SECOND OPINION | Conversion Disorder | APT | Full Episode

SECOND OPINION | Conversion Disorder | APT | Full Episode


SECOND OPINION
EPISODE 906 CONVERSION DISORDER ANNOUNCER: MAJOR FUNDING
FOR “SECOND OPINION” IS PROVIDED BY THE BlueCross
AND BlueShield ASSOCIATION, AN ASSOCIATION OF INDEPENDENT, LOCALLY OPERATED,
AND COMMUNITY-BASED BLUE CROSS AND BLUE SHIELD COMPANIES.
FOR MORE THAN 80 YEARS, BLUE CROSS AND BLUE SHIELD COMPANIES
HAVE OFFERED HEALTH CARE COVERAGE IN EVERY ZIP CODE
ACROSS THE COUNTRY AND SUPPORTED PROGRAMS
THAT IMPROVE THE HEALTH AND WELLNESS
OF INDIVIDUAL MEMBERS AND THEIR COMMUNITIES.
THE BlueCross AND BlueShield ASSOCIATION’S MISSION IS
TO MAKE AFFORDABLE HEALTH CARE AVAILABLE TO ALL AMERICANS.
NEWS ABOUT OUR INNOVATIONS IS ONLINE AT BCBS.COM AND ON TWITTER
@BCBSAssociation. “SECOND OPINION” IS PRODUCED
IN ASSOCIATION WITH THE UNIVERSITY OF ROCHESTER MEDICAL CENTER,
ROCHESTER, NEW YORK. SALGO: WELCOME TO “SECOND OPINION,”
WHERE YOU GET TO SEE, FIRSTHAND, HOW SOME OF THE
COUNTRY’S LEADING HEALTH CARE PROFESSIONALS TACKLE HEALTH
ISSUES THAT ARE IMPORTANT TO YOU.
I’M YOUR HOST, DR. PETER SALGO, AND TODAY I’M HAPPY TO WELCOME
AUTHOR SIRI HUSTVEDT. OUR “SECOND OPINION”
PRIMARY CARE PHYSICIAN, DR. LISA HARRIS.
DR. JONATHAN MINK, FROM THE UNIVERSITY OF ROCHESTER
MEDICAL CENTER. DR. JOHN WALKUP, FROM NEW YORK
PRESBYTERIAN HOSPITAL/ WEILL CORNELL MEDICAL CENTER.
AND DANIELLE KERR, WHO’S HERE TO SHARE HER STORY WITH US —
A STORY, BY THE WAY, THAT OUR PANELISTS, ALONG WITH YOU AT
HOME, ARE GOING TO BE HEARING FOR THE FIRST TIME, SO LET’S GET
RIGHT TO WORK. THANK YOU FOR JOINING US,
DANIELLE. AFTER YOU GRADUATED FROM
HIGH SCHOOL, YOU MOVED FROM YOUR HOMETOWN
IN LONDON — CANADA. ONTARIO, RIGHT? KERR: YEP. SALGO: TO ENROLL AT NORTHEASTERN
UNIVERSITY, AND THAT’S IN BOSTON.
AND SET THE STAGE FOR US, IF YOU WOULD.
WHAT LED YOU TO ACHIEVE, IF YOU WILL, EVERY PARENT’S
DREAM, A FREE RIDE ON A GOOD SCHOLARSHIP AT A MAJOR
UNIVERSITY? KERR: A LOT OF HARD WORK.
I WAS ALWAYS IN THE RINK. I ALWAYS HAD A RINK IN MY
BACKYARD, AND I WAS ALWAYS JUST REALLY PUSHING, AND I WANTED TO
MAKE IT, AND I WAS LUCKY ENOUGH TO GET THE OPPORTUNITY
TO GO TO SCHOOL. SALGO: SO LET’S JUST BE CLEAR,
THIS IS HOCKEY, ICE HOCKEY. YOU WERE NUMBER 96,
IS THAT RIGHT? KERR: YEP. SALGO: AND IT’S NOT JUST ICE HOCKEY,
IT’S A DIVISION I PROGRAM. YOU WERE GOOD!
REALLY, REALLY GOOD. HARRIS: REALLY GOOD! SALGO: TELL ME ABOUT WHAT IT WAS LIKE
TO BE A REALLY GOOD ATHLETE GROWING UP. KERR: IT WAS GREAT.
IT GAVE YOU A LOT OF CONFIDENCE IN EVERYDAY THINGS.
A LOT OF CONFIDENCE. EVERYWHERE YOU WENT, YOU ALWAYS
FELT LIKE A HOCKEY PLAYER, AND IT MAKES YOU TOUGH. SALGO: HOW COMPETITIVE WERE YOU,
GROWING UP? I’M VERY COMPETITIVE STILL. SALGO: WAS ATHLETICS THE CENTER OF
YOUR LIFE, OR WAS IT ACADEMICS? IT WAS ALL SPORTS
ALL THE TIME. HARRIS: BUT THERE HAD TO BE SOME
ACADEMICS BECAUSE YOU GOT INTO NORTHEASTERN. SALGO: YOU’RE VERY BRIGHT,
AND YOU DID ALL YOUR WORK, AND YOU WERE ONE HECK OF A HOCKEY
PLAYER. TELL ME ABOUT HOW OFTEN YOU
WERE HURT, WHAT YOUR INJURIES WERE LIKE. KERR: WHEN I WAS YOUNGER, I HAD
A COUPLE CONCUSSIONS. SALGO: YOU DID? KERR: YEP. SALGO: IT’S A CONTACT SPORT. KERR: THERE’S NOT SUPPOSED TO BE
HITTING, BUT THERE DEFINITELY IS. SALGO: HOW WOULD YOU DESCRIBE YOUR
GENERAL STATE OF HEALTH WHEN YOU FINISHED YOUR FRESHMAN YEAR
AT NORTHEASTERN? KERR; I WAS HEALTHY.
I WAS IN MY PEAK. I WAS TOP SHAPE.
