mental resources to cope with them. This causes excitement in the psyche, which is transformed into aggressive and sexual desires that overwhelm a person, and obsessions arise as a defense against the breakthrough of these impulses.

Obsessive symptoms act as a barrier to forbidden impulses, which is why there is great anxiety if you try to stop the symptoms by volitional effort. A person seems to be deprived of restraining mechanisms and is left alone with his frightening desires.

Psychoanalysis makes it possible to investigate the cause and significance of the symptoms of obsessive-compulsive disorder. Reconstruction of the past and its connection with the present helps the patient understand himself, reduce the need for obsessive symptoms, and develop more adaptive mechanisms for coping with the onslaught of unbridled desires. When a person understands the meaning of his symptoms, he becomes able to find harmony with his inner world.

The meaning of the most intricate obsessive rituals can be understood if we trace how their appearance is connected in time with the patient's experiences, determine when the symptoms appeared and what events they are associated with.

Obsessive repetition

The symptoms of obsessive-compulsive disorder are very diverse and are described within the framework of various approaches, but the following manifestation of obsession has been studied mainly or even exclusively in psychoanalysis. It's about compulsive repetition. This is an inevitable hit of a person in the same circumstances. Certain life difficulties, tragic events can seem to haunt you through life. Moreover, the person himself feels such repetitions as bad luck or the disfavor of fate. One's own contribution to the formation of obsessive situations is often not recognized. However, there is always an unconscious motive to constantly experience the same situation.

An example is a series of relationships that miraculously develop and end according to the same scenario. It can be love relationships, friendships, situations with colleagues at work, and so on. It is as if the same circumstances find a person, or, more correctly, unconsciously he finds them, as if on purpose choosing exactly the path where “the same rake” lurked.

The treatment of neurosis with psychoanalysis helps to see the connection between the patient's past and his current life, which makes it possible to get out of the vicious circle of the same situations.

6) Emotional lability

Instability in the emotional sphere is another characteristic feature of neurosis.

The cause of emotional states and reactions often remains unclear both to those around him and to the neurotic individual himself. This is because the repressed desires and ideas, although not realized, continue to evoke feelings associated with them.

Among the feelings that are rooted in unconscious fantasies and desires, one can name: shame, guilt, anger, resentment, despondency, envy, jealousy, fear.

One of the basic feelings in a neurosis, and even forming a neurosis, is guilt. The repressed sexual and aggressive desires associated with the Oedipus complex, although not realized, continue to be condemned by their own morality. The feeling of guilt is the most difficult to endure, it torments a person, but without the ability to understand its origins and cope with it.

Dissatisfaction, despair to achieve love, internal conflicts, hatred, the causes of which remain in the unconscious, lead to aggressiveness, outbursts of indignation. If aggression is redirected to oneself, there is a depressed mood, despondency and depression.

Self-pity, low spirits, depression, and low self-esteem often accompany neurosis. A negative emotional background and underestimation of oneself lead to isolation, lack of initiative, and the loss of various opportunities. But addiction to these experiences can also arise, when the need for someone to feel sorry, sympathetic or feel guilty leads to fantasies about this or open demonstration of one's suffering. This, in turn, can form features masochism, in which pain and suffering begin to bring pleasure. As a result, a person unconsciously always seeks to turn his cheek where there is an opportunity to get hit on it.

Hot temper and irritability, becoming traits of character, can bring their owner a hidden or not so hidden pleasure, a feeling of triumph over the victims. This behavior is a manifestation sadism. But at the same time, it complicates relationships both with relatives and in professional and other areas. A person may feel like a hostage to his own explosive temperament or bad character. Behind such manifestations are unconscious motives, the understanding of which in the process of undergoing psychoanalysis helps to curb one's own temper.

Suspicion and suspiciousness can become a character trait that complicates a person's life when one's own aggressive impulses are projected outside and attributed to others. As a result, other people are perceived as bad and persecuting. This is an unconscious mechanism that allows you to keep feeling good, but violates the objective perception of other people.

The feeling of a special attitude towards oneself, condemnation from others, even if they are strangers on the street, arises under the influence of guilt.

Love heals many diseases. But in the context of the topic under discussion, questions arise: what is love and can it save from a mental disorder?

Passion, lust, addiction, habit can be mistaken for love, but the ability to experience a mature feeling is not available to everyone. Neurosis impairs a person's ability to enter into close, truly deep relationships.

According to one of the concepts of mental development, neurosis is associated with the undermining in early childhood of faith in unconditional love on the part of the closest. The capacity for deep attachment suffers from this. A person insures himself from experiencing disappointment associated with a possible break in relations, guided by the principle that he can only rely on himself. Such defense against attachments leads to loneliness, emotional closeness, lack of reciprocity and trust in relationships.

The ability to empathize and sympathize, to understand one's own emotions and the feelings of others, can be significantly limited as a result of neurosis. But the longing for close relationships remains.

