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FACTS OF TREATMENT IN INDIA: CONVERSION DISORDER

1 Samiksha Kaur  2Jai Singh Yadav

Psychologist SRLN Marwari Hospital Varanasi India, 1 Assist. Prof. AIIMS New Delhi India2

 

 

 

Abstract

Background- Conversion disorder causes patients to suffer apparently neurological symptoms, such as numbness, blindness, paralysis, or fits, but without a neurological cause. It is thought that these problems arise in response to difficulties in the patient's life, and conversion is considered a psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV).

Aim-     A) To Know about the facts of treatment in conversion disorder.

B) Combined therapy (Pharmacological and non- pharmacological) treatment was higher effective in conversion disorder.

Methodology-120 female subjects were taken for the study. They were diagnosed by consultant psychiatrist as conversion disorder as per DSM IV criteria. Random sample were used. The age group of subject was 18-40 years. First demographic data were filled individually then apply the questioner first day and after the twelve week. During this session benzodiazepine, clonazepam 5mg (1HS), 10 mg Amitryptiline (1HS) and escitalopram were given along with psychotherapy.Conversion Disorder questioner was applied for the assessment of current position.

Results- the result was show that 80% females first time treated by the faith hillers but improvement was poor, it was only 10%. Higher conversion age group was 26-34 years. It was also found in the study that around 35% female was abused by faith hillier. Main stress was poor marital adjustment, Family stress and educational problem. Around 29.15% female under treated by the faith hillier last six month. It was shown in the study that 10% cases were improved by faith hillier. Combined therapy improved 95% of female. It was done by pre and post tail of questioner.

Conclusion- It was found in the study that faith hillier treatment was a misconception right way was combined therapy. Unfortunately faith hillier was done many disease whole the world, due to unawareness’ of psychiatry disorder.

Key Words: Conversion disorder

Introduction

The classification of DSM-IV-TR conversion disorder as one of the somatoform disorders, Conversion disorder included as a group of mental disorders in 1980 DSM III. As per defined by Diagnostic and Statistical Manual of Mental Disorders , 4th Edition, Text Revision, also known as the DSM-IV-TR, conversion disorder central feature is affecting the patient's senses or voluntary movements that suggest a neurological or general medical disease or condition.1

Other terms that are used for conversion disorder include pseudoneurologic syndrome, hysterical neurosis, and psychogenic disorder. Primary care of conversion disorder practitioners by doctors estimates that 25–72% of office visits involve to psychological distress that takes the form of somatic (physical) symptoms. Another study estimates that at least 10% of all medical treatments and diagnostic services are ordered for patients with no evidence of organic disease. Patients who convert their emotional problems into physical symptoms spend nine times as much for health care as people who do not somatosize; and 82% of adults with conversion disorder stop working because of their symptoms. 2

 

Two terms used in conversion disorder, primary gain and secondary gain. Primary gain refers to the lessening of the anxiety and communication of the unconscious wish that the patient derives from the symptom. Secondary gain refers to the interference with daily tasks, removal from the uncomfortable situation or increased attention from significant others that the patient obtains as a result of the symptom.2,3

Physical, emotional, or sexual abuse is the contributing factor of both adults and children for conversion disorder. In a study of 34 children who developed pseudo seizures, 32% had a history of depression or sexual abuse, and 44% had recently experienced a parental divorce, death, or violent quarrel. In the adult population, conversion disorder may be associated with mobbing, mobbing means psychological abuse in the workplace. This term generally used by European psychiatrists and industrial psychologists.4 Adult males sometimes develop conversion disorder during military basic training. Conversion disorder may also develop in adults as a long-delayed after-effect of childhood abuse. A team of surgeons reported on the case of a patient who went into a psychogenic coma following a throat operation. The surgeons found that she had been repeatedly raped as a child by her father, who stifled her cries by smothering her with a pillow.

 

In India, high occurrence of conversion disorder has been reported in young adults, from poor low income, joint families and significantly higher in females, illiterates married housewife’s.5,6 We discussed too much about the conversion and their types and causes but one part is also necessary to discuss about the treatment. Yes; this is fact whole the world belief in faith healer. And it is true a number of person treated by them in the whole world like Iraq, Nepal, Australia, Pakistan, and America. So our concentration about this topic first time treatment in conversion disorder and how many percent patients go to proper place. Many studies have been found method of treatment of faith healer but paucity of study about treatment/malpractice of conversion disorder.   

Aim-     A) To know the facts of treatment in conversion disorder.

B) Combined therapy (Pharmacological and non- pharmacological) treatment was higher effective in conversion disorder.

Methodology 120 female subjects were taken for the study. They were diagnosed by consultant psychiatrist as conversion disorder as per DSM IV criteria. Random sample were used. The age group of subject was 18-40 years.

Procedure first demographic data were filled individually then apply the questioner first day and after the twelve week. During this session benzodiazepine, clonazepam 5mg (1HS), 10 mg Amitryptiline (1HS) and escitalopram were given along with psychotherapy.