ESPECIALLY AFTER FRESHMAN YEAR, BECAUSE THEY WORKED US
PRETTY HARD, SO… I WAS FEELING GOOD. SALGO: NOW, IN THE SUMMER AND THEN
THE FALL OF 2010, YOU EXPERIENCED SOME MORE PHYSICAL
INJURIES. WHAT WAS THAT ABOUT? KERR: THERE WAS AN INCIDENT IN
THE FALL, AND I CAN’T REALLY TALK TOO MUCH ABOUT IT, BUT I
SUFFERED A CONCUSSION, AND IT WAS A FAIRLY BAD ONE.
AND AFTER THAT I WAS OUT FOR ABOUT 4 1/2 MONTHS.
I WAS NOT ALLOWED TO PLAY HOCKEY. SALGO: SERIOUS INJURY. KERR: YEAH. SALGO: AND WHEN YOU WENT BACK, DID
YOU PLAY AFTER THAT? KERR: SO, AFTER THE 4 1/2 MONTHS,
I GOT CLEARED FINALLY, AND THEN I GOT HIT FROM BEHIND INTO
THE BOARDS AGAIN. AND THAT WAS ABOUT THREE WEEKS
AFTER I’D BEEN CLEARED. SO AFTER THAT, THEY SAID,
“NO MORE HOCKEY THIS YEAR.” SALGO: THEN IN 2011, HEALTH-WISE,
THINGS CHANGED DRAMATICALLY FOR YOU.
TELL ME ABOUT THAT. KERR: IN JANUARY, THAT’S WHEN I WAS
HIT AGAIN, AND THEN IT WAS IN FEBRUARY I FAINTED AND I HIT
MY HEAD AGAIN. SO, AFTER THAT I WENT TO
THE HOSPITAL AND THEY RAN A WHOLE BUNCH OF TESTS,
LIKE HEAD CT, EVERYTHING, AND I WAS LOOKING PRETTY GOOD STILL,
SO THEY SENT ME HOME, BUT THEN THAT NIGHT MY LEGS BEGAN
TO START SHAKING, JUST WHEN I WAS LIKE WALKING
AND STUFF. AND LIKE I COULD LAY DOWN AND BE
FINE, BUT WHEN I STARTED WALKING, LIKE MY LEGS SHAKED,
AND IT GRADUALLY GOT WORSE. SO I WENT BACK TO THE HOSPITAL,
AND THEY RAN MORE TESTS, DID A LUMBAR PUNCTURE, EVERYTHING. SALGO: THAT’S A SPINAL TAP. KERR: YEAH.
AND EVERYTHING WAS STILL LOOKING FINE.
THEY SENT ME HOME AGAIN. AND THE SHAKING PROGRESSED, AND
IT WAS STARTING TO LOOK LIKE I WAS HAVING LIKE SEIZURES, LIKE
IT WAS GETTING MORE CONSTANT. I WAS STARTING TO STUTTER A BIT.
SO I WENT BACK TO THE HOSPITAL, LIKE, OKAY, SOMETHING’S
GOING ON. AND THEY ADMITTED ME THEN, AND
THEY RAN EVEN MORE TESTS. I STAYED A FEW NIGHTS, AND
THE SHAKING JUST KEPT CONTINUING. SALGO: YOU MUST HAVE BEEN
TERRIFIED. KERR: I THOUGHT I WAS DYING.
LIKE INSTANTLY I THOUGHT I WAS DYING.
I DIDN’T KNOW WHAT WAS GOING ON, AND I’D HIT MY HEAD SO MANY
TIMES THAT I WAS SO SCARED THAT SOMETHING, LIKE MY BRAIN
WAS BLEEDING. I DIDN’T KNOW WHAT WAS GOING ON. SALGO: AND WE HAVE SOME VIDEO OF YOU
FROM THAT TIME TO SHOW OUR AUDIENCE WHAT YOU’RE TALKING
ABOUT. WE CAN ROLL THAT IN AND WE’LL
TAKE A LOOK AT IT. THERE YOU ARE IN THE HOSPITAL.
THIS IS THE SAME GIRL… WHAT, A YEAR BEFORE,
YOU WERE PLAYING HOCKEY. FOLKS, YOU’RE LOOKING AT THIS.
DO YOU HAVE ANY COMMENTS ABOUT THIS VIDEO? MINK: WELL, SHE HAS SHAKING,
WHAT WE CALL “TREMOR,” THAT SEEMS TO, AT TIMES,
INVOLVE THE LEGS, AND AT OTHER TIMES SEEMS
TO INVOLVE — AT LEAST WE SAW THE RIGHT ARM THERE, BUT SEEMED
TO MOVE FROM PART TO PART, DEPENDING ON WHAT YOU
WERE DOING. WALKUP: “TREMOR” IS A BIG WORD, AND
THERE’S FINE TREMOR AND GROSS TREMOR.
AND SOMETIMES AS A PSYCHIATRIST WHEN I SEE THAT TREMOR, I THINK
OF TREMULOUSNESS, WHICH IS SLIGHTLY DIFFERENT THAN
TREMOR. MINK: AS A NEUROLOGIST, WE OFTEN
LOOK PRIMARILY WHEN THE TREMOR OCCURS.
WHEN YOU’RE AT REST — WHICH REALLY MEANS SUPPORTED AGAINST
GRAVITY. WHEN YOU’RE SUSTAINING
A POSTURE, WHEN YOU’RE DOING SOME KIND OF ACTIVE MOVEMENT.
AND THERE ARE SOME TREMORS THAT GET WORSE THE CLOSER YOU GET TO
A PARTICULAR TARGET. WE ALSO LOOK AT WHAT BODY PARTS
ARE AFFECTED. HOW FAST, HOW SLOW IT IS.
HOW BIG AN AMPLITUDE IT IS. AND, DID IT COME ON GRADUALLY
AND SPREAD FROM ONE BODY PART TO ANOTHER, OR DID IT COME ON
SUDDENLY AND SUDDENLY SHIFT FROM ONE BODY PART TO ANOTHER?
AND WE USE ALL OF THOSE THINGS TO HELP US FIGURE OUT WHAT TYPE
OF TREMOR IT IS, WHETHER IT’S COMING FROM A PARTICULAR PART OF
THE BRAIN OR, AS JOHN POINTED OUT, TREMULOUSNESS
OFTEN… I’D STILL CALL IT TREMOR, BUT
YOU DO GET THIS KIND OF SENSE THAT IT IS MODIFIED MORE BY
CURRENT EMOTIONAL OR PHYSICAL STATE. SALGO: WHAT TESTS WOULD
YOU GUYS ORDER? HARRIS: CERTAINLY, AN MRI, WITH AND
WITHOUT CONTRAST — JUST GIVEN THE HISTORY OF RECURRENT HEAD
INJURIES, YOU ABSOLUTELY NEED TO HAVE THAT DONE.