Hysteria is associated with the need to attract attention to oneself by any means, hence the pretense in behavior, drama, theatricality, demonstrativeness. A person with such traits may, however, feel lonely and misunderstood, despite the increased interest in himself. This is due to the fact that the relationship remains superficial.

Experience depression is a difficult state of mind that cannot be compared with a bad mood. The psyche is trying to get out of this state, resorting to desperate attempts. There is inspiration, reaching to mania, when a person is overwhelmed with positive emotions, an indefatigable thirst for activity, he is like the sea knee-deep. But these states occur spontaneously without any reason, their character is artificial and superficial. The desire to take on everything at the same time does not allow you to productively focus on one thing. Such outbursts of irrepressible fun are abruptly replaced by low spirits, depressed mood, and a depressive phase begins.

Emotional swings can manifest themselves in different situations and relationships. For example, in the form of an unpredictable change of anger to mercy and back in relationships with loved ones, with children, in social contacts. The treacherous onslaught of feelings can negatively affect personal life and professional activities.

Mood lability, emotional instability are integral companions of neurosis, which psychoanalysis is designed to overcome. Awareness of the motives of arising feelings contributes to finding peace of mind.

7) Sexual disorders

Klimt G. « Kiss ", 1907-1908. Gustav Klimt led a very unbridled sexual life. The artist had numerous novels, but he never married. Klimt is credited with up to forty illegitimate children. Psychoanalysis pays great attention to the ability to build and maintain reliable relationships.

Sexuality is one of the fundamental components of life. Surprisingly, such a fundamental instinct becomes very fragile under the influence of neurotic disorders. Sexual function, one way or another, is affected by any mental disorders.

For example, with depression, along with the general tone, sexual desire is also suppressed. Inadequate mental states hinder the development and maintenance of relationships, respectively, limit the possibility of a normal intimate life.

Mature sexuality is not limited to sexual intercourse. Mutual support, care for offspring, genuine intimacy in the broadest sense - these are the components associated with the manifestation of libido. Violations of interpersonal relationships, the inability to sincere intimacy undermine openness and trust in a couple. As a result, serious difficulties arise in intimate life and personal life in general, which not everyone succeeds in solving, as they say, amicably.

Mental conflicts, unconscious inhibitions, fantasies that are felt to be unacceptable and repressed, all underlie sexual disorders.

These include: impotence, which in most cases has a psychogenic nature; in men, premature ejaculation or difficulty reaching orgasm; among women frigidity, sexual coldness, inability to achieve orgasm, vaginismus - contraction of the muscles of the vagina before intercourse, which makes it impossible to penetrate the penis; aversion to sex; psychogenic pain and discomfort from sexual intercourse without somatic causes; neurotic experiences that impede the enjoyment of sexual life, such as: fear, anxiety, paralyzing shame, guilt, latent homosexuality that turns sexual relations of heterosexual partners into a kind of formal process.

A man who is afraid that he will not be patent enough, courageous, will disappoint the other half, really loses potency from these experiences, which instills even more uncertainty and forms a vicious circle.

A woman may worry about whether she is attractive to a man, how much she will be accepted by him, whether she will lose control if she gives herself to sexual pleasure. If such experiences are too intense, it prevents a woman from reaching orgasm or even enjoying sex.

It happens that the female gender identity is violated by disappointment, which was broadcast to the girl in childhood by her parents, who openly or covertly show dissatisfaction with her gender. Rudeness or coldness on the part of one or both parents, a ban on sexuality as such - all this prevents you from accepting femininity in yourself and undermines sexual sensuality in the future.

Men have the so-called division of the female image into “Madonna and prostitute”. It manifests itself in the fact that a man is able to sexually liberate himself and experience satisfaction only with a woman for whom he does not have tender feelings, while with one for whom he feels reverent love, sexual satisfaction is impossible.

In each case, their unconscious causes of sexual disorders.

Some of these disorders can be overcome as a result of the emergence of trust in the couple.

If both partners are aimed at gaining each other's trust, demonstrate acceptance, openness, sensitivity, in the end they achieve harmony in intimate life.

However, the neurotic foundations of sexual disorders are quite deep, behind them there may be: unconscious hatred, fear, undermining basic trust, envy, violated sexual identity. When it comes to the violation of interpersonal relationships in general, this is reflected in the sexual sphere.

In this case, psychoanalysis will help the patient to establish contact with his inner world and with other people. Problems in the intimate sphere will be solved as a person begins to realize their hidden causes.

8) Daydreaming

Not only thoughts can be intrusive, but also fantasies, or, as Freud called them, daydreams. When a person would like to change the external reality, but it is impossible to achieve immediate changes, he consoles himself with fantasy, where he can imagine himself as a hero, a winner, a desired object of love, a successful person, embody revenge for the wrongs inflicted in his dreams, or assert himself. Such comforting daydreams are a common component of mental life, but in the case of a neurosis they seem to enslave the consciousness.

