I wonder if “conversion disorder” — a classical psychiatric term for the conversion of psyche into soma in the form of psychosomatic issues — could be one way of thinking about the present. Especially with so many patients complaining of bodily symptoms, armed at times with cadres of healers; with so many seeking recourse to pharmacological treatments or bodily modification of various sorts, plastic and otherwise; with young men and women seemingly willing to direct violence at any-body, including themselves, in the name of powerful religious ideals. Something increasingly insists on the level of the body.
There are even times when I feel like we are living in the nineteenth century. The fads for body-based healing reminiscent of an age of sanatoriums and hydrotherapy in Europe and the global pull toward religious fundamentalism akin to the intensity of something like the burned-over district of western New York. In fact, the metaphor of burned-over feels apt, meaning that there is no fuel left to burn, everything having been converted — a nod to the chemical meaning of conversion as instantaneous and complete transformation.
Conversion disorder is a late-nineteenth century term originally fastened to hysteria, a term taken from the Greeks to denote bodily symptoms, mostly feminine, that were medically inexplicable and so linked to psyche more generally. Hysteria eventually disappears from the medical lexicon in the 1980s, marking the centennial anniversary of psychoanalysis with its absence. Conversion, however, remains. Ambiguous. More gender-neutral. Less arduous of a term than “conversion hysteria,” but one that still speaks to the problem of the relationship between body and mind — all those puzzling aches and pains that seem to come with anxiety or depression, that act like a constant companion of sorts, or, on the more extreme end, problems like hypertension and colonitis, and the more ambiguous diseases like auto-immune issues or the chronics of Lyme, pain, and fatigue. Conversion disorder carries within itself the failure of diagnosis mapping so many bodily issues that seem to follow the fault lines of culture.
Historically, of course, conversion is linked to the idea of complete personal transformation in the religious sense. A.D. Nock in his classic book Conversion from 1933 sees religions of conversion arising at a point when the older religions couldn’t speak to the predicaments of the present. The prophet, he says, is someone who knows the hot house in which he lives, knows how to “fuse into a white heat” the combustible material that is there, to express and “to appear to meet the half-formed prayers” of his contemporaries. Maybe conversion — there like a beam of light in a rather murky present — will tell us why bodily disorder and the promise of transformation, body and soul, continue to slip into every realm of life. What is possible? What conversion may be hoped for?
Here I want to pick up the term again as a psychoanalyst, because conversion is linked to combustible effects, to desires and fears that remain hidden, unspoken, but ripe, a demand that takes place through the body. This is certainly the situation with the original “conversion hysterics” of psychoanalysis. “I have a sounding board in my abdomen…if anything happens, it starts up my old pain,” said a woman to Breur in Studies in Hysteria (1895, p. 204). Some thirty-odd pages later, Freud takes over, as he would do, this hysteric’s imagery as his own, laying down the foundation for the existence of “unconscious ideas” and the “splitting” of the mind on the basis of her words. Freud writes, “the lively affects into which they are thrown by relatively trivial causes become more intelligible if we reflect that the ‘split-off’ mind acts like a sounding-board to the note of a tuning fork.” Conversion hysteria is an act that preserves some part of your psyche or emotional life in the body, not allowing it to undergo the usual wearing away.
These women’s bodies and personalities move in concert — Breur and Freud describing them as lively, restless, intolerant of monotony, volatile, and impressionable. The unity of soma-psyche in conversion hysteria provides Freud, paradoxically, with a model of the dis-unity of the human mind. Or perhaps better, this logical ordering of their disorder provides Freud with a similar psychological theory. Breur and Freud followed the signals on their body from strange paralyses and pains, blackouts, coughing fits, and the like. The goal was not simply the removal of the pathogenic disturbance in order to return to normal. Freud abandons the cathartic aim — perhaps something closer to an idea deconversion — because it doesn’t last. He must find a more radical change, leaving us with one of the greatest of tautologies in psychoanalysis: conversion must be subject to conversion.
We are only a few short steps away from the invention of psychotherapy, which, far from the clichés of digging up one’s love or hatred for parents, was already at this time — 1895 — a listening to these women’s unknown indictments of the present via their history as well as their wish for a more just and equitable life, their longing for intimacy and sexual satisfaction. This story is perhaps familiar to many, but it is worth telling again because conversion disorders have not gone away. If anything, they have multiplied and mutated, permeating most sectors of life, love, and work.
What psychoanalysis locates is the importance of listening and listening closely; not to hear that these symptoms were psychosomatic and so therefore not real — Freud always said the maladies were real, meaning in the body. Rather, the analyst attempts to hear what is real in these wishes, what in reality, in the present situation, these wishes are responding to — their discontented bodies a sounding board to the note of the tuning fork of civilization.