IN SOME INSTANCES, SOME PEOPLE MIGHT EVEN DO A PET SCAN TO TRY
TO LOOK AT SOME FUNCTIONALITY OF THE BRAIN, EVEN THOUGH THAT IS
NOT THE GOLD STANDARD FOR EVALUATION. SALGO: AND A PET SCAN IS
A SCAN THAT ACTUALLY SHOWS SOME OF THE METABOLIC ACTIVITY IN
THE BRAIN TO SEE HOW THE BRAIN IS WORKING. HARRIS: AND YOU WANT A SET OF
ELECTROLYTES, SO LOOKING AT SODIUM AND POTASSIUM AND
CHLORIDE AND BICARBONATE, TO MAKE SURE THAT THERE’S NOT
SOMETHING ELSE WITHIN THE SYSTEM THAT COULD BE CAUSING PROBLEMS. HUSTVEDT: IT’S TRUE, BUT I THINK IT’S
ALSO IMPORTANT TO POINT OUT THAT, EVEN IN SOME CASES OF
EPILEPSY, fMRI WILL SHOW ABSOLUTELY NOTHING. HARRIS: THAT’S CORRECT. SALGO: WHAT DID THE TESTS SHOW?
ALL THESE, THE MRIs, EVERYTHING? KERR: NOTHING. HARRIS: AND THAT HAD TO BE REALLY
FRUSTRATING FOR YOU. KERR: IT WAS FRUSTRATING AT
THE TIME, AND IT WAS SCARY, TOO. BECAUSE WHEN THERE’S NOTHING,
YOU HAVE NO ANSWERS, AND WHEN YOUR BODY’S SHAKING, YOU FEEL
COMPLETELY OUT OF CONTROL. WALKUP: AND THE FACT THAT THERE WAS
NO BRAIN DAMAGE, THAT YOU WERE INTACT AS A HUMAN BEING.
ALL OF THOSE KINDS OF THINGS ARE THE POSITIVE SIDE OF THE STORY,
BUT SOMETIMES, IN THE MIDDLE OF THAT EVALUATION, YOU ALMOST WANT
BAD NEWS SO THAT YOU KIND OF HAVE AN EXPLANATION. SALGO: “GIVE ME A REASON,” RIGHT? HUSTVEDT: WELL, I THINK THERE’S GREAT
COMFORT IN A NAME. IT’S AS IF YOU’VE IDENTIFIED,
LOCATED THE ILLNESS, AND IT MAKES PEOPLE FEEL BETTER. SALGO: THEY DID FINALLY GIVE
YOU A DIAGNOSIS. WHAT DID THEY TELL YOU? KERR: THEY SAID IT WAS CONVERSION
DISORDER. THEY SAID IT WAS…
IT WAS PSYCHOLOGICAL. IT WAS THINGS THAT I HAD
SUPPRESSED, AND THEY WERE COMING OUT IN PHYSICAL SYMPTOMS. SALGO: CAN YOU GIVE ME A MORE
PRECISE DEFINITION OF CONVERSION DISORDER? MINK: THE ONLY THING I’D REALLY ADD
TO THAT IS THEY’RE TYPICALLY NEUROLOGIC SYMPTOMS,
ABNORMALITIES OF MOVEMENT, EITHER TOO MUCH MOVEMENT OR TOO
LITTLE MOVEMENT, WEAKNESS, NEUROLOGIC DISABILITY, THAT WE
ATTRIBUTE, SOMETIMES WITH — THIS IS A PATTERN RECOGNITION
THING, BUT WE DON’T ALWAYS HAVE A SPECIFIC TRAUMATIC EVENT OR
A SPECIFIC EMOTIONAL TRIGGER, BUT WE DO ATTRIBUTE TO
PSYCHOLOGIC FACTORS RATHER THAN TO PHYSICAL CHANGES THAT WE CAN
SEE IN THE CHEMISTRY OF THE BRAIN. HARRIS: BUT I THINK IT’S IMPORTANT TO
VALIDATE THAT PSYCHOLOGICAL ISSUES OR CONCERNS, WHATEVER
THE CAUSE IS, IT’S JUST AS IMPORTANT
AND JUST AS VALID AND JUST AS REAL AS IF YOU DID HAVE BRAIN
DAMAGE AND HAD SEIZURES RESULTING FROM IT. HUSTVEDT: IT’S TRUE, BUT IT’S VERY
COMPLICATED MAKING DISTINCTIONS BETWEEN PSYCHOLOGICAL AND
PHYSIOLOGICAL DISORDERS. AND, IN FACT, THE DIFFERENCE
BETWEEN NEUROLOGY AND PSYCHIATRY HAS BECOME
INCREASINGLY BLURRED. SALGO: ALL RIGHT, SO WHO GETS
CONVERSION DISORDER? AND, WHILE WE’RE ON THE TOPIC,
I KNOW PEOPLE ARE THINKING, GEE, THIS SOUNDS LIKE THAT
POST-TRAUMATIC STRESS DISORDER. IS THERE A DIFFERENCE, AND
WHAT’S THE DIFFERENCE? WALKUP: THERE IS THE SUGGESTION THAT
SUGGESTIBILITY, SO THAT PEOPLE WHO ARE SMARTER AND POTENTIALLY
MORE VULNERABLE TO SUGGESTION GET IT.
BUT, YOU KNOW, MANY PEOPLE HAVE HAD MULTIPLE HEAD INJURIES AND
DON’T HAVE THE SYMPTOMS THAT YOU HAD, AND SO IF YOU LOOK AT
REALLY THE BASE RATE FOR MULTIPLE HEAD INJURIES
IN SPORTS — WE’RE SEEING IT NOW WITH FOOTBALL, HOCKEY, TOO. HARRIS: SOCCER. WALKUP: SOCCER.