Neurosis is different in that it does not have enough mental strength to try to change the real state of affairs. Instead, satisfaction occurs in fantasies. When a person plunges into the world of dreams, he becomes divorced from the real world, which further deprives him of the opportunity to set goals and achieve them. This position is akin to masturbation, which in neurosis can completely crowd out attempts to build relationships with other people.

With neurosis, mental pain or unbearable excitement arising from various experiences, memories or vivid impressions, like anesthesia, requires immersion in the comforting world of an alternative fantasy reality.

Addiction to the world of dreams can lead to pathological states of dependence, such as: gambling, alcohol, drug addiction, this also includes: extreme hobbies leading to injury and death, promiscuity or promiscuity, passion for everything that is associated with risk and excitement . Adventurism can become second nature to a person.

There are many manifestations of addiction, one of the leading feelings in them is the emerging excitement, detachment from reality and severe anxiety, if it is impossible to indulge in hobbies to which addiction has developed.

Psychoanalytic treatment aims to help the patient understand what is in their history that has prevented them from developing more mature ways of coping with reality. This research helps to understand the origins of social failures and learn how to adequately overcome difficulties. Gradually, a tolerance for anxiety develops, which previously could only be fought by escaping into the world of dreams.

5. Treatment of neurosis by psychoanalysis

Treatment of neurosis by psychoanalysis aims to help the patient understand the unconscious causes of his experiences and even certain life circumstances, come to terms with repressed fantasies and desires, see the impact of childhood history and relationships with loved ones on today's life, and develop more mature and adaptive ways to cope with various difficulties.

The fact is that the development of neurosis is associated with the so-called secondary benefit from the disease, which is not only responsible for the occurrence of the disorder, but also interferes with coping with it. The motives for the disease of neurosis consist in achieving a certain goal, the understanding of which is often not available to the sick person in the first place.

However, neurosis is not at all a voluntary choice of a person. Freud gives a metaphor, comparing neurosis with the instinctive impulse of an animal, replacing one difficult circumstance with another.

Imagine a traveler who rides a camel along a narrow path along a steep cliff, a lion appears from behind the turn. There is nowhere to go. But the camel finds a solution, he escapes from the lion by rushing down with the rider. The symptoms of neurosis are not the best way out, it is rather an automatic action, a lack of adaptive mechanisms from childhood. Such a choice does not allow us to cope with the situation, the solution is no better than the difficulty itself. But this is the only maneuver that the psyche of a person with a neurosis is capable of.

An ordinary conversation, no matter how confidential and warm it may be, is not able to reveal the deep unconscious motives for the emergence of a neurosis, and, consequently, to cope with it. The secondary benefit from the restrictions imposed by neurosis allows you to avoid certain circumstances, or with the help of the symptoms of neurosis to influence loved ones, to achieve a certain attitude towards yourself. All this makes nervoz a valuable acquisition, to get rid of which turns out to be unprofitable for mental economy. However, this way of solving problems is not mature, along with benefits, often imaginary, neurosis brings severe mental suffering.

Difficulties arise in interpersonal relationships, adaptation to the environment is disturbed, a person loses the ability to adequately perceive his psychological needs and be in harmony with himself.

The psychoanalyst is able not only to treat the patient's experiences with sympathy, but he also tactfully explores the questions: what do the symptoms of a neurosis mean, why and for what did the patient fall ill?

The emergence of neurosis is associated with psychological trauma received in childhood and reactivated by a similar traumatic event in adulthood. Here the expression is suitable: "Where it is thin, it breaks there." Often these topics are associated with severe mental pain, which does not allow you to directly approach them.

Everything that prevents a person from understanding his inner world and overcoming neurosis in psychoanalysis is called resistance. To demonstrate to the patient the work of resistance and to help him overcome it is one of the main tasks of the psychoanalyst. It helps to achieve it by creating trusting and reliable relationships based on unconditional acceptance, empathy and the opportunity to discuss any topic. At the same time, confidentiality and respect for the patient's personality are guaranteed.

At the dawn of psychoanalysis, when the method was just being formed, Freud achieved success in the treatment of neuroses by helping patients remember scenes that led them to psychological trauma and subsequently repressed from consciousness. However, it soon became clear that memories do not always eliminate the symptoms of neurosis, or the result is not stable. In addition, in some cases, patients remember sad events and even realize their connection with the current state, but this does not help to cope with mental suffering.

Just remembering an event that the psyche preferred to forget means making an unhappy person out of a neurotic sufferer. That is, to return him to the moment when he acquired his neurosis. Actually, a neurosis would not have developed if a person would be able to cope with life's difficulties. Therefore, Freud came to the conclusion that in the treatment of neurosis by psychoanalysis, in addition to the memories of traumatic events, it is necessary to work out their consequences. The goal of working through is to make the patient mentally more mature, to help him overcome mental suffering, to strengthen his ability to withstand emotional stress and to use more adequate means for solving life problems than those that the neurosis forced him to resort to.