Tools-Conversion Disorder questioner was applied for the assessment of current position.

 

 

 

Table-1 Age Group of Patients

Age Group

No of Patients

18-22

28%

22-26

21%

26-30

31%

30-34

14%

34- 40

06%

 

 

Table-2 Socio economic status

Socio economic status

No of Patients

High

12%

Middle

45%

Low

65%

 

 

 

Table -3Duration of course

Duration of course

No. of Patients

2-6 month

38%

6-10 month

16%

10-14 month

25%

14-18 month

08%

18-22 month

13%

 

 

 

 

Table-4 Main Stressor

Main Stressor

No of Patients

Academic Problem

26%

Family Stress

32%

Poor Marital Adjustment

40%

Love/rejection/failure

13%

Premarital/extramarital relationship

16%

Issueless

04%

Rap/Child abuse

09%

 

 

 

Table-5 First time treatment in conversion Disorder with faith healer

Urban

Rural

21.42%

78.57%

 

 

 

Table-6 First time taking treatment in Conversion Disorder with Medical Care

Types of Specialty

Urban

Rural

General Physician

40.90%

58%

Heart Specialist

13.63%

12.5%

Neurologist

18.48%

00

Gynecologist

4.54%

 37.5%

Psychiatrist

18.18

00

Total patient

22

08=30

 

 

 

Table-7 Duration of course with faith healer

Duration of course

No of Patients

Improvement

6 month

50%

14.28%

1 year

28.15

 

16 month

14.28%

 

24 month

7.14%

 

Total patient

70

 

 

 

 

Table-8Combined therapy with faith healer (6month)

Types of Specialty

No of Patients

Psychiatrist

16.66%

Only Faith Healer

41.66%

Heart Specialist

06.66%

General physician

46.66%

Gynecologist

05%

Total no of Patients

70

 

 

Table-9 Pharmacological and non pharmacological treatment

Sub Category of Questioner

1st Day

3month Improvement

Numbness/aphonia /aphasia

38%

36%

Blindness,

10 %

09%

Paralysis/ fits,

57%

54%

Headache

48%

44%

Agitation

75%

69%

Unconsciousness

70%

65%

 

 

 

 

Result-

The result was show that 70% females first time treated by the faith hillers but improvement was poor, it was only 10%. . In a hundred cases that were investigated, no single case revealed that the healer's intervention alone resulted in any improvement or cure of a measurable organic disability.7Higher conversion age group was 26-34 years. It was also found in the study that around 35% female was abused by faith hillier. Main stress was poor marital adjustment, Family stress and educational problem.14% female had multiple problems. Around 50% female under treated by the faith hillier last six month. It was shown in the study that 10% cases were improved by faith hillier. Combined therapy improved 95% of female. It was done by pre and post trail of questioner.

 

Discussion- Faith healing is very old method of treatment and the way of treatment is not scientific. But belief of faith healer was amazing; data show not only in India but all over the world faith healer position is too much strong then medical professionals in field of psychiatry by literature. We are not consulting only about faith healing but we are taking about the unawareness of treatment in psychiatry disorder. In this paper we found that first time treatment of conversion disorder by faith healer was 70%. Not only in psychiatry disorder but use of faith healing in physical disorder8,9 Faith healer can eliminate disease or heal injuries through a close connection to a higher power. Faith healing can involve prayer, a visit to a religious shrine, or simply a strong belief in a supreme being.

Many religious sects claim faith can cure blindness, deafness, cancer, AIDS, developmental disorders, anemia, arthritis, corns, defective speech, multiple sclerosis, skin rashes, total body paralysis, and various injuries. Certain religious groups, for instance, believe that illness is an illusion that can be healed through prayer, either for oneself or by trained practitioners. Christian physician Reginald B. Cherry views faith healing as a pathway of healing in which God uses both the natural and the supernatural to heal.10,11 Being healed has been described as a privilege of accepting Christ's redemption on the cross.12

