Jesus and Conversion Disorders

Some critics say Jesus' healings were a matter of reversing "conversion disorders" which cause things like blindness, paralysis, and so forth.

I have noted in response, briefly, that such theorizing is of no epistemic worth for it is unfalsifiable; it provides no way to differentiate between blindness, etc. caused by such disorder and that which is not, and merely assumes that the conditions described must be associated as such. As noted, this amounts to an admission that the data, as it stands, does not support the critic's view, and therefore must be serviced with speculation amenable to the assumed skeptical paradigm.

We will now pursue the question further using clinical material on conversion disorder. Davies offers [70] the official diagnosis from DSM-III-R:

The essential feature of this disorder is an alternation or loss of physical functioning that suggests physical disorder, but that instead is apparently an expression of a psychological conflict or need.

The DSM goes on to note these suggested mechanisms:

In one mechanism, the person achieves "primary gain" by keeping an internal conflict or need out of awareness. In such cases there is a temporal relationship between an environmental stimulus that is apparently related to a psychological conflict or need and initiation or exacerbation of the symptom. For example, after an argument, inner conflict about the expression of rage may be expressed as "aphoria" (dumbness) or as a "paralysis" of the arm; or if a person views a traumatic event, a conflict about acknowledging that event may be expressed as "blindness." In such cases the symptom has a symbolic value that is a representation and particular solution of the underlying psychological conflict.
In the other mechanism, the person achieves "secondary gain" by avoiding a particular activity that is noxious to him or her and getting support from the environment that otherwise might not be forthcoming. For example, with a "paralyzed" hand, a solider can avoid firing a gun.

Even at this point it is abundantly clear that we have no evidence in the Gospels of any person healed by Jesus having any such conflicts as described. One must assume such events to be in the background, unreported. Moreover, one must assume (as Davies does, and as we have noted in our review of his book) that modern psychological responses obtained in the ancient setting of the NT, which was an agonistic culture in which people constantly defended their personal honor (thus making it unlikely, if not impossible, that they would suffer such "conflict or need" as described, being that they had the "safety valve" of personal release; i.e., the "insult contests" between Jesus and the Pharisees).

Our operative questions, then, are as follows:

But leaving that aside, we may now consider our two questions based on data from the field of psychology. For this project I will run over what is offered in a variety of web-based sources (confirmed as well by several textbooks of abnormal psychology, such as the one by Davison and Neale).

As a caveat it should be noted that we only expect to address here the matter of whether conversion disorder specifically offers a suitable explanation for what is reported in the Gospels. Obviously, critics would still be able to posit other explanations even if this point is negated (and would obviously have to, for healings like the man born blind, or for persons raised from death).


We begin with material from a site now defunct which offered a case study of "hysterical blindness":

Mr. B.W. is a 34-year-old man who worked as a boxing coach and teacher for the local school system. It was his job to teach children, particularly some underprivileged and troubled children, to put their energy into defensive boxing and to learn to express themselves through the art.
On October 24, 1994, he was sparring with a young man who kept taking "potshots" at him. He tried to fend him off, but the young man kept coming at him and one punch actually hit him in the jaw, stunning him and creating some pain. Suddenly, without any forethought, as a defensive tactic, he let loose and hit the young man so hard that he was knocked onto the floor. The young man had trouble catching his breath and was rushed to the Johns Hopkins Hospital where he was treated conservatively for a cervical neck strain.
Mr. B.W. became overwhelmed that he could do such a thing to this child. He immediately rushed to the hospital to visit him. He apologized profusely to the child's father who stated that the boy had created a great deal of problems and that he could understand totally why this might have happened and had no ill feelings toward Mr. B.W. Nevertheless, Mr. B.W. was stunned and shocked that he could lose control and let this happen.

We may note at this point that the situation by itself that Mr. B. W. was in would not obtain in an ancient culture. There were no such missions to the underprivileged; there was no such thing as boxing by such amateurs as these (disputes were usually settled with verbal honor challenges, and fist-fights would be broken up by bystanders), and guilt as we understand it was unknown. Critics would obviously need to hypothesize other situations which would produce similar reactions in the ancient world.

The next morning Mr. B.W. woke up and found that he had some trouble seeing. This began a process where his ability to function slowly began to deteriorate. He was struggling with agitation regarding what happened and now thought that he suddenly, for whatever reason, was going blind.
He was carefully evaluated at the Wilmer Eye Clinic at Johns Hopkins Hospital and this evaluation has continued. The various experts at this wonderful clinic have not been able to actually point to the physical cause for this, but continue to try to come up with an explanation. In the meantime, Mr. B.W. has taken a Workers' Compensation claim. He has been unable to work and has applied for Social Security Disability. He is quite frustrated that his case is still in limbo, particularly since he is now blind.
He walks with a cane, manages to dress with much dignity and is always neatly groomed with well coordinated clothing. He always carries a briefcase with voluminous papers, well organized and often printed by him on his home computer.
He has become increasingly angry at the city for not giving him the disability that he wants. He is frustrated with the doctors who will not come out and actually state definitively what the cause of his blindness might be.
In my initial interpretation, particularly the passive way in which he presented his case, I began to suspect that Mr. B.W. is really not blind, but may be struggling with a very rare psychological disorder known as "hysterical blindness." In this instance, somehow the emotional turmoil within him has created such an impact that he actually blocks off visual impulses going between areas of the brain to the point that he cannot see.