In conclusion, I would like to say about such an advantage of psychoanalysis as high standards of qualification. In psychoanalysis, a prerequisite for professional development is the passage of personal analysis. In order to be able to provide psychological assistance to patients, you need to understand yourself. The professional community monitors the observance of the ethical principles of psychoanalytic work. Psychoanalysis is the most developed and researched method of depth psychotherapy, which has many directions. Entire institutes specialize in the study of psychoanalysis.

If you need psychological help, there are experiences that you would like to deal with, relationships do not add up, difficult life circumstances arise - contact me, I will be happy to help!

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Martynov Yu.S.

Conversion is the process of rejecting the mental content of the subconscious, replacing it with bodily forms of manifestation of various phenomena. This is where the name of such a syndrome as conversion disorder comes from - this is a reaction of the psyche, in which, against the background of stressful situations, depression and resentment, they are replaced at a subconscious level, leading to the development of symptoms of physiological disorders and diseases in the body.

Conversion disorder (hysterical conversion,) is a psychological disease of a special type. Also, the phenomenon is called dissociative conversion disorders. With this syndrome, a person’s sensory or motor functions are disturbed, for this reason he begins to notice the real symptoms of various diseases in himself. In fact, there are no functional disorders in the body, despite their obvious symptoms, and the person feels sick at the same time (the subconscious mind replaces stressful situations with imitation of diseases).

At first, the French doctor, neurologist J.-M. Charcot, he gave the phenomenon the name of hysterical conversion. In the course of observing his patients suffering from the disorder, he found that patients do not feign illness, they really suffer from the symptoms of various diseases that do not really exist.

Later, information about the disorder appeared in the works of Z. Freud, who explained that the mental energy of a patient with a conversion disorder is transformed into somatic. The replacement of depressive states by the subconscious leads to fantasies of bodily illness and the development of a clinical picture of conversion.

The syndrome is manifested by a loss of consciousness control over memory and sensations, as well as over the motor function of the body. In dissociative disorders, the control process is so disturbed that it can change daily and even hourly. It is difficult to find out how much the functions of consciousness control over the body are damaged, it has been established that personality conversion disorder is characterized by a close temporal connection with traumatic events in life, conflict situations, a break in relations with a partner, and other unbearable events for the psyche.

Reasons for development

It has been established that women, as well as young people and the elderly are most susceptible to the development of the conversion syndrome, since it is in these categories of people that the emotional sphere is most vulnerable and unstable.

The main cause of conversion disorder is considered to be an internal psychological conflict, in which a person is biased towards others, makes excessive demands and ceases to realistically assess the situation around him.

In most cases, such behavior is inherent in people with a low level of self-esteem, in whom the desire to increase their own importance in the eyes of others leads to conversion - subconsciousness replacing stressful situations with the development of disease symptoms. Thus, even through various illnesses, a person tries to be in the spotlight, if he cannot achieve this in other ways.

The second reason for the body's conversion reaction to replace psychic energy with somatic energy is the desire to get away from the existing internal or external conflict. The body builds a protective reaction in the form of an imaginary illness in order to hide from stressful situations.

A person cannot consciously control both factors, he feels a firm belief that he is seriously ill, and begins to actually experience the symptoms and signs of any diseases.

A common psychological factor in personality conversion disorder is to receive some kind of unconscious benefit from this syndrome. So, a person with a dissociative disorder tries to manipulate the object of love, and keep him close at least with the help of an imaginary illness.

Symptoms

Data from studies that were conducted back in the 19th century claimed that the symptoms of personality conversion disorder are reduced to fainting, mental disorders, hysterical seizures and paralysis of varying severity. Subsequent studies have shown that the symptoms of this syndrome can spread to any system of the body, as well as to any organ of the human body. The most common manifestations are a feeling of a lump in the throat, difficulty in swallowing, loss of one of the senses of sensory perception.

Conversion symptoms are divided into several groups:

Symptoms can have a fairly severe degree of manifestation, from periodic (occasionally occurring) to chronic. The regular manifestation of signs of the disorder makes it difficult for a person to function both socially and professionally, and in family life.

Treatment

Therapy for dissociative disorders includes medication and psychotherapy.

Pharmacotherapy for conversion disorders includes drugs:

• neuroleptics;
• tranquilizers;
• nootropics;
• antidepressants;
• psychostimulants;
• thymoleptics.

The most commonly used drugs in the treatment of hysterical conversion are drugs from the groups of antidepressants and tranquilizers. The effect of drug treatment is reduced to symptomatic and pathogenetic. Improving the patient's condition after taking medication can go into a state of stable remission.

