But for decades after Freud’s death, European women still carried vials of “smelling salts.” It was commonly believed that their pungent odors would settle their uteruses and there deflect “hysteria.” First described among women in ancient Egypt in the second millennium B.C., the “wandering uterus” was believed to cause everything from anxiety attacks to depressive periods.
Since then, it’s not just an understanding of conversion disorder that’s evolved. Many experts have theorized that societies can evolve away from the condition.
“From an epidemiological perspective, conversion disorder as a pathological condition disappeared almost, if not completely, from many developed societies,” Wen-Shing Tseng wrote in his Handbook of Cultural Psychiatry in 2002.
“It is thought to occur primarily in societies with relatively strict social systems, in which people cannot express their feelings or desires toward others directly, particularly when they encounter conflict or distress,” he continued. “Temporary somatic dysfunction is one mode of communication available to people, particularly for a suppressed gender or less-privileged group of people.”
The theory that social liberalization nullified the conditions in which conversion disorder might arise has gained recognition, even though there’s not much evidence to support it.
The theory didn’t hold up in one of the only broad, cross-cultural studies of medically-unexplained bodily complaints. Of 15 cities sampled, the highest prevalence of inexplicable symptoms was in Santiago, Chile, followed by Rio de Janeiro, Brazil; Ankara, Turkey; Berlin; and then Manchester in the United Kingdon. Notably, Ibadan, a city in Nigeria, had the lowest percentage of cases in the study.
“It’s a nice idea that in societies where people can’t express themselves, they would have a physical symptom, but I don’t think the evidence supports it,” says Jon Stone, a clinical neurologist based at the University of Edinburgh.
“There’s various reasons for why that [idea] gained prominence,” he says. “But I think it’s a slight superiority issue that the West has [that makes us think] ‘We’re more sophisticated’ or ‘We’ve moved on.’”
Another issue that makes it difficult to make such an assertion is how different health systems function across countries. In a paper he co-authored, an additional explanation for why “hysteria” appeared to decline in developed societies was the way health and education systems deal with the disciplines of neurology and psychiatry.
“Neurologists were not interested in seeing the [conversion] patients and the patients were mostly not interested in seeing psychiatrists,” he writes, along with four other experts on the topic. Treatment of the disorder fell into a chasm between the two.
Stone has also argued against the theory that all patients with conversion disorder have repressed feelings or memories. He was one of the advisers to the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which no longer requires the presence of a psychological stressor for a diagnosis of conversion disorder.