That’s not how it works – Conversion Disorder edition

TW: conversion disorder, discussion of psychiatric illness

Spoilers for Chicago Med episodes 1×08 and 2×17

 

So I like to laugh (inside my mind) at medical shows. When I watch more than one at a time (e.g. Code Black and Chicago Med), I see how they often have patients with very similar stories and conditions within a very short time, if not on the exact same week. I see how the patients become the B-story foil for the doctors’ emotional arcs, I see quite a few variations on ‘that’s not how … works’ – things like sterilisation (or lack of), ER doctors overseeing day-to-day care on long-term or chronic conditions, rare conditions being instantly diagnosed and cured in 40 mins.

 

Last year, I was actually really excited to see conversion disorder mentioned on Chicago Med, although I agreed with the rather loud internet reaction at the time, that using it the way it was used wasn’t responsible and devalued an actual real physical diagnosis.

 

Since then I’ve been put firmly in the position where my real physical issues have been flat out dismissed because I have a diagnosis of conversion disorder. Everything, even things which predate the incident which supposedly precipitated the conversion disorder, is written off by my psychiatrist as psychosomatic – sore throat and low thyroid levels? just my brain not wanting to talk! – I can really understand and empathise with that position. Except my psychiatrist, somehow, positioned himself as directing my physical care as well, which has actually prevented me getting physical medical care, and so I’m the other way around from what was in the show.

 

Now, it normally takes a few seasons for these types of shows to begin repeating themselves, except for things which are really common or dramatic (pregnancy, heart attack – things which function as plot shortcuts that most people understand), or are things which are repeatedly shown so that viewers learn them as plot markers (for example, dead body + broken hyoid bone = strangulation, even though that’s not strictly true in real life).

Imagine, then, my surprise when the new episode of Chicago Med pulled it out again.

SPOILERS below the cut

 

 

Today’s episode featured a teenage boy who had been clumsy for a while, fell, and then in the ER experienced partial paralysis and was immediately accepting of that. The drama was not about him, though, but about the warring doctors – one who wanted to treat him for stroke, and one who did not. This led to the involvement of our resident non-threatening affable psychiatrist, Dr Charles, who just so happened to run into the boy’s friend outside, and upon hearing that a teenage boy had become withdrawn after finding out he had to move across the country, set the two up together in a room where we had the dramatic reveal that this other boy’s presence immediately reversed the paralysis!

 

In both episodes, Dr Charles had a very neat, pat, explanation, that the patient had feelings they couldn’t express and therefore they were being expressed physically. In both cases, the patient’s parents being absent when the physical condition improved was the main fact driving Dr Charles’ diagnosis.

That’s not how conversion disorder works. There’s even a test for it – the current, probably still flawed, explanation is that signals meant for one part of the brain go to another, causing various effects depending on what parts of the brain are involved. This means that those signals show up on a functional MRI – the same way you see in articles about studies that show things like “the creative centre of the brain is more active in musicians”. Certainly, on a show that has doctors who can access clinical trials with a single phone call and portable x-ray machines in every ER treatment bay, they could at least confirm it.

They do not.

Instead, they show conversion disorder as a very specific and limited circumstance which gets magically fixed on the application of certain factors like, say, the absence of a trigger (a parent).

 

That’s not how conversion disorder works. And, of course, writing it off as conversion disorder prevents people getting the care they need. The girl last year? Was told she didn’t have mito because she didn’t look the same kind of sick all the time, and she was better when her helicopter parent was out of the room. The boy just now? His parents were told that he couldn’t tell them he didn’t want to move and it came out as paralysis, and it wasn’t a stroke so they would just observe him overnight. (Disregarding, of course, all the other times a scan has been returned negative and the doctors have ordered different tests in case it’s something else – an infection, immunodeficiency, and so on. This also disregarded the opinion of their frequent flyer neurologist, and the fact that some strokes don’t do enough of/or the right kind damage to show up on scans immediately or ever.)