Psychotherapeutic treatment is a set of measures:

Psychodynamic therapy is used to treat children and adolescents using cognitive behavioral approaches. Family therapy is indicated for couples whose conversion disorder is related to family problems. In the treatment of adolescents, group therapy is used - with the development of survival skills in a social environment.

If outpatient treatment fails, there is an indication for hospitalization of the patient. In a hospital setting, a deeper diagnosis of organic disorders is carried out and the patient's condition is improved outside of dysfunctional conditions.

Symptoms seen in loved ones, signaling the presence of such a condition as personality conversion disorder, should not go unnoticed. Only a timely appeal to a qualified psychotherapist and the elimination of provoking factors - stress, misunderstanding and conflicts in the family and at work, will become the path to successful therapy and recovery.

Conversion— Mechanism of symptom formation in hysteria, especially in conversion hysteria (cf. conversion hysteria).

Displacement of mental conflict and attempt to resolve it through various symptoms - somatic, motor (paralysis) or sensory (loss of sensation or localized pain).

The term " conversion ” in Freud correlates primarily with his economic concept: the libido, separated from the repressed representation, is transformed into the energy of innervation. However, it is precisely the symbolic meaning, or, in other words, the bodily expression of the repressed representations, that is characteristic of the symptoms of conversion.

The concept of conversion was introduced by Freud into psychopathology to account for the "jump from the realm of the psychic into the somatic innervation", which he himself considered difficult to comprehend. This idea, which was new at the end of the 19th century, later, as we know, became widespread, especially in connection with the development of psychosomatic research. Moreover, it is necessary to highlight in this expanded field that which relates to the actual conversion. Freud himself strove for this, distinguishing between hysterical and somatic symptoms of actual neuroses.

The concept of conversion arose already in Freud's earliest studies of hysteria. This concept has primarily an economic meaning: it is about the transformation, the conversion of libidinal energy into somatic innervation. When converting libido is separated from representation in the process of repression, and then this libidinal energy "moves into the realm of the body."

This economic interpretation of conversion is inextricably linked in Freud with its symbolic interpretation: repressed representations, distorted by the mechanisms of condensation and displacement, "speak" through bodily symptoms. Freud notes that the symbolic relationship of a symptom to its meaning is such that the same symptom can express different meanings not only simultaneously, but also sequentially: “Over time, one of the meanings of a symptom, or even its main meaning, may change. The process by which such a symptom arises is so intricate, the transfer of a purely psychic excitation to a region of the body (which I conversion ) is so dependent on a favorable set of circumstances that it is so rare to achieve the somatic correspondence necessary for conversion that the onslaught of the unconscious, pushing excitations to discharge, sometimes forces one to be satisfied, if possible, with the former method of such discharge.

Interested in psychoanalysis? Psychologist, psychotherapist of the psychoanalytic direction Gorkova Tatyana.

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Psychological dictionary. A.V. Petrovsky M.G. Yaroshevsky

Conversion(in psycholinguistics) (from lat. conversio - change, transformation)- the formation of a new meaning of the word either when it passes into a new paradigm of inflection (for example, “oven” - in a hut, “oven” - bread), or when it is used in a context that differs from the traditional one.

Conversion is the cause of semantic barriers in communication. The K. mechanism is used as one of the methods for constructing a humorous statement.

Dictionary of psychiatric terms. V.M. Bleikher, I.V. Crook

Conversion (lat. conversio - change)- splitting off the affective reaction from the content of the psychic trauma and directing it along a different channel.

According to A. Jakubik, there are three options for Conversion:

1. Conversion serves as a means of protection against fear, is a psychological defense mechanism;
2. With K., the transformation of “mental energy” (libido) into a somatic syndrome or symptom is carried out;
3. The conversion manifests itself in the symbolization of somatic syndromes or symptoms, reflecting the underlying internal conflict.

Given the wide range, as well as the metaphorical understanding of Conversion by psychoanalysts, A. Jakubik suggests using the concept of “hysterical disorders of the sensory-motor sphere” instead of this term, although one might think that the latter term excessively narrows the concept of K. Syn.: conversion reaction, hysterical conversion, conversion hysteria, hysterical neurosis of the conversion type.

Neurology. Complete explanatory dictionary. Nikiforov A.S.

there is no meaning and interpretation of the word

Oxford Dictionary of Psychology

Conversion- the transformation of something from one state to another. Consequently:

An abrupt shift from one set of beliefs to another, especially with regard to religious beliefs.

Transformation of psychological inconsistency into physical forms (see conversion disorder).

Shifting a set of values ​​from one scale to another.

Permutation of terms in a judgment.

subject area of ​​the term

HYSTERIC CONVERSION - somatic resolution of the conflict of the unconscious; the process in the course of which the normal exit was closed to the affect that developed under pathogenic conditions, which is why these “pinched affects” find abnormal expression (application), or remain as sources of constant excitation, burdening mental life.

