Brady and Lind

Hystrical Blindness


Freud, who coined the term conversion disorder (Breuer & Freud, 1895), believed that the repressed energy of trauma or conflict somehow "converted" into physical ailment by damaging the individual's voluntary motor (e.g., paralysis and seizures) or sensory system (e.g., blindness). However, the underlying causes of this disorder remain a mystery that has only become more complicated as studies that refute the existence of the Freudian repression (e.g., Piper, Lillevik, & Kritzer, 2008, Rofé, 2008). Moreover, recent neurological findings seemingly indicate that this behavior is controlled by biological mechanisms (Van Beilen, Vogt, & Leenders, 2010). Accordingly, researchers suggested changing the name of conversion disorder to "Functional Neurological Disorder" (e.g., Stone, Lafrance, Brown, Spiegel, et al., 2011), which DSM-5 accepted to some extent (American Psychiatric Association, 2013). However, these findings complicate the understanding of this disorder (see Kanaan, Carson, et al, 2010; Row, 2010; Stone, Vuilleumier, & Friedman, 2010).  In a review article, it was demonstrated that PBT is the only theory that adequately integrates research and clinical evidence pertaining to the development and treatment of conversion disorder into one theoretical system (Rofé & Rofé (2013). As in psychoanalysis, PBT preserves the concept of "conversion," since preoccupation with the stressor is replaced with symptom-related thoughts. In Freudian terms, the repression of psychological energy (i.e., contemplation of stress-related thoughts) is converted into preoccupation with a fictitious physical ailment.

      A clinical example of conversion disorder is the case of a 40 year-old man who developed hysterical blindness in response to an unbearable level of stress (Brady & Lind, 1961). The patient, described as immature and irresponsible, left school early (eighth grade) and had trouble keeping even simple jobs. He depended greatly on his wife, whom he described as "often nervous and upset," and was under almost constant harassment by her and his mother-in-law. Shortly after his marriage, at the age of 23, the patient was drafted into the army and served three years. While in the army, the patient developed an eye infection that resulted in partial loss of vision in one eye. Consequently, he received a medical discharge and a small pension. Over the next twelve years, the patient held several simple jobs, none of which lasted more than a year, and he largely depended on aid from relatives and public assistance. During this period, he suffered a recurrence of his eye infection. He requested an increase in his pension, but was refused because his visual acuity had not decreased.

     On one occasion, while grocery shopping with his wife and mother-in-law, suddenly, without any immediate precipitating event, the patient became completely blind in both eyes. This blindness occurred at a time when his wife and mother-in-law were unusually demanding, requiring him to perform various chores under their supervision. It seems that the stress became intolerable as his wife and mother-in-law became more demanding and critical, and the preoccupation with his blindness enabled him to cope with his unbearably stressful life. The patient’s attention was further occupied with extensive medical examinations (which failed to find a physiological cause for his blindness), prolonged, unsuccessful psychiatric treatment, and behaving like a blind person (e.g., attempting to learn Braille). Thus, like the former case, this case demonstrates the advantage of PBT's concept of repression compared with psychoanalysis, which also enabled the preservation of the name of conversion coined by Freud for this disorder. The hysteric blindness also met the patient's controllability demands as it successfully stopped the constant demands and criticisms of his wife and mother-in-law. The patient chose this specific behavior because of its availability where he exaggerated his eye infection to blindness.

      This case also reinforces the usefulness of PBT's diagnostic criteria of madness. The symptoms heavily preoccupied the patient's attention and severely disrupted his daily functioning, which meets the first criteria. The sudden onset of his symptom occurred in the absence of any event that is exclusively linked with and can account for this behavioral change (criterion 2); The patient was unaware of the cause of his symptom and he was completely unaware of the underlying causes for the dramatic change in his behavior (criterion 3); his disorder is extremely rare (criterion 4); and his blindness was stigmatized by his behavior as reflection of mental illness (criterion 5).