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Lloyd I. Sederer, MD

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Mysterious Illness at Le Roy School: Understanding Conversion Disorders

Posted: 02/03/2012 9:53 am

When we get embarrassed, our faces turn red.

When we get nervous, our hearts pound and our palms sweat.

When we feel really sad, we cry.

Our minds can -- and do -- speak through our bodies. All the time. Yet sometimes it can seem hard to believe.

Recently, the media has burst with stories about 15 teenagers (all but one of them girls) in Le Roy, N.Y., a small town east of Buffalo, where their tic-like symptoms and uncontrolled utterances have baffled local residents, school officials and families. The NYS Department of Health, in collaboration with the Centers for Disease Control and Prevention (CDC) and local physicians, has been on the scene. These agencies have assisted in the examination of the teenagers as well as in searching for possible environmental causes such as viral or bacterial diseases and toxins in water and soil.

Erin Brockovich, renowned for championing the investigation of a California power company that allegedly polluted a city's water supply (and played by Julia Roberts in the 2000 movie sporting Brockovich's name), has sent her investigative team to Le Roy.

To date, there is no evidence that any toxin or infectious agent is causing the outbreak of symptoms in these 15 adolescents. Monitoring of symptoms and their possible causes continues.

Distress abounds in this community and among the teenagers and families affected. In the absence of evident physical causes for these symptoms, clinicians and public health officials understand that the mind has the power to produce these problems.

There is abundant medical literature reporting clusters of young people with symptoms like those in Le Roy, and many other physical problems, without any physical cause. A classic paper appeared in the New England Journal of Medicine, almost 20 years ago, from the Massachusetts General Hospital, describing 41 school-age youth in a town near Boston who developed a variety of symptoms including abdominal pain, shortness of breath and fainting; some required hospitalization. No physical causes were discovered and all improved over time. Since then, many other articles have appeared -- reporting outbreaks in this country and other nations.

Medical symptoms that prove to have no infectious or toxic basis can be explained by how the body can express emotional distress. This is often called conversion disorder (literally, where emotional distress is converted to bodily symptoms) or somatoform disorder, where physical symptoms are not the result of a physical illness. The symptoms truly look like a physical disease but are rooted in stress and distress and typically begin in adolescence.

These young people are not "faking" their symptoms. They are having a physical response to emotional distress. They are in considerable distress, as are their families, and they cannot simply stop, or control, the symptoms they are having.

Hippocrates, the Greek father of medicine, hundreds of years before Christ, called this problem hysteria. Without the sophistication we have today where we appreciate how the mind and body are inseparable, the Greeks attributed hysteria (a condition then regarded specific to women) to "the wandering womb." A woman's womb was thought to move from its proper place and settle elsewhere in the body where it produced symptoms. A recent movie, A Dangerous Method , dramatized hysteria in a young woman almost 100 years ago.

Independent of what is causing the problems in the Le Roy youth, stress aggravates any medical disorder, be it physical or mental in nature. Perhaps more importantly, stress interferes with a person's ability to recover from their condition, whatever the cause.

The Le Roy adolescents need to continue under the care of specialists, like neurologists and infectious disease experts, as well as their family doctors. They, as well as their families, should consider counseling if they believe it would be helpful to assist in managing the stress of these symptoms and the concerns they raise.

References:

Small, GW, Borus, JF: New England Journal of Medicine March 17, 1983

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