Cultural considerations in family therapy: boys with conversion

Background: Conversion disorder is mostly reported in girls. One factor that makes girls vulnerable for emotional problems is the cultural practice of son preference, which is prevalent in many Asian countries including Thailand. However, other cultural factors make boys vulnerable to develop conversion disorders.

Objective: We reported clinical symptoms, family assessment, and important points in family therapy in two boys with conversion disorder.

Method: Two boys age 10 and 14 years old presented with seizures. Neurological tests were unremarkable and an organically-based seizure disorder was ruled out. The patients were diagnosed as having conversion disorder and were sent for psychiatric evaluation and treatment.

Result: Family assessment revealed some cultural practices that led to frustration and conversion. These factors included the culture of silence and the tendency to somatize; the cultural practice of mourning; and the parentification of children especially the first-born. In family therapy, therapeutic work included breaking the silence in the family and helping the family develop the ability to talk about feelings; helping the family deal with frustration more effectively, and dealing with somatic symptoms in an empathic manner. When the patients were able to reconnect with their families and to voice their needs, the body no longer needed to speak for them and the symptoms remitted.

Conclusion: The case vignettes illustrated the role culture plays in modifying the manifestations of both intrapsychic and interpersonal conflicts in boys. Understanding such a role will help therapists to treat conversion disorders in boys more effectively.