When we are taking about Iraq, it is important to consider how different cultural traditions may affect care. Society’s has negative image of mental health. Iraq has commonly consulted faith healers rather than help from doctors. Dr. Hashim Zainy, director of the Ibn Rushd Hospital in Baghdad, explained that under Saddam Hussein’s regime psychiatry was neglected and patients were instead sent to religious healers. Mental illness was seen as an anomaly that could not affect faithful Muslims. This belief in religious healers persists and they continue to be consulted for the treatment of mental illness. A recent study from 2011 investigated the use of faith healers among acute schizophrenic patients admitted to the Ibn Rushd Hospital. 22% reported no contact with faith healers, while almost half reported contact both before and after their diagnosis and treatment. In our study 70% women’s first time taken treatment to faith healer and 16.66% treated by psychiatrist. Other sub specialty also responsible for misguide to proper treatment.  Much attention was brought to the subject by a New York Times article in which a doctor from the United States described his encounter with a faith healer in Iraq. The author, Dr. Amir A. Afkhami, was allowed to observe the treatment of a young woman brought to a healer, Mullah Eskandar, by her family. The woman’s mother explained that since her daughter had become engaged to a relative, she had been experiencing fainting fits, nightmares, bad moods, and was unable to walk. Upon hearing her symptoms, Dr. Afkhami and his colleague thought of a diagnosis well known to mental health professionals: conversion disorder. It is a condition brought on by a particular stressor and symptoms tend to involve motor or sensory functions. The faith healer of course had a different diagnosis, explaining that the woman was possessed by jinn, a kind of evil spirit mentioned in the Koran. The healer chanted a verse from the Koran and instructed her on a regime of prayers, daily bathing and rosewater perfume. He also spoke to her about a daughter’s duty to marry and the joys of having a family. Dr. Afkhami explains seeing a similarity between the rituals and counseling of Mullah Eskander and the typical supportive therapy of Western medicine. "It is often claimed that faith healing may not work but at least does no harm. In fact, reliance on faith healing can cause serious harm and even death.13,14,15 This is evident in both higher mortality rates for children16 and in reduced life expectancy for adults.17 study have found serious injury that has resulted from falsely labelled "healings", where patients erroneously consider themselves cured and cease or withdraw from treatment.18,19 in a case  six people have died after faith healing by their church and being told they had been healed of HIV and could stop taking their medications.20 

Culture and socioeconomic status also responsible for any type of development either physical, mental. It was found in the study that low socioeconomic status has higher conversion disorder 65%. Due to educational and unawareness, lake of knowledge of specialty it was supported by study (5, 6).

This was the fact of hear but due to unawareness of specialty of villagers generally not known about the specialist. So they misguide and face many problems in medical care. In our study it was found after the treatment of faith healer first time treated with different medical professionals 41.66% Neurologist and 46.66% were general physician. So they suffer too much problem and their consequence was poor health and wastage of time and money.

 

References

1.        Diagnostic and statistical manual of Mental Disorder. Fourth edition. APA

2.        Mace CJ. Hysterical Conversion: A history Br J psychiatry 1992; 161: 369-77.

3.        Gottlieb RM. Psychosomatic medicine: the divergent legacies of Freud and Janet. J Am Psychoanal Assoc 2003; 51:857-81.

4.        Micale MS, On the disappearance of hysteria. A study in the clinical destruction of a diagnosis. ISIS 1993; 84:469-529.

5.        Vyas JN. Bharatraj PK.A Study of Hysteria- An analysis of 304 Patients. Indian J of Psychiatry1977; 19:71-4.

6.        Saxena S. Pachauri R, Wig NN.DSM-111 diagnostic categories for ICD-9 Hysteria: A study of 103 cases Indian J of psychiatry 1986; 28:47-9.

7.        Louis Rose. Some Aspects of Paranormal Healing. The British Medical Journal, Vol. 2, No. 4900 (Dec. 4, 1954), pp. 1329–1332.

8.        Stephen Barrett, M.D. "Some Thoughts about Faith Healing." June 15

9.        Faith Healing." Making Treatment Decisions. American Cancer Society. June 15, 2009.

10.     Reginald B. Cherry. The Bible Cure. Harper One, 1999. ISBN 0-06-251615-9

11.     Bosworth, F.F. Christ the Healer. Revell, 2001. ISBN 0-8007-5739-4

12.     Village, Andrew. "Dimensions of Belief about Miraculous Healing." Mental Health, Religion & Culture, June 2005; 8(2): 97–107

13.     Flamm, Bruce L. (Fall/Winter 2004–2005). "Inherent Dangers of Faith Healing Studies". Scientific Review of Alternative Medicine 8 (2). Archived from the original on 2007-08-16. Retrieved 2008-01-17. 

14.     Flamm, Bruce (2004-09). "The Columbia University 'Miracle' Study: Flawed and Fraud". Skeptical Inquirer. Committee for Skeptical Inquiry. Archived from the original on 2007-12-26. Retrieved 2008-01-17. 

15.     Randi, James (1989). The Faith Healers. Prometheus Books. ISBN 0-87975-535-0 page 141 

16.     Asser, Seth M.; Rita Swan (1998-04). "Child Fatalities from Religion-motivated Medical Neglect". Pediatrics 101 (4): 625–629. 

17.     Simpson, W. F. (1989-09-22). "Comparative longevity in a college cohort of Christian Scientists". Journal of the American Medical Association 262 (12): 1657–1658.

18.     Barrett, Stephen (2003-03-03). "Some Thoughts about Faith Healing". Quack watch. Retrieved 2008-01-17.

19.     Randi, James (1989). The Faith Healers. Prometheus Books. ISBN 0-87975-535-0 page 141 

20.     Liz Lane (November 25, 2011). "Church Tells HIV Patients To Stop Treatment". Sky News.