MANY OF THOSE YOUNG PEOPLE WILL NOT HAVE THE SYMPTOMS YOU HAVE,
SO THERE IS SOMETHING ABOUT, AT LEAST IN MY EXPERIENCE,
ANYWAY, IT HAS TO DO WITH A SENSITIVITY, AND IT ALSO HAS
TO DO WITH INTELLIGENCE. MINK: THERE ARE SOME TRENDS.
YOUNGER PEOPLE ARE MORE LIKELY THAN OLDER PEOPLE.
GIRLS AND WOMEN A LITTLE MORE LIKELY THAN BOYS AND MEN.
BUT CLEARLY BOYS AND MEN DEVELOP CONVERSION SYMPTOMS AND OLDER
PEOPLE CAN AS WELL AS YOUNGER PEOPLE. WALKUP: THERE ARE PEOPLE WHO HAVE
CONVERSION, WHICH IS THIS IDEA THAT PEOPLE HAVE SYMPTOMS THAT
HAVE NO OBVIOUS MEDICAL CAUSE BUT ALSO HAVE NO PURPOSE,
REALLY. THEY DON’T SEEM TO HAVE
A FUNCTION. THERE ARE PEOPLE WHO HAVE
MEDICAL SYMPTOMS THAT FACILITATE THEIR INVOLVEMENT IN
THE PATIENT ROLE. AND THOSE ARE PEOPLE WHO HAVE
SYMPTOMS. THEY KIND OF KNOW THEY HAVE
SYMPTOMS. THEY KIND OF LIKE HAVING
SYMPTOMS BECAUSE IT PUTS THEM IN A DOCTOR-PATIENT RELATIONSHIP
AND THEY GET BENEFIT FROM HAVING SYMPTOMS.
THOSE ARE CALLED “FEIGNERS” IN THE LITERATURE, OR
“FACTITIOUS DISORDER” IS THE KIND OF FANCY NAME FOR IT.
AND THEN THERE’S A GROUP OF PEOPLE WHO ACTUALLY MALINGER,
AND THESE ARE PEOPLE WHO HAVE PHYSICAL SYMPTOMS FOR
THE PURPOSE OF FINANCIAL GAIN. SO, WE HAVE TO BE A LITTLE
CAREFUL ABOUT LUMPING ALL OF THESE THINGS TOGETHER INTO
A BAILIWICK. SALGO: I STILL HAVEN’T HEARD
A DISTINCTION BETWEEN PTSD AND CONVERSION.
HELP ME OUT. WALKUP: PTSD.
YOU HAVE TO HAVE A TRAUMA. IT’S GOT TO BE PRETTY GOOD SIZE.
LIFE-THREATENING IS USUALLY WHAT PEOPLE KIND OF LIKE AS A CLASSIC
KIND OF ONE. THEN YOU HAVE AUTONOMIC AROUSAL,
WHERE YOU’RE JITTERY, SHAKY, JUMPY.
YOU HAVE FLASHBACKS, WHERE YOU KIND OF RE-EXPERIENCE THE EVENT.
SO IT COMES IN FORMS OF NIGHTMARES, INTRUSIVE THOUGHTS.
YOU’RE WALKING DOWN THE STREET AND YOU SEE SOMETHING OR YOU
HEAR A LOUD NOISE AND IT REMINDS YOU AND YOU HAVE THOSE KINDS OF
EXPERIENCES. SO THAT REALLY HAS TO BE THERE. SALGO: THAT’S PTSD. WALKUP: THAT’S PTSD.
CONVERSION DOESN’T HAVE THAT RELATIONSHIP WITH THE TRAUMATIC
EVENT IN QUITE THAT TIGHTLY KNITTED A WAY. SALGO: DOCTORS HAVE A PHRASE,
“DIAGNOSIS OF EXCLUSION.” WHICH IS, “I’VE RULED EVERYTHING
OUT; THEREFORE, IT CAN’T BE A, B, C, OR D —
IT’S CONVERSION DISORDER.” DOES THAT DIAGNOSIS FIT? MINK: NO. SALGO: WHY NOT? MINK: IT IS, LIKE ANY DIAGNOSIS, WE
HAVE A DIFFERENTIAL DIAGNOSIS. WHAT KINDS OF THINGS CAN CAUSE
THESE SYMPTOMS, MANY OF WHICH WE RULE OUT
BASED ON THE STORY, AND THEREFORE EXCLUDE THEM.
BUT CONVERSION DISORDER, IN MOST CASES, IS A POSITIVE DIAGNOSIS,
MEANING WE BASE IT ON THE HISTORY AND ON PHYSICAL
FINDINGS. SALGO: IF CONVERSION DISORDER IS NOT
CAUSED BY A PHYSIOLOGICAL AILMENT — THERE’S NO BACTERIA,
THERE’S NO VIRUS, THERE’S NO BRAIN INJURY YOU CAN FIND
ON SCAN — DOES THAT MEAN THE SYMPTOMS AREN’T REAL? HARRIS: I THINK I ALREADY MENTIONED
THAT EARLIER, THAT, THIS IS JUST AS REAL AS IF SHE HAD
BRAIN TRAUMA. YOU DON’T FIND, NECESSARILY,
ANYTHING WITH DEPRESSION OR ANXIETY OR MANY OTHER, OR EVEN
CHRONIC PAIN SYNDROME, THAT THOSE ARE JUST AS REAL AND JUST
AS TREATABLE AND JUST AS VALID AS ANYTHING ELSE THAT WE TREAT
IN MEDICINE. SALGO: THERE’S ALWAYS REPORTS IN
THE PAPER OF NOT JUST ONE PERSON BUT WHOLE COMMUNITIES SUFFERING
SOMETHING. AND THERE WAS ONE IN, WHAT,
LE ROY, NEW YORK. WHAT HAPPENED THERE? MINK: I THINK WE’RE STILL TRYING TO
FIGURE OUT EXACTLY WHAT HAPPENED THERE.
BUT THERE WAS A GROUP OF 15 OR SO INDIVIDUALS WHO ALL WERE
HIGH SCHOOL STUDENTS WHO DEVELOPED UNUSUAL REPETITIVE
MOVEMENTS THAT WERE DESCRIBED IN THE PRESS AS BEING “TIC” LIKE.
LIKE THE KINDS OF SYMPTOMS WE SEE IN TOURETTE’S SYNDROME.