We may note here the observation that this disorder particularly is very rare. Even in the broader expanse of possible conversion disorder reactions, is it really likely that Jesus ran into so many people with a "rare" disorder in just the space of 2-3 years?

He describes a background where he was very much controlled by an autocratic and violent father. He indeed stated that at times he was quite upset and angry, but always wanted to control that anger. It is my feeling that this was accomplished through his pursuit of martial arts and boxing. This gave him a sense of power and control.
He could teach the troubled youth but was always in control. When this one troubled boy kept punching him, he lost that control, let loose on his rage, and indeed hurt the boy. The thought that this rage could come to the surface overwhelmed him, but it continues with his struggling with the city and its various agencies.
Although he comes across as very sad, frustrated, and pathetic, there is an extreme anger underneath. I feel that this anger has always been there, but he is not consciously in touch with it. The closest he got to expressing that anger was the day that he punched that student and then proceeded to go blind.

We would again stress that this sort of reaction would not obtain in a culture in which people were used to expressing themselves openly and defending their honor. The idea of someone "not being in touch with their anger" finds no place among the ancients, and especially among the Jewish people, for whom earthy, emotional expression was common.


From Link 2 below we have an item on conversion disorders by Dr. Mark Landau, Assistant Chief of Neurophysiology Section at the Walter Reed Army Medical Center. Following a description of the disorder and its causes and history, we have a note on frequency:

In the US: Stefansson et al report that the annual incidence of conversion reactions is 22 cases per 100,000 persons per year in Monroe County, New York. However, the reported rates vary widely. In a study of 100 consecutive women following a normal full-term pregnancy, 33 were noted to have a past history of conversion symptoms. In a study of 100 randomly selected patients from a psychiatry clinic, 24 were noted to have unexplained neurological symptoms. It is reported to be more common in rural populations, in individuals with lower socioeconomic status, and in individuals with less medical knowledge.
Internationally: Stefansson et al report that the annual incidence is 11 cases per 100,000 persons per year in Iceland.

We should firmly note, again, that the US-reported cases are in the context of an entirely different cultural setting. Even so, the relative rarity of certainly-diagnosed cases (22 out of 100,000) leads us to again wonder of the convenience of the explanation that Jesus just happened to run into what were probably the only serious cases (not just "conversion reactions" but ones serious enough to cause blindness, for example) in all of Palestine.

Other sources claim that conversion disorder may be seen in anywhere from 5% to 14% of typical visits to a medical office, though this says nothing about the degree of such incidences.

History: Conversion symptoms are those that suggest neurological disease, but no explanation of these symptoms is found following physical examination and diagnostic testing. Conversion symptoms are seen in various clinical settings and include conversion disorder; somatization disorder; affective disorders; antisocial personality disorder; alcohol or drug abuse; or organic, neurological, or medical illnesses. In some situations, an immediate precipitating source of stress may be disclosed, such as a loss of employment or divorce. The patient may have a discordant home life. A history of sexual or physical abuse is not uncommon. Therefore, a complete and comprehensive psychosocial history is important. It has been stated that patients with conversion disorder have a relative lack of concern about the nature or implications of the symptoms (la belle indifference). This is not a helpful diagnostic characteristic because it is not specific or sensitive for conversion.

Our points about a differing cultural setting, and of lack of background evidence for things like sexual abuse (note the importance placed upon having a comprehensive psychosocial history), apply again; but we also note there is not a single case of Jesus healing someone who was indifferent to their symptoms. Indeed, every indication is that these persons were VERY concerned with their conditions.

After listing diagnostic criteria (again, obviously, not able to be applied here), we have this telling note:

The physician should contrast formal examination from functional observations. Patients who do not move a limb when asked on examination may be observed to use that limb inadvertently while dressing or talking. Patients who do not dorsiflex the foot while seated may walk on the heels when asked to do so. Another example might be a patient who cannot stand on one leg who may be observed to do so while putting on pants.

Textbooks give examples of "blind" person who manages not to run into things and "paralyzed" persons who get up and run in an emergency and are surprised to find themselves doing so.

This factor is more important in our context: In a collectivist society like the ancient Mediterranean in which everybody minded everyone else's business, any claim of illness that had obvious results -- blindness and deafness for example -- would not have passed muster had it been merely been the result of conversion disorder. One's neighbors would have seen you doing whatever the equal was to putting on your pants. Conversion "disorderlies" would not have been recognized as actually ill and would instead be suspected of malingering (which as it happens is something that is sometimes mistaken for conversion disorder).

After discussion of what professionals can do to diagnose conversion disorder, Landau notes treatment options. Here is one that has direct relevance:

Avoid invasive diagnostic and therapeutic interventions.

