Psychosomatic Medicine 13:254-259 (1951)
© 1951 American Psychosomatic Society

Symbolism and Organ Choice in Conversion Reactions

An Experimental Approach

¹ Department of Dermatology and Syphilology and the Department of Psychiatry--Functional Disease Clinic--of the Hospital of the University of Pennysylvania, and the Skin and Cancer Hospital of Philadelphia; Division of Psychiatric Research, Department of Neuropsychiatry, Indiana University School of Medicine, Indianapolis, Indiana. Acknowledgment is made for the generous support of the Indiana Council for Mental Health.

An experimental method has been described which offers further opportunities for investigating the problems of symbolism and organ choice in conversion reactions, and possibly also the psychodynamics of organ choice in somatization reactions. This experimental approach represents merely a method for objectifying and broadening our understanding of these phenomena. The method consists of psychiatric study of patients with conversion reactions in order to ascertain the nature of emotional conflicts as well as the symbolic meaning and purpose of symptoms. An attempt is then made hypnotically to substitute other symptoms for the original conversion reaction. It is found that certain psychodynamically and symbolically equivalent symptoms may replace the original conversion reaction, whereas other nonequivalent symptoms may not be substituted in this way. A modification of this method has been included, in which spontaneous substitute reactions are observed to appear in place of hypnotically suggested symptoms. The principal disadvantages of this experimental approach appear to be the extended length of time required for study of each individual case, and the inescapable fact that the psychophysiology of hypnosis itself remains obscure.

Nine pilot experiments have been reported to illustrate the application of this method. It was possible to replace psychogenic chorea with blushing and with circumscribed areas of excoriated pruritus. Pruritus alone, hyperhidrosis of the palms, and anesthesia of the scalp could not replace the chorea, although these symptoms would occur when given as posthypnotic suggestions. Further hypnotic experiments resulted in spontaneous symptom substitutions: nausea and vomiting occurred when warts were suggested hypnotically. Anesthesia of the scalp developed in place of suggested alopecia areata. When urticaria was suggested as a substitute for weeping, coryza and eczematous dermatitis appeared instead. Suggested vesiculation on the hand resulted in "accidental" injury in precisely the designated area.

The results of these exploratory experiments tend to confirm Alexander's hypothesis concerning symbolism and organ choice in conversion reactions. This experimental approach may also provide a method for studying these problems in somatization reactions.

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