 

So how does conversion disorder work? Well, it can go away on its own, and be a short term thing with a specific trigger. Except then? It doesn’t happen only once, never to happen again. That kind of conversion disorder is called acute, because it comes on suddenly and has a significant impact. If it happens with one thing, it happens with others – if it’s a stress reaction, it will happen with stress from work and stress from home, for example. These don’t really get diagnosed, since they’re actually really short and don’t really leave a trace. There can be work done to minimise the trigger, if one even knows what it is, but usually? If that’s being done, it’s part of a mental health treatment plan for something else, and the conversion isn’t diagnosed/recognised/considered separately. If, say, when you get really upset and cry and you can’t make words, but it stops when you calm down. You might be diagnosed with depression and work on ways to turn the crying into something else, but the fact that your brain is so busy with crying that the talking part doesn’t work is not relevant to that.

Functional conversion disorder, on the other hand, is when this happens most or all the time, and the person with it? Functions.

This is what I have/am meant to have/whatever. I started as acute, with incidents and ER trips to show for it, but I got a headache over my right eye, a place I had never had headaches before – a sharp, intense pain I’d never experienced as a headache before – and suddenly I was losing words, falling over, stopped being able to eat, lost dexterity on one side… and it just keeps getting worse. It sounds like a stroke, right? And it has been explained to me that way, too – it’s like the brain thinks it had a stroke, but it didn’t. (Disregarding, of course, that MRIs before and after this headache are, according to what I have seen of the reports – because doctors don’t share -have some very large differences called ‘lesions’, and the fact that the neurologist saw a twenty-something female-looking person, heard ‘stress’, and immediately ceased the assessment and wrote a referral for his best buddy psychiatrist. Profiling, preconceptions and stereotypes are an issue here.) The thing is – it doesn’t stop just because the trigger is no longer there, or is processed and filed away. Like a stroke, it takes a ton of work to regain ‘normal’ function, and even then it may never come back all the way, or be ‘normal’ all the time. The brain’s conversion of one thing to another isn’t a thing that happens sometimes – it is ‘normal’ for that person.

 

In both cases, there is a physical cause, though brain science is nowhere near sophisticated enough to understand it, let alone have the nice, pat, jargon-free explanation that would make it suitable for one-off episodes of a tv show. That cause is neurons/brain signals/lights on an fMRI not performing how they should, like going to one place when they should be going to another, or not going at all. In no way does this only ever happen once in someone’s lifetime. Nobody I know or have talked to since being diagnosed has the same presentation as me, but none of them have said it only happened to them once and they knew what caused it, got diagnosed, and everything got fixed. Most of them tell me I’m lucky because I got diagnosed, because they got so sick of people not believing them that they gave up trying to get answers and just dealt with it from reading things online. The exact why isn’t known – I’m told it’s ‘this part is overloaded so the brain is going around it and then things end up there’, and after the eighth or ninth iteration of the same diagram, it does sound as vague and unhelpful as it did the first time. But it’s never like it is on TV. That much, I can tell you with absolute certainty.

 

In one of those articles I linked earlier, the author explicitly points out that in her experience, a diagnosis of conversion disorder has actively prevented patients receiving the correct care. This has happened to me. However, I feel that showing conversion disorder as being so simple on TV can only contribute to this continuing to happen. Eventually, people will be like ‘oh, I saw that on tv!’ and then ‘but you can just get over it, right?’.

Then, because I don’t, it will be my fault I don’t get better. (Never mind how I’m getting worse, which, you know, isn’t supposed to happen.)

 

Then, in a hundred years or so, if we’re still around, people will look back at ‘conversion disorder’ like they do ‘hysteria’ now – a diagnosis made by doctors who didn’t understand and couldn’t deal with their patients otherwise, and a society who wanted to label people who didn’t act the right way and find a way to put them somewhere they didn’t have to be seen. Maybe by then I’ll be famous enough to have future doctors guess over my diagnosis they way they say Mozart was depressed or Einstein had Aspergers.

 

 

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