Psychoanalytic Observations on the Mechanism of Conversion Symptoms*

It is the aim of this presentation to add to the clarification and understanding of conversion processes and conversion symptoms, in the light of certain clinical investigations and findings which I will describe. But first let me refer to the theoretical and clinical formulations of those who have laid down foundations toward an understanding of this complex process.

Freud2 originally proposed the name “conversion” for a process whereby an unbearable idea is rendered innocuous by the transformation of the excitation initially attached to the idea into some bodily form of expression. He felt that conversion proceeded along the line of the motor or sensory enervation and was more or less intimately connected to a traumatic experience. He demonstrated that the conversion operated in the service of defence, pointing out that the affect attached to a repressed erotic idea was used to intensify or revive a symptom which was simultaneously present or existed prior to the traumatic experience. He demonstrated the importance of identification associated with conversion mechanism and implied constitutional endowment as a possible qualitative factor in the genesis.

Based on Freud's3 conceptualization of visual dream images, Deutsch1 proposed a chain of events which begins with a physiological sensory perception leading to symbolization, this in turn stimulates the physiological processes, which in turn recathect and revive need-gratifying objects in an hallucinatory way. When a need arises, an impulse or a wish seems to recathect the object. The first memory is established only by gratification which stills the impulse. Deutsch