Behavioral Approach to Hysterical Blindness

Abstract

Hysterical symptoms are viewed by behavior therapists as learned maladaptive responses. So these therapists try to use the thechniques derived from learning theories. Conversion neuroses include hysterical anaesthesia, analgesia, deafness, muscular spasm, spasmodic torticollis and so on.At our out-patient clinic of pediatrics, the authors are asked to treat the patients of hysterical blindness several times a year, who were referred by opthalmologists. Usually they visit with the exclusive diagnosis because no organic pathologies were found.As already known, Brady-Lind or Grosz-Zimmerman reported a behabioral approach to hysterical blindness with an operant conditioning technique. Ohno, et al, however, criticized their methodologies. They insisted that such methodologies were sophisticated but not so useful in the situations of daily clinical practice. Ohno, et al, made a simpler approach using an aversive stimulus.We also treated patients of hysterical blindness using the operant technique. They were verbally praised whenever they gave the correct answers. We thought that the aversie therapy was not preferable because our patients were children. In this report we presented three cases of hysterical blindness which consisted of a 13-year old boy, a 12-year old girl and an 11-year old girl. The first 2 cases were urged to point out the big letters, which appeared in the settled distance and were gradually and syntematically changed into lesser sizes when the patients gave the correct answers.We noticed that all of the caess revealed some conflictual situations in their lives which were assumed to be the cause of blindness. So family therapy was concurrently tried and we believe our interventions were effective. In the case of the 13-year old boy, his father was an artist of surrealism and painted grotesque scenery in his work. So these pictures might have influenced the psychology of this boy in some degree. The father was a person of good sense and frankly admitted that those factors could induce his child's symptoms. He was able to handle the situation in such a way not to effect his son. We believe that the attitudes of the parents can lead to better prognosis.In this study the disturbance of visual acuity was treated using operant techniques, and psychological interventions were performed at the same times. The second of the 12-year old girl was treated almost in the same way as the first case and revealed a good result. In the last case the patient complained of poor visual ability but could study at shool. So we did not try operant conditioning techniques with her and only conducted family interviews with special focus on her mother because there seemed to be some conflictural situations in the family. The symptom itself did not improve markedly although her psychological problems wre solved.