Conversion has been explained with many definitions and concepts from the past to the present. The oldest definition made It goes back to 1900. While the symptoms of conversion were mentioned as the wandering of the uterus in the human body in the sources of the Egyptian Civilization, it was only in the seventeenth century that it was revealed that the uterus is not a disorder caused by different movements in the human body. In the years Hippocrates lived, the Greeks used this word in their writings by deriving the word hysteria from the root of the word hysteria, which is the equivalent of the word womb. In the medieval period, it was thought that hysteria would be more related to demonic features and evil spirits. These patients were believed to be people who practiced magic, they were perceived differently by the society and were excluded. Again, the “Saint-Guy Dance” in the form of community hysteria seen in the same period was understood as the patients’ selling their souls to the devil, causing the patients to be burned in the fire (Alpat, 2017).
In the nineteenth century, some scientists determined that this disorder emerged as a Central Nervous System Disorder due to some psychological reasons. Again, Freud, the founder of Psychoanalysis, used the word “Conversion” for the first time in the text to emphasize the bodily effects of suppressed thoughts in a sexual and aggressive nature. According to Freud, it reduces anxiety by transforming this conflict into a physical form in order to avoid the feeling of anxiety created by the conflicts between the unconscious and motivation.
Babinski, on the other hand, put forward the thesis that physical and mental symptoms occur when hysteria such as paralysis, contractures, anesthesia is revealed through speech and disappears again through speech. Conversion Disorders, which are included in the current modern psychiatry diagnosis system, are expressed as a specific disorder with one or more neurological symptoms that cause loss of physical functionality along with psychological friction and inhibitions.
Experts in the field of psychiatry discuss how to classify Conversion Disorder, and due to the uncertainties in the diagnostic criteria of this disorder, similar items between Dissociative Disorder and Somatoform Disorder share a more similar causality process depending on the overlaps. According to DSM IV, Conversion Disorder is a functional disorder that is not accompanied by a neurological disorder, cannot be manifested by other medical conditions or substance abuse, is associated with psychological effects, does not occur on purpose, is not fixed by pain or sexual dysfunction, and is clearly distressed or distressed. It was also emphasized that it causes weakening of functionality in social, occupational and different areas (Uğuz, 1998).
At the origin of Conversion Disorder, there is no anatomical and physiological disorder of the Central or Peripheral Nervous System, and it is a picture resembling neurological disorders. It manifests itself when a spiritual struggle or need that is not directly verbalized disrupts the physical functionality of the individual. There are those who see Conversion Disorder as a reaction that every individual encounters in a part of his life or as a symptom that can be seen in almost every psychiatric disorder, as well as those who see it as a reaction against socioeconomic reasons and close association with education (Uğuz, 1998).
Primary and Secondary Gains of Conversion
Psychodynamic Approach Conversion symptoms are processes that help resolve unconscious pressures and conflicts. While the impulses suppressed by the superego cause the individual to be exposed to conflict, another sign of Conversion is explained by making it a symbol of this conflict. Through the manifestations of the conversion, the individual can associate himself with the generation that has disappeared. As a result of conversion symptoms, the feeling of relaxation experienced by the individual with very little expression of the suppressed impulse is stated as the primary gain. As a result of the conversion symptoms, the person is perceived as sick and weak by the society and the environment, and the patient’s environment strives to show interest and concern. The interest that the individual receives from his environment and this pleasure from the outside world is called secondary gain. Occurrence of symptoms occurs due to primary gain, and the continuation of the disease occurs due to secondary gain (Doğan, 2007).
In fact, the primary gain is the individual’s relief from the anxiety caused by the psychological disorder. In other words, basically, another situation arises because the person’s brain cannot face the pain caused by the psychological problem he is experiencing. This is also about suppression. If this mechanism did not work, every individual would have to experience the effects of traumatic events as they are at every moment. While the main motive in factitious disorder is to adopt the patient role and to provide medical evaluation and treatment, there are more specific purposes in simulation such as getting monetary compensation, avoiding duty, avoiding legal proceedings or providing medication. These purposes may be similar to the secondary gain in Conversion Disorder (Öztürk,2016).
It is said that the most important of the operational therapy methods in Conversion Disorder is effective in increasing the repetition of healthy behavior by reducing the secondary gains negatively affecting the individual and increasing the complaint. In addition, it has been observed that there is a sensitivity to verbal persuasion in patients with Conversion Disorder and that this situation can be used in therapy (Moene et al. 2003). A large proportion of individuals identified with Conversion Disorder want to maintain their status soon and maintain their vague affect on ending. Here, this complaint is expected to be resolved by preventing secondary gains with operational therapies and reinforcing it in order to repeat the correct action. A conscious effort should be made to end this complaint.
Physical teacher Hasan Bey is always in conflict with his mother-in-law and he thinks that his feet are on fire because he cannot convey his thoughts to the other party. In the face of this situation, Hasan Bey is seen as sick, so his mother-in-law does not argue or clash with him.
Id: “Hasan, you can say anything that comes to your mind.”
Ego: “You can tell your mother-in-law within reason.”
Superego: “You have to pick up on your mother-in-law no matter what your elder says.”
Because of this situation, the point of susceptibility to verbal suggestion is emphasized, and it is suggested that the individual can be successful in standing and walking behavior that he/she wants to transform into behavior by making an effort to treat him with behavioral therapy, and that he/she can have a say in the complaints. It has been observed that verbal communication patterns and cry for help can be seen in people who have difficulty in expressing or making sense of their physical symptoms, and the course of the disease can be effective thanks to their secondary gains (Pehlivantürk 1996).