THEY WERE 14-, 15-, 16-YEAR-OLD GIRLS.
THEY ALL WENT TO THE SAME HIGH SCHOOL.
THEY ALL DEVELOPED SYMPTOMS AROUND THE SAME FRAME OF TIME,
WITHIN MONTHS, AT LEAST. BUT THEY HAD SOMETHING
DIFFERENT. MOST — WELL, PEOPLE WITH
CONVERSION DISORDER, IT’S USUALLY AN INDIVIDUAL PERSON
WITH AN INDIVIDUAL SET OF SYMPTOMS.
IN THIS SITUATION, IT WAS MORE THAN A DOZEN PEOPLE WHO ALL HAD
THE SAME SYMPTOMS. PROBABLY BEST REFERRED TO AS
A MASS PSYCHOGENIC ILLNESS. SALGO: DANIELLE, YOU KNEW ABOUT
THE LE ROY, NEW YORK, PROBLEM. WHAT WAS YOUR TAKE ON IT? KERR: I WAS JUST SHOCKED.
I WAS SURPRISED. I WAS JUST SURPRISED THAT A
WHOLE GROUP OF PEOPLE COULD COME DOWN WITH THE SAME DISORDER THAT
I WAS DEALING WITH. SALGO: HOW COMMON IS THIS? WALKUP: IF YOU THINK ABOUT, ON
AN EVERYDAY BASIS, IF I TOUCH MY HAIR AND I DO IT A COUPLE OF
TIMES, SOMEONE IN THIS GROUP IS GOING TO MIMIC THAT BEHAVIOR. MINK: OR YAWNING. WALKUP: OR YAWNING, FOR EXAMPLE.
WE MIMIC EACH OTHER ALL THE TIME.
IF YOU THINK ABOUT TAKING IT TO THE MOST EXTREME END WITHIN PEER
GROUPS WHERE THERE’S A LOT OF SUPPORT, WHERE THERE’S STRONG
EMOTION, AND I THINK, IN THE LE ROY,
HARD TO KNOW, BUT THERE CERTAINLY WAS A LOT OF ATTENTION
POURED ON THAT GROUP. AND I THINK THE COMMUNITY
DECIDED AT SOME POINT THAT IT WOULD BE VERY HELPFUL TO PULL
BACK FROM GIVING ALL THAT ATTENTION BECAUSE IT WASN’T
HELPFUL. THOSE ARE THE KINDS OF THINGS
THAT CAN TAKE A VERY HUMAN PHENOMENON OF IMITATION AND MAKE
IT SPREAD IN A VERY COMPLICATED WAY. HARRIS: AND I THINK IT’S IMPORTANT TO
POINT OUT THAT, WHEN WE’RE TALKING ABOUT IMITATION AND
MIMICKING, THAT IT’S NOT A CONSCIOUS EFFORT THAT OCCURS,
IT’S ENTIRELY SUBCONSCIOUS. SALGO: LET ME PAUSE JUST FOR
A MINUTE. I WANT TO SUM UP WHERE
WE’VE BEEN. WE’VE COME A LONG WAY.
AND THEN WE’RE GOING TO LAUNCH BACK INTO THIS DISCUSSION, WHICH
IS JUST FASCINATING, BY THE WAY. SOMETIMES NEUROLOGIC SYMPTOMS
LIKE BLINDNESS, PARALYSIS, INVOLUNTARY MOVEMENTS, ARE
CAUSED NOT DIRECTLY BY A PHYSIOLOGICAL PROBLEM
BUT BY A PSYCHOLOGICAL UPSET OF SOME KIND.
CONVERSION DISORDER IS A CONDITION WHERE MENTAL OR
EMOTIONAL CRISIS PRODUCES STRESS THAT CONVERTS TO
A PHYSICAL PROBLEM. PEOPLE DIAGNOSED WITH CONVERSION
DISORDER ARE NOT FAKING IT. THEIR DISTRESS IS VERY REAL.
IT CANNOT BE TURNED ON OR TURNED OFF AT WILL.
THEY’RE NOT MALINGERING. WALKUP: TO DIFFERENTIATE MENTAL
PROCESSES AS NONPHYSIOLOGIC IS A MISTAKE. SALGO: I THINK THAT’S ALSO
FAIR, BECAUSE… HUSTVEDT: WE ALL MUST AGREE ABOUT THAT.
EVEN THOUGH, FOR EXAMPLE, NO ONE KNOWS HOW NERVES ARE
CONNECTED TO THOUGHTS. THIS IS STILL UNSOLVED. MINK: BUT THAT’S WHAT THE BRAIN
DOES, AND OFTEN PEOPLE WILL SAY, “YOU’RE TELLING ME IT’S ALL IN
MY HEAD,” AND I SAY, “WELL, YOUR BRAIN IS IN YOUR HEAD AND THIS
IS ALL IN YOUR BRAIN.” SALGO: AFTER YOU RECEIVED
YOUR DIAGNOSIS, HOW DID YOU FEEL?
WERE YOU RELIEVED TO GET SOME SORT OF EXPLANATION, SOME
DIAGNOSIS FOR IT? KERR: WELL, AT THE BEGINNING,
I WAS STILL UNSURE ABOUT IT. ‘CAUSE I’D HIT MY HEAD
SO MANY TIMES. AND THEN THEY TOLD ME WHAT I
NEEDED TO DO TO GET BETTER, AND THEY SAID I NEEDED TO DO A LOT
OF THERAPY AND COUNSELING AND GO THROUGH TRAUMATIC EVENTS THAT
HAVE HAPPENED IN MY LIFE. AND SO, AT THAT POINT, IT WAS
LIKE, I WANT TO GET BETTER AND THIS IS WHAT THEY’RE TELLING ME
TO DO, SO I GAVE IT A SHOT. BUT THE WAY I NEEDED TO DEAL
WITH IT WAS I NEEDED TO LAUGH, AND SO, I’VE TOLD EVERYBODY.
WE WOULD JOKE AROUND. LIKE SOMETIMES I’D BE WALKING,
MY LEG WOULD GET STUCK, AND I’D TELL MY MOM TO KICK IT.
