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Theories abound about conversion disorder and illnesses in LeRoy, N.Y.

Downtown LeRoy, N.Y.
CC/Flickr/basykes
LeRoy, N.Y., is the site of what is thought to be a manifestation of conversion disorder.

Psychologist Vaughan Bell, a clinical and research psychologist at King’s College London, weighed in recently at Discover magazine on the bizarre illness that has afflicted more than a dozen teenagers and one 36-year-old woman in the small town of LeRoy, N.Y.

Since last fall, those LeRoy residents have experienced uncontrollable twitching and verbal tics.

New York Health officials have diagnosed this strange outbreak as conversion disorder — a condition in which (in the website words of the Mayo Clinic) “you show psychological stress in physical ways.” The media sometimes defines conversion disorder as “mass hysteria.” But that definition is both misleading and confusing, says Bell.

“Hysteria is used in everyday language to mean ‘panic,’” he explains, “but it has a long history as a medical condition.”

For most of that history, only women were thought to be affected. Hippocrates blamed hysteria on a womb “wandering” around the body, with negative influences on the mind. (Hysteria comes from the Greek word for uterus.) By the end of the 19th century, removal of the uterus, or hysterectomies, was routinely performed to cure “hysterical” women. 

By then, though, doctors had begrudgingly acknowledged that hysteria could affect men as well. Sigmund Freud famously argued that it was caused by the subconscious mind trying to suppress a deep emotional stress.

“Although his theory about hysteria being caused by the ‘unconscious repression of trauma’ isn’t very popular among scientists,” writes Bell, “it’s a simple fact that patients can develop what seem like neurological disorders — such as paralysis, blindness, seizures, and tics — despite having a perfectly functioning nervous system. And despite popular claims that the condition is rare or ‘doesn’t happen any more,’ it still commonly presents in neurological clinics. Numerous studies have found that up to one-third of patients who consult with neurologists typically have symptoms that are not fully explained by neurological damage.”

In 1980, the American Psychiatric Association reclassified hysteria as conversion disorder.

Other theories

Not everybody is convinced, however, that conversion disorder explains what has happened in LeRoy. A New Jersey neurologist publically announced in February that at least some of the teenagers who developed the involuntary movements probably have PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders with Streptococcal infections. This rare and strange illness, which can trigger tics and/or compulsive behavior, is believed linked to a viral or bacteria infection, according to the National Institutes of Mental Health.

Some environmentalists, on the other hand, have proposed that the LeRoy symptoms may be due to exposure to a nerve-damaging toxin, either from an old (1970) train spill of 30,000 gallons of cyanide and trichloroethylene that wasn’t cleaned up properly or from recent leaks from natural gas wells on the property of the school that most of the teenagers attend.

Environmental activist Erin Brockovich-Ellis (yes, the one portrayed by Julia Roberts in the 2000 film) is leading an investigation into these possible environmental causes.

The New York State Department of Health, however, has investigated — and nixed — both the PANDAS and the environmental-toxin theories.

Symptoms aren’t ‘faked’

Bell seems to support those officials. “It’s unlikely that the New York teenagers’ problems are linked to an ‘unknown virus,’ ‘mystery illness,’ or ‘toxin,’” he writes. “… Viruses, bacteria, or poisons are most likely to cause the symptoms by damaging the neural pathways — something we can normally detect fairly easily.”

But that doesn’t mean that the affected LeRoy patients are faking their symptoms, Bell adds. “We have good evidence that this is not the case,” he says. “The majority gain nothing from their disability, making a poor case for deception. What’s more, neuroimaging studies show that someone with conversion disorder paralysis has markedly different brain activity during an attempt to move an immobilized limb, compared to people who have been taught to fake the same symptoms.”

Still, little is understood about conversion disorder.

“We’re still not entirely sure why this situation occurs in the first place — why does the brain’s control system decide to hit the brakes, destabilize a coordination system, or cause unnecessary movement?” writes Bell. “We have some clues. It turns out very similar brain activation patterns occur in hypnotized people if they are given suggestions to simulate conversion disorder-like symptoms, but these effects are temporary, unlike conversion disorder, which can be long-lasting.”

“We know that patients with conversion disorder are more likely to have other forms of emotional instability,” he adds. Stress seems to be a major trigger. Some press reports suggest that bullying has been a problem in the school that the LeRoy teenagers attend.

On the road to recovery

Last week, a doctor reported that two of the teenagers she had been treating had recovered and others were on their way to recovering. There seems to be confusion about whether the recovered teenagers are among those who received antibiotics for PANDAS. (Even if the recovering teenagers did receive antibiotics, that doesn’t prove they had a PANDAS illness.)

Oh — and the EPA has  finally removed the last of the barrels of waste from the site of the 1970 chemical spill.

You can read Bell’s discussion of conversion disorder on the Discover magazine website.

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Comments (1)

Statistics

The first question to be addressed is whether a real cluster of events exist.
People are very sensitive to patterns, and impose them on even random collections of events.
So, we'd need a thorough statistical analysis to tell if these collections of symptoms are occurring at a significantly greater frequency than would be predicted by simple random clustering.
I don't see any statistical analysis in the Discover article (and I can think of more professional places to publish ;-).

By the way, there are some questions as to whether the cluster of symptoms reported by Erin Brockovich were likely to have occurred in the same time and place. It's been a dozen years so I'm a bit hazy on the details, but I seem to recall that the whole thing was rather weak on the science end.

We have enough real problems to deal with.