Maybe You Should Talk to Someon - Lori Gottlieb Page 0,94
biopsy those nodes!
In class the next morning, our professor felt my neck. My nodes were big but within the normal range. I didn’t have lymphoma; I had medical students’ disease.
I probably had nothing now too, I figured. Except deep down, I knew it wasn’t normal for somebody in her forties who used to be a runner not to be able to run anymore and to feel sick every day. I’d wake up tingling, my fingers red and thick as sausages, my lips swollen as if stung by bees. My internist ran even more lab tests, some of which came back abnormal or, as he put it, “quirky.” He sent me for MRIs and scans and biopsies, some of which were also “quirky.” He sent me to specialists to interpret the various quirky labs and scans and signs and symptoms, and I saw so many specialists that I began calling my odyssey the Medical Mystery Tour.
It was indeed a mystery. One doctor thought I had a rare form of cancer (based on lab tests, but the scan ruled this out); another thought it was some kind of virus (starting with the rash); another thought it was a metabolic condition (my eyes were riddled with deposits that nobody could diagnose); and yet another thought I had multiple sclerosis (my brain scan showed spots that weren’t typical of MS, but they could be an unusual presentation). At various times it was thought that I might have thyroid disease, scleroderma, or, yes, lymphoma (again, those enlarged glands; did this actually start back then, in medical school, lying dormant until now?).
But all those tests came back negative.
About a year in—by which point I’d developed subtle jaw and hand tremors—one doctor, a neurologist who wore green cowboy boots and spoke with a thick Italian accent, believed he’d figured out my condition. The first time I met him, he walked into the room, logged on to the hospital network’s computer, noted the long list of specialists I’d seen (“Well, you’ve certainly seen everyone in town, haven’t you?” he said flippantly, as if I’d been sleeping around), and—skipping the exam—immediately had the diagnosis. He thought I was a modern-day version of Freud’s female hysteric, experiencing what’s known as conversion disorder.
This is a condition in which a person’s anxiety is “converted” into neurologic conditions such as paralysis, balance issues, incontinence, blindness, deafness, tremors, or seizures. The symptoms are often temporary and tend to be related (sometimes symbolically) to the psychological stressor at its root. For instance, after seeing something traumatic (like one’s spouse in bed with another person or a grisly murder), a patient might experience blindness. After a terrifying fall, a patient might experience leg paralysis even though there was no functional evidence of nerve damage. Or a man who feels that his anger toward his wife is unacceptable might experience numbness in the arm he fantasized about raising to hit her.
People with conversion disorder aren’t faking it—that’s called factitious disorder. People with factitious disorder have a need to be thought of as sick and intentionally go to great lengths to appear ill. In conversion disorder, though, the patient is actually experiencing these symptoms; it’s just that there’s no identifiable medical explanation for them. They seem to be caused by emotional distress that the patient is completely unconscious of.
I didn’t think I had conversion disorder. But then again, if conversion disorder was caused by an unconscious process, how could I know?
Conversion disorders have a long history and have been documented as far back as four thousand years ago in ancient Egypt. Like most emotional conditions, they were disproportionately diagnosed in women. In fact, symptoms were thought to be caused by a woman’s uterus moving either up or down, a syndrome that came to be known as a “wandering uterus.”
The treatment? A woman was to place pleasing aromas or spices near her body in the opposite direction of where the uterus had supposedly wandered. This “cure” was thought to lure the uterus back to its proper location.
In the fifth century BC, however, Hippocrates noted that aromas didn’t seem to be working for this malady, which he had named hysteria, from the Greek word for “uterus.” Accordingly, the treatment for hysterical women went from aromas and spices to exercise, massages, and hot baths. That lasted until the beginning of the thirteenth century, at which point there was thought to be a connection between women and the devil.
The new treatment? Exorcism.
Finally, in the late 1600s, hysteria came to be thought of