Notice: Avoid invasive diagnostic and therapeutic interventions." What could be more "invasive" than confronting people, putting spit and mud in their eyes, or laying hands on them? Landau recommends subtle, tactful options like:

Provide socially acceptable examples of diseases that often are deemed stress-related (eg, peptic ulcer disease, hypertension).
Provide common examples of emotions producing symptoms (eg, queasy stomach when talking in front of an audience, sweaty palms when asking someone for a date).
Provide examples of how the subconscious influences behavior (eg, nail biting, pacing).
Provide positive reinforcement that the symptoms can improve spontaneously.
Inform patients that the symptoms are not volitional, and no one believes that they are faking.
Provide antidepressant or anxiolytic medications, if appropriate.
Physical therapy may be warranted.

In other words, Jesus did exactly the wrong sort of things for treating conversion disorder. Consider this list of interventions from Landau:

A textbook example of conversion disorder notes a mentally disabled woman named Eloise who suffered "paralysis" in her legs. As it happened her mother owned a small business and kept Eloise in the back and told her to stay put. As a result, Eloise "converted" and "lost" use of her legs. After many weeks of intensive work, and having Eloise "practice" walking every day, she regained function -- only to "lose" it again when back in her mother's store where she had been told to sit in her place and stay there.

And the result of all of this? "Spontaneous resolution in most - Approximately 75%. Recurrence of same or different conversion symptoms - Approximately 25% in 15-year follow-up studies." It is clear that Jesus' "sudden" treatments are far from what would be needed to effect a "cure" of someone with conversion disorder; even if "cured" for the moment, if the unattested cause of the disorder (supposed trouble at home, for example, and assuming the same matters obtain in an ancient psychological setting) is left unattended, the "healing" will reverse --- putting a serious blemish on Jesus' reputation as a healer.

This can be made even clearer with another case study.


From Link 3 below, an article from the International Journal of Psychopathology, Psychopharmacology, and Psychotherapy, we have an item titled "Hysterical Paralysis In An Adolescent Female" by Dr. Eric Affsprung of Bucknell University. The abstract states:

An sixteen-year-old female was seen for fifteen sessions of once-a-week, individual, psychodynamic psychotherapy over the course of five months. The patient presented with symptoms of depression as well as pain and extensive paralysis in both legs. Despite the patient's unwillingness to utilize anti-depressant medication and little family support, treatment was successful in both the alleviation of her depression and the elimination of somatic symptoms.

After detailing the cause of the condition, the treatment is described in more detail:

Treatment consisted of fifteen sessions of once-a-week, individual, psychodynamic psychotherapy over the course of five months. The initial prognosis was not particularly good. There was concern that the patient might soon have to be hospitalized in order to prevent permanent physical deterioration of her leg muscles. In addition, both daughter and parents refused to agree to family sessions and even consultation with the parents proved difficult. Finally, although anti-depressant medication was prescribed by the consulting psychiatrist, the patient refused to participate in the recommended psychopharmacological treatment.
Under these conditions and in order to be successful, treatment required a minimum of two things. First, was the provision of a supportive, non-judgemental setting in which this adolescent girl could feel that her thoughts and feelings would be validated. The second involved a facilitation of the patient's recognition and direct and open expression of her previously disavowed grief and anger toward her mother whom she felt did not love or understand her. An important turning point, at about the tenth session, involved the patient's voicing her desire to kill her mother by gouging out her eyes and then cutting off her head. After several months of tears and rage the patient's symptoms began to diminish rapidly (although flaring up temporarily whenever she felt pushed by her parents to recover more quickly). By termination, the patient had completely regained her ability to walk and was reporting an absence of physical pain. Her affect was also noticeable improved.
With regard to transference, it was probably fortunate that this patient was not referred to a female clinician. Her antagonism toward her mother (as well as several other female students and teachers in her school and expressed through various reenactments) might very well have prevented her from forming the therapeutic alliance necessary for the rapid gains which were needed to avoid permanent physical damage to her legs. The greatest counter-transference difficulty consisted of avoiding getting caught up in a power struggle with the patient in which she would feel pushed to recover in the same way that she felt pushed by her parents. In fact, during sessions, the patient's somatic difficulties and their eventual disappearance were seldom discussed directly.
This case is interesting not only because of the somewhat dramatic quality of the patient's symptoms but also because it would seem to support the idea that one can indeed treat such patients individually, from a psychodynamic orientation, and in a relatively brief period of time. This stands in contradiction to the objections voiced by those (typically structural or strategic family therapists) who argue that adolescent patients with rather serious psychopathology which is related at least in part to family dynamics cannot be treated without working with the family as a whole.

Note well: Five months of therapy -- versus a moment in time with Jesus? Such would be a miracle as fantastic as curing a man born blind.

Our conclusion, such as can be briefly reached: Critics have a great deal to do before they can claim with any basis that any of Jesus' healings were matters of reversals of "conversion disorder".

-JPH

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