LIKE WE HAD TO JOKE ABOUT IT AND YET WE HAD TO TURN IT INTO
A POSITIVE THING. ESPECIALLY WHEN THEY’RE TELLING
YOU IT’S IN YOUR HEAD. WELL, HOW DO YOU CHANGE THAT?
YOU PUT A POSITIVE OUTLOOK ON IT. SALGO: WHAT DOES TREATMENT
LOOK LIKE? MINK: IT DEPENDS ON THE SYMPTOMS
AND THE INDIVIDUAL, IN MY OPINION.
I THINK, FIRST OF ALL, THE PRESENTATION IS CRITICALLY
IMPORTANT. WE TALK OFTEN ABOUT
THE PHYSICIAN-PATIENT PARTNERSHIP.
IT TAKES A PARTNERSHIP, AND IT TAKES A NUMBER OF THINGS.
SOME EMPHASIZE MORE OF THE EMOTIONAL PSYCHOTHERAPY
COMPONENT, SOME EMPHASIZE MORE OF
THE PHYSICAL THERAPY COMPONENT. BUT IT’S BASICALLY —
AND FOR SOME PEOPLE, LEARNING HOW TO WALK AGAIN, AND OFTEN IT
TAKES SOMEONE TO GIVE YOU GOOD, POSITIVE REINFORCEMENT FOR
TAKING THAT FIRST STEP, AND THEN FOR THAT SECOND STEP, AND TO
HAVE SOMEONE YOU CAN CHECK IN WITH ON A REGULAR BASIS, SO YOU
DON’T HAVE TO GET WORSE TO GO SEE YOUR DOCTOR.
YOU CHECK IN TO SAY HOW YOU’RE DOING AND PUT YOUR DOCTOR IN
A POWERFUL POSITION TO HELP CONTINUE THE MOTIVATION
TO GET BETTER. WALKUP: WHAT WE DO WITH YOUNG PEOPLE
WHO HAVE SYMPTOMS LIKE YOURS IS WE PROBABLY WOULD SPEND A LITTLE
LESS TIME TALKING WITH YOU ABOUT KIND OF DEEP
PSYCHOLOGICAL CONFLICT. WE’D PROBABLY SPEND MORE TIME
WITH YOU IN PHYSICAL THERAPY, TEACHING YOU HOW TO WALK AGAIN
AND HOW TO USE YOUR HANDS AGAIN. AND THAT APPROACH OFTENTIMES
LEADS PEOPLE TO BEGIN TO TALK, BECAUSE WHEN YOU’RE IN PHYSICAL
THERAPY, YOU’VE GOT TO TALK TO THE THERAPIST ABOUT SOMETHING.
AND WHEN YOU START MOVING YOUR LEGS AND YOUR HANDS, YOU BEGIN
TO TALK ABOUT KIND OF WHAT’S HAPPENING TO YOU, THE FUNCTION
YOU’VE LOST, HOW MUCH YOU’VE KIND OF BEEN FRIGHTENED AT
VARIOUS PERIODS OF TIME, AND SHARE LIFE STORIES AND THINGS
LIKE THAT, AND IT HAPPENS IN KIND OF A NATURAL, ORGANIC WAY
AS YOU BEGIN TO GET STRONGER IN REGAINING CONTROL OF YOUR BODY. HUSTVEDT: I DON’T THINK, AS WITH
EVERYTHING ELSE, THAT THERE IS A SINGLE METHOD
THAT SHOULD BE GLOBALLY RECOMMENDED.
CERTAINLY, PSYCHOTHERAPY HAS HELPED A NUMBER OF PEOPLE WITH
THIS AILMENT. WALKUP: THE ONLY PROBLEM I HAVE WITH
SOME OF THE TALK THERAPIES IS THAT THEIR TIME COURSE IS LONG.
AND I THINK WE KNOW THAT, FOR THIS CONDITION, ANYWAY,
THE FASTER YOU GET TO IT AND THE FASTER YOU GET IT UNDER
CONTROL AND MANAGED AND EMPOWER THE PERSON TO GET
BACK FULLY FUNCTIONAL TO LIFE AGAIN, THE BETTER.
THAT PEOPLE, IN ADDITION TO HAVING THE PROBLEM WHICH CREATES
A DISABILITY, THE DISABILITY ITSELF AS IT EXISTS OVER
A PERIOD OF TIME ACCUMULATES AND IMPACTS A VARIETY OF
OTHER FACTORS. MINK: AND OFTEN, I THINK, THE WORST
THING WE CAN DO FOR PATIENTS WHEN WE MAKE THE DIAGNOSIS IS TO
SAY, “YOU’RE A MYSTERY. I DON’T KNOW WHAT’S GOING ON.
YOU HAVE TO GO SEE YET ANOTHER SPECIALIST.”
BECAUSE THAT PROLONGS THE RECOVERY. SALGO: I HEARD A “RIGHT”
TO MY LEFT. HARRIS: MY DREAM TEAM IS TO WORK WITH
THE PERSON THAT YOU TRUST THE MOST, WHICH, OF COURSE,
WOULD BE YOUR PRIMARY CARE PHYSICIAN. MINK: WELL, YOU’RE ABSOLUTELY
RIGHT, AND THERE ARE ACTUALLY DATA ON THAT, THAT THE BEST
LONG-TERM FOLLOW-UP AND SHORT-TERM FOLLOW-UP IS WITH
A PRIMARY CARE PHYSICIAN. HARRIS: BUT YOU CERTAINLY WOULD WANT
TO HAVE PSYCHIATRY INVOLVED TO MAKE SURE THAT YOU’RE STILL
ON THE RIGHT TRACK, WHETHER OR NOT YOU NEED TO INSTITUTE
PSYCHOTHERAPY IF OTHER SYMPTOMS START TO MANIFEST.
OCCUPATIONAL THERAPY, PHYSICAL THERAPY.
ALL OF THOSE MODALITIES NEED TO BE ENGAGED. SALGO: DANIELLE, YOU ARE OUR
RESIDENT EXPERT. KERR: OH, YEAH.
