The Daily Item, Sunbury, PA

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February 17, 2014

Freud’s hysteria theory backed by patients’ brain scans

MMELBOURNE, Australia — MELBOURNE, Australia — Sigmund Freud may have been right about repressed memories causing hysteria.

Scientists at King’s College London and the University of Melbourne have found, using brain scans, that psychological stress may be to blame for unexplained physical symptoms, including paralysis and seizures.

Patients showed differences in brain activity when they recalled traumatic memories compared with healthy volunteers in a study published in last month’s edition of JAMA Psychiatry. Besides supporting Freud’s theory and helping to explain one of the most common complaints seen by neurologists, the research may lead to new treatment approaches for patients whose symptoms were often written off by doctors in the past.

“This is the first paper that I’m aware of that really shows that previous traumatic events can definitely trigger this kind of motor response,” said John Speed, a professor of physical medicine and rehabilitation at the University of Utah in Salt Lake City, who wasn’t involved in the research. “It’s very exciting.”

The research is among the latest to demonstrate how brain- scanning devices made by companies such as Siemens, General Electric and Philips are being used to help unravel neuropsychiatric symptoms that used to baffle doctors.

The scientists used functional magnetic resonance imaging, or fMRI, to trace changes in blood flow to particular areas of the brain while participants were probed about their past, yielding both anatomical and functional views of their brains.

“I hope in a decade or so that we will be able to use functional MRI as a diagnostic tool,” Speed said in a telephone interview.

The U.S. market for MRI systems will expand an average of 2.8 percent annually to reach $1.04 billion by 2016 from $907 million in 2011, according to Mountain View, Calif.-based researcher Frost & Sullivan.

Repressed memories were a tenet of Freud’s psychological theories about the nature of unconscious mental processes. The Austrian neurologist, who became known as the founding father of psychoanalysis, used the term repression to describe the way emotionally painful events could be blocked out of conscious awareness. This self-protective mechanism, he postulated, could bring on psychosomatic symptoms labeled “hysteria” at the time in a process now known as conversion.

Conversion disorder is one of the main reasons people visit a neurologist — accounting for 16 percent of neurology outpatients, according to a two-year study from Scotland the authors cited.

Cases typically manifest as weakness or paralysis down one side of the body reminiscent of a stroke. Symptoms can include non-epileptic seizures. Doctors have never found a neurological basis for the condition — the brains, nerves and muscles of patients all appeared to be normal — leading them to believe the symptoms are psychosomatic and raising suspicions that the patients are making up their illness, said Richard Kanaan, a professor of psychiatry at the University of Melbourne and a co- author of the study.

“It remains poorly understood, even by most physicians,” said Speed, who has treated more than 200 cases. “I’ve had countless patients tell me they weren’t believed, or were bluntly told they were faking it.”

The study conducted by Kanaan and colleagues at King’s College London involved 12 patients with conversion disorder and 13 healthy adults without the condition.

All participants were identified as having experienced stressful life events. The researchers used fMRI to pinpoint areas of brain activity when participants were asked to recall details about those experiences.

In the conversion patients, the reminiscing appeared to activate an area of the brain known as the left dorsolateral prefrontal cortex, whereas other memories — even upsetting ones — in both patient groups activated the hippocampus, a part of the brain important for the formation of memories.

The authors interpreted the different brain patterns to mean that conversion patients activated one part of their brain in order to still another, so that the emotional content of a stressful event could be suppressed.

“It is, I think, the first scientific exploration of something like a Freudian model that has been neglected for a long time,” Kanaan said in an interview in his office at Melbourne’s Austin Hospital, where he’s head of psychiatry.

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