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February 16, 1979

Organic Disease vs Conversion Reaction

Author Affiliations

Chappaqua, NY

JAMA. 1979;241(7):695. doi:10.1001/jama.1979.03290330015012

To the Editor.—  The recent article by James R. Hillard, MD, and W. J. Kenneth Rockwell, MD, "Dysesthesia, Witchcraft, and Conversion Reaction: A Case Successfully Treated With Psychotherapy" (240:1742, 1978), is extremely informative and deserving of comment. Differentiating organic disease from hysterical conversion reaction is one of the most difficult tasks facing physicians today. The diagnosis can be made only by demonstrating on examination positive evidence that indicates the symptoms are inconsistent with known patterns of anatomy and physiology. Exclusion and placebo effect are not acceptable criteria. In hysteria the symptoms will invariably change with suggestion and repeated examination. The presence of la belle indifference is variable and depends on the effectiveness of the personality to repress anxiety, and this process may be partial or complete. Taking a thorough history is important in all areas of medicine and is especially valuable in cases with bizarre findings. Since subconscious conflicts form