SALGO: YOU’VE BEEN THROUGH THE
THERAPY — WHAT THERAPY DID YOU GET? KERR: I DID EMDR THERAPY. SALGO: WHAT IS THAT? KERR: IT BRINGS YOU THROUGH YOUR
PAST EXPERIENCES, BASICALLY, AND IT’S SUPPOSED TO BRING BACK
MEMORIES THAT YOU’VE SUPPRESSED, PUT BEHIND YOU, THAT YOU’VE
FORGOTTEN ABOUT. SALGO: IT STANDS FOR
“EYE MOVEMENT DESENSITIZATION AND REPROCESSING.”
WHAT IS THE ACTUAL MECHANICS OF THIS THING?
WHAT DID YOU DO? KERR: SO, I HAD TWO LITTLE THINGS
THAT I WOULD HOLD IN MY HANDS, AND THEY WOULD VIBRATE BACK AND
FORTH, AND THEN THERE WAS A LIGHT IN FRONT OF ME AND IT
WOULD GO BACK AND FORTH. AND THEN I HAD A HEADSET ON AND
IT WOULD BEEP BACK AND FORTH. AND EVERYTHING WOULD BE
IN SYNCH. AND THEN MY THERAPIST WOULD
BASICALLY TELL ME TO THINK ABOUT THIS THING, WHATEVER IT WAS,
FOR 30 SECONDS. AND SHE’D GO, “WHAT DID THAT
BRING UP?” AND I’D BE LIKE, “WELL, IT BROUGHT UP THIS.
I DON’T KNOW WHY I STARTED THINKING ABOUT THIS.”
SHE’D GO, “THINK ABOUT THAT FOR 30 SECONDS,” AND THAT’S WHAT WE
DID, AND IT BROUGHT BACK A LOT OF STUFF.
IT BROUGHT UP A LOT OF INTERESTING THINGS. MINK: AND HOW DID THE TREMORS START
TO GO AWAY — WAS IT ALL OF THE SUDDEN OR WAS IT A VERY
GRADUAL THING? KERR: NO, IT WAS GRADUAL.
AND I STILL GET TREMORS ONCE IN A WHILE.
LIKE IF I GET STRESSED OUT, I KNOW A TREMOR’S COMING.
LIKE I CAN SEE THE CONNECTION NOW. HUSTVEDT: DANIELLE SEEMS TO BE
A CLASSICAL EXAMPLE OF SOMEONE WHO ADDRESSED ACTUAL MATERIAL,
MATERIAL IN YOUR PAST. AND BY ADDRESSING THAT, YOU WERE
ABLE TO MOVE FORWARD AND AWAY FROM THE SYMPTOM. WALKUP: WHEN I HEARD ABOUT YOUR
MOTHER KICKING YOU IN THE LEG, THAT WAS WHAT I THOUGHT MIGHT
HAVE BEEN ACTUALLY MORE EFFECTIVE FOR YOU,
GOING FORWARD. BECAUSE YOU WERE GETTING STUCK,
AND YOU DEPENDED ON PEOPLE AROUND YOU TO HELP YOU MOVE ON
AND GET YOUR FUNCTION GOING AGAIN.
AND YOU ARE THE KIND OF PERSON WHO CAN BE MOTIVATED BY
APPLAUSE, OUTSTANDING SUCCESS, PHYSICAL CAPACITY. MINK: WHAT WE NEED IS, WE NEED
A BAG OF TRICKS. AND SOMETIMES ONE TRICK DOESN’T
WORK FOR A PARTICULAR PATIENT AND WE HAVE TO BE ABLE TO SAY,
NOT, “THAT DIDN’T WORK, GO SEE SOMEONE ELSE,” BUT, “THAT DIDN’T
WORK, LET’S TRY THIS.” SALGO: PROGNOSIS OVERALL,
ALL COMERS? MINK: I THINK IT DEPENDS ON AGE AND
DURATION OF SYMPTOMS. IN MY EXPERIENCE, THE 7-, 10-,
12-YEAR-OLDS HAVE A MUCH BETTER ABILITY TO COMPLETELY GET
THE SYMPTOMS TO GO AWAY AND NOT COME BACK.
IF THEY’VE BEEN PRESENT FOR A YEAR, IT’S A MUCH TOUGHER NUT
TO CRACK. SALGO: WHAT ABOUT PREVENTION?
CAN WE PREVENT THIS IN THE FIRST PLACE? WALKUP: I THINK THERE ARE SOME
PATIENTS WHO HAVE A SIMPLER FORM OF THIS THAT CAN BE ADDRESSED
VERY QUICKLY. BUT ONE OF THE THINGS THAT WE
SEE SOMETIMES IS THAT PEOPLE DO THE MILLION-DOLLAR WORKUP.
AND THEY DON’T GO QUICKLY TO THE IDEA OF WHAT
THE DIAGNOSIS IS. AND IT’S BECAUSE PEOPLE ARE
UNCERTAIN AND THEY DON’T KNOW WHAT TO DO, AND THERE’S ACTUALLY
A RISK TO AN EXTENDED EVALUATION,
THAT ACTUALLY PROLONGS THE “LOOK FOR,” IF YOU WILL, AND
GETS IN THE WAY AND FACILITATES INCAPACITY. SALGO: LET’S PAUSE ONCE AGAIN.
LET’S SUM UP WHERE WE’VE BEEN IN THE SECOND PART OF THIS
BROADCAST. THERE IS HELP FOR
CONVERSION DISORDER. AN EFFECTIVE TREATMENT PLAN CAN
INCLUDE TALK THERAPY, MEDICATION, RELAXATION
TECHNIQUES, SOMETIMES THE SIMPLE PASSAGE OF TIME.
WHATEVER APPROACH WORKS FOR YOU. MANY PEOPLE WITH CONVERSION
DISORDER BENEFIT FROM A TEAM APPROACH TO THEIR RECOVERY.
IT’S INDIVIDUAL. AND I WANT TO ASK YOU NOW,
DANIELLE — YOU LOOK GREAT. HOW HAS THIS CHANGED YOUR LIFE?
AND HOW ARE YOU DOING NOW? KERR: COMPARED TO WHAT I WAS,
IT’S NIGHT AND DAY. I’M DOING GREAT.
HOWEVER, I STILL, LIKE AT LEAST A COUPLE TIMES A WEEK, SOMETHING
WILL GET IN MY MIND AND I WILL TREMOR.