The psychoanalyst, unlike the prophet or the guru, does not bend these wishes to his or her will, but rather returns them to the patient, returns what the patient has learned from her body-like-an-antenna concerning the contemporary landscape. “Conversion disorder” speaks a powerful truth about the way our bodies are affected by the world around us — a world we are born into, and so did not chose, which moves at lightning speed and with which we are all trying to catch up.
Let me illustrate with the case of a 10-year-old girl I will call Jessica. Jessica was the first daughter of a second-generation mother of Hispanic parents who immigrated to the United States. Being a female in this family meant identifying with potential sin and devastation in the realm of love and family as well as probable failure and poverty in the attempt at professional success. Her mother practically daring the child not to identify with her only made Jessica cling to her mother all the more. I watched this little girl enter into puberty with this injunction on her shoulders. Without the space to symbolize her obscure desires as an imagined woman, the narrow straights of conversion seemed to open up to her.
Her body was increasingly presented to me as a body either in pain because of strange feelings in her abdomen or skin or in play because of all the things a woman must do with her body — comb her hair, shave her legs, wax her private parts, do her nails — that felt like a curse. Jessica got her period when she was close to 12 years old and her mother said something to her like, “Now you can get pregnant.” The strange command had far-reaching effects on this little girl who was at the school nurse’s office for days complaining of stomachaches.
During a number of sessions, we pieced together the following story: there was a great deal of interest at home in her period, including by her little brother who was following her into the bathroom. At one point, he went to the bathroom, and then she went after him. Jessica realized she thought she might be pregnant from this because her mother told her never to put her underwear with her brother’s in the laundry bin, meaning she had a child’s theory of procreation as happening when things touch that aren’t supposed to.
This theory of touch has another layer because Jessica’s mother feared her daughter’s body (which she did not touch), which signaled to her the possibility of getting in trouble as she did, getting pregnant too young, with the wrong man, like all the women before her — hence, female underwear had to be separated as an object of shame. With this revelation, I heard in her mother’s strange ambiguous statement — “Now you can get pregnant” — the permission granted, as opposed to the prohibition that was consciously intended.
But this is not the end of it. A second conversion symptom emerges in the treatment! Jessica is at the school nurse’s office again, this time because she felt pains in her veins and she said she had a splinter — she doesn’t know where it had gone — and she heard that it could go into your blood and pierce your heart. She is in a state of terror and can think of nothing else. The compulsive thought is easily interpreted: she can now imagine something going into her, namely, her acknowledgement of sexual intercourse and the role of the penis in procreation that she had gained in the previous sessions. More than this empirical fact, however, in this strange conversion symptom one must also hear this child’s desire — for something to enter into her, the wish for love, for something to pierce her heart, to touch her intimately on the inside.
Perhaps this is a deeply held wish in the face of a mother who treated her like something to be afraid of. Perhaps also this is her response to the ambiguity of the “now you can” that spoke the truth of these women and their split-off desires: that they too crave sexual relationships, intimacy, something forbidden to them not only by religion, but also by the demands of a competitive atmosphere where all this must be put aside lest they remain entrenched in poverty, generations of the family stuck at the same level of education and hardship. The threat of poverty and giving into one’s feminine sexuality are often condensed in powerful ways for immigrant and marginalized women.
What fascinates me in this case is that conversion is not dissipated by therapy or a greater sense of reality, but instead intensified to reveal increasingly deeper truths. Access to these layers of truth reveals the present against the varied attempts at fending it off that fuel repetition and acting-out. In fact, in speaking this symptom to her analyst, the “can” is transformed into the freedom this mother desperately wants to give her daughter without knowing it or knowing how. The curse can finally be overturned, meaning her daughter’s conversion symptoms show exactly how she may be converted.
I wager that the particular truth of this case is true for many mother-daughter relationships in a time when equality has not always meant greater freedom or choice in one’s life as a woman. We cannot have it all — be mothers, be sexual, be attractive, be successful. To be told that we can brings further shame that no longer has a place except in our bodies. I also wonder whether this speaks to the questions we have about so many young western women being recruited by ISIS, which preys on their latent desires by acknowledging what is impossible for them, precisely, as women today. The false promise to them of something more certain touches them more intimately than the advantages we assume they think they have — our liberal perspective one more burden, one more denial coming from the outside.
Similar to Jessica, the very first patient of psychoanalysis, Anna O., suffered from a hysterical pregnancy, something that scared Breur into abandoning her treatment and intrigued Freud who insisted on writing Studies in Hysteria. Beyond Freud, what many don’t know is that Anna O. went on to become one of the first women social workers, went on to fight for women’s rights, especially prostitutes, young mothers, and orphaned children. Although she was furious at Breur and Freud — men she felt had used her for their own fame — one still wonders whether the therapy gave her the impetus to fight for exactly what she came to understand ailed her in her body as a young woman, desperately loyal to her family and caught in the contradictions of her day.