My sister was seen at a clinic recently and following some investigations, we were told that the paralysis of the right arm was psychological and only a psychiatrist can help her. Is it possible to have a weakness of this type due to psychological reasons? Many years ago, we saw a girl whose right arm was weak, and she could not hold a pen, hence unable to write her Form Four examinations. This latter fact was the most revealing of all the other information. The examination was the proximal stressor and all we needed to do was to establish why this examination was so important to this girl.
She was the last born of four and the older siblings had passed this exam with high grades and her parents, who were both teachers, spoke to her often about their expectations. In what she would later describe as long and boring lectures, the father would explain how he, got to a national school, passed his exams and obtained a degree without having failed a single exam, and in many cases coming top of his class (a doubtful claim the girl would tell us later). This lecture would always end in the same way.
Her mother was no better. She expected a straight ‘A’. This stance would further be pursued by her siblings who would tell the girl that they all knew she had the capacity to break the family academic record because she was the youngest, most loved and had the capacity. The teachers sang from the same hymn sheet.
In the weeks and months before the examination, the girl experienced what she told her mother was a fog in the head and things did not seem as clear. A doctor was called in and found her eyesight to be perfect. She was told to relax, and that things would be fine.
Soon she had problems sleeping and a sleeping pill was prescribed. This made her drowsy during the day and she was unable to stay awake in class. Then came the trembling and sweating and a rapid heartbeat which attacked her every morning before school.
This was interpreted as a heart condition and after a thorough evaluation, nothing was found, and it was insinuated that she was putting it on and was described by the family as a pretender!
Then came the paralysis! The neurologist could tell at once that the type of paralysis the girl had, did not follow any known anatomical pattern and sent the family to the mental health team. In therapy, the girl opened up about what she called “a lifetime of torture in the hands of parents, siblings and teachers” who seemed to see only a bright girl; not the person she was; with her fears and imperfections.
Therapy was carried out over several months. She lost one year of school but as her father said later, “our daughter was dead, now she lives”. This statement captures the relief that came to the family, upon the realisation that the pressure to achieve academic excellence was breaking this girl apart.
This type of paralysis is what in the past was called hysteria. It was thought that the condition was caused by the movement of the uterus from one part of the body to another, causing the part afflicted to be the seat of the uterus.
In modern parlance, it is now known as “Somatic Symptom Disorder” which in modern understanding of the condition, the patient by becoming paralysed in the way your sister did, is communicating the fact that there is something in their lives, that is causing psychological distress. As we have seen in the case of our patients, it sometimes takes the entire family to resolve such a crisis.