LIKE, IT STILL COMES. MINK: AND WHEN THAT HAPPENS,
WHAT DO YOU DO? KERR: I LAY DOWN. MINK: AND WAIT FOR IT TO PASS? KERR: I WAIT FOR IT TO PASS AND I
TALK ABOUT IT. I IMMEDIATELY TALK ABOUT
WHATEVER IT WAS THAT BOTHERED ME, WITH WHOEVER IT WAS,
ANYTHING, LIKE I GOTTA TALK ABOUT IT. MINK: AND IT SOUNDS LIKE, AT THIS
POINT, THOUGH, YOU’VE LEARNED THAT IT WILL PASS. KERR:
MM-HMM. SALGO: DO YOU STILL PLAY
HOCKEY? KERR: NO. SALGO: WHY NOT? KERR: WITH ALL THE CONCUSSIONS AND
EVERYTHING, IT’S TOO MUCH RISK. SALGO: NOW, I DON’T WANT TO LEAVE
WITHOUT GIVING A LITTLE COMPLIMENT TO YOUR UNIVERSITY,
NORTHEASTERN. YOU WERE THERE ON A FULL RIDE
HOCKEY SCHOLARSHIP. CAN’T PLAY HOCKEY ANYMORE.
WHAT DID NORTHEASTERN DO? KERR: THEY HONORED IT. PANEL: WOW! KERR: THEY BROUGHT ME BACK TO SCHOOL.
WHATEVER I NEEDED, THEY LET ME TAKE MEDICAL LEAVE. SALGO: THAT’S WONDERFUL.
NORTHEASTERN, IF YOU’RE WATCHING, THUMBS UP.
YOU TOLD ME THAT, TO A VERY REAL DEGREE, HOCKEY WAS YOUR LIFE.
TO SOME DEGREE, I SUSPECT YOU DEFINED YOURSELF AS A HOCKEY
PLAYER. YOU’RE NOT A HOCKEY PLAYER NOW.
SO, WHAT DO YOU DO? KERR: I STARTED COACHING
LAST YEAR, YEAH. SO, I COACHED MY HIGH SCHOOL
HOCKEY TEAM. SALGO: I’VE GOT TO TELL YOU, IT IS
A THRILL TO HAVE MET YOU. I THINK I CAN SPEAK FOR ALL
OF US. WE’RE SO PLEASED YOU’RE DOING
GREAT, AND WE WISH YOU THE BEST OF SUCCESS GOING FORWARD.
I HOPE, HOWEVER, OUR AUDIENCE WILL CONTINUE THE CONVERSATION
ON OUR WEB SITE. THERE YOU’LL FIND THE ENTIRE
VIDEO OF THIS SHOW, AS WELL AS THE TRANSCRIPT AND LINKS
TO RESOURCES. THE ADDRESS IS
SecondOpinion-tv.org. SO, THANKS FOR WATCHING.
THANK ALL OF YOU FOR BEING HERE. ESPECIALLY YOU, DANIELLE.
I’M DR. PETER SALGO, AND I’LL SEE YOU NEXT TIME
FOR ANOTHER “SECOND OPINION.” ANNOUNCER: MAJOR FUNDING
FOR “SECOND OPINION” IS PROVIDED BY THE BlueCross
AND BlueShield ASSOCIATION, AN ASSOCIATION OF INDEPENDENT, LOCALLY OPERATED,
AND COMMUNITY-BASED BLUE CROSS AND BLUE SHIELD COMPANIES.
FOR MORE THAN 80 YEARS, BLUE CROSS AND BLUE SHIELD COMPANIES
HAVE OFFERED HEALTH CARE COVERAGE IN EVERY ZIP CODE
ACROSS THE COUNTRY AND SUPPORTED PROGRAMS
THAT IMPROVE THE HEALTH AND WELLNESS
OF INDIVIDUAL MEMBERSAND THEIR COMMUNITIES. THE BlueCross AND BlueShield ASSOCIATION’S
MISSION IS TO MAKE AFFORDABLE HEALTH CARE AVAILABLE TO
ALL AMERICANS. NEWS ABOUT OUR INNOVATIONS IS ONLINE AT BCBS.COM
AND ON TWITTER @BCBSAssociation.
“SECOND OPINION” IS PRODUCED IN ASSOCIATION WITH
THE UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NEW YORK.

5 comments / Add your comment below

  1. A Tilt test should be always done for any sort of seizure because these people could have a rare syndrome called POTS Syndrome. ED Syndrome could also cause this. Rule out Lyme by a blood test.

  2. I'm disturbed that there is no mention of looking for elusive causes like autoimmune encephalitis. Sadly, many people who are eventually found to have autoimmune encephalitis were originally diagnosed with conversion disorder.

  3. I feel sorry for the girl that being talked about like she is not there. Now why would someone in her shape and good at her sport suddenly start making up stuff to want to have a doctor patient relationship. I have this and have actually been told by a doctor I could not have all the things I told him and needed a psychiatrist. I started taking pictures because so many of the things come and go. I have different things on different days. Some days I can't stay awake and sometimes I can't sleep. I wish one of those arrogant doctors would get this so they would understand. I have a master's degree in education and have run 3 businesses. The symptoms have come and gone since my 20's but came and stayed after 50 and now I am 56 and having to use food stamps and apply for disability. Thankfully I have a great friend that started going with me to appointments and when they rolled their eyes, she could say that she had seen it. But why would I choose food stamps and disability and live on $600 a month and food stamps. The tremors and stuff come and go. The seizures come and go. All of it comes and even thought they call them psuedoseizures, they happen but the same neurologist who gave me medicine for seizures later told me he thought he didn't even know if I have seizures so I stopped the medicine. I know when one comes on but since I am not driving I don't worry about it. But for anyone that has this, be ready for doctors to treat you like you are crazy or making it up. Another thought is why would anyone want to have a doctor patient relationship and spend their money on doctors. I have spent all my savings trying to find an answer and if I knew then what I know now I would have taken all that savings and moved to an island.

  4. I've had conversion disorder for a few years now, and I'm pretty sure I disagreed with almost everything these people were saying aside from the girl with the CD. I was hoping I could show this video to my friends and family so they could get a peek into my world and how CD works, but I absolutely do not want to share this video with anyone (aside from my husband so he can disagree too!)

Leave a Reply

Your email address will not be published. Required fields are marked *