Laura Dimon has an interesting piece on The Atlantic’s website, titled “What Witchcraft is Facebook?” (with a picture of Dr. Charcot!) in which she reports on the phenomenon of mass psychogenic illness–basically an epidemic of conversion disorder.
Conversion disorder, of course, is a common diagnosis in neurology. One of the neurologists quoted in the article makes a great point (actually made many years before by Francis Peabody–see below) that many behaviors we’re all familiar with and don’t consider pathological are actually mild forms of conversion. Think about foot tapping or nail biting, for example. Arguably, the border between normal and abnormal here is socially determined. Foot tapping can be thought of as a physical manifestation of pent-up anxiety, but is socially acceptable. Psychogenic non-epileptic seizures–not socially acceptable, and very distressing to patients (sometimes) and families (almost always).
Neurologists may be casually familiar with the episode in Le Roy, NY back in 2011, when a dozen or two high schoolers developed vocal and motor tics, psychogenic seizures, and other symptoms. I actually recall a medical student showing me, after rounds one day, a YouTube video of a young woman with what appeared to be a psychogenic movement disorder. The really interesting angle in this article is the idea that social media may have helped spread the disease. One adult woman not affiliated with the affected high school developed the same manifestations of conversion disorder after being exposed to it via Facebook. The daughter of a friend of hers was one of those afflicted, and there were posts about the young woman’s plight in the older woman’s feed.
The article doesn’t go this far, but I wonder whether social media, if able to facilitate epidemics of this disease, could also facilitate a pandemic? The Le Roy patients were mostly adolescent, and so had geographically restricted social circles. But what if a group of college students were to develop conversion disorder? Could Facebook and the like allow it to spread around the country and even around the world to their friends and acquaintances at other colleges?
Getting back to the individual patient suffering from conversion, I just realized that it’s September already and I forgot to send around a very important article that all clinicians, especially neurology residents, need to read (and re-read from time to time): The Care of the Patient, by Dr. Francis W. Peabody. You can read a little about Dr. Peabody here. He gave a series of lectures to the Harvard medical students in 1926 and this was published in JAMA in 1927. It is even more relevant today than it was then. He starts by discussing the explosion of scientific knowledge in the prior 30 years and its effects on medical education. He talks about the importance of maintaining the human connection in medical care. But particular attention should be paid to the section, “Patients Who Have ‘Nothing Wrong With Them'”. A quote you may not have heard before: “Medically speaking, they are not serious cases as regards prospective death, but they are often extremely serious as regards prospective life.” A quote you probably have heard before: “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.”