Follow-up on the twitching cheerleaders

Too bad a ten page article is just too long for some folks. It is a fascinating and well-written article. I thought it did come to a conclusion: The girls are suffering from conversion disorder.

I have worked with conversion patients, and they are some of the most interesting cases I have seen. The best one was an elderly woman who woke up one morning unable to feel or use her legs. However, she did have bowel and bladder control, which set up a suspicion that it was conversion. The MDs did tests, determined it was not physical, and she was sent to the rehab unit, where I worked. The physical therapists worked on “strengthening” and I talked to her about stress. Turns out her husband had recently had a catastrophic stroke and was hospitalized. Once I reassured her that no one would blame her for not being able to care for him at home, she started making progress and was walking within a week or so.

Psychosomatic is not the same thing as voluntary.

Can you elaborate on what a conversion disorder is, Brynda? I’m afraid I have no idea what it is. (In other words, please help fight my ignorance.)

Conversion disorder is diagnosed when someone develops symptoms (usually neurological, like paralysis, numbness, etc) that do not appear to have a physical cause. It is a diagnosis of exclusion, which means that it is only diagnosed when all reasonable medical causes have been ruled out. This is tricky, and some estimate that as many as half of all patients diagnosed with conversion are later found to have a medical cause that just wasn’t found at first.

Conversion is not faking; the patients have no idea they are converting emotional distress into physical symptoms. Conversion tends to be more likely to occur in people who are not expressing their distress, either because they don’t know how, or feel they shouldn’t, etc. In my example, for instance, the patient would have felt disloyal or unloving if she had said how worried she was. As she said, he was the one who needed worrying about. It is as if their bodies have found a way to express what they are not.

I fear the battle is over before it can begin for some people; they think “Psychological” means “All in your head” means “Walk it off, you damned slacker”. Anything with a physical cause more subtle than a broken limb will forever be a closed book to them.

Thank you, Brynda; I understand better now. Thanks again!

I’d just like to contribute the important fact that the Twitching Cheerleaders would be a great band name.

Yeah, but people shout “BULLSHIT” because they think it makes them seem smart.

You’re welcome, Spoons! Happy to edumicate.

This case is a cool example of both conversion and mass hysteria. And yeah, it is no accident that the victims are teen girls.

The NY Times article suggested that people calling them fakers likely raised their stress level and prolonged their suffering. What was gross was how all these parasites like Erin Brokovitch started sniffing around making everything worse.

A serious question - could the treatment for someone suffering from mass hysteria be a placebo?

If you mean “could you give them a placebo and would it work”? the answer is no, because it is unethical to give placebos for treatment. If you are asking if “real” treatment is needed, the answer is probably no, unless you think of reassurance as a treatment.

My example was about conversion, not mass hysteria, but the physical therapy the conversion patients got was just to reassure them.

There’s a classic story in one of Berton Roueche’s books on medical detection about an episode of mass hysteria, which started in a Miami elementary school with the fainting of an 11-year-old girl.* About seventy other students then began feeling faint, nauseous and collapsing. In short order, medical teams, fire rescue and environmental investigators began combing through the school for answers (an environmental toxin was suspected because of a funny odor in the halls**).

In the midst of all this chaos, the head of the medical team, convinced that this was an outbreak of mass hysteria, convened an impromptu news conference, convinced skeptical parents of the problem, and took decisive action to stand down the “emergency”. The rescue teams left, the kids started recovering and things were back to normal in relatively short order.

So what’s needed to “treat” these cases (after other reasonable causes have been excluded) could mostly be a firm hand and rejection of bullshit explanations by people with axes to grind (such as Erin Brockovitch). Endless investigations and finger-pointing don’t help the sick kids.

*the trigger case, a girl named Sandy, was a popular student who had a respiratory illness. The others who popped up with the same symptoms were experiencing mass hysteria.
**the “funny odor” in the school was from a harmless adhesive used to put down new carpets.

That was something touched upon in the article - how the student population at the high school was being split between healthy kids, kids who were perceived to be totally faking their illness and kids that felt the need to prove that they truly were sick… not a situation that will lead to a cure of this conversion disorder.

I’m convinced that this is a real illness - but a mental illness, not one caused by drugs, toxins or an outside source. I don’t think anyone is really faking (at least not the girls in the core group being treated), but perhaps accepting that they don’t have to prove that they are sick will be sufficient to start to heal.

For their sake, I hope so, and I hope outsiders are more respectful than to go around saying “Ha, bullshit!”

No it wasn’t. It had about two pages at most of useful information and was padded and bloated with all kinds of touchy-feely nonsense.

I was thinking on the first page that it was some form of group hysteria, so unless they would ultimately demonstrate it was something else, the last nine pages were mostly a waste.

And the writer didn’t draw any conclusions – there was an implication that it was all psychosomatic, but I think she wouldn’t say it outright out of fear of offending that community.

I’m thinking that that might be the case too. And to me, that’s far more fascinating than a toxin.

In the NY Times article, some of the kids start to get better while being treated with antibiotics by a doctor who is convinced that they have an infection. The article suggests that their improvement might be due to the placebo affect.

The idea of an actual mental condition being contagious or virulent is interesting as well.

It is, and it happens far more often, but in subtler ways, than you might think. A psychologist friend wanted to do a study about how an entire nation can dissociate.

There was a student I knew who had some compulsive behaviours around getting her work done. She was doing a very demanding course and was being compelled to put in 18 hours a day every day. One day she woke up with a paralysed right hand – so she couldn’t write any more. There’s a bit more to the story but it sounds like this would have been a conversion disorder then.