​

Social factors relating to family conflict were found in a study  by Lian-Bodenbach, (2013), which included patients diagnosed with conversion disorder as described in the ICD-10 (the sample group) and individuals who are not diagnosed with conversion disorder ( the control group).   The study measured the outcomes using both qualitative and quantitative methods.  The qualitative findings uncovered themes which were common and consistent with other researchers.  A reoccurring theme found was that family and/or marital conflicts were over many issues but no resolution was sought by individuals diagnosed with conversion disorders.  However, the control group also had family and/or marital conflicts but they seemed to be able to resolve conflict.

An important finding is that the sample group seems to have more difficulty with managing conflict resulting from social stressors such as family strife than the control group, who seemed to be able to discuss a solution to the conflict, even to a small degree of success.  Although it appears to be a cultural norm to keep silent and walk away, individuals with conversion disorder are less likely to seek a favorable resolution, and therefore they remain dissatisfied, when the same issues resurface in the future.  Indian research literature suggests that this behavior of coping with stress through converting emotional unhappiness into physiological pain is due to social modeling (Sridhar & Sudharkar, 1997). The study’s findings seem to support this theory as participants responded consistently that walking away from the conflict and remaining passive is an acceptable social norm in dealing with conflict.   The lack of conflict resolution skills seems to be a significant factor in conversion disorder.  Choosing how and when to confront any conflict is an important skill to develop, especially when patients have not witnessed this process performed within their families.  Often, patients express their lack of desire to confront issues because of the possibility that it can escalate into a huge argument and hurtful words are spoken.  Although walking away seems to be the best strategy to keep the peace, prolonged psychological traumatic conflicts and stresses can be manifested into conversion disorder for those who utilize this method solely and do not seek resolution at a later time,

We recommend developing conflict resolution skills and modeling them so that patients are aware that there are alternative ways of dealing with conflict instead of internalizing it.  As well, learning that silence can be a good strategy to diffuse an escalating conflict but it is not helpful in resolving conflict.  Learning peaceful and loving ways to communicate our feelings and thoughts and then resolve the conflict is more useful.  Furthermore, the finding that social factors such as family strife contribute to conversion disorder suggests that developing effective conflict resolution skills for families may be a useful therapeutic method, which is purported by other researchers such as Chinhta, Malhi & Singhi, and Prabahshakr (2002).  Additionally, family therapy can also be an effective intervention strategy for conversion disorder patients.  For instance, family counseling explores family dynamics through tools like genograms and delves deeply into family structure and discovers family triangles.  This method will help illuminate the possible causes of the family strife and stresses that are being perpetuated in the current family system and family culture.  As the literature review suggests, family counseling techniques are in alignment with the Indian culture (Laungani, 1996).

 Furthermore, the findings indicate that previous understanding of the psychological underpinning of conversion disorders may not be a result of immature defense mechanism as described by Freud or a traumatic experience as suggested by Janet, but rather is a learned behavior from their role models (Sridhar & Sudharkar, 1997).  As stated by both participants in control and sample groups, the social norm in dealing with conflict and the stress it incurs is to walk away.  We need to be more sensitive and aware of possible differences between the Western and Eastern social norms and psychological underpinnings of mental illnesses. We cannot assume that the psychological theories of the West apply to another culture in the East.  Therefore, incorporating ethnic, spiritual and cultural dimensions are essential for a more comprehensive understanding of these individuals’ needs. 

 

References

Baetz, M. & Toews, J. (2009). Clinical Implications of Research on Religion, Spirituality and Mental Health. Canadian Journal of Psychiatry, 54(5), 292-301.

Bhui, K., King, M., Dein, S., & O’Connor, W. (2008). Ethnicity and religious coping with mental distress. Journal of Mental Health, 17(2), 141-151.

Campion, J. & Bhugra, D. (1998). Religious and indigenous treatment of mental illness in South India-a descriptive study. Mental Health, Religion and Culture, 1 (1),98.

Cloniger, C.R. (2006). The science of well-being: an integrated approach to mental health and its disorders. World Psychiatry. June, 71-76.

Ghosh J. Majundar P., Pant, P.,Dutta R. Bhatia P.(2007). Clinical profile and outcome of conversion disorder in children in a tertiary hospital of north India. Journal of Tropical Pediatristics, 53 (3), 213.

Laungani P.(1997). Cultural variations and understanding and outcomes of psychiatric disorders in India. Counselling Psychology Quarterly, 5(3) 231-246.

Lian-Bodenbach, Grace (2013). Delivering services with faith perspective. (Doctoral Dissertation) https://www.worldcat.org/title/delivering-services-with-faith-perspective/

Srinath, S. Bharat S. Girimaji S. and Seshadri S. (1993). Characteristics of a Child Inpatient Population with Hysteria in India. American Academy Child Adolescent Psychiatry. 32(4), 822-825.

Sridhar M.S, Sudharkar T.P (1997). Dissociate (Conversion) disorder: Epidemiology and phenomenology in a general hospital set up. Indian Journal of Psychiatry, 39 (Supplement) 24-25.

Surendra K. M., Gupta N. Lobana A., and Bedi B. (1989). Mass family hysteria: A report from India. The British Journal of Psychiatry,154, 504-509.

Taylor, Nicole (2001). Utilizing religious schemas to cope with mental illness. Journal of religious and health, 40 (3), 22