CONVERSION is the process by which rejected mental content is converted into bodily phenomena. Symptoms take on a variety of forms, including motor, sensory and visceral reactions: anesthesia, pain, paralysis, tremor, convulsions, gait and coordination disorders, deafness, blindness, vomiting, hiccups, swallowing disorders. Freud's first cases of hysteria were conversion symptoms; hysteria became the model for all psychopathology and for the construction of the theory of neuroses. Freud viewed conversion as a hysterical phenomenon aimed at resolving the conflicts of the Oedipal phase: “an unacceptable idea is rendered harmless by the transformation of the excitement associated with it into something somatic” (1894, p. 49).

Although conversion has hitherto been considered exclusively in connection with hysteria, Rengell (1959) and others have insisted on expanding its scope, giving clinical examples of conversion symptoms in the most diverse psychopathological disorders at all levels of libido and ego development. The essence of conversion, writes Rengelp, is 'a shift or displacement of mental energy from the cathexis of mental processes to the cathexis of somatic innervation, as a result of which the latter expresses in a distorted form the derivatives of repressed forbidden impulses' (p. 636). Somatic phenomena have a symbolic meaning, they are 'body language', expressing in a distorted form both forbidden instinctive impulses and protective forces. Through analysis, thoughts and fantasies associated with bodily symptoms can be translated back into words. The early cases on which the notions of hysteria and conversion were based are now considered to be much more complex than first thought. These cases are overdetermined, their dynamic mechanisms stemming from multiple points of fixation and regression, including pregenital components as well as phallic and oedipal ones. But, according to Freud's observations, favorable conditions are necessary for the occurrence of conversion, and the spectrum of these conditions is very wide. He conceded that in order to resolve the conflict through conversion, rather than through phobic and obsessional symptoms, a certain 'ability to convert' or 'somatic readiness' is required; however, conversion phenomena are often associated with phobic and obsessional symptoms.

Although Freud's notions of conversion are economic—psychic energy moves or transforms from the psychic to the somatic—in the same work he laid the groundwork for another, now more acceptable explanation. Just as obsessions can arise from separating the affect from the rejected idea and replacing it with a more acceptable one, so, as a compromise formation, the affect can be attributed to the fantasy of bodily disease and lead to a clinical picture of conversion (Freud, 1894, p. 52 ). The relationship between hysterical conversion symptoms and other psychosomatic manifestations remains unclear.

Thus, for example, in orgone neuroses, functional disturbances apparently have no psychic significance of their own, since they are not a translation of specific fantasies and impulses into body language. The same applies to pregenital conversions (Fenichel, 1945), including stuttering, tics, and asthma. To avoid classifying any shift from psyche to soma as conversion, Rangell (1959) proposed that cases of conversion disorders be limited to the criteria described above; he proposed to exclude cases of inevitable, but non-specific somatic consequences of mental stress and undischarged affect. This separation, however, is often clinically difficult.

Hysteria and conversion symptoms. Psychotherapy of hysteria. What is hysterical conversion?

In conversions, somatic symptoms unconsciously and in a distorted form express repressed instinctive impulses.

Any neurotic symptom will interfere with the satisfaction of the instinct. Since arousal and satisfaction are phenomena that manifest themselves somatically, the "jump" into the somatic realm that is characteristic of conversion is not surprising in principle. However, conversion symptoms are not just somatic expressions of affects, but very specific representations of thoughts that can be relayed from "somatic language" to the original verbal language.

Conversion symptoms can be viewed in analogy to affective seizures. These seizures occur when intense stimulation (or normal stimulation under "damping") temporarily disrupts the ego's ability to control movements and archaic discharge syndromes interfere with goal-directed action (such syndromes are subsequently "tamed" and used by the restored ego). Conversion symptoms also occur when there is a sudden disturbance in the ego's ability to control movements and involuntary somatic discharge. The difference, however, is that in normal affects, the syndromes that interfere with actions are similar in all people (we do not know their origin and in attempts to explain we turn to phylogenesis). Conversion symptom syndromes are unique in each case. Psychoanalysis shows that their origin is due to the peculiarities of ontogenesis, the experiences of the individual, repressed in the past. These syndromes distortly express the repressed instinctive needs, the specificity of the distortion is determined by the events of the past that caused the repression.

Prerequisites for the development of conversion

There are two prerequisites for the development of conversion: somatic and mental. The somatic premise is the general erogenousness of the human body, which makes it possible for every organ and every function to express sexual arousal. The psychic presupposition is above all the possibility of turning away from reality to fantasy, of replacing real sexual objects with imaginary representations of infantile objects. This process is called "introversion".

Recall that after the function of predicting actions is assigned to thinking, two types of thinking are distinguished, preparing actions and replacing actions. The first kind of thinking is logical and verbal, its functions correspond to the principle of reality; the second is archaic, figurative, magical, and its functions correspond to the pleasure principle. Fantasies represent the second kind of thinking, they are a pleasant substitute for painful reality, fantasies often find connection with repressed needs, they are supercathected by the transfer of energy from the repressed material and thus become its derivatives.

