Dr Judith Guedalia

Confusing and Converting Symptoms

I had already received four different phone messages referring this child for assessment.  The parents, the Talmud Torah Rebbe, and the Rav they consulted.  The forth call was from an Askan (literally ‘an operator') but in the Ultra Orthodox world, the interlocutor between the ‘professional world' and the lay members of the community.  Would I please see this child who has difficulty reading, possibly ‘suffering' from an odd form of Dyslexia.  Okay, I thought, that isn't so unusual here, the Neuropsychology Unit I head at Shaare Zedek Medical Center in Jerusalem.  To paraphrase the words of the Hagada, ‘why is this dyslexic different than all other dyslexics', which translates, what's the rush and why can't he wait for his turn on the patient ‘list'?  Experience has taught me that, this many and varied a group exercising ‘Protexia' (use of ‘pull'/special treatment), connotes a case where there is more than meets the eye.


They, both parents and their 10 year old child, arrived on time.   I set out three chairs and wait to see who sits where.  This is the beginning of the diagnostic process, well really the initial phone call is the beginning, coming on time was the second and now taking seats would be the third.  Intake and testing come last.  The father sits down first, nearest to my side of the desk, the son sits next to him and the mother, looking a bit lost, chooses the final seat and sits with her left arm to the wall.  Hum, I think, this is already unusual.   No one has spoken and she seems a little out of the ‘loop'.  I ask some basic ‘getting-to-know-you' questions, and ask the mother to fill out a form.  The father takes the form, says her hand hurts her, and begins to fill out the form (about pregnancy and delivery of this child), not very respectful to his wife, I think.

I turn to Moshe (not his real name) and ask him why his parents brought him.  He looks at me, then at his father and then at me again.  "Well if you don't know and I don't know why you are here, we are really in trouble", I say.  "He has trouble reading" his father says.  "But not always", pipes up Moshe.

"Could you explain this?"; "Well some days I can read and some days I can't."   

I felt he was being earnest and sincere, even though the premise was preposterous.  One cannot be a ‘some time' dyslexic.  You are either dyslexic (Latin word for disorder in reading) or not. 

After doing a full ‘intake' it turned out that the ‘days' that Moshe ‘was dyslexic', were days that his father slept away from home.  He had taken to doing this while he was considering divorcing his wife.  Moshe's ‘odd' condition, which was not in his conscious control, served as a means of ‘bringing his father home' to help solve the problem. 

I referred the parents to couples' counseling to see if the marriage could be saved.  A short time later I was informed that Moshe's ‘dyslexia' disappeared.

Case 2:
About two months after the uprooting/disengagement from Gaza I received a phone call from an anxious mother.  My son, Yossi's (not his real name) behavior is frightening us.  "Since he returned home from three weeks of actively protesting in Gush Katif (Gaza Jewish settlements) his physical and mental condition is deteriorating.  He has stopped speaking and using his right hand."

This was right before the holidays when Israel ‘closes down' for a month- from Rosh Hashana until after Sukkot.     There is no such thing as a neuropsychological emergency, and I needed to be assured that the ‘medical' realm, where emergency conditions can exist, be looked into, before I would see him.  I insisted that they consult a neurologist and also a psychiatrist.  A neurologist would be assess his neurological functioning to ‘rule out' a physiological condition that may be putting pressure on the neurological systems that may cause the ‘paralysis' his mother was describing.  The psychiatrist would ‘rule out' psychosis, a break with reality.  If both these physicians would rule out pathology, I would see them, the parents and Yossi immediately following the holidays. 

As we were talking about Yossi's condition, an hypothesis, more like an odd association, came to mind.   

As I noted above, Yossi's mother described his symptoms as ‘not speaking and loosing the use of his right hand'.  I thought of Psalm 137: By the waters of Babylon -- there we sat and also wept when we remembered Zion . . . And we vowed:  If I forget you, O Jerusalem, let my right hand forget its skill. Let my tongue adhere to my palate if I fail to recall you, if I fail to elevate Jerusalem above my foremost joy. (Tehillim 137:1;5-6)   Wasn't Yossi ‘mourning' the loss of Gush Katif?

I related my somewhat ‘off-the-wall' association regarding Yossi's symptoms to his mother, and asked her to share it with both the neurologist and the psychiatrist.

Immediately after Sukkot, Yossi's mother called me and said that both physicians said there was no pathology.  Also, though Yossi was still not using his right hand, he was speaking again.  Could they please have an appointment? 

When Yossi and his parents were sitting in my office, Yossi's first comment to me was: "What you told my mother about the Psalm was 60% correct".  I told him that for psychology, at best an inexact science, 60% was a terrific ‘grade'!

The ‘defense' that both these boys' minds were exhibiting is known as ‘conversion disorder' (once known as Hysterical Paralysis).

Conversion Disorder:

Conversion symptoms suggest a physical disorder but are the result of psychological factors. According to the psychodynamic model, the symptoms are a consequence of emotional conflict, with the repression of conflict into the unconscious.

It has been postulated that the patient derives primary and secondary gain. With primary gain, the symptoms allow the patient to express the conflict that has been suppressed unconsciously. With secondary gain, symptoms allow the patient to avoid unpleasant situations or garner support from friends, family, and the medical system that would otherwise be nobtainable.

I know I am preaching to the ‘converted' when I share my awe with the divine and wondrous workings of the mind and body to aid the soul.

         American Psychiatric Association: Somatoform disorders. In: Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: APA Press; 1994: 452-7.
         Carter AB: The prognosis of certain hysterical symptoms. Br Med J 1949; 1: 1076-9.
        Gould R, Miller BL, Goldberg MA, Benson DF: The validity of hysterical signs and symptoms. J Nerv Ment Dis 1986 Oct; 174(10): 593-7[Medline].
        Stevens H: Is it organic or is it functional. Is it hysteria or malingering? Psychiatr Clin North Am 1986 Jun; 9(2): 241-54[Medline].

Originally published in the Jewish Press on June 21, 2006.

Tags: Conversion Disorder | Disengagement | Disorder In Reading | Dyslexia | Gush Katif | Hysterical Paralysis | Jewish Press | Neuropsychological Emergency | Paralysis | Pathology | Psychosis