In introversion, tantrums regress from disgusted reality to magical thinking in fantasies. This process can be conscious as long as the fantasies are far enough away from the content of the repressed material, especially the reprehensible Oedipus complex, but if the fantasies cross the forbidden line, they are also repressed. They then return in disguise from repression in the form of conversion symptoms.

In accordance with introversion, hysterical individuals are turned to their inner world. Their activities, instead of outwardly directed actions (alloplastic activity), are simply "internal innervations" (autoylastic activity). In other words, the fantasies of hysterical individuals, when repressed, find plastic expression in changes in somatic functions. In this connection, Ferenczi speaks of the "hysterical materialization" of fantasies. With hysterics, “materialization” only exaggerates what is similarly manifested in normal fantasizing, but in fact in all thinking. Thinking, replacing actions, nevertheless, is their "grain": in the process of thinking, the actions that are thought are innervated, only to a lesser extent than during their actual implementation. This "action component", which is especially noticeable in introverted hysterics, forms the basis of the innervation that makes up the conversion symptoms.

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Found 11 definitions of the term CONVERSION

Synonym: conversion reaction, hysterical conversion, conversion hysteria, hysterical neurosis of the conversion type.

CONVERSION

The process by which rejected mental content is transformed into bodily phenomena. Symptoms take on a variety of forms, including motor, sensory and visceral reactions: anesthesia, pain, paralysis, tremor, convulsions, gait and coordination disorders, deafness, blindness, vomiting, hiccups, swallowing disorders.

Freud's first cases of hysteria were conversion symptoms; hysteria became the model for all psychopathology and for the construction of the theory of neuroses. Freud viewed conversion as a hysterical phenomenon aimed at resolving the conflicts of the oedipal phase:

“an unacceptable idea is rendered harmless by the transformation of the excitement associated with it into something somatic” (1894, p. 49). Although conversion has hitherto been considered exclusively in connection with hysteria, Rengell (1959) and others have insisted on expanding its scope, giving clinical examples of conversion symptoms in the most diverse psychopathological disorders at all levels of libido and ego development. The essence of conversion, writes Rengelp, is 'a shift or displacement of mental energy from the cathexis of mental processes to the cathexis of somatic innervation, as a result of which the latter expresses in a distorted form the derivatives of repressed forbidden impulses' (p. 636). Somatic phenomena have a symbolic meaning, they are 'body language', expressing in a distorted form both forbidden instinctive impulses and protective forces. Through analysis, thoughts and fantasies associated with bodily symptoms can be translated back into words.

The early cases on which the notions of hysteria and conversion were based are now considered to be much more complex than first thought. These cases are overdetermined, their dynamic mechanisms stemming from multiple points of fixation and regression, including pregenital components as well as phallic and oedipal ones. But, according to Freud's observations, favorable conditions are necessary for the occurrence of conversion, and the spectrum of these conditions is very wide. He conceded that in order to resolve the conflict through conversion, rather than through phobic and obsessional symptoms, a certain 'ability to convert' or 'somatic readiness' is required; however, conversion phenomena are often associated with phobic and obsessional symptoms.

Although Freud's notions of conversion are economic—psychic energy moves or transforms from the psychic to the somatic—in the same work he laid the groundwork for another, now more acceptable explanation. Just as obsessions can arise from separating the affect from the rejected idea and replacing it with a more acceptable one, so, as a compromise formation, the affect can be attributed to the fantasy of bodily disease and lead to a clinical picture of conversion (Freud, 1894, p. 52 ).

The relationship between hysterical conversion symptoms and other psychosomatic manifestations remains unclear. Thus, for example, in orgone neuroses, functional disturbances apparently have no psychic significance of their own, since they are not a translation of specific fantasies and impulses into body language. The same applies to pregenital conversions (Fenichel, 1945), including stuttering, tics, and asthma. To avoid classifying any shift from psyche to soma as conversion, Rangell (1959) proposed that cases of conversion disorders be limited to the criteria described above; he proposed to exclude cases of inevitable, but non-specific somatic consequences of mental stress and undischarged affect. This separation, however, is often clinically difficult.

In a conceptually formalized form, the idea of ​​​​conversion was expressed by J. Breuer and Z. Freud on the basis of their therapeutic activities related to the treatment of patients suffering from hysteria. This idea was reflected in their work “Studies in Hysteria” (1895), although in terms of terminology, it is Freud who has the priority in introducing the term “conversion” into scientific circulation, which he used to characterize “an anomalous release of persistent excitations”. In the article “Protective Psychoneuroses” (1894), he considered conversion in terms of the separation of mental energy from the representation of a person, as a result of which a shift of mental excitation to the area of ​​the body was observed, which led to the emergence of somatic symptoms.

As Z. Freud tried to build a general theory of neuroses, he made a distinction between "conversion hysteria" and "hysteria of fear." The first form of hysteria is associated, in his opinion, with the direction of the affect of the mental process from the mental sphere to the bodily area. The second - with the displacement of traumatic experiences into the unconscious, but their preservation in the human psyche. Initially, Z. Freud believed that "conversion hysteria" could have an independent meaning, in no way connected with neurotic diseases, the symptoms of which are characterized by mental manifestations. Then he suggested the presence of mixed neuroses and extremely rare cases of manifestation of exclusively "conversion hysteria". However, in his Analysis of the Phobia of a Five-Year-Old Boy (1909), he expressed the point of view that there are not only cases of pure "hysteria of fear", expressed in the manifestation of phobias without an admixture of conversion, but also "pure cases of conversion hysteria without any fear" .

In Z. Freud's understanding, conversion correlated with the economic point of view on hysteria, which takes into account the quantitative factor of psychic energy. Expressed in his early studies, this point of view actually predetermined his subsequent metapsychological developments, combining topical (according to the location of unconscious and conscious systems), dynamic (transition of conscious and unconscious processes from one system to another) and economic (the amount of mental charge) ideas about the nature and causes of neurotic diseases. As S. Freud noted in his Autobiography (1925), his theory of hysteria takes into account, along with the distinction between unconscious and conscious mental acts and the dynamic view of the symptom, as a result of counteracting affect, also the economic factor, since it considers the same symptom "as a result of the conversion of a certain amount of energy, usually turned to something else (the so-called conversion)."

Conversion symptoms can take a variety of forms, including paralysis, convulsions, incoordination, blindness, deafness, vomiting, and other bodily manifestations. From a psychoanalytic point of view, they can be both the result of the transfer of mental energy or the rejection of mental content, and the consequence of a person's fantasies about a particular bodily disease.

In modern psychoanalysis, the questions remain debatable as to whether all movements from the psyche to the bodily organization of a person should be considered conversion or whether we can talk about specific forms of the corresponding shift, what are the criteria for separating conversion symptoms from other psychosomatic manifestations, how and how conversion manifestations are combined with phobias, hypochondria and other mental illnesses.

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7. Concepts of hysterical conversion and Freud's anxiety attack equivalents

Z. Freud formulated the basic theoretical provisions of the psychodynamic concept of psychosomatic disorders (1856-1939). However, it must be remembered that the psychosomatic problem itself was never the focus of attention of the founder of the method of psychoanalysis and his closest followers.
As the first psychosomatic model, psychoanalysis developed the concept of conversion. Freud described it as a hysterical symptom complex.

Its classic examples were, for example, psychogenic paralysis of the arm, hysterical seizures, hysterical dysbasia (disturbance of walking) or psychogenic anesthesia (disturbance of sensitivity). The prototype of the psychoanalytic concept of conversion is a voluntary movement: the ideational scheme of movement that initially arises in the representation is then realized in a motor performance, such as showing, explaining, grasping with hands or punching.
In Freud's understanding, by conversion, an unpleasant representation becomes harmless because its "sum of excitation" is transferred into the somatic sphere. The symptom binds psychic energy and leaves the unbearable idea unconscious, but requires additional attention and secondarily leads to an increase in libidinal substitution and, thus, has the character of both satisfaction and punishment. Freud always defended his position that "somatic readiness" is necessary - a physical factor that matters for the "choice of an organ" and which can be imagined in the process of its occurrence, starting from a genetic disposition, in the form of a current overload of an organ up to early childhood traces within a specific bodily experience. Although due to social development such conversion symptoms have become rarer, the theoretical and therapeutic validity of this model in certain patients with hysterical symptom complexes, paralysis, disturbances of sensitivity or emotionality is undeniable.
Hysteria as a psychopathological syndrome is caused, according to Z. Freud, by an unresolved emotional conflict (psychic trauma), the awareness of which is not encouraged by social norms. In other words, instead of being reacted in spontaneous expression, the person's negative emotions that arise from the traumatic event are suppressed. However, the energy tension caused by the affect does not go away and turns into a painful symptom. This gives rise to the idea of ​​a conversion (conversion, transition from one state to another) mechanism of hysterical disorders, when a painful symptom acts as a symbolic expression of an emotional conflict. Violation of the bodily function is a somatized expression of ideas incompatible with the conscious "I".
An unreacted repressed emotional (intrapersonal) conflict becomes an energy reservoir that fuels the disease. Therefore, in order to stop a hysterical disorder, it is necessary to be aware of this conflict, which can be achieved by actualizing the personal resources of the patient himself. Further development of this idea went along the path of searching for and improving the method of updating personal resources. Therefore, psychosomatic disorders in psychoanalysis for a long time were identified only with a